WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 845/15

Size: px
Start display at page:

Download "WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 845/15"

Transcription

1 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 845/15 BEFORE: S. Netten: Vice-Chair HEARING: April 28, 2015 at Toronto Written DATE OF DECISION: June 3, 2015 NEUTRAL CITATION: 2015 ONWSIAT 1201 DECISION UNDER APPEAL: WSIB Appeals Resolution Officer decision dated January 9, 2014 APPEARANCES: For the worker: For the employer: Interpreter: J. Johnson, Paralegal Not participating None Workplace Safety and Insurance Appeals Tribunal Tribunal d appel de la sécurité professionnelle et de l assurance contre les accidents du travail 505 University Avenue 7 th Floor 505, avenue University, 7 e étage Toronto ON M5G 2P2 Toronto ON M5G 2P2

2 Decision No. 845/15 REASONS (i) Issue [1] The issue under appeal is entitlement for right shoulder arthroscopic decompression surgery of May 2, (ii) Overview [2] The worker, a company truck driver, was granted entitlement for a right shoulder strain sustained upon removing a strap which caught, causing sharp shoulder pain, on June 12, He returned to modified duties, followed by regular duties from September 4, Entitlement was subsequently extended, in December 2012, to include a thin partial thickness supraspinatus tear. Entitlement for shoulder surgery, recommended in March 2013, was denied on the basis that it was not required as a result of the workplace injury. [3] The worker s objection to this determination was denied at the appeals level of the Board in January 2014, and the worker appealed to the Tribunal. This appeal was selected for a written hearing pursuant to the Tribunal s Practice Direction on Written Appeals. In written submissions dated February 25, 2015, the worker s representative notes that the worker had no prior right shoulder impairments, argues that there is a relationship between the partial thickness tear and the impingement syndrome, and requests consideration of the benefit of the doubt. (iii) Law and Policy [4] The Workplace Safety and Insurance Act, 1997 ( WSIA ) applies to this appeal. All statutory references in this decision are to the WSIA, as amended, unless otherwise stated. Section 126 requires the Tribunal to apply Board policy when making its decisions. [5] Entitlement to health care is governed by section 33: 33(1) A worker who sustains an injury is entitled to such health care as may be necessary, appropriate and sufficient as a result of the injury [6] Tribunal jurisprudence applies the test of significant or material contribution to questions of causation. A significant or material contributing factor is one of considerable effect or importance. It need not be the sole contributing factor. [7] The standard of proof applicable in workers compensation proceedings is the balance of probabilities. Pursuant to section 124(2), the benefit of the doubt is given to the claimant in resolving an issue where the evidence for and against is approximately equal in weight. (iv) Evidence [8] The worker had been hired in His regular duties were outlined in chart notes as requiring the strapping of cars on and off his truck, four truck loads daily, each with nine cars, and each car with four straps. The worker described his injury in the Worker s Report of Injury dated June 25, 2012, as follows: I was removing a tire strap from vehicle on the trailer and the strap caught between the tire and fender causing a sharp pain in my right shoulder.

3 Page: 2 Decision No. 845/15 [9] Clinical notes from the worker s family doctor, Dr. S. Rahman, were provided from June 2010 to September The first mention of the shoulder is on June 12, 2012, the date of injury, at which time Dr. Rahman assessed a likely strain. She wrote RC injury when the worker returned on June 14, 2012 with complaints of difficulty lifting, pulling and shifting gears. The worker was referred for physiotherapy. [10] On June 19, 2012, physiotherapist P. Ho noted limited shoulder flexion and abduction, a positive empty can test (for the supraspinatus tendon), and tenderness of the infraspinatus, teres minor and supraspinatus. [11] On June 28, 2012 Dr. Rahman s notes indicate that the worker s pain was not much better. She completed a Functional Abilities Form (FAF) stating that the worker was unable to lift arm overhead or lift any weight with R arm/shoulder. A right shoulder ultrasound of July 4, 2012 identified a possible small partial-thickness tear in the right supraspinatus, with the rotator cuff and biceps tendon normal and impingement testing was negative. Dr. Rahman noted on July 16, 2012 that the worker was 50% better, still on modified duties, and abduction and internal rotation were better. An MRI of July 26, 2012 found mild tendinosis of the supraspinatus tendon with a thin linear interstitial partial thickness tear, as well as mild osteoarthritis of the acromioclavicular (AC) joint. [12] On August 9, 2012, Dr. Rahman noted that the worker could abduct to 110 degrees without pain, and internal rotation was also improved. The worker continued with physiotherapy. Her FAF that day indicated that the worker could not do overhead activities or lifting due to right rotator cuff tendonitis/tear. Dr. Rahman s FAF of August 27, 2012 stated that the worker was capable of returning to work with no restrictions. Her chart note for that day states: right shoulder much better wants to go back to work full duties ROM improved no no [sic] pain [13] However, on September 27, 2012 Dr. Rahman noted that the worker had increased pain after returning to regular duties, and his abduction was restricted to 90 degrees. She reinstated work restrictions on overhead activities, pushing, pulling and lifting, noting aggravation of previous injury. She wrote a letter that day: [The worker] sustained a right shoulder injury while at work on June 12 th, He was on modified duties from then until the end of August. He was undergoing physiotherapy and medical treatment and was overall much better before he re-started work on full duties After returning to physical work for approximately a week, his shoulder pain has returned (same as before). This is likely an aggravation of his previous injury and not a new injury. He has been referred to the surgeon, appointment pending. He has been advised to continue physiotherapy in the meantime. [14] The worker saw orthopedic surgeon Dr. S. Haider on November 29, He diagnosed an impingement syndrome and recommended further physiotherapy. [15] Without consideration of Dr. Haider s report (not then on file), the Board allowed entitlement to the rotator cuff tear found on MRI; the memorandum of December 11, 2012 states:

