The authors declare that they have no competing interests. No external funding was received for this study.
HR (PT, PhD) conceived the idea, supervised data extraction and entry, performed data analysis and drafted the manuscript. SL (PT, MSc) and DB (PT, MSc) performed clinical examination and reviewed electronic files of patients who were referred for investigations. CG (BSc, MSc, FRCSC) performed clinical examination. IM (BHSc, MHSc, OT, CHE), CV (BPHE, BScPT, RPT) and RRR (MD, FRCSC) posed research questions and were involved in program development. All authors have contributed to data analysis interpretation and manuscript preparation and have read and approved the final manuscript.
There is minimal research on demographics, type of injury and diagnosis of injured workers with shoulder problems. The purposes of this study were: 1) to document the demographics of patients with shoulder complaints referred to an Early Shoulder Physician Assessment (ESPA) Program and to describe the recommended management, and 2) to examine the relationship between patient characteristics and their subjective complaints of pain and functional difficulty.
This study involved a retrospective review of electronic files of injured workers mostly seen within the first 16 weeks of injury or recurrence. Measures of functional difficulty and pain were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Numeric Pain Scale (NPS).
Files of 550 consecutive patients, 260 females (47%), 290 men (53%) were examined. The average age was 49 (SD = 11, range 22–77), with 28 (5%) patients being 65 years of age or older. Patients who were not working were the most disabled group based on Quick DASH (F = 49.93, p < 0.0001) and NPS (F = 10.24, p = 0.002). Patients who were working full time performing regular duties were the least disabled according to both measures, the QuickDASH (F = 10.24, p = 0.002) and NPS (F = 7.57, p = 0.006).
Patients waiting more than 16 weeks were slightly older (53 years of age vs. 49, p = 0.045) than those who met the criteria for early assessment with similar levels of pain and functional difficulty. Biceps pathology had the highest prevalence (37%). Full thickness tear had a prevalence of 14%. Instability, labral lesions and osteoarthritis of glenohumeral joint were uncommon conditions (3, 2 and 1% respectively). Fifty-five patients (10%) were surgical candidates and had higher scores on QuickDASH (F = 7.16, p = 0.008) and NPS (F = 4.24, p = 0.04) compared to those who did not require surgery.
This study provides information on characteristics and prevalence of important variables in injured workers with shoulder problems and highlights the impact of these characteristics on pain and disability.
Wasiak R, Verma S, Pransky G, Webster B. Risk factors for recurrent episodes of care and work disability: case of low back pain. J Occup Environ Med. 2004;46(1):68–76. PubMed
Picavet HS, Schouten JS. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003;102(1–2):167–78. PubMed
Mustard CA, Chambers A, Ibrahim S, Etches J, Smith P. Time trends in musculoskeletal disorders attributed to work exposures in Ontario using three independent data sources, 2004–2011. Occup Environ Med 2014, Oct 13.
Mroz TM, Carlini AR, Archer KR, Wegener ST, Hoolachan JI, Stiers W, et al. Frequency and cost of claims by injury type from a state workers’ compensation fund from 1998 through 2008. Arch Phys Med Rehabil. 2014;95(6):1048–1054.e6. PubMed
MacDonald K, King D. Work-related musculoskeletal disorders in veterinary echocardiographers: a cross-sectional study on prevalence and risk factors. J Vet Cardiol. 2014;16(1):27–37. PubMed
Lee SJ, Faucett J, Gillen M, Krause N. Musculoskeletal pain among critical-care nurses by availability and use of patient lifting equipment: an analysis of cross-sectional survey data. Int J Nurs Stud. 2013;50(12):1648–57. PubMed
Shanahan EM, Sladek R. Shoulder pain at the workplace. Best Pract Res Clin Rheumatol. 2011;25(1):59–68. PubMed
Hanvold TN, Veiersted KB, Waersted M. A prospective study of neck, shoulder, and upper back pain among technical school students entering working life. J Adolesc Health. 2010;46(5):488–94. PubMed
Long MH, Bogossian FE, Johnston V. The prevalence of work-related neck, shoulder, and upper back musculoskeletal disorders among midwives, nurses, and physicians: a systematic review. Workplace Health Saf. 2013;61(5):223–9. quiz 230. PubMed
Martimo KP, Shiri R, Miranda H, Ketola R, Varonen H, Viikari-Juntura E. Self-reported productivity loss among workers with upper extremity disorders. Scand J Work Environ Health. 2009;35(4):301–8. PubMed
Cuff DJ, Pupello DR. Prospective evaluation of postoperative compliance and outcomes after rotator cuff repair in patients with and without workers’ compensation claims. J Shoulder Elbow Surg. 2012;21(12):1728–33. PubMed
Henn 3rd RF, Tashjian RZ, Kang L, Green A. Patients with workers’ compensation claims have worse outcomes after rotator cuff repair. J Bone Joint Surg Am. 2008;90(10):2105–13. PubMed
Holtby R, Razmjou H. Impact of work-related compensation claims on surgical outcome of patients with rotator cuff related pathologies: A matched case–control study. J Shoulder Elbow Surg. 2010;19(3):452–60. PubMed
Kemp KA, Sheps DM, Luciak-Corea C, Styles-Tripp F, Buckingham J, Beaupre LA. Systematic review of rotator cuff tears in workers’ compensation patients. Occup Med (Lond). 2011;61(8):556–62.
