New York Shoulder Injury Medical Treatment …

1 New york Shoulder Injury Medical Treatment guidelines . Second Edition January 14, 2013. Effective March 1, 2013. Copyright 2008, 2007, 2004, 1997 by the American College of Occupational and Environmental Medicine (ACOEM). Commercial reproduction or other use beyond fair use prohibited without explicit ACOEM permission. New york State Workers' Compensation Board New york Shoulder Injury Medical Treatment guidelines TABLE OF CONTENTS. A GENERAL GUIDELINE PRINCIPLES .. 1. Medical CARE .. 1. RENDERING OF Medical SERVICES .. 1. POSITIVE PATIENT RESPONSE .. 1. RE-EVALUATE Treatment .

2 1. EDUCATION .. 2. DIAGNOSTIC TIME FRAMES .. 2. Treatment TIME FRAMES .. 2. SIX-MONTH TIME FRAME .. 2. DELAYED RECOVERY .. 2. ACTIVE 3. ACTIVE THERAPEUTIC EXERCISE PROGRAM .. 3. DIAGNOSTIC IMAGING AND TESTING PROCEDURES .. 3. SURGICAL INTERVENTIONS .. 4. 4. PERSONALITY/PSYCHOLOGICAL/PSYCHOSOCIAL EVALUATIONS .. 4. PERSONALITY/PSYCHOLOGICAL/PSYCHOSOCIAL INTERVENTION .. 5. FUNCTIONAL CAPACITY EVALUATION (FCE) .. 5. RETURN TO WORK .. 6. JOB SITE EVALUATION .. 6. GUIDELINE RECOMMENDATIONS AND Medical EVIDENCE .. 7. EXPERIMENTAL Treatment .. 7. Second Edition, January 14, 2013 i INJURED WORKERS AS PATIENTS.

3 7. SCOPE OF PRACTICE .. 7. B INTRODUCTION TO Shoulder Injury .. 8. C HISTORY TAKING AND PHYSICAL EXAMINATION .. 10. HISTORY TAKING .. 10. PHYSICAL FINDINGS .. 10. RED FLAGS .. 10. FOLLOW-UP DIAGNOSTIC 11. D SPECIFIC DIAGNOSES, TESTING AND Treatment PROCEDURES .. 11. ACROMIOCLAVICULAR (AC) JOINT SPRAINS/DISLOCATIONS .. 11. History and Mechanism of Injury (AC Joint Sprains/ Dislocations) .. 12. Physical Findings (AC Joint Sprains/Dislocations) .. 13. Laboratory Tests (AC Joint Sprains/Dislocations) .. 13. Testing Procedures (AC Joint Sprains/Dislocations) .. 13. Non-Operative Treatment Procedures (AC Joint Sprains/Dislocations).

4 13. Operative Procedures (AC Joint Sprains/Dislocations) .. 14. Post-Operative Procedures (AC Joint Sprains/Dislocations) .. 14. ADHESIVE CAPSULITIS/FROZEN Shoulder DISORDER .. 15. History and Mechanism of Injury (Adhesive Capsulitis/Frozen Shoulder ) 15. Physical Findings (Adhesive Capsulitis/Frozen Shoulder ) .. 15. Laboratory Tests (Adhesive Capsulitis/Frozen Shoulder ) .. 16. Testing Procedures (Adhesive Capsulitis/Frozen Shoulder ) .. 16. Non-Operative Treatment Procedures (Adhesive Capsulitis/Frozen Shoulder ) .. 16. Operative Procedures (Adhesive Capsulitis/Frozen Shoulder ).

5 18. Post-Operative Procedures (Adhesive Capsulitis/Frozen Shoulder ) .. 18. Second Edition, January 14, 2013 ii BICIPITAL TENDON DISORDERS .. 18. History and Mechanism of Injury (Bicipital Tendon Disorders) .. 18. Physical Findings (Bicipital Tendon Disorders) .. 19. Laboratory Tests (Bicipital Tendon Disorders) .. 20. Testing Procedures (Bicipital Tendon Disorders) .. 20. Non-Operative Treatment Procedures (Bicipital Tendon Disorders) .. 20. Operative Procedures (Bicipital Tendon Disorders) .. 21. Post-Operative Procedures (Bicipital Tendon Disorders) .. 22. BRACHIOPLEXUS INJURIES.

