The shoulder injury is now America’s #1 injury in terms of frequency and cost per claim. That comment, by the director of Workers’ Compensation, Corporate Insurance & Risk Management for American Airlines, comes despite the fact that many of these injuries are easily preventable. It should serve as a wakeup call for employers to do everything they can to prevent and lessen the impact of these injuries.

Shoulders and Injuries

The shoulder is an extremely mobile joint and allows us to reach and move in many directions. But they can be very prone to injury if they are overused or moved improperly.

The shoulder is comprised of the humerus (arm bone), the scapula (shoulder blade) and the clavicle (collarbone). The shoulder joint can be visualized as a golf ball sitting on top of a tee. The rounded end of the humerus moves within the scooped out socket of the scapula next to the end of the clavicle. There are many ligaments that support it and muscular attachments that help the shoulder move. Unlike a golf ball though, the head of the arm stays in a confined space but still moves freely. 

We often see injuries involving the rotator cuff, a group of 4 muscles and tendons that keep the shoulder joint stable. These injuries can result from repeated overuse of the shoulder, as well as an accident or trauma. The aging process increases the risk of shoulder injuries.

Rotator cuff tears are fairly common among certain workers and typically result from repeated actions with the arms working above shoulder level. An untreated tear can become severely painful and reduce the person’s ability to use the arm altogether. People with these may experience pain, shoulder weakness, loss of shoulder movement, numbness or tingling, and an inability to lift the arm to reach up or behind the back.

Workers most at risk for rotator cuff tears are those who do repetitive tasks, such as painting, hanging curtains, repairing automobiles on an overhead lift, filing, and lifting objects, especially over the shoulders. Poor posture is another cause of rotator cuff injuries, as it can place increased stress on the shoulder.

In addition to rotator cuff injuries, we also often see shoulder impingement syndrome. This can occur when one of the tendons of the rotator cuff muscles becomes pinched in the space between the arm bone and the shoulder blade, irritating the tendon and causing pain and decreased function.

Frozen shoulder is another condition, and happens when the tissue surrounding the shoulder joint becomes thick and tight and is hard to move. Scar tissue forms and can further limit motion.  It often happens to people who’ve kept their arm immobilized for a long period of time.

Though less common among workers, we also see shoulder fractures and trauma, which can result from a fall.

Prolonged, repetitive and awkward movements can lead to chronic shoulder pain. Some additional workplace risk factors for shoulder injuries are:

• Repetitive overhead reaching or lifting.
• Falling on an outstretched arm.
• Pulling, pushing or tugging on an object.

Small, repetitive activities can also cause shoulder pain associated with repetitive strain injuries. Using a computer mouse or swiping items at a store checkout stand can aggravate the muscles and tendons of the upper body including the shoulder.

Treatments

The most important thing to do for a shoulder injury is get help as soon as possible. Early treatment from a physical therapist can reduce the pain and prevent it from developing into a major injury.

While some workers believe it is OK to work through the pain, this is not the case with shoulder injuries. Continuing to use it can aggravate it further, possibly causing long term damage.

A physical therapist will typically teach the injured worker exercises that strengthen the shoulder and increase range of motion. Hands-on manipulation is also helpful with some injured workers.

The specific treatment for a shoulder injury depends on several factors:

• The type of injury.
• The person’s anatomy and overall physical fitness.
• The person’s goals, especially specific job tasks.

Working one-on-one with a physical therapist offers the best chance for a quick and effective recovery. The therapist should watch what day-to-day tasks the injured worker does and work with him to ensure he is moving properly — to help the injury and prevent a recurrence. A customized treatment plan should be developed.

Prevention

Preventing shoulder injuries should be the goal of every employer. Workers should be trained and informed on ways to maintain shoulder health, such as:

• Avoid repeated overhead arm positions, where possible. If not, a physical therapist with ergonomics expertise can be called in to advise ways to do the job with less risk.
• Keep arms close to the body when holding even small loads. Keeping the arms extended while holding anything can decrease stability.
• Use proper lifting techniques.
• Do exercises that strengthen the rotator-cuff and muscles attached to the shoulder-blades.
• Use good posture. Research shows that a forward position of the head and shoulders can alter shoulder-blade position and create shoulder impingement syndrome.
• Take ‘posture’ breaks for several minutes every hour.
• Use a step stool or other stable platform when reaching for heavy objects that are stored high up.
• Avoid sleeping on the side with an arm stretched overhead, or lying on the shoulder.
• Avoid smoking, which can decrease the blood flow to the rotator cuff.

Conclusion

Shoulder injuries are painful for workers, and costly for payers. Many are avoidable. Employers that understand the risks and train their employees can keep their workers safe and free from shoulder problems.