Lambers Heerspink FO, Dorrestijn O, van Raay JJ, Diercks RL. Specific patient-related prognostic factors for rotator cuff repair: a systematic review. J Shoulder Elbow Surg. 2014;23(7):1073–80. PubMed
Nicholson GP. Arthroscopic acromioplasty: a comparison between workers’ compensation and non-workers’ compensation populations. J Bone Joint Surg Am. 2003;85-A(4):682–9. PubMed
Sundstrup E, Jakobsen MD, Andersen CH, Jay K, Persson R, Aagaard P, et al. Participatory ergonomic intervention versus strength training on chronic pain and work disability in slaughterhouse workers: study protocol for a single-blind, randomized controlled trial. BMC Musculoskelet Disord. 2013;14:67. 2474-14-67. PubMedPubMedCentral
Savoie 3rd FH, Field LD, Jenkins RN. Costs analysis of successful rotator cuff repair surgery: an outcome study. Comparison of gatekeeper system in surgical patients. Arthroscopy. 1995;11(6):672–6. PubMed
Theodore BR, Mayer TG, Gatchel RJ. Cost-effectiveness of early versus delayed functional restoration for chronic disabling occupational musculoskeletal disorders. J Occup Rehabil 2014, Sept 7.
De Guzman M. Ontario WSIB launches specialized care for shoulder injuries. http://www.cos-mag.com/Health-Page/Health-Page-Stories/ontario-wsib-launches-specialized-care-for-shoulder-injuries.html
Kim HM, Caldwell JM, Buza JA, Fink LA, Ahmad CS, Bigliani LU, et al. Factors affecting satisfaction and shoulder function in patients with a recurrent rotator cuff tear. J Bone Joint Surg Am. 2014;96(2):106–12. PubMed
Rudbeck M, Jensen SL, Fonager K. Arthroscopic subacromial decompression and predictors of long-term sick leave benefit and permanent benefits. J Shoulder Elbow Surg. 2013;22(9):1167–72. PubMed
Lederer V, Rivard M. Compensation benefits in a population-based cohort of men and women on long-term disability after musculoskeletal injuries: costs, course, predictors. Occup Environ Med. 2014;71(11):772–9. PubMed
Beaton DE, Wright JG, Katz JN, Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005;87(5):1038–46. PubMed
Mintken PE, Glynn P, Cleland JA. Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patients with shoulder pain. J Shoulder Elbow Surg. 2009;18(6):920–6. PubMed
Pichora D, Grant H. Upper extremity injured workers stratified by current work status: an examination of health characteristics, work limitations and work instability. Int J Occup Environ Med. 2010;1(3):124–31. PubMed
Graves JM, Fulton-Kehoe D, Jarvik JG, Franklin GM. Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain. Health Serv Res. 2014;49(2):645–65. PubMed
American College of Radiology. ACR Appropriateness Criteria. Online document, https://acsearch.acr.org/docs/69433/Narrative/ accessed December 20, 2014
Wise JN, Daffner RH, Weissman BN, Bancroft L, Bennett DL, Blebea JS, et al. ACR Appropriateness Criteria(R) on acute shoulder pain. J Am Coll Radiol. 2011;8(9):602–9. PubMed
Krishnan SG, Harkins DC, Schiffern SC, Pennington SD, Burkhead WZ. Arthroscopic repair of full-thickness tears of the rotator cuff in patients younger than 40 years. Arthroscopy. 2008;24(3):324–8. PubMed
Dwyer T, Razmjou H, Holtby R. Full-thickness rotator cuff tears in patients younger than 55 years: clinical outcome of arthroscopic repair in comparison with older patients. Knee Surg Sports Traumatol Arthrosc. 2015;23(2):508–13. PubMed
Pomeranz SJ, Modi N. Adhesive capsulitis. J Surg Orthop Adv. 2014;23(2):119–21. PubMed
Tighe CB, Oakley Jr WS. The prevalence of a diabetic condition and adhesive capsulitis of the shoulder. South Med J. 2008;101(6):591–5. PubMed
Denard PJ, Ladermann A, Burkhart SS. Long-term outcome after arthroscopic repair of type II SLAP lesions: results according to age and workers’ compensation status. Arthroscopy. 2012;28(4):451–7. PubMed
McKee MD, Yoo DJ. The effect of surgery for rotator cuff disease on general health status. Results of a prospective trial J Bone Joint Surg Am. 2000;82-A(7):970–9. PubMed
Razmjou H, Holtby R, Myhr T. Gender differences in quality of life and extent of rotator cuff pathology. Arthroscopy. 2006;22(1):57–62. PubMed
Franchignoni F, Ferriero G, Giordano A, Sartorio F, Vercelli S, Brigatti E. Psychometric properties of QuickDASH - a classical test theory and Rasch analysis study. Man Ther. 2011;16(2):177–82. PubMed
- Examining outcome of early physician specialist assessment in injured workers with shoulder complaints
Robin R Richards
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II