4 Page: 3 Decision No. 845/15 Based on a review of the medical documentation, the worker s current and ongoing right shoulder symptoms appear to be the direct result of the workplace injury Given the accident history, the medical continuity subsequent to the accident, and no evidence of right shoulder issues prior to this incident, the partial thickness tear is a result of the workplace injury. [16] The Case Manager clarified entitlement to the worker verbally on December 11, 2012, noting that the AC joint osteoarthritis was not part of the claim. The worker reported having had a cortisone injection from a sports medicine physician in September 2012, giving him one month s relief, as well as seeing Dr. Haider who suggested six weeks of physiotherapy. [17] In follow-up on February 13, 2013, Dr. Haider recommended more physiotherapy and an MRI, noting possible rotator cuff injury, and referred the worker to upper extremity specialist Dr. C. Smith. Physiotherapy extensions were accepted by the Board up to March 29, [18] Prior to seeing Dr. Smith, however, the worker was assessed by orthopedic surgeon Dr. A. ElMaraghy on March 22, 2013: He has pain in his right shoulder for the last nine months. It is staying the same with time and waking him up at night. There is [sic] no neurological symptoms. On examination, he has good active range of motion, no capsular pattern, no AC joint tenderness or long head of biceps pathology. He has positive impingement signs but a good rotator cuff strength. Superior labral testing is positive. He has no real instability or apprehension. MRI shows diffuse tendinosis of both supraspinatus and subscapularis as well as infraspinatus. The sagittal view shows a type 3 acromion consistent with impingement. he will be a candidate for an arthroscopic rotator cuff decompression. [19] The surgery was expedited by the Board. [20] On April 10, 2013, Dr. Rahman wrote: The pain started immediately after the injury. He has never sustained an injury to his right shoulder or had a problem with his right shoulder before this incident; there was no known pre-existing condition in his right shoulder. He has gone through extensive rehabilitation including physiotherapy, home exercises and a cortisone injection without relief of his symptoms. He has seen a sports medicine specialist as well as 2 orthopedic surgeons. Surgery has been recommended for his condition. Based on medical history, physical examination and investigations, [the worker s] condition is consistent with the injury sustained at work in June [21] The Case Manager sought an opinion on whether the proposed surgery was more related to the pre-existing O/A or in your opinion associated to his June 12, 2012 work related incident. Occupational medicine specialist Dr. S. Somerville responded on April 20, He provided his opinion that the small partial thickness tear was likely an incidental finding unrelated to the workplace accident, and went on to discuss impingement syndrome: Impingement syndrome occurs when the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space beneath the acromion. Narrowing of this space by osteoarthritic spurs, anatomic variations in the shape of the acromion such as type 2 or 3 acromion, calcification of the coracoacromial ligament, or other means can cause impingement. Onset of symptoms may be acute if due to injury or may be gradual if due to degenerative changes. IW s symptoms came on abruptly on date of accident, but there is no evidence of trauma.

5 Page: 4 Decision No. 845/15 The MRI scan is stated to demonstrate a type 2 acromion, while the surgeon indicated IW has a type 3 acromion. Type 2 or 3 acromion refers to an anatomic variant of the normal acromion (which is a bony part of the shoulder). There are three variants of the acromion, namely Types 1, 2 and 3. Type 1 is flat, while Types 2 and 3 are curved. The type of acromion an individual has is basically determined by their genetics. Type 2 and 3 acromions are associated with increased prevalence of impingement and rotator cuff tears. IW likely sustained a simple shoulder strain in the workplace accident. IW s impingement is due to his underlying type 2 or 3 acromion The proposed left shoulder surgery is for IW s impingement syndrome which is a pre-existing condition. [22] Entitlement for the surgery was denied in accordance with this opinion. [23] On May 1, 2013, the worker s physiotherapist W. Hsieh wrote that the worker s right shoulder impingement was due to his tear in his supraspinatus tendon. [24] The operative report is not on file. Dr. ElMaraghy wrote on May 2, 2013 that the worker had a right arthroscopic rotator cuff decompression. He responded to questions from the worker s representative on February 18, 2015: Is there a relationship between the partial thickness tear and the impingement syndrome? A partial thickness rotator cuff tendon tear can be caused by subacromial impingement due to repetitive contact of the supraspinatus tendon with the coracoacromial arch. Did the decompression surgery have any effect on the partial thickness tear? Arthroscopic decompression surgery is performed to treat subacromial impingement by relieving the pressure on the underlying muscle and tendon. This is achieved by shaving the undersurface of the acromion and in some cases removing the outer end of the clavicle. The goal of surgery is to decrease pain and improve shoulder strength. The surgery did not have a direct effect on the partial thickness tear. Is there a reason that the tear was not repaired? The partial thickness tear is low grade and does not represent a significant structural discontinuity, and therefore it does not mechanically need a structural repair. Do you feel that the impingement syndrome is a result of the June 12, 2012 injury? Impingement syndrome generally develops over time through repetitive use of the shoulder. The June 12, 2012 injury may have initiated and/or exacerbated the symptoms of impingement, but it is unlikely that this injury was the sole cause of the impingement. [25] A medical discussion paper on Shoulder Injury and Disability, revised by orthopedic surgeon Dr. H. Uhthoff in October 2010, was included in the case materials for this appeal. The Tribunal s medical discussion papers are written by independent experts who are recognized in their fields of specialization. They are designed to provide parties and representatives with a general overview of medical topics; it is open to the parties to rely upon a discussion paper, or to distinguish or challenge it with other evidence. Dr. Uhthoff s discussion paper has not been disputed in this appeal. With respect to impingement syndrome, Dr. Uhthoff writes: Impingement Syndrome The Impingement Syndrome is caused by a squeezing of the contents of the space bordered on one side by the coraco-acromial arch and the other side by the humeral head. Both structures are visible on plain x-rays. The contents consist of soft tissues, namely the rotator cuff, in particular the supraspinatus tendon, and the subacromial bursa. The squeezing of these contents in an unyielding space can have two causes:

6 Page: 5 Decision No. 845/15 1. A thickening of the contents, a swelling of the tendon (tendonitis) and/or a swelling of the bursa (bursitis). 2. A decrease of the space, mostly caused by bony outgrowths, such as acromial spurs, osteophytes of the acromio-clavicular joint and/or osteophytes of the humeral head. As a syndrome is defined as a set of symptoms which occur together (Dorland, Medical Dictionary), the pathologic changes leading to the squeezing must be clearly described. As a symptom is the subjective evidence of a disease or of a patient s condition (Dorland, Medical Dictionary), Impingement Syndrome cannot be accepted as a free-standing diagnosis; the cause(s) must be given. The pain caused by the Impingement Syndrome is usually aggravated by internal rotation and flexion (forward elevation) of the glenohumeral joint. It is sometimes argued that impingement may cause a rotator cuff tear through wear and tear. This is an exception. In most instances, the tendon is the site of the original disease, leading to a tear due to the structural weakening of the tendon; the resulting impingement will make the situation worse. In fact, outgrowths of the acromion (bony spurs) form in response to a continued pressure of thickened tendon against the acromial arch. This is important, as the argument often goes that spurs lead to a tendinitis; spurs may aggravate the existing tendinitis. Degenerative processes inside the rotator cuff can be made worse by repeated activities with the hands at shoulder level or above it or by operating vibrating tools. Such activities, when performed repeatedly over a period lasting months and years may also affect the acromioclavicular joint leading to a joint degeneration and the formation of osteophytes. Impingement affects both genders equally. Impingement can start at an early age (around age 20) particularly in athletes. It can develop spontaneously in older people (around 50 to 60 years of age). Is there a relationship between an isolated injury to and recurrent disorders of the shoulder and impingement syndrome? I do not think that an isolated injury can induce an impingement syndrome. However, recurrent episodes and, more so, repetitive work and/or sports activities can cause an impingement (a disorder), usually secondary to wear and tear of the rotator cuff tendons. (v) Discussion and conclusion [26] The question I must answer is whether the worker s June 12, 2012 accident significantly contributed to subacromial impingement, thus establishing a causal link between the accident and the decompression surgery. [27] The worker had no history of right shoulder problems prior to the accident of June 12, He then sustained an injury to his shoulder as a result of a strap catching on a vehicle he was loading on his truck. Following a course of physiotherapy, the worker returned to full duties and had an almost immediate recurrence of symptoms. This led to a diagnosis of impingement syndrome from two specialists, in November 2012 and March [28] The medical opinions on file are each incomplete in some respect. Dr. Rahman highlights claim continuity and the lack of a pre-existing condition, concluding that the worker s condition was consistent with the workplace injury and requires surgery, but does not explain the nature of that condition and the physiological mechanism by which it is linked to the accident history. Dr. Somerville attributes the worker s impingement syndrome solely to the shape of his acromion, but this anatomic variation does not explain the timing of the worker s symptom onset. Moreover, it is unclear why his reporting indicates that there was no shoulder trauma in June 2012, while simultaneously accepting that there was a compensable shoulder strain.

