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All employers play a crucial role in the prevention and management of workplace injuries.
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Information for Psychologists, Occupational Therapists, Nurses, Exercise Physiologists and Doctors.
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Other key stakeholders are also encouraged to provide Information and comments about issues of relevance .
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Shoulder injury

 

 

What is a shoulder?

 

 

The shoulder is a ball and socket joint. Whilst allowing for a wide range of movement, this type of joint is inherently unstable, relying on muscles to hold it in place. Collectively these muscles are known as the “Rotator Cuff”. The shoulder muscles are attached to bones by ligaments. To prevent the ligaments rubbing against bones there are fluid filled sacks (known as a bursa).

 

Examples of shoulder injuries include shoulder dislocations, tears of the ligaments, inflammation of the bursa, fractures of bones or tears of the shoulder joint cartilage (for example SLAP lesions or Blankart lesions). Shoulder Impingement occurs where the tendons of the rotator cuff muscles get pinched between the bones of the upper arm and the shoulder (the subacromial space). This can occur because of tissue swelling associated with an injury, or shoulder instability due to loss of shoulder muscle bulk (for example following disuse of the shoulder). A “Frozen” shoulder occurs when the shoulder joint capsule gets inflamed causing a loss of shoulder range of movement in all directions.

 

 

Symptoms

 

Symptoms may include pain in the shoulder (worse with shoulder movement), loss of shoulder movement or loss of use of the shoulder.

 

 

Incidence

 

Shoulder injuries are relatively common injuries, particularly in jobs where heavy or awkward manual handling is involved, or with repetitive above shoulder work or repetitive reaching to full arm stretch.

 


Key Points

 

Some of the key points outlined by the ACC for shoulder/rotator cuff sprains and tendon tears are:

 

  • Patients aged > 40 with significant shoulder injury have a high possibility of a rotator cuff tear
  • At least 50% of patients who are 40 years of age or older and presenting with a dislocated shoulder will have a rotator cuff tear
  • Significant rotator cuff tears do not always heal and may require surgical repair
  • Referral to a musculoskeletal or orthopaedic specialist should be made early if a rotator cuff tear is suspected
  • Ultrasound is a good investigation for establishing degree of rotator cuff tear. Particularly in the older age group, ultrasounds may overdiagnose rotator cuff tears. If this is suspected, it is recommended that both shoulders (the injured and the un-injured one) be ultrasounded
  • Rest and ice compression as well as elevation is a recommended treatment
  • Early intervention and treatment give the best results

 

 

Red flag conditions (Dr R Mills):

 

  • Significant trauma, or possible fracture

  • “Shoulder drop” sign

  • Objective evidence of shoulder wasting

  • Unable to reach to above shoulder height

  • Weight loss

  • History of cancer

  • Fever

  • Intravenous drug use

  • Steroid use

  • Patient aged over 50 years

  • Severe unremitting night time pain

 

 

Yellow flag conditions (Dr R Mills):

 

  • Attitudes and beliefs about pain

  • Emotions

  • Behaviours

  • Compensation issues

  • Work

  • Diagnostic and treatment issues

  • Workplace conflict

 

 

Suggested alternate duties (Dr R Mills):

 

  • Keep the elbow close to the body

  • Avoid over-reaching

  • Avoid above shoulder work

  • Maximum lift of 5 kg

  • No heavy pushing or pulling

 

 

When to Consider Referral for Specialist Opinion


  • The presence of any red flag conditions

  • The worker has had more than two weeks certified unfit for duties, or more than one month on selected duties

  • The worker has had more than three weeks off work, or on selected duties and has significant yellow flag conditions

  • Not back at pre-injury duties within six weeks of the injury

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