Wednesday, February 18, 2009

Work-Related Rotator Cuff Tears

Rotator cuff tears are very common workplace injuries. They can be the result of a single, traumatic incident, or they can be caused by repetitive use. People who are especially at risk for repetitive use rotator cuff tears are those who engage in repetitive overhead motions.

The rotator cuff is made up of four muscles and a number of tendons that form a cover over the top of the upper arm bone. The rotator cuff holds the upper arm bone in place in the shoulder joint and allows the arm to rotate. The four muscles of the rotator cuff, the supraspinatus, infraspinatus, subacpularis, and teres minor muscles, are attached to the scapula on the back, and to the greater tuberosity of the humerus on the side and front of the shoulder.

Most rotator cuff tears occur in the supraspinatus muscle, but tears can occur in other parts of the cuff as well. Rotator cuff tears are generally classified into three types:
  • Partial thickness tears are tears that do not go all the way through the tendon. They often appear as fraying of an intact tendon.
  • Full thickness tears are tears that go all the way through the tendon. They can range in size from the size of a pin-point, to tears that involve the majority of the tendon. When there is a full thickness tear, the tendon is still substantially attached to the humeral head.
  • Full thickness tears can also involve a complete detachment of the tendon from the humeral head which can cause serious impairment in shoulder motion and function.
Some symptoms of a rotator cuff tear include:
  • Atrophy or thinning of the muscles about the shoulder
  • Pain when lifting the arm
  • Pain when lowering the arm from a fully raised position
  • Weakness when lifting or rotating the arm
  • Crepitus or crackling sensation when moving the shoulder in certain positions
Diagnosis of a rotator cuff tear is usually based on symptoms, examination, X-rays, MRI’s, or ultrasounds.

Often, conservative, or nonsurgical treatment can provide pain relief and improve the function of the shoulder. Conservative treatment options can include rest and limited overhead activity, use of a sling, anti-inflammatory medication, steroid injection, and physical therapy.

If conservative treatment does not relieve symptoms, if the tear causes severe pain, and if the strength and motion of the shoulder is significantly impaired, surgery may be considered as a treatment option.

The type of surgery performed depends on the type, size, shape, and location of the tear. A partial tear may require only a trimming procedure called a “debridement.” A complete tear is usually repaired by suturing the two sides of the tendon back together. If the tendon is torn away from the bone, it is usually repaired by reattaching it to the bone.

In general, there are three types of surgical procedures to repair a torn rotator cuff. An arthroscopic repair involves insertion of a fiber-optic scope and small, fine instruments through a small incision. A mini-open repair involves a open surgery through a relatively small incision. Open surgical repair is often required if the tear is large or complex, or if additional reconstruction of the rotator cuff and shoulder joint must be performed. In some cases, where there is severe arthritis, total shoulder joint replacement may be an option.

Rehabilitation after surgery usually involves immobilization of the arm and physical therapy.

While rotator cuff tears can occur as the result of a specific trauma, more often, they occur over a long period of time. Under Minnesota workers’ compensation law, injuries that occur over a long period of time are known as Gillette-type injuries. Employees frequently have difficulty dealing with the workers’ compensation insurance company when the injury occurred as the result of repetitive use rather than as the result of a specific injury.

If you’ve sustained a rotator cuff tear as the result of your work activities, whether it was caused by a specific injury, or whether it was caused by years of overuse, and you’re having difficulties dealing with your employer or the workers’ compensation insurance company, call Meuser & Associates at 877-746-5680 or click here to email us to schedule a free consultation.

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