7 Page: 6 Decision No. 845/15 Dr. ElMaraghy states that impingement syndrome develops over time and that the workplace injury was not the sole cause but may have initiated and/or exacerbated the symptoms of impingement, without further explanation. The worker s physiotherapist asserts that the worker s supraspinatus tear led to the impingement, whereas Dr. ElMaraghy suggests the opposite. [29] The Medical Discussion Paper provides some assistance by outlining the causes of impingement, being a thickening of the contents (supraspinatus tendon, bursa) between the coraco-acromial arch and the humeral head, and/or a decrease in the subacromial space due to bony outgrowths. The paper suggests that tendon tear precedes impingement rather than the contrary, and indicates that weakened tendons can lead to impingement. While a single injury is unlikely to induce an impingement syndrome, recurrent episodes and repetitive work might do so. Spontaneous onset is also possible in older people. [30] It is clear that factors other than the workplace accident contributed to the worker s impingement syndrome. Nevertheless, it is sufficient if the accident is a significant contributing factor, rather than the sole factor responsible for the impingement syndrome and associated surgery. [31] On balance, I find the evidence to be in favour of the proposition that the accident of June 12, 2012 was a significant factor in the development of the worker s impingement syndrome. While Dr. Somerville asserts that the shape of the worker s acromion was the cause of the impingement, Dr. Rahman believes that the worker s pre-surgery condition was a result of the workplace injury and Dr. ElMaraghy indicates that the injury may have triggered or aggravated impingement symptoms. There is no evidence of pre-existing symptomology, and the development of the impingement syndrome corresponded with the period following the injury interrupted only by an attempt at full duties. While refuting impingement induced by an isolated injury, the Medical Discussion Paper suggests that the worker s impingement diagnosis is compatible with tendon changes associated with the shoulder injury, the supraspinatus tear, and a premature return to physical duties involving above-shoulder work, as well as the decreased subacromial space due to the congenitally curved acromion and possibly the mild AC joint osteoarthritis. I find, on a balance of probabilities, that the June 12, 2012 accident was a significant factor within this multi-factorial complex. [32] I conclude, therefore, that the worker has entitlement for the decompression surgery undertaken in May 2013, as it constitutes health care which was necessary as a result of the compensable injury.

8 Page: 7 Decision No. 845/15 DISPOSITION [33] The appeal is allowed. The worker has entitlement for the right shoulder arthroscopic decompression surgery of May 2, DATED: June 3, 2015 SIGNED: S. Netten

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 621/14

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 621/14 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 621/14 BEFORE: S. Netten: Vice-Chair HEARING: April 3, 2014 at Toronto Written DATE OF DECISION: April 30, 2014 NEUTRAL CITATION: 2014 ONWSIAT

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 983/15

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 983/15 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 983/15 BEFORE: J. Goldman : Vice-Chair B. Davis : Member Representative of Employers C. Salama : Member Representative of Workers HEARING: May,

More information

ANATOMY: ACROMIAL SHAPE AND SLOPE:

ANATOMY: ACROMIAL SHAPE AND SLOPE: ROTATOR CUFF DISEASE AND IMPINGEMENT Irritation and injury of the rotator cuff are the most common shoulder problems encountered the sports medicine community. While these problems can occur after a specific

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 704/16

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 704/16 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 704/16 BEFORE: M. Crystal : Vice-Chair J. Blogg : Member Representative of Employers C. Salama : Member Representative of Workers HEARING: March

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1708/15

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1708/15 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1708/15 BEFORE: E. Kosmidis : Vice-Chair E. Tracey : Member Representative of Employers C. Salama : Member Representative of Workers HEARING:

More information

Rotator Cuff Injury and Pathology

Rotator Cuff Injury and Pathology Rotator Cuff Injury and Pathology The rotator cuff is made up of four muscles - supraspinatus, infraspinatus, subscapularis and teres minor. The tendons of these muscles blend together to form a cuff around

More information

Notice of Independent Review Decision DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE:

Notice of Independent Review Decision DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE: Notice of Independent Review Decision DATE OF REVIEW: 12/10/10 IRO CASE #: NAME: DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE: Determine the appropriateness of the previously denied request for right

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1047/14

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1047/14 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1047/14 BEFORE: C. M. MacAdam: Vice-Chair HEARING: June 3, 2014 at Toronto Written DATE OF DECISION: June 18, 2014 NEUTRAL CITATION: 2014 ONWSIAT

More information

A Patient s Guide to Shoulder Pain

A Patient s Guide to Shoulder Pain A Patient s Guide to Shoulder Pain Part 2 Evaluating the Patient James T. Mazzara, M.D. Shoulder and Elbow Surgery Sports Medicine Occupational Orthopedics Patient Education Disclaimer This presentation

More information

Rotator Cuff Tears. Most tears occur in the supraspinatus but other parts of the tendon may be involved.

