Search for other papers by James B. Talmage in
Current site
Google Scholar
PubMed
Search for other papers by Robert B. Snyder in
Current site
Google Scholar
PubMed
Search for other papers by J. Willis Oglesby in
Current site
Google Scholar
PubMed
Abstract
Shoulder injuries can present a puzzling picture for physicians. It is important to understand how biases affect physicians when they are making decisions regarding shoulder surgery. This article discusses what can be considered “normal” for shoulder function, how to determine when surgery is and is not indicated, and what might delay return to work in workers' compensation cases.
Contributor Notes
This article was originally published in the Tennessee AdMIRable Review, Summer 2023 issue, and has been updated and modified with permission from the authors. Permission provided by the Tennessee Bureau of Workers' Compensation to republish in the AMA Guides Newsletter.
-
1.
Jannsen SJ, Teunis T, Ring D, Parisien RC. Cognitive biases in orthopaedic surgery. J Am Acad Orthop Surg. 2021;29(14):624–633. doi: 10.5435/JAAOS-D-20-00620.
-
2.
Applegate KA, These MS, Merryweather AS, et al. Association between cardiovascular disease risk factors and rotator cuff tendinopathy: a cross-sectional study. J Occup Environ Med. 2017;59(2):154–160. doi: 10.1097/JOM.0000000000000929.
-
3.
Djerbi I, Chammas M, Mirous M-P, et al. Impact of cardiovascular risk factor on the prevalence and severity of symptomatic full-thickness rotator cuff tears. Orthop Traumatol Surg Res. 2015;101(6)(suppl);S269-S273. doi: 10.1016/j.otsr.2015.06.011.
-
4.
Bishop JY, Santiago-Torres JE, Rimmke N, Flanigan DC. Smoking predisposes to rotator cuff pathology and shoulder dysfunction: a systematic review. Arthroscopy. 2015;31(8):1598–1605. doi: 10.1016/j.arthro.2015.01.026.
-
5.
Hegmann KT, Thiese MS, Wood EM, et al. Cardiovascular disease risk factors predict the development and numbers of common musculoskeletal disorders in a prospective cohort. J Occup Environ Med. 2023;65(8):e527–e533.
-
6.
Thaler AI, Thaler MS. The Only Neurology Book You'll Ever Need. Wolters Kluwer. 2023: 52–57.
-
7.
Holdaway LA, Hegmann KT, These MS, Kapellusch J. Is sleep position associated with glenohumeral shoulder pain and rotator cuff tendinopathy: a cross-sectional study. BMC Musculoskelet Disord. 2018;19:408. doi: 10.1186/s12891-018-2319-9.
-
8.
Hippensteel KJ, Brophy R, Smith MV, Wright RW. Comprehensive review of provocative and instability physical examination tests of the cervical spine, scapula, and rotator cuff. J Am Acad Orthop Surg. 2019;27:385–394. doi: 10.5435/JAAOS-D-17-00090.
-
9.
Hippensteel KJ, Brophy R, Smith MV, Wright RW. Comprehensive review of provocative and instability physical examination tests of the shoulder. J Am Acad Orthop Surg. 2019;27:395–404. doi: 10.5435/JAAOS-D-17-00637.
-
10.
Somford MP, Nieuwe Weme RA, Sierevelt I, et al. The reliability of orthopaedic eponymous terms. J Bone Joint Surg Am. 2017;99(13):e70. doi: 10.2106/JBJS.16.01433.
-
11.
Lee CS, Davis SM, Boremus B, et al. Interobserver agreement in the classification of partial-thickness rotator cuff tears using the Snyder classification system. Orthop J Sports Med. 2016;4(9). doi: 10.1177/2325967116667058.
-
12.
Frank RM, Taylor D, Verma N, et al. The rotator interval of the shoulder: implications in the treatment of shoulder instability. Orthop J Sports Med. 2015;3(12). doi: 10.1177/2325967115621494.
-
13.
Pappas ND, Hall DC, Lee DH (2013). Prevalence of labral tears in the elderly. J Shoulder Elbow Surg. 22:e11–e15. https://doi.org/10.1016/j.jse.2012.08.02319.
-
14.
Wolf BR, Uribe B, Hettrick CM, et al. Shoulder instability: interobserver and intraobserver agreement in the assessment of labral tears. Orthop J Sports Med. 2018;6(9):2325967118793372. doi: 10.1177/2325967118793372.
