Return to work a,er rotator cuff repair. Dr. Jean Stalder FB- Tag / Journée de perfec?onnement
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1 Return to work a,er rotator cuff repair Dr. Jean Stalder FB- Tag / Journée de perfec?onnement
2 CH cases/year (average )
3 Treatment 48.2 Mio /year
4 Work compensa?on Mio/year
5 Work compensa?on in the US $95 billion/year
6 Social and economic factors
7 Return to work as a func?on of type of work in France p=0.42 Number of cases Total amount of cases regards their type of work number of cases who went back to work 0 Peropera?ve light- Peropera?ve medium- work/sedentary work work Type of work Peropera?ve heavy- work 1 Nové- Josserand L, Liotard J- P, Godeneche A, Neyton L, Borel F, Rey B, et al. Occupa?onal outcome a,er surgery in pa?ents with a rotator cuff tear due to a work- related injury or occupa?onal disease. A series of 262 cases. Orthopaedics & Traumatology: Surgery & Research. juin 2011;97(4):361 6.
8 Return to work as a func?on of type of work; Chicago USA 1 45 p= Number of cases Total amount of cases regards their type of work number of cases who went back to work 5 0 Peropera?ve light- Peropera?ve medium- work/sedentary work work Type of work Peropera?ve heavy- work 1 Bha?a S, Piasecki DP, Nho SJ, Romeo AA, Cole BJ, Nicholson GP, et al. Early Return to Work in Workers Compensa?on Pa?ents A,er Arthroscopic Full- Thickness Rotator Cuff Repair. Arthroscopy: The Journal of Arthroscopic & Related Surgery. août 2010;26(8):
9 Time away from work regards type of work 12 (p=0.05) Months 6 4 Time away from work regards type of work 2 0 Non- manual Manual Heavy manual type of work Nové- Josserand L, Liotard J- P, Godeneche A, Neyton L, Borel F, Rey B, et al. Occupa?onal outcome a,er surgery in pa?ents with a rotator cuff tear due to a work- related injury or occupa?onal disease. A series of 262 cases. Orthopaedics & Traumatology: Surgery & Research. juin 2011;97(4):361 6.
10 Time away from work in CH 117 days
11 Return to work as a func?on of work compensa?on status (WC)
12 Toronto (CA) vs Indianapolis (USA) Return to work regards work compensafon (WC) status Number of cases returning to work aaer rotator cuff surgery Holtby and al. Misamore and al. p>0.01 NWC WC 1 Holtby R, Razmjou H. Impact of work- related compensa?on claims on surgical outcome of pa?ents with rotator cuff related pathologies: A matched case- control study. Journal of Shoulder and Elbow Surgery. avr 2010;19(3): Misamore GW, Ziegler DW, Rushton JL. Repair of the rotator cuff. A comparison of results in two popula?ons of pa?ents. J Bone Joint Surg Am. sept 1995;77(9):
13 Return to work as a func?on of age % 80.00% 70.00% 60.00% 50.00% p= % 30.00% Return to work No return to work 20.00% 10.00% 0.00% 50 years years 55 years Age distribufon Nové- Josserand L, Liotard J- P, Godeneche A, Neyton L, Borel F, Rey B, et al. Occupa?onal outcome a,er surgery in pa?ents with a rotator cuff tear due to a work- related injury or occupa?onal disease. A series of 262 cases. Orthopaedics & Traumatology: Surgery & Research. juin 2011;97(4):361 6.
14 Effect of alcohol use on return to work 1 1 Bha?a S, Piasecki DP, Nho SJ, Romeo AA, Cole BJ, Nicholson GP, et al. Early Return to Work in Workers Compensa?on Pa?ents A,er Arthroscopic Full- Thickness Rotator Cuff Repair. Arthroscopy: The Journal of Arthroscopic & Related Surgery. août 2010;26(8):
15 Return to work and alcohol dependence in lilerature
16 Anatomical factors
17 Nature of tendon injury (%) Supraspinatus only Subscapularis only 50 Supra + infraspinatus Supra + subscapularis 7.6 Supra + infra + subscapularis Nové- Josserand L, Liotard J- P, Godeneche A, Neyton L, Borel F, Rey B, et al. Occupa?onal outcome a,er surgery in pa?ents with a rotator cuff tear due to a work- related injury or occupa?onal disease. A series of 262 cases. Orthopaedics & Traumatology: Surgery & Research. juin 2011;97(4):361 6.
18 Time before returning to work as a func?on of number of tendons injured p=0.04 Months Time away from work regards number of tendons injured Number of tendons Nové- Josserand L, Liotard J- P, Godeneche A, Neyton L, Borel F, Rey B, et al. Occupa?onal outcome a,er surgery in pa?ents with a rotator cuff tear due to a work- related injury or occupa?onal disease. A series of 262 cases. Orthopaedics & Traumatology: Surgery & Research. juin 2011;97(4):361 6.