Rotator Cuff Tears. Most tears occur in the supraspinatus but other parts of the tendon may be involved. Rotator Cuff Tears Description Rotator cuff tear is a common cause of pain and disability in the adult population. The rotator cuff is made up of four muscles and their tendons. These combine to form a

More information

.org. Shoulder Pain and Common Shoulder Problems. Anatomy. Cause

.org. Shoulder Pain and Common Shoulder Problems. Anatomy. Cause Shoulder Pain and Common Shoulder Problems Page ( 1 ) What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion in the arm from scratching

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2115/14

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2115/14 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2115/14 BEFORE: C. M. MacAdam : Vice-Chair S. T. Sahay : Member Representative of Employers K. Hoskin : Member Representative of Workers HEARING:

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 975/06

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 975/06 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 975/06 BEFORE: M. Crystal: Vice-Chair HEARING: February 28, 2007 at Toronto Written case DATE OF DECISION: March 1, 2007 NEUTRAL CITATION: 2007

More information

Shoulder Impingement/Rotator Cuff Tendinitis

Shoulder Impingement/Rotator Cuff Tendinitis Copyright 2011 American Academy of Orthopaedic Surgeons Shoulder Impingement/Rotator Cuff Tendinitis One of the most common physical complaints is shoulder pain. Your shoulder is made up of several joints

More information

J F de Beer, K van Rooyen, D Bhatia. Rotator Cuff Tears

J F de Beer, K van Rooyen, D Bhatia. Rotator Cuff Tears 1 J F de Beer, K van Rooyen, D Bhatia Rotator Cuff Tears Anatomy The shoulder consists of a ball (humeral head) and a socket (glenoid). The muscles around the shoulder act to elevate the arm. The large

More information

Torn. acromioclavicular. ligament. Acromion

Torn. acromioclavicular. ligament. Acromion Acromioclavicular Joint Injury Acromioclavicular (AC) joint injuries are common in contact or collision sports such as American football, rugby, hockey, or lacrosse. The injury typically occurs during

More information

Workers who do overhead activities such as painting, stocking shelves or construction Athletes such as swimmers, pitchers and tennis players

Workers who do overhead activities such as painting, stocking shelves or construction Athletes such as swimmers, pitchers and tennis players Rotator Cuff Tears Description Rotator cuff tears are a common cause of pain and disability in the adult population. The rotator cuff is made up of four muscles and their tendons. These combine to form

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1602/11

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1602/11 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1602/11 BEFORE: M. M. Cohen: Vice-Chair HEARING: August 16, 2011 at Toronto Written DATE OF DECISION: August 23, 2011 NEUTRAL CITATION: 2011

More information

Shoulder pain and Rotator Cuff Shoulder impingement and rotator cuff tears

Shoulder pain and Rotator Cuff Shoulder impingement and rotator cuff tears Shoulder pain and Rotator Cuff Shoulder impingement and rotator cuff tears Introduction The shoulder is a very mobile, shallow ball and socket joint that allows you great range of movement and power in

More information

Ms. Ruth Delaney ROTATOR CUFF DISEASE Orthopaedic Surgeon, Shoulder Specialist

Ms. Ruth Delaney ROTATOR CUFF DISEASE Orthopaedic Surgeon, Shoulder Specialist WHAT DOES THE ROTATOR CUFF DO? WHAT DOES THE ROTATOR CUFF DO? WHO GETS ROTATOR CUFF TEARS? HOW DO I CLINICALLY DIAGNOSE A CUFF TEAR? WHO NEEDS AN MRI? DOES EVERY CUFF TEAR NEED TO BE FIXED? WHAT DOES ROTATOR

More information

Rotator cuff tears Acute or chronic? Mary Obele ANZSOM September 2012 Acknowledgement: ACC

Rotator cuff tears Acute or chronic? Mary Obele ANZSOM September 2012 Acknowledgement: ACC Rotator cuff tears Acute or chronic? Mary Obele ANZSOM September 2012 Acknowledgement: ACC Anatomy Epidemiology Asymptomatic rotator cuff tears: prevalence is 35% (5) 15% full thickness and 20% partial

More information

.org. Rotator Cuff Tears. Anatomy. Description

.org. Rotator Cuff Tears. Anatomy. Description Rotator Cuff Tears Page ( 1 ) A rotator cuff tear is a common cause of pain and disability among adults. In 2008, close to 2 million people in the United States went to their doctors because of a rotator

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2437/15

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2437/15 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2437/15 BEFORE: S. Netten: Vice-Chair HEARING: November 10, 2015 at Toronto Written DATE OF DECISION: November 17, 2015 NEUTRAL CITATION: 2015

More information

A Simplified Approach to Common Shoulder Problems

A Simplified Approach to Common Shoulder Problems A Simplified Approach to Common Shoulder Problems Objectives: Understand the basic categories of common shoulder problems. Understand the common patient symptoms. Understand the basic exam findings. Understand

More information

IN THE MATTER of the Accident Compensation Act 2001 IN THE MATTER (A ) Appellant ACCIDENT COMPENSATION CORPORATION

IN THE MATTER of the Accident Compensation Act 2001 IN THE MATTER (A ) Appellant ACCIDENT COMPENSATION CORPORATION IN THE DISTRICT COURT HELD AT WELLINGTON Decision No. [2010] NZACC 19d IN THE MATTER of the Accident Compensation Act 2001 - AND IN THE MATTER of an appeal pursuant to Section 149 of the Act BETWEEN GARNETT

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2289/08

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2289/08 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2289/08 BEFORE: M. Crystal: Vice-Chair HEARING: October 31, 2008 at Toronto Written case DATE OF DECISION: October 31, 2008 NEUTRAL CITATION:

More information

Impingement Syndrome of the Shoulder & Rotator Cuff Problems

Impingement Syndrome of the Shoulder & Rotator Cuff Problems H U N T E R D O N ORTHOPEDIC P.A. INSTITUTE L IVE L IFE B ETTER www.hunterdonortho.com Impingement Syndrome of the Shoulder & Rotator Cuff Problems Types of Injuries Treatment Options Rehabilitation Robert

More information

ACROMIO-CLAVICULAR JOINT (AC JOINT) DEGENERATION

ACROMIO-CLAVICULAR JOINT (AC JOINT) DEGENERATION ACROMIO-CLAVICULAR JOINT (AC JOINT) DEGENERATION Anatomy of the AC joint: This is the small joint on the top of the shoulder. It connects the tip of the clavicle (collar bone) to the acromion (shoulder

More information

Impingement series what and why?

