RELIABILITY, VALIDITY, AND RESPONSIVENESS OF THE AMERICAN SHOULDER AND ELBOW SURGEONS SUBJECTIVE SHOULDER SCALE IN PATIENTS WITH SHOULDER INSTABILITY, ROTATOR CUFF DISEASE, AND GLENOHUMERAL ARTHRITIS

Most orthopedic surgeons, and even many shoulder experts, are a little intimidated by the evaluation and management of patients with conditions affecting the scapula, periscapular muscles, and scapulothoracic joint. Explanations for this include relative unfamiliarity with the anatomy, function, physical examination, and diagnostic categories related to the scapula, and the fact that surgical procedures around the scapula are not performed commonly. Dysfunction of the scapulothoracic joint may play a major role in patients with diverse shoulder conditions such as disorders of the clavicle and the acromioclavicular joint, shoulder instability, and rotator cuff disease. Additionally, the scapulothoracic joint and periscapular muscles may be affected by disorders such as traumatic muscle avulsions, injuries to various nerves, fractures of the scapula and the glenoid cavity, bursitis, osteochondromas, and congenital abnormalities. Finally, some patients present with pain and dysfunction secondary to poor control of the periscapular muscles in the absence of specific structural pathology.

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Sleep Impairment

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2009.mayjun04 ◽

2009 ◽

Vol 14 (3) ◽

pp. 7-10

Author(s):

Craig Uejo ◽

Stephen Demeter

Keyword(s):

Rotator Cuff ◽

Distal Clavicle ◽

Rotator Cuff Disease ◽

Degenerative Arthritis ◽

Sixth Edition ◽

Cuff Tear ◽

Shoulder Region ◽

Illness Causation ◽

Traumatic Rotator Cuff Tear ◽

Distal Clavicle Resection

Abstract In the AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, distal clavicle resection (resection arthroplasty of the acromioclavicular joint [ACJ]) results in ratable impairment, but only a single diagnosis within a region may be rated. Therefore, if another impairing condition is present in the shoulder region (eg, impingement syndrome or rotator cuff disease) only that resulting in the greatest causally related impairment is rated. In the setting of an occupational or other compensable injury or illness, causation of the impairment often is a key issue because, typically, only impairment that is causally related to the injury can be rated. For example, assume that a lifting injury at work caused a tear in a rotator cuff tendon that was already attenuated by repetitive impingement on inferiorly projecting spurs from longstanding degenerative arthritis of the ACJ. If surgery was performed for a traumatic rotator cuff tear and the distal clavicle also was resected due to preexisting ACJ arthritis, the latter surgery is not considered to be related to the injury. In other words, because the ACJ arthritis was neither caused nor worsened by the injury, this condition is not rated. The distal clavicular resection may have been warranted to diminish pain due to ACJ arthritis and/or eliminate the distal clavicle as a source of impingement.

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