trauma and overuse syndromes of the shoulder
DESCRIPTION
Trauma and Overuse Syndromes of the Shoulder. You don ’ t have to be a Professional Athlete to be Treated Like One. Can You Shoulder the Load?. Shoulder Upper Extremity Neck Injuries. Are one of the most common areas of occupational injury. Causes. - PowerPoint PPT PresentationTRANSCRIPT
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Trauma and Overuse Syndromes of the
Shoulder
You don’t have to be a Professional Athlete to be Treated Like One
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Can You Shoulder the Load?
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ShoulderUpper Extremity
Neck Injuries
Are one of the most common areas of occupational injury
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Causes
• Industrial setting, Manufacturing Products, Repetitive Usage, Over Usage
• Accidental Motion, Stretch or Rotation of Upper Extremity
• Falls
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Repetitious Activity – May:
• Lead to Chronic Shoulder Pathology: Impingement Most Commonly
• Claims may arise from this – NO Acute Event
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Will Easily be claimed as an Acute Event
Abrupt Stretch or Rotational Injury
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Number 1 cause of shoulder, upper extremity complaint and
physiologic injury
FALLS
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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
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I.Muscle Strain Ligament Sprain
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These CanOccur From:
OVER USE
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UNDERUSE
“Supervisor Injury”
Supervisors who try to “help out”
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FALLS
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II. Rotator Cuff Tears
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Caused by:
OVER USE
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Caused by:
UNDER USE
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Caused by:
FALLS
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TRUE FULL THICKNESS Rotator Cuff Tears
Should be distinguished from
“Partial Thickness” Tears
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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 asym-tomatic RC tears
• Partial thickness tears are more frequent than Full thickness tears (50% higher incidence)
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Radiologist MRI Terminology
Full Thickness Tear
QuickTime™ and aPhoto - JPEG decompressor
are needed to see this picture.
Partial Thickness Tear
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Full Thickness Tear
May Be Acute or Chronic –
Radiologist should address on MRI
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If Chronic:
May NOT be a result of recent “complaint”
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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
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Falls are mostcommon cause
III. Neck Issues
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Cervical Spondylosis/Degenerative Disc Disease May Be Aggravated:
• Leading to Pain or Radiating Burning, Numbness, Tingling – Shoulder, Arm, Hand
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Conservative Treatment Best:
• Anti inflammatory Meds, Physical Therapy, Short Term Use of Pain Relievers
• Avoid Surgery – Poor Prognosis for Return to Work…. except
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IV. Other Diagnoses
• Shoulder Dislocation
• AC Separation
• Labral Tears
• Fractures
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Diagnosis Specific Treatment:
• Adhere to conservative principles
• Surgery only when clear indication
• May be associated with impairment
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Return to Work
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Barriers to Recovery from Occupational Injury
• Anxiety about return
• $$$ without work
• FACT: Better Outcome = Lower Impairment Rating
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Anxiety about Return….
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$$$ Without
Work
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Lower Impairment
Rating
Better Outcomes
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What Gets Patients Back
to Work?
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Correlates Best With Return to Work
And Especially Early Return to Work
(Job Satisfaction)
“I Love My Job”
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Early Return to Work =
• Best Outcome for ALL Patients
*Not necessarily elimination of pain, just return to work
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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)
Can You Shoulder the Load?
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Thank You
Samuel I. Brown MD