Impingement series what and why? SHOULDER Impingement series what and why? ANATOMY Bony elements of the shoulder include Humerus Scapula Clavicle http://www.frozenshoulder.ca/anatomyimages/bones3.jpg ROTATOR CUFF Supraspinatus Infraspinatus

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2904/16

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2904/16 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2904/16 BEFORE: A. G. Baker: Vice-Chair HEARING: November 7, 2016 at Thunder Bay Oral DATE OF DECISION: November 10, 2016 NEUTRAL CITATION:

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1119/09

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1119/09 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1119/09 BEFORE: T. Mitchinson: Vice-Chair HEARING: June 3, 2009 at Sudbury Oral DATE OF DECISION: June 8, 2009 NEUTRAL CITATION: 2009 ONWSIAT

More information

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. F910691. TERRY FOSTER, Employee. TYSON SALES & DISTRIBUTION, Self-Insured Employer

BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. F910691. TERRY FOSTER, Employee. TYSON SALES & DISTRIBUTION, Self-Insured Employer BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. F910691 TERRY FOSTER, Employee TYSON SALES & DISTRIBUTION, Self-Insured Employer CLAIMANT RESPONDENT OPINION FILED NOVEMBER 20, 2013 Hearing

More information

The Rotator cuff. Dr Tom Lieng June 2011

The Rotator cuff. Dr Tom Lieng June 2011 The Rotator cuff Dr Tom Lieng June 2011 Content 1. Anatomy 2. Rotator cuff pathology 3. Treatment of rotator cuff injury 4. Prognosis 5. Other common shoulder conditions:adhesive capsulitis 6. Acromio-clavicular

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 193/14

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 193/14 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 193/14 BEFORE: C. M. MacAdam : Vice-Chair J. Blogg : Member Representative of Employers A. Grande : Member Representative of Workers HEARING:

More information

Rotator Cuff Pathophysiology. treatment program that will effectively treat it. The tricky part about the shoulder is that it is a ball and

Rotator Cuff Pathophysiology. treatment program that will effectively treat it. The tricky part about the shoulder is that it is a ball and Rotator Cuff Pathophysiology Shoulder injuries occur to most people at least once in their life. This highly mobile and versatile joint is one of the most common reasons people visit their health care

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1599/15

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1599/15 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1599/15 BEFORE: S. Peckover: Vice-Chair HEARING: August 7, 2015 at Toronto Written DATE OF DECISION: August 10, 2015 NEUTRAL CITATION: 2015

More information

Knowing about your Rotator Cuff

Knowing about your Rotator Cuff Knowing about your Rotator Cuff Knowing about rotator cuff disorder The shoulder joint is the most mobile joint in the body and can therefore be quite unstable. It is vulnerable to injuries from sport

More information

UPPER EXTREMITY INJURIES. Recognizing common injuries to the upper extremity

UPPER EXTREMITY INJURIES. Recognizing common injuries to the upper extremity UPPER EXTREMITY INJURIES Recognizing common injuries to the upper extremity ANATOMY BONES Clavicle Scapula Spine of the scapula Acromion process Glenoid fossa/cavity Humerus Epicondyles ANATOMY BONES Ulna

More information

SHOULDER PAIN LIFE OR SPORTS, WE GET YOU BACK IN THE GAME.SM.

SHOULDER PAIN LIFE OR SPORTS, WE GET YOU BACK IN THE GAME.SM. LIFE OR SPORTS, WE GET YOU BACK IN THE GAME.SM SHOULDER PAIN Fort Sanders Regional The Trustees Tower 501 19th Street, Suite 600 Knoxville, TN 37916 Tel 865.524.5365 Fax 865.673.8007 The Tower at Parkwest

More information

The Rotator Cuff Explained

The Rotator Cuff Explained The Rotator Cuff Explained Live Teleseminar with Brian Schiff, PT, CSCS January 24, 2008 Objectives Review pertinent shoulder anatomy Discuss tendonitis, bursitis & tears Highlight common injury causes

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2444/06

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2444/06 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2444/06 BEFORE: M. Crystal: Vice-Chair HEARING: December 4, 2006 at Toronto Written case DATE OF DECISION: December 5, 2006 NEUTRAL CITATION:

More information

Shoulder Injuries. Why Bother? QAS Injury Prevalence. Screening Injury 29.2% 12 month cumulative injury prevalence. Dr Simon Locke

Shoulder Injuries. Why Bother? QAS Injury Prevalence. Screening Injury 29.2% 12 month cumulative injury prevalence. Dr Simon Locke Shoulder Injuries Dr Simon Locke Why Bother? Are shoulder and upper limb injuries common? Some anatomy What, where, what sports? How do they happen? Treatment, advances? QAS Injury Prevalence Screening

More information

Shoulder Orthopedic Tests

Shoulder Orthopedic Tests Shoulder Orthopedic Tests Tendinitis (Supraspinatus) Supraspinatus tendinitis is a common inflammatory condition of the shoulder that causes anterior shoulder pain. Pain is present especially in abduction.

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2165/16

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2165/16 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2165/16 BEFORE: K. Jepson: Vice-Chair HEARING: August 18, 2016 at Toronto Oral DATE OF DECISION: November 1, 2016 NEUTRAL CITATION: 2016 ONWSIAT

More information

Discussion paper prepared for. The Workplace Safety and Insurance Appeals Tribunal. July Prepared by: Dr. Hans K. Uhthoff. Orthopaedic Surgeon

Discussion paper prepared for. The Workplace Safety and Insurance Appeals Tribunal. July Prepared by: Dr. Hans K. Uhthoff. Orthopaedic Surgeon Discussion paper prepared for The Workplace Safety and Insurance Appeals Tribunal July 2002 Prepared by: Dr. Hans K. Uhthoff Orthopaedic Surgeon This medical discussion paper will be useful to those seeking

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL 2005 ONWSIAT 469 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1300/04 [1] This appeal was considered in Toronto on August 3, 2004, by Tribunal Vice-Chair M. Crystal. THE APPEAL PROCEEDINGS

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1617/14

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1617/14 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1617/14 BEFORE: T. Mitchinson: Vice-Chair HEARING: August 29, 2014 at Sudbury Oral DATE OF DECISION: September 4, 2014 NEUTRAL CITATION: 2014

More information

SHOULDER PAIN. Procedures: Subacromial, Glenohumeral and Acromioclavicular Injections Nonprocedural Treatments

SHOULDER PAIN. Procedures: Subacromial, Glenohumeral and Acromioclavicular Injections Nonprocedural Treatments SHOULDER PAIN Anatomy Conditions: Muscular Spasm Pinched Nerve Rotator Cuff Tendonitis Procedures: Subacromial, Glenohumeral and Acromioclavicular Injections Nonprocedural Treatments Surgery: Rotator Cuff

More information

Refer to Specialist. The Diagnosis and Management of Shoulder Pain 1. SLAP lesions, types 1 through 4

Refer to Specialist. The Diagnosis and Management of Shoulder Pain 1. SLAP lesions, types 1 through 4 The Diagnosis Management of Shoulder Pain 1 Significant Hisry -Age -Extremity Dominance -Hisry of trauma, dislocation, subluxation -Weakness, numbness, paresthesias -Sports participation -Past medical

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 376/08

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 376/08 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 376/08 BEFORE: A. Morris: Vice-Chair HEARING: February 7, 2008 at Toronto Oral DATE OF DECISION: June 9, 2008 NEUTRAL CITATION: 2008 ONWSIAT