19 Return to work as a func?on of the number of tendons injured p=0.04 Number of cases returning back to work aaer rotator cuff repair (%) 64.00% 62.00% 60.00% 58.00% 56.00% 54.00% 52.00% 50.00% 48.00% Number of tendons injured number of cases returning to work (%) Nové- Josserand L, Liotard J- P, Godeneche A, Neyton L, Borel F, Rey B, et al. Occupa?onal outcome a,er surgery in pa?ents with a rotator cuff tear due to a work- related injury or occupa?onal disease. A series of 262 cases. Orthopaedics & Traumatology: Surgery & Research. juin 2011;97(4):361 6.
20 Return to work as a func?on of surgical technique 70% p= % Return to work in % 50% 40% 30% 20% % of pa?ents returning to work regards to surgical technique 10% 0% open mini- open arthroscopy Surgical technique Nové- Josserand L, Liotard J- P, Godeneche A, Neyton L, Borel F, Rey B, et al. Occupa?onal outcome a,er surgery in pa?ents with a rotator cuff tear due to a work- related injury or occupa?onal disease. A series of 262 cases. Orthopaedics & Traumatology: Surgery & Research. juin 2011;97(4):361 6.
21 Take home message Age Number of tendons Time out of work (pre- &post surgery) Compensa?on system
22 References 1. Nové- Josserand L, Liotard J- P, Godeneche A, Neyton L, Borel F, Rey B, et al. Occupa?onal outcome a,er surgery in pa?ents with a rotator cuff tear due to a work- related injury or occupa?onal disease. A series of 262 cases. Orthopaedics & Traumatology: Surgery & Research. juin 2011;97(4): Hawkins RJ, Brock RM, Abrams JS, Hobeika P. Acromioplasty for impingement with an intact rotator cuff. J Bone Joint Surg Br. nov 1988;70(5): Webb D, Gulmann D, Cawley P, Lubowitz JH. Con?nuous Infusion of a Local Anesthe?c Versus Interscalene Block for Postopera?ve Pain Control A,er Arthroscopic Shoulder Surgery. Arthroscopy: The Journal of Arthroscopic & Related Surgery. sept 2007;23(9): Viola RW, Boatright KC, Smith KL, Sidles JA, Matsen FA. Do shoulder pa?ents insured by workers compensa?on present with worse self- assessed func?on and health status? J Shoulder Elbow Surg. oct 2000;9(5): Bha?a S, Piasecki DP, Nho SJ, Romeo AA, Cole BJ, Nicholson GP, et al. Early Return to Work in Workers Compensa?on Pa?ents A,er Arthroscopic Full- Thickness Rotator Cuff Repair. Arthroscopy: The Journal of Arthroscopic & Related Surgery. août 2010;26(8): Hawkins RJ, Chris T, Bokor D, Kiefer G. Failed anterior acromioplasty. A review of 51 cases. Clin Orthop Relat Res. juin 1989;(243): Holtby R, Razmjou H. Impact of work- related compensa?on claims on surgical outcome of pa?ents with rotator cuff related pathologies: A matched case- control study. Journal of Shoulder and Elbow Surgery. avr 2010;19(3): Denard PJ, Lädermann A, Burkhart SS. Long- Term Outcome A,er Arthroscopic Repair of Type II SLAP Lesions: Results According to Age and Workers Compensa?on Status. Arthroscopy: The Journal of Arthroscopic & Related Surgery. avr 2012;28(4): Sallay PI, Hunker PJ, Brown L. Measurement of baseline shoulder func?on in subjects receiving workers compensa?on versus noncompensated subjects. Journal of Shoulder and Elbow Surgery. mai 2005;14(3): Tashjian RZ, Henn RF, Kang L, Green A. The effect of comorbidity on self- assessed func?on in pa?ents with a chronic rotator cuff tear. J Bone Joint Surg Am. févr 2004;86- A(2): Watson EM, Sonnabend DH. Outcome of rotator cuff repair. Journal of Shoulder and Elbow Surgery. mai 2002;11(3): S?glitz Y, Gosselin O, Sedagha?an J, Sirveaux F, Molé D. Pain a,er shoulder arthroscopy: A prospec?ve study on 231 cases. Orthopaedics & Traumatology: Surgery & Research. mai 2011;97(3): Weber SC, Jain R, Parise C. Pain Scores in the Management of Postopera?ve Pain in Shoulder Surgery. Arthroscopy: The Journal of Arthroscopic & Related Surgery. janv 2007;23(1): Misamore GW, Ziegler DW, Rushton JL. Repair of the rotator cuff. A comparison of results in two popula?ons of pa?ents. J Bone Joint Surg Am. sept 1995;77(9): McKee MD, Yoo DJ. The effect of surgery for rotator cuff disease on general health status. Results of a prospec?ve trial. J Bone Joint Surg Am. juill 2000;82- A(7): Mackenzie EJ, Morris Jr JA, Jurkovich GJ, Yasui Y, Cushing BM, Burgess AR, et al. Return to work following injury: the role of economic, social, and job- related factors. American journal of public health. 1998;88(11):
23 Thanks to Maria Stoichita (Cand.Med. Lausanne - CHUV)
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