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Trauma and Overuse Syndromes of the Shoulder

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.

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Trauma and Overuse Syndromes of the Shoulder

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  1. Trauma and Overuse Syndromes of the Shoulder You don’t have to be a Professional Athlete to be Treated Like One

  2. Can You Shoulder the Load?

  3. ShoulderUpper ExtremityNeck Injuries Are one of the most common areas of occupational injury

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

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

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

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

  8. 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

  9. Muscle StrainLigamentSprain

  10. These Can Occur From: OVER USE

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

  12. FALLS

  13. II. Rotator Cuff Tears

  14. Caused by: OVER USE

  15. Caused by: UNDER USE

  16. Caused by: FALLS

  17. TRUE FULL THICKNESS Rotator Cuff Tears Should be distinguished from “Partial Thickness” Tears

  18. 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)

  19. Radiologist MRI Terminology Full Thickness Tear Partial Thickness Tear

  20. Full Thickness Tear May Be Acute or Chronic – Radiologist should address on MRI

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

  22. 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

  23. III. Neck Issues Falls are most common cause

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

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

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

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

  28. Return to Work

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

  30. Anxietyabout Return….

  31. $$$ Without Work

  32. Better Outcomes Lower Impairment Rating

  33. What Gets Patients Back to Work?

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

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

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

  37. Thank You Samuel I. Brown MD

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