-
15.
Wolf BR, Britton CL, Vasconcellos DA, Spencer EE; MOON Shoulder Group. Agreement in the classification and treatment of the superior labrum. Am J Sports Med. 2011;39(12):2588–2594.
-
16.
Gobezie R, Zurakowski D, Lavery K, et al. Analysis of interobserver and intra-observer variability in the diagnosis and treatment of SLAP tears using the Snyder classification. Am J Sports Med. 2008;36(7):1373–1379.
-
17.
Sasyniuk TM, Mohtadi NG, Hollinshead RM, et al. The inter-rater reliability of shoulder arthroscopy. Arthroscopy. 2007;23(9):971–977.
-
18.
Calvo E, Rebollón, Itoi E, et al. Reliable inter-observer and intra-observer agreement of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification system of rotator cuff tears. J ISAKOS. 2022;7(2):56–61. doi: 10.1016/j.jisako.2021.12.004.
-
19.
Adriani M, Saccomanno MF, Motta M, et al. Reliability of magnetic resonance imaging criteria for the preoperative assessment of rotator cuff tears: a systematic review. Am J Sports Med. Published online May 15, 2023. doi: 10.1177/03635465231166077.
-
20.
Roy JS, Braën C, Leblond J, et al. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med. 2015;49:1316–1328. doi: 10.1136/bjsports-2014-094148.
-
21.
Arirachakaran A, Boonard M, Chaijenkij K, et al. A systematic review and meta-analysis of diagnostic test of MRA versus MRI for detection superior labrum anterior to posterior lesions type II-VII. Skeletal Radiol. 2017;46(2):149–160. doi: 10.1007/s00256-016-2525-1.
-
22.
Symanski JS, Subhas N, Babb J, et al. Diagnosis of superior labrum anterior-to-posterior tears by using MR imaging and MR arthrography: a systematic review and meta-Analysis. Radiology. 2017; 285(1):101–113. doi: 10.1148/radiol.2017162681.
-
23.
Ajuied A, McGarvey CP, Harb Z, et al. Diagnosis of glenoid labral tears using 3-tesla MRI vs. 3-tesla MRA: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2018;138(5):699–709. doi: 10.1007/s00402-018-2894-0.
-
24.
Shfiei M, Zadeh FS, Shafiee A, et al. Diagnostic performance of MRA in abduction and external rotation position in the detection of glenoid labral lesions: a systematic review and meta-analysis. Skeletal Radiol. 2022;51(8):1611–1621. doi: 10.1007/s00256-022-03996-9.
-
25.
Theodoropoulos JS, Andreisek G, Harvey EJ, et al. Magnetic resonance imaging and magnetic resonance arthrography of the shoulder: dependence on the level of training of the performing radiologist for diagnostic accuracy. Skeletal Radiol. 2010;39(7):661–667. doi: 10.1007/s00256-009-0811-x.
-
26.
Suri P, Hunter DJ, Katz JN, et al. Bias in the physical examination of patients with lumbar radiculopathy. BMC Musculoskelet Disord. 2010;11:275. doi: 10.1186/1471-2474-11-275.
-
27.
Calfee R, Fynn-Thompson E, Stern P. Surgeon bias in the medical record. Orthopedics. 2009;32(10). doi: 10.3928/01477447-20090818-07.
-
28.
Dictionary.com. Normal. Accessed November 1, 2023. https://www.dictionary.com/browse/normal.
-
29.
Sher JS, Uribe JW, Posada A, et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg. 1995;77(1):10–15. doi: 10.2106/00004623-199501000-00002.
-
30.
Needell SD, Zlatkin MB, Sher JS, et al. MR imaging of the rotator cuff: peritendinous and bone abnormalities in an asymptomatic population. American J Roentgenology 1996; 166 (4):863–7. doi: 10.2214/ajr.166.4.8610564.
-
31.
Reilly P, Macleod I, Macfarlane R, et al. Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Ann R Coll Surg Engl. 2006;88:116–121. doi: 10.1308/003588406X94968.
-
32.
Moosmayer S, Tariq R, Stiris MG, et al. MRI of symptomatic and asymptomatic full-thickness rotator cuff tears: a comparison of findings in 100 subjects. Acta Orthop. 2010;81(3):361–366. doi: 10.3109/17453674.2010.483993.
