Shoulder Injuries

66-year-old male injured in the course of work when he slipped and fell off of his truck from wet conditions, and while pulling on a railing, causing  a loud “pop” in his left shoulder.  He was at first diagnosed as having a sprain. But based on the amount of rotational weakness and severity of his injury, an MRI was prescribed to confirm any tearing of the rotator cuff. The MRI showed a traumatic full thickness tear of the supraspinaus tendon of the left shoulder with a large tear and significant atrophy. His diagnosis was an acute, chronic full thickness tear of the left shoulder. He did continue with home exercises to prevent more stiffness. At times the pain extended down to his elbow, and he had numbness and tingling in the 3^rd, 4^th, and 5^th fingers of his left hand.  He did have some therapy, but since the pain was 9/10, therapy was discontinued. Surgery was performed in the nature of an arthroscopy of the left shoulder with a subscromial decompression, biceps tenodesis and a single row rotator cuff repair. The supraspinatus and infraspinatus tendons were completely torn and held together only by thin strands of tissue. Three Stryker Inconix anchors were used during his shoulder repair. Several days later he returned to his doctor for his shoulder dressing changes. He continued to complain of numbness in two fingers of his left hand. He started physical therapy again three weeks later and gentle ROM to prevent elbow stiffness before then. He remained  in an arm sling and off of work. Given the ongoing left hand numbness with symptoms of lack of grip and the inability to voluntarily flex his fingers, his doctor ordered an EMG. Nerve conduction studies were done and there were findings of moderate left carpal tunnel syndrome and mild left ulnar neuropathy at the elbow. Unfortunately, surgery was not an option while our petitioner was having therapy. When weights were added to his therapy routine, there was a decrease in range of motion. Therapy was discontinued indicating that he had reached a “plateau.” An MRI arthrogram of his left shoulder was recommended. Petitioner was told to use a left wrist lacer at night. Work restrictions continued. The MRI arthrogram showed the possibility of bicipital tendinopathy; recurrent tearing of the supraspinatus tendon; and mild degenerative joint disease at the AC joint. He was seen by his doctor following the arthrogram and basically just “dropped” as a patient and was told to return if he had any further problems. He ceased his truck driving employment. This case settled for $265,373.50, plus $28,927.97 for a Medicare set aside.

25-year-old woman suffered an injury to her right shoulder while lifting person at her workplace. When initially seeking treatment, she was diagnosed with an AC joint strain and a 20 pound lifting restriction was placed on her. She was later diagnosed with rotator cuff tendonitis and a possible AC joint strain. When she returned to the doctor again, he noted positive anterior apprehension, positive O’Brien’s, Speed’s, Neer’s and Hawkins’ tests, increased pain in her right shoulder and popping in the shoulder when lifting away from her body and with external rotation. An MRI was ordered and showed OS Acromiale and bicep tendonitis or SLAP tear was diagnosed. She was ordered to undergo physical therapy, but it showed little improvement and her shoulder popping persisted. Her doctor then administered 40 mg of Depo-Medrol and 2 ml of Marcaine via injection into her shoulder. The injections did not help lessen her pain. Her doctor questioned the benefit of physical therapy without improvement so the nurse case manager halted physical therapy. An IME was performed by the respondent’s chosen physician, at which time he said she was ready to return to work, but during the exam, he forced a forward flexion of our client’s arm, causing it to pop. She had severe sharp pain since the forced flexion. She returned to her own doctor who took x-rays and diagnosed right rotator cuff tendonitis and recommended physical therapy, e-stim therapy and iontophoresis. After more doctor visits, she had again been given a diagnosis which was anterior/interior instability of the right shoulder with secondary impingement. She underwent a right shoulder capsulorrhaphy procedure and the doctor placed a suture anchor in the glenoid rim to plicate and cinch down tissue and placed 2 other suture anchors, anteriorly to the first along with 2 plication stitches. His pre- and post-operative diagnosis was multidirectional instability of the right shoulder. She was later released to work full duty. Our client still has residuals from her shoulder injury. This case settled for $26,806.34, representing approximately 7 weeks of disputed, unpaid TTD at her nominal rate of $275.61; 25% loss of use of her right arm at a rate of $253.00 ($16,002.25); consideration for the Public Aid lien ($8,349.45); the difference due her between the net short term disability paid and TTD owed her ($115.86); and a recovery for her mileage medical care ($525.37). The respondent’s initial position was 12.5% of arm ($7,672.19). Our client received our support and guidance on how and where to seek her needed medical treatment. -HB

39 year old man injured his right arm and shoulder from lifting heavy boxes at work.  He was diagnosed with right rotator cuff tendinopathy, receiving 3 injections on different dates and participating in physical therapy, but with no relief.  After three months, surgery was requested and approved and he underwent a right shoulder superior and anterior labral tear repair and subacromial decompression.  Our client has returned to work but still suffers some loss of strength and stamina in his right arm.  This case settled for $25,189.00, representing 12.65% loss of the body as a whole.  The defense raised a number of issues to limit payment, including the argument that our client was not making full efforts in therapy or later on the job.  Our firm worked to negate these defense arguments to clear the way for fair and full compensation.