More information

DECISION 13080. Lloyd Piercey. Review Commissioner

DECISION 13080. Lloyd Piercey. Review Commissioner WORKPLACE HEALTH, SAFETY & COMPENSATION REVIEW DIVISION 6 Mt. Carson Ave., Dorset Building Mt. Pearl, NL A1N 3K4 DECISION 13080 Lloyd Piercey Review Commissioner May 2013 WORKPLACE HEALTH, SAFETY & COMPENSATION

More information

Rotator Cuff Tears in Football

Rotator Cuff Tears in Football Disclosures Rotator Cuff Tears in Football Roger Ostrander, MD Consultant: Mitek Consultant: On-Q Research Support: Arthrex Research Support: Breg Research Support: Arthrosurface 2 Anatomy 4 major muscles:

More information

ROTATOR CUFF SYNDROME Arbejds- og Miljømedicinsk Årsmøde 2008 ROTATOR CUFF SYNDROME = SHOULDER PAIN Steen Bo Kalms, Shoulder- and Elbow Surgeon ROTATOR CUFF SYNDROME VERY COMMON DIAGNOSIS ON REFERRED PTT

More information

Shoulder Tendonitis. Brett Sanders, MD Center For Sports Medicine and Orthopaedic 2415 McCallie Ave. Chattanooga, TN (423) 624-2696

Shoulder Tendonitis. Brett Sanders, MD Center For Sports Medicine and Orthopaedic 2415 McCallie Ave. Chattanooga, TN (423) 624-2696 Shoulder Tendonitis Brett Sanders, MD Center For Sports Medicine and Orthopaedic 2415 McCallie Ave. Chattanooga, TN (423) 624-2696 Shoulder tendinitis is a common overuse injury in sports (such as swimming,

More information

Uncovering the Cause of Your Shoulder Pain. Joseph Lorenzetti PT, DPT, MTC Athleticare Kenmore 1495 Military Road Kenmore, NY 14217

Uncovering the Cause of Your Shoulder Pain. Joseph Lorenzetti PT, DPT, MTC Athleticare Kenmore 1495 Military Road Kenmore, NY 14217 Uncovering the Cause of Your Shoulder Pain Joseph Lorenzetti PT, DPT, MTC Athleticare Kenmore 1495 Military Road Kenmore, NY 14217 What do Physical Therapists do? Skilled in the assessment of musculoskeletal

More information

Introduction: Rotator Cuff Anatomy:

Introduction: Rotator Cuff Anatomy: Introduction: Shoulder pain is a common complaint by patients, and it can be due to a variety of causes. The major cause of shoulder pain in patients older than 40 years is rotator cuff impingement and

More information

Rotator Cuff Disease Update 2015

Rotator Cuff Disease Update 2015 Rotator Cuff Disease Update 2015 Mark Lembach MD Orthopaedic Surgery and Sports Medicine Disclosures I have no financial or other disclosures related to this talk. Overview Scope of the problem Review

More information

FD: FD: DT:D DN:301 STY: PANEL:Catton; Lankin; Jago DDATE: TYPE:A ACT: DECON: CCON: SCON: BDG: REGS: PDCON: DIST: KEYW:accident; disablement;

FD: FD: DT:D DN:301 STY: PANEL:Catton; Lankin; Jago DDATE: TYPE:A ACT: DECON: CCON: SCON: BDG: REGS: PDCON: DIST: KEYW:accident; disablement; FD: FD: DT:D DN:301 STY: PANEL:Catton; Lankin; Jago DDATE:250587 TYPE:A ACT: DECON: CCON: SCON: BDG: REGS: PDCON: DIST: KEYW:accident; disablement; significant contribution; aggravation; pre-existing condition

More information

Shoulder Surgery. How the Normal Shoulder Works.

Shoulder Surgery. How the Normal Shoulder Works. Page 1 of 6 Shoulder Surgery Your shoulder is the most flexible joint in your body. It allows you to place and rotate your arm in many positions in front, above, to the side, and behind your body. This

More information

Pilates Can Help After a Shoulder Impingement and Rotator Cuff Surgery

Pilates Can Help After a Shoulder Impingement and Rotator Cuff Surgery Pilates Can Help After a Shoulder Impingement and Rotator Cuff Surgery Written by: Jannel Krug Date: February 2013 Location: Fit from the Core Mountain View, CA 1 Abstract I would like to explain the wonders

More information

Σύνδροµο Υπακρωµιακής Προστριβής

Σύνδροµο Υπακρωµιακής Προστριβής Slide 1 Σύνδροµο Υπακρωµιακής Προστριβής Χρήστος K. Γιαννακόπουλος Ορθοπαιδικός Χειρουργός Διευθυντής Ορθοπαιδικής Κλινικής ΙΑΣΩ General, Αθήνα Γενικός Γραµµατέας Ελληνικής Αρθροσκοπικής Εταιρείας www.orthosurgery.gr

More information

GP Assessment of the Shoulder. Keith Littlebury MSc Grad dip Phys Extended Scope Physiotherapist Camden CATS service

GP Assessment of the Shoulder. Keith Littlebury MSc Grad dip Phys Extended Scope Physiotherapist Camden CATS service GP Assessment of the Shoulder Keith Littlebury MSc Grad dip Phys Extended Scope Physiotherapist Camden CATS service Aims Refresh shoulder anatomy Classification of common shoulder conditions seen in primary

More information

SUMMARY DECISION NO. 1162/97. Aggravation (preexisting condition) (osteoarthritis) (knee).

SUMMARY DECISION NO. 1162/97. Aggravation (preexisting condition) (osteoarthritis) (knee). SUMMARY DECISION NO. 1162/97 Aggravation (preexisting condition) (osteoarthritis) (knee). The worker suffered left knee injuries in 1976, 1980 and 1987. The worker appealed a decision of the Appeals Officer

More information

Rehabilitation Guidelines for Shoulder Arthroscopy

Rehabilitation Guidelines for Shoulder Arthroscopy Rehabilitation Guidelines for Shoulder Arthroscopy Front View Long head of bicep Acromion Figure 1 Shoulder anatomy Supraspinatus Image Copyright 2010 UW Health Sports Medicine Center. Short head of bicep

More information

SHOULDER IMPINGEMENT OXFORD SHOULDER & ELBOW CLINIC INFORMATION FOR YOU. Shoulder Impingement SHOULDER IMPINGEMENT

SHOULDER IMPINGEMENT OXFORD SHOULDER & ELBOW CLINIC INFORMATION FOR YOU. Shoulder Impingement SHOULDER IMPINGEMENT OXFORD SHOULDER & ELBOW CLINIC INFORMATION FOR YOU Shoulder Impingement SHOULDER IMPINGEMENT Shoulder Impingement The aim of this information sheet is to give you some understanding of the problem you

