Shoulder work injury, and workplace disease involving shoulders, are fairly common. In fact, there are many ways shoulder work injuries can occur. There are also many industrial disease processes that affect shoulders. For instance, when work requires repetitive and heavy use of the arms and shoulders. Like many conditions in L&I claim settings, the cause (or causes) of the shoulder problems frequently becomes an issue.
Shoulder work injury: sprain and strain
Doctors sometime diagnose a workplace injury as sprain or strain. In essence, these usually refer to soft tissue injuries. Here, soft tissues are things like muscles, tendons, and ligaments. These kinds of injuries are extremely common in the workman’s compensation claim ecosystem. Many work activities like reaching over head, lifting, pushing, and pulling cause shoulder sprains and strains. In my experience, medical providers don’t always define sprains and strains the same way.
Some providers use the two terms interchangeably. In general, sprains mean that there’s a damage to tissues connecting bones. In contrast, strains reflect damage to muscles or tissues attaching a muscle to a bone. Sprains and strains can be stretching, tearing, or fraying of the soft tissue. Symptoms include pain, bruising, and swelling. Sprains and strains usually resolve within weeks or a few months. Also, treatment is conservative. For example, over the counter pain relievers, ice, heat, and physical or massage therapy. A cortisone or steroid injection may also be an option for reducing pain and swelling.
Shoulder impingement as a condition in an L&I claim
Shoulder impingement happens following pinching of soft tissues in the shoulder. Usually, the pinching happens during arm movement. The result is pain, swelling, and sometimes weakness. In a workers’ compensation claim, overhead work activities may cause shoulder impingement. Like sprains and strains, doctors often treat shoulder impingement conservatively. Many times, treatment can include physical therapy, home exercise, or injections.
Shoulder tear due to work activity
There are different kinds of shoulder tears that can occur. The most common kinds of tears I see in the workers comp setting are rotator cuff tears and SLAP tears. Rotator cuff tears happen when a rotator cuff tendon rips, either partially or in full. Partial tears are more common. They can sometimes occur without experiencing any symptoms. However, when symptoms are present, they might include pain, stiffness, weakness, and difficulty moving the arm. Personally, in my experience, rotator cuff tears are very common in construction work injury and among healthcare workers. Frequently, repetitive overhead work activities are the culprit. For care, doctors might recommend a variety of treatment options depending on the severity of the tear. Treatment may be conservative like physical therapy or injections. Other times, surgery may be considered if the tear is severe.
SLAP is the abbreviation for “Superior Labrum Anterior Posterior”. SLAP tears involve the labrum. The labrum surrounds the shoulder socket. A SLAP tear is when the tear is in the upper part of the labrum. Here, the tear extends to the back and to the front. Symptoms may include deep pain, popping, clicking, and difficulty sleeping. SLAP tears can happen because of a sudden injury or they can develop over time. Work injury occurrences that may cause a SLAP tear include heavy lifting, a blow to the shoulder, or falling on an outstretched arm. On top, repetitive overhead work activities can cause a SLAP tear over a period of time. Medical providers usually treat SLAP tears conservatively – initially with things like physical therapy and pain management. If conservative treatment fails, then surgery may be necessary.
Frozen shoulder in the workplace
Some refer to the condition frozen shoulder as “adhesive capsulitis”. People that suffer from this condition characterize it as stiffness or inability to move the shoulder joint. This happens form thickening of the shoulder capsule. In some cases, it comes from developing tissue adhesion or scar tissue. Frozen shoulder usually starts with mild symptoms that progress in stages. Initially, symptoms include general aching and sharp pain with movement. Over time, the range of motion decreases.
With the decrease, patients usually report pain and difficulty doing basic daily-living activities. However, if you receive appropriate treatment, the symptoms dissipate, and shoulder activity returns to normal. This can happen in a matter of months. Unfortunately, the symptoms of frozen shoulder can also linger for years. Normally, I see frozen shoulder in workers compensation claim instances following an acute workplace injury.
Shoulder arthritis and joint instability in workers’ comp claims
Unlike soft tissue injuries, arthritis involves significant wear-down of supportive tissue and cartilage in the shoulder. When there’s significant loss of cartilage, the bones in the shoulder joint may become unstable. Specifically, instability refers to looseness in the shoulder joint, which is a ball and socket joint. Simply put, the ball begins to slip in the socket. Sadly, sometimes it can dislocate entirely.
It’s important to know that a sudden work injury damaging the shoulder tissues and ligaments can cause traumatic instability. Yet, it’s also common for instability to develop due to wear and tear over time. If the slippage becomes too severe, treatment may include partial or total joint replacement surgery.
Shoulder work injury and causation
Causation tends to be an issue when more significant shoulder conditions develop. After all, shoulders are an important joint in the human body. They tend to wear down over the years due to various daily activities. Therefore, when a shoulder injury or condition isn’t purely traumatic in nature, it can be challenging to determine whether work activity is a contributing factor.
Generally, if your work requires repetitive shoulder joint activity, especially overhead, there is higher likelihood of a causal connection between work activity and the shoulder condition. Similarly, if a work injury claimant has no shoulder symptoms prior to a work injury but becomes symptomatic after the workplace accident, under the law, there’s likely a causal connection.
Summary and final comments
In summary, the topic of shoulder injury is complex. We use our shoulders very frequently. There are many parts of the shoulder that can suffer a damage due to work injury or workplace activities. Moreover, there are a variety of shoulder medical conditions. Furthermore, one condition may cause or progress into another, and treatment usually begins conservatively.
For me, it’s important to monitor if conservative treatment fails. It’s also critical to track if more severe conditions develop. When that happens, you should ask your doctor or workers’ compensation attorney for assistance. Why? Because you want to ensure that causation does not become a barrier to coverage under your L&I claim in Washington State.