49 year old woman suffered injuries to her right shoulder, left elbow and both hands from repetitive traumas at work.  Her initial diagnoses were right shoulder rotator cuff tendinopathy and bilateral cubital tunnel syndrome.  She participated in a physical therapy program for three months.  Failing improvement from therapy, cortisone injections and anti-inflammatory medications, the decision was made to have surgery.  Her doctor performed a right shoulder arthroscopy including a Bankart lesion repair involving an anterior and inferior labral tear with suture anchor repair, rotator cuff interval closure, arthroscopic subacromial decompression, partial bursal-sided rotator cuff tear repair with debridement and pain pump catheter insertion.  Her post-op diagnosis was a large, severe partial tear of the right rotator cuff.  She complained of continuing shoulder problems.  Another MRI showed evidence of chronic impingement.  She then underwent a revision acromioplasty of the right shoulder and her post-op diagnosis was failed subacromial arthroplasty of the right shoulder.   She next visited the doctor due to worsening symptoms in both her arms and hands.  Electrodiagnostic testing showed mild carpal tunnel syndrome and an MRI showed medial epicondylitis of the left elbow.  She then underwent a right endoscopic carpal tunnel release, left endoscopic carpal tunnel release and left cubital tunnel release.  The employer resisted approval of her therapy so her recovery was a long process and adversely affected her recovery.  Legal efforts were necessitated throughout to secure the best and most timely medical treatment.  This case settled for $87,000.00 representing 40% PPD of the right arm, 20% of the left arm, 15% of the right hand and 15% of the left hand, as well as including five weeks of disputed TTD the company had refused to pay.  The company’s initial permanency and global offer for her disability and all issues was just over half of that amount.

35 year old man suffered injuries to his left shoulder/arm and right arm from repetitively pushing heavy objects at his work.  An MRI indicated mild supraspinatus tendinosis with minimal bursal surface fraying involving the distal fibers, and a partial or full-thickness tear.  There was also concern for a glenoid labrum tear; possible capsular sprain or adhesive capsulitis; minimal long head biceps tendinosis; and degenerative changes of the AC joint with centered marrow edema possibly from a stress reaction or contusion.  Our client later returned to his doctor complaining of persistent left shoulder pain.  His doctor reviewed his x-rays and MRI scan which demonstrated gross abnormality of the AC joint with some mild degenerative changes.  There was severe edema of the distal end of the clavicle with some reciprocal edema at the acromion.  There was a small amount of fluid within the AC joint.  The doctor opined that the findings represented an acute inflammatory response at the AC joint with probable early distal clavicle osteolysis.  The rotator cuff was notable for some minimal tendinopathy.  He recommended an aggressive course of treatment including an injection at the AC joint as well as a Medrol Dosepak.  The injection did not help the pain and a decision was made to go ahead with surgery.  The doctor performed a left shoulder exam under anesthesia; diagnostic arthroscopy; left shoulder arthroscopy with debridement of a posterior labral tear; left shoulder arthroscopy with subacromial decompression; bursectomy; and acromioplasty and a left shoulder distal clavicle excision.  Our client later returned to the doctor for his shoulder and also for evaluation of complaints of right elbow pain from relying too much on his right arm while his left shoulder healed.  He underwent a right elbow exam under anesthesia; an open fasciotomy; debridement of the right elbow; and a partial lateral epicondylectomy.  Our client still has pain in his right elbow and left shoulder and has a difficult time with every day activities at home.  This case settled for $20,505.02, representing approximately 12% loss of use of the left arm and 5% of the right arm.  These percentages represented new disability with credit given for a recovery years earlier to his arms of 16.25% for each arm.  This in essence establishes this worker’s permanent loss of his left arm of 28.25% and 21.25% for his right arm, with a return to full duties in his heavy labor position.

46 year old woman suffered injuries from repetitive trauma to both her shoulders at work.  She was diagnosed with bilateral subacrominal bursitis, was treated with a corticosteroid injection in her right shoulder and given restrictions of no lifting above the shoulder.  She had an MRI which showed tendonitis, and surgery was ultimately recommended.  A synovectormy and right subacromial decompression with bursectomy were performed.  She was released full duty and given another injection to reduce the pain.  After returning to her doctor complaining of right shoulder pain, she underwent another surgery.  This surgery was an arthroscopy with biceps tenotomy and subsequent tendonesis and open decompression with acromioplasty, bursectomy and biceps tendonesis.  Post-operatively she maintained a follow-up regimen with exercises, medications, and off work/light-duty restrictions.  This case settled for $52,500.00 representing 27.2% loss of body as a whole for her bilateral shoulder injuries.