-
33.
Pennock AT, Dwek J, Levy E, et al. Shoulder MRI abnormalities in asymptomatic little league baseball players. Orthop J Sports Med. 2018;6(2). doi: 10.1177/2325967118756825.
-
34.
Su BY, Yeh WC, Lee YC, et al. Internal derangement of the shoulder joint in asymptomatic professional baseball players. Acad Radiol. 2020;27:582–590. doi: 10.1016/j.acra.2019.06.010.
-
35.
Lee CS, Goldhaber NH, Davis SM, et al. Shoulder MRI in asymptomatic elite volleyball athletes shows extensive pathology. J ISAKOS. 2020;5:10–14. doi: 10.1136/jisakos-2019-000304.
-
36.
Hacken B, Onks, C, Flemming D, et al. Prevalence of MRI shoulder abnormalities in asymptomatic professional and collegiate ice hockey athletes. Orthop J Sports Med. 2019;7(10). doi: 10.1177/2325967119876865.
-
37.
Liu TC, Leung N, Edwards L, et al. Patients older than 40 years with unilateral occupational claims for new shoulder and knee symptoms have bilateral MRI changes. Clin Orthop Relat Res. 2017;475(10):2360–2365. doi: 10.1007/s11999-017-5401-y.
-
38.
Boersma E, Crijns T, Nijhuis-van der Sanden M, et al. Accuracy and reliability of MRI-reports to determine which shoulder is symptomatic for workers compensation patients with unilateral symptoms. J Orthop. 2020;21:199–202. doi: 10.1016/j.jor.2020.03.044.
-
39.
Barreto RPG, Braman JP, Ludewig PM, et al. Bilateral magnetic resonance imaging findings in individuals with unilateral shoulder pain. J Shoulder Elbow Surg. 2019;28:1699–1706. doi: 10.1016/j.jse.2019.04.001.
-
40.
Yoon T-H, Kim S-J, Choi Y-R, et al. Age, tear size, extent of retraction, and fatty infiltration associated with a high chance of a similar rotator cuff tear in the contralateral shoulder regardless of symptoms in patients undergoing cuff repair in the index shoulder. Arthroscopy. 2023;39(7):1611–1617. doi: 10.1016/j.arthro.2023.02.008.
-
41.
Waterman BR, Newgren J, Gowd AK, et al. Randomized trial of arthroscopic rotator cuff with or without acromioplasty: no difference in patient-reported outcomes at long-term follow-up. Arthroscopy. 2021;37(10):3072–3078. doi: 10.1016/j.arthro.2021.04.041.
-
42.
Woodmass JM, Khatib LA, McRae S, et al. Arthroscopic rotator cuff repair with and without acromioplasty in the treatment of full-thickness rotator cuff tears: long-term outcomes of a multicenter, randomized controlled trial. J Bone Joint Surg Am. 2022;104:2101–2107. doi: 10.2106/JBJS.22.00135.
-
43.
Mall NA, Kim HM, Keener JD, et al. Symptomatic progression of asymptomatic rotator cuff tears: a prospective study of clinical and sonographic variables. J Bone Joint Surg Am. 2010;92:2623–2633. doi: 10.2106/JBJS.I.00506.
-
44.
Moosmayer S, Tarip R, Stiris M, Smith H-J. The natural history of asymptomatic rotator cuff tears: a three-year follow-up of fifty cases. J Bone Joint Surg Am. 2013;95:1249–1255. doi: 10.2106/JBJS.L.00185.
-
45.
Keener JD, Galatz LM, Teefey SA, et al. A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears. J Bone Joint Surg Am. 2015;97:89–98. doi: 10.2106/JBJS.N.00099.
-
46.
Harris I, Mulford J, Solomon M, et al. Association between compensation status and outcome after surgery: a meta-analysis. JAMA. 2005;293:1644–1652. doi: 10.1001/jama.293.13.1644.
-
47.
Gruson KI, Huang K, Wanich T, DePalma AA. Workers' compensation and outcomes of upper extremity surgery. J Am Acad Orthop Surg. 2013;21:67–77. doi: 10.5435/JAAOS-21-02-67.
-
48.
Fujihara Y, Shauver MJ, Lark ME. The effect of workers' compensation on outcome measurement methods after upper extremity surgery: a systematic review and meta-analysis. Plast