More information

Partial Articular Surface Rotator Cuff Tears in the Overhead Athlete. Michael S. McGuire MD

Partial Articular Surface Rotator Cuff Tears in the Overhead Athlete. Michael S. McGuire MD Partial Articular Surface Rotator Cuff Tears in the Overhead Athlete Michael S. McGuire MD No Financial Disclosures Objectives To get a better understanding of one of the causes of shoulder pain in young

More information

Orthopaedic and Spine Institute 21 Spurs Lane, Suite 245, San Antonio, TX Tel#

Orthopaedic and Spine Institute 21 Spurs Lane, Suite 245, San Antonio, TX Tel# Orthopaedic and Spine Institute 21 Spurs Lane, Suite 245, San Antonio, TX 78240 www.saspine.com Tel# 210-487-7463 PATIENT GUIDE TO SHOULDER ARTHROSCOPY ACROMIOPLASTY WHAT IS ARTHROSCOPIC SURGERY? Athroscopic

More information

THE SHOULDER. Shoulder Pain. Fractures. Instability and Dislocations of the Shoulder

THE SHOULDER. Shoulder Pain. Fractures. Instability and Dislocations of the Shoulder THE SHOULDER Shoulder Pain 1. Fractures 2. Sports injuries 3. Instability/Dislocations 4. Rotator Cuff Disease and Tears 5. Arthritis Fractures The shoulder is made up of three primary bones, the clavicle,

More information

Arthroscopic Shoulder Procedures. David C. Neuschwander MD. Shoulder Instability. Allegheny Health Network Orthopedic Associates of Pittsburgh

Arthroscopic Shoulder Procedures. David C. Neuschwander MD. Shoulder Instability. Allegheny Health Network Orthopedic Associates of Pittsburgh Arthroscopic Shoulder Procedures David C. Neuschwander MD Allegheny Health Network Orthopedic Associates of Pittsburgh Shoulder Instability Anterior Instability Posterior Instability Glenohumeral Joint

More information

Adhesive Capsulitis. Jennifer Holden, MD PGY-2 Department of Emergency Medicine University of Mississippi Medical Center

Adhesive Capsulitis. Jennifer Holden, MD PGY-2 Department of Emergency Medicine University of Mississippi Medical Center Adhesive Capsulitis Jennifer Holden, MD PGY-2 Department of Emergency Medicine University of Mississippi Medical Center Definition: A condition of varying severity characterized by the gradual development

More information

Biceps tendon To Divide or Not to Divide

Biceps tendon To Divide or Not to Divide Biceps tendon To Divide or Not to Divide Anatomy of the Biceps Tendon Proposed Functions of the Biceps Weak humeral head depressor role that increases in relative importance in the presence of rotator

More information

28% have partial tear of the rotator cuff.

28% have partial tear of the rotator cuff. ROTATOR CUFF TENDON RUPTURE Anatomy: 1. Rotator cuff consists of: Subscapularis anteriorly, Supraspinatus superiorly and Infraspinatus and Teres minor posteriorly. 2 Biceps tendon is present in the rotator

More information

Hand and Upper Extremity Injuries in Outdoor Activities. John A. Schneider, M.D.

Hand and Upper Extremity Injuries in Outdoor Activities. John A. Schneider, M.D. Hand and Upper Extremity Injuries in Outdoor Activities John A. Schneider, M.D. Biographical Sketch Dr. Schneider is an orthopedic surgeon that specializes in the treatment of hand and upper extremity

More information

Shoulder and Elbow Problems

Shoulder and Elbow Problems Shoulder and Elbow Problems Mr Amir Salama Consultant Orthopaedic Surgeon Heart of England Trust Parkway Hospital Shoulder Pain Traumatic/ Injury fracture Dislocation/ instability SLAP Cuff tear Non

More information

Evaluation & Management of Common Shoulder and Elbow Disorders

Evaluation & Management of Common Shoulder and Elbow Disorders Evaluation & Management of Common Shoulder and Elbow Disorders Anil K. Koganti, M.D. Sports Medicine, Shoulder/Elbow Reconstruction EVALUATION OF THE SHOULDER History Location of Pain Onset Trauma? Weakness?

More information

Shoulder Problems-Overview

Shoulder Problems-Overview Shoulder Problems-Overview Shoulder Arthritis Rotator Cuff Shoulder Instability Shoulder Arthroscopy Shoulder Problems - Rotator Cuff Tear Printer Friendly PDF Questions and Answers What is the rotator

More information

DECISION NO. 1708/10

DECISION NO. 1708/10 B. Kalvin WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1708/10 BEFORE: B. Kalvin : Vice-Chair HEARING: September 9, 2010 at Toronto Oral DATE OF DECISION: September 15, 2010 NEUTRAL CITATION:

More information

IMPINGEMENT REVISITED. W. Ben Kibler, MD. From what angle are you looking at impingement -WHAT IS IT - EVALUATION - TREATMENT GUIDES

IMPINGEMENT REVISITED. W. Ben Kibler, MD. From what angle are you looking at impingement -WHAT IS IT - EVALUATION - TREATMENT GUIDES IMPINGEMENT REVISITED -WHAT IS IT - EVALUATION - TREATMENT GUIDES W. Ben Kibler, MD Medical director From what angle are you looking at impingement Bone spur- Acromion type 1, 2, 3 Rotator cuff injury

More information

WORKERS COMPENSATION APPEAL TRIBUNAL

WORKERS COMPENSATION APPEAL TRIBUNAL WORKERS COMPENSATION APPEAL TRIBUNAL BETWEEN: [PERSONAL INFORMATION] CASE ID #[PERSONAL INFORMATION] APPELLANT AND: WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND RESPONDENT DECISION #199 Appellant

More information

Clues to Diagnosing and Managing Common Shoulder & Elbow Disorders. Dr John Trantalis

Clues to Diagnosing and Managing Common Shoulder & Elbow Disorders. Dr John Trantalis Clues to Diagnosing and Managing Common Shoulder & Elbow Disorders Dr John Trantalis Overview Key diagnostic criteria for common shoulder and elbow disorders Then give summary of condition. Demog, hs,

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1292/05

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1292/05 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1292/05 BEFORE: J. Josefo: Vice-Chair D. McLachlan: Member Representative of Employers R.J. Lebert: Member Representative of Workers HEARING:

More information

WORKERS COMPENSATION APPEAL TRIBUNAL. EMPLOYER CASE ID #[personal information] WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND WORKER DECISION #114