6 22. Brachial Plexus .. 23. Axillary Nerve .. 24. Long Thoracic 26. Musculocutaneous Nerve .. 27. Spinal Accessory 29. Suprascapular Nerve .. 30. BURSITIS OF THE Shoulder .. 32. History and Mechanism of Injury (Bursitis of the Shoulder ) .. 32. Physical Findings (Bursitis of the Shoulder ) .. 32. Laboratory Tests (Bursitis of the Shoulder ) .. 32. Testing Procedures (Bursitis of the Shoulder ) .. 33. Non-Operative Treatment Procedures (Bursitis of the Shoulder ).. 33. Operative Procedures (Bursitis of the Shoulder ) .. 33. IMPINGEMENT SYNDROME .. 34. History and Mechanism of Injury (Impingement Syndrome).

7 34. Physical Findings (Impingement Syndrome) .. 35. Second Edition, January 14, 2013 iii Laboratory Tests (Impingement Syndrome) .. 35. Testing Procedures (Impingement Syndrome) .. 35. Non-Operative Treatment Procedures (Impingement Syndrome) .. 36. Operative Procedures (Impingement Syndrome) .. 37. Post-Operative Procedures (Impingement Syndrome) .. 38. ROTATOR CUFF 38. History and Mechanism of Injury (Rotator Cuff Tear) .. 38. Physical Findings (Rotator Cuff Tear) .. 39. Laboratory Tests (Rotator Cuff Tear) .. 39. Testing Procedures (Rotator Cuff Tear) .. 40. Non-Operative Treatment Procedures (Rotator Cuff Tear).

8 40. Operative Procedures (Rotator Cuff Tear) .. 41. Post-Operative Procedures (Rotator Cuff Tear).. 43. ROTATOR CUFF 44. History and Mechanism of Injury (Rotator Cuff Tendinitis) .. 44. Physical Findings (Rotator Cuff Tendinitis) .. 44. Laboratory Tests (Rotator Cuff Tendinitis) .. 44. Testing Procedures (Rotator Cuff Tendinitis) .. 44. Non-Operative Treatment Procedures (Rotator Cuff Tendinitis) .. 45. Operative Procedures (Rotator Cuff Tendinitis) .. 45. Shoulder FRACTURES .. 45. Clavicular Fracture .. 45. Proximal Humeral Fracture .. 47. Humeral Shaft Fracture.

9 50. Scapular Fracture .. 52. Second Edition, January 14, 2013 iv Sternoclavicular Dislocation/Fracture .. 54. Shoulder INSTABILITY .. 55. History and Mechanism of Injury ( Shoulder Instability) .. 55. Physical Findings ( Shoulder Instability).. 56. Laboratory Tests ( Shoulder Instability) .. 57. Testing Procedures ( Shoulder Instability) .. 57. Non-Operative Treatment Procedures ( Shoulder Instability) .. 57. Operative Procedures ( Shoulder Instability) .. 58. Post-Operative Procedures ( Shoulder Instability) .. 58. SUPERIOR LABRUM ANTERIOR AND POSTERIOR (SLAP) LESIONS.

10 59. History and Mechanisms of Injury (SLAP lesion) .. 59. Physical Findings (SLAP lesion) .. 60. Diagnostic Testing Procedures (SLAP lesion).. 61. Non-Operative Treatment Procedures (SLAP Lesion) .. 61. Surgical Indications .. 62. Operative Procedures (SLAP lesion) .. 63. Post-Operative Treatment (SLAP lesion) .. 64. E THERAPEUTIC PROCEDURES: 64. MEDICATIONS .. 64. 64. Hypnotics .. 65. Narcotics .. 65. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) .. 66. Psychotropic/Anti-Anxiety Medications .. 68. Skeletal Muscle 68. Second Edition, January 14, 2013 v Topical Drug 68.