and
Syndromes of the
You don ’t have to be a Professional Athlete to be Treated Like One

Are one of the most common areas of occupational injury

Causes
• Industrial setting, Manufacturing Products,
Repetitive Usage, Over Usage
• Accidental Motion, Stretch or Rotation of
Upper Extremity
• Falls

Repetitious Activity – May:
• Lead to Chronic Shoulder Pathology:
Impingement Most Commonly
• Claims may arise from this – NO Acute
Event

Abrupt Stretch or Rotational Injury
Will Easily be claimed as an
Acute Event

FALLS
Number 1 cause of shoulder, upper extremity complaint and physiologic injury

Most Common Shoulder Injuries:
• Muscle Strain/Ligamentous Sprain
• Rotator Cuff Tears
• Neck/Cervical problems with referred pain to shoulder/arm/hand
• Others – should dislocation, labral tears,
AC joint separation, fractures

I.
Muscle Strain
Ligament
Sprain

These Can
Occur From:
OVER USE

UNDERUSE
“Supervisor Injury”
Supervisors who try to “help out”

II. Rotator Cuff Tears

Caused by:
OVER USE

Caused by:
UNDER USE

Caused by:
FALLS

Should be distinguished from

R Cuff Tears are Common
• The incidence and prevalence of RC tears increases with age
• 23% of people age 50-59 have asymptomatic rotator cuff tears
• At least 51% of pts older than 80 have asymtomatic RC tears
• Partial thickness tears are more frequent than
Full thickness tears ( 50% higher incidence)

Radiologist MRI Terminology
Full Thickness
Tear
Partial Thickness
Tear
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Full Thickness Tear
May Be Acute or
Chronic –
Radiologist should address on MRI

If Chronic:
May NOT be a result of recent “ complaint ”

Partial Thickness Tears:
• Associated with ongoing impingement:
• OFTEN not related to current “complaint”
• Which may only be muscle or ligamentous sprain – No
Causation
• Rarely require surgery

III. Neck Issues
Falls are most common cause

Cervical Spondylosis/Degenerative
Disc Disease May Be Aggravated:
• Leading to Pain or Radiating Burning,
Numbness, Tingling –
Shoulder, Arm, Hand

Conservative Treatment Best:
• Anti inflammatory Meds, Physical
Therapy, Short Term Use of
Pain Relievers
• Avoid Surgery – Poor Prognosis for
Return to Work…. except

IV. Other Diagnoses
• Shoulder Dislocation
• AC Separation
• Labral Tears
• Fractures

Diagnosis Specific Treatment:
• Adhere to conservative principles
• Surgery only when clear indication
• May be associated with impairment

Return to Work

Barriers to Recovery from
Occupational Injury
• Anxiety about return
• $$$ without work
• FACT: Better Outcome = Lower
Impairment Rating

Anxiety about
Return….

$$$
Without
Work

Better Outcomes
Lower
Impairment
Rating

What Gets
Patients Back to Work?

“I Love My Job”
Correlates Best With
Return to Work
And
Especially Early
Return to Work
(Job Satisfaction)

Early Return to Work =
• Best Outcome for ALL Patients
*Not necessarily elimination of pain, just return to work

Can You Shoulder the Load?
1) Early and accurate assessment of problem
2) Early conservative/supportive treatment
3) Avoidance of surgery when possible
4) Positive environment for work and job satisfaction (hopefully)

Samuel I. Brown MD