WORKERS COMPENSATION APPEAL TRIBUNAL. EMPLOYER CASE ID #[personal information] WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND WORKER DECISION #114 WORKERS COMPENSATION APPEAL TRIBUNAL BETWEEN: EMPLOYER CASE ID #[personal information] AND: APPELLANT WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND RESPONDENT AND: WORKER EMPLOYEE DECISION #114 Appellant

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2529/07E

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2529/07E WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2529/07E BEFORE: U. Ferdinand: Vice-Chair HEARING: November 5, 2007 Written DATE OF DECISION: December 11, 2007 NEUTRAL CITATION: 2007 ONWSIAT

More information

Shoulder Injury and Disability

Shoulder Injury and Disability Discussion paper prepared for The Workplace Safety and Insurance Appeals Tribunal Revised: October 2010 Prepared by: Dr. Hans K. Uhthoff Orthopaedic Surgeon Dr. Hans K. Uhthoff graduated from the University

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2133/14

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2133/14 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 2133/14 BEFORE: B. Goldberg: Vice-Chair HEARING: November 19, 2014 at Toronto Oral DATE OF DECISION: December 2, 2014 NEUTRAL CITATION: 2014

More information

NOVA SCOTIA WORKERS COMPENSATION APPEALS TRIBUNAL

NOVA SCOTIA WORKERS COMPENSATION APPEALS TRIBUNAL NOVA SCOTIA WORKERS COMPENSATION APPEALS TRIBUNAL Appellant: [X] (Employer) Participants entitled to respond to this appeal: [X] (Worker) and The Workers Compensation Board of Nova Scotia (Board) APPEAL

More information

Frozen Shoulder. Dr Keith Holt. What happens in frozen shoulder? The clinical picture

Frozen Shoulder. Dr Keith Holt. What happens in frozen shoulder? The clinical picture Frozen Shoulder Dr Keith Holt Frozen shoulder is a relatively common condition involving the shoulder joint, which causes pain and loss of motion in that joint, often for a substantial period of time.

More information

Workplace Health, Safety & Compensation Review Division

Workplace Health, Safety & Compensation Review Division Workplace Health, Safety & Compensation Review Division WHSCRD Case No: WHSCC Claim No: Decision Number: 15171 Gordon Murphy Review Commissioner The Review Proceedings 1. The hearing of the review application

More information

ARTHROSCOPIC (KEY-HOLE) SHOULDER SURGERY

ARTHROSCOPIC (KEY-HOLE) SHOULDER SURGERY ARTHROSCOPIC (KEY-HOLE) SHOULDER SURGERY Information Leaflet Your Health. Our Priority. Page 2 of 8 What is arthroscopic ( key-hole ) surgery? Key-hole surgery is the technique of performing surgery though

More information

Shoulder Impingement and Rotator Cuff Tears. Course Objectives. First, I Digress 02/21/12. The Hand and Upper Extremity Center of Northeast Wisconsin

Shoulder Impingement and Rotator Cuff Tears. Course Objectives. First, I Digress 02/21/12. The Hand and Upper Extremity Center of Northeast Wisconsin The Hand and Upper Extremity Center of Northeast Wisconsin Shoulder Impingement and Rotator Cuff Tears Nathan L. Van Zeeland Hand & Upper Extremity Center of Northeast Wisconsin 2/24/12 Course Objectives

More information

WORKERS COMPENSATION APPEAL TRIBUNAL [PERSONAL INFORMATION] CASE ID #[PERSONAL INFORMATION] WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND

WORKERS COMPENSATION APPEAL TRIBUNAL [PERSONAL INFORMATION] CASE ID #[PERSONAL INFORMATION] WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND WORKERS COMPENSATION APPEAL TRIBUNAL BETWEEN: [PERSONAL INFORMATION] CASE ID #[PERSONAL INFORMATION] APPELLANT AND: WORKERS COMPENSATION BOARD OF PRINCE EDWARD ISLAND RESPONDENT DECISION #194 Appellant

More information

ROTATOR CUFF TEARS. A guide to the symptoms and treatment for tears to the rotator cuff

ROTATOR CUFF TEARS. A guide to the symptoms and treatment for tears to the rotator cuff ROTATOR CUFF TEARS A guide to the symptoms and treatment for tears to the rotator cuff ROTATOR CUFF TEARS The rotator cuff is a group comprising of four muscles the supraspinatus, infraspinatus, subscapularis

More information

1 of 6 1/22/2015 10:06 AM

1 of 6 1/22/2015 10:06 AM 1 of 6 1/22/2015 10:06 AM 2 of 6 1/22/2015 10:06 AM This cross-section view of the shoulder socket shows a typical SLAP tear. Injuries to the superior labrum can be caused by acute trauma or by repetitive

More information

Shoulder vs Neck Pathology. Goal: Simplify Evaluation of the Painful Shoulder. Shoulder: Bony Anatomy Three major bones. Shoulder Disorders: Overview

Shoulder vs Neck Pathology. Goal: Simplify Evaluation of the Painful Shoulder. Shoulder: Bony Anatomy Three major bones. Shoulder Disorders: Overview 4 5:45 pm Orthopedic Update: Hand and Shoulder SPEAKERS Charles S. Day, MD, MBA Arun J. Ramappa, MD Presenter Disclosure Information The following relationships exist related to this presentation: Charles

More information

BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION

BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION BEFORE THE APPEALS BOARD FOR THE KANSAS DIVISION OF WORKERS COMPENSATION DONALD BRYAN SMITHHISLER Claimant VS. LIFE CARE CENTERS AMERICA, INC. Respondent Docket No. 1,014,349 AND OLD REPUBLIC INSURANCE

More information

Musculoskeletal: Acute Lower Back Pain

Musculoskeletal: Acute Lower Back Pain Musculoskeletal: Acute Lower Back Pain Acute Lower Back Pain Back Pain only Sciatica / Radiculopathy Possible Cord or Cauda Equina Compression Possible Spinal Canal Stenosis Red Flags Initial conservative

More information

Subacromial Decompression Surgery

Subacromial Decompression Surgery Subacromial Decompression Surgery Exceptional healthcare, personally delivered This leaflet aims to help you gain the maximum benefit from your operation. It is not a substitute for professional medical

More information

A Patient s Guide to Labral Tears of the Hip

A Patient s Guide to Labral Tears of the Hip A Patient s Guide to Labral Tears of the Hip 6565 Fannin Street Houston, TX 77030 Phone: 713-790-3333 DISCLAIMER: The information in this booklet is compiled from a variety of sources. It may not be complete

More information

TOWN CENTER ORTHOPAEDIC ASSOCIATES P.C. Labral Tears

TOWN CENTER ORTHOPAEDIC ASSOCIATES P.C. Labral Tears Labral Tears The shoulder is your body s most flexible joint. It is designed to let the arm move in almost any direction. But this flexibility has a price, making the joint prone to injury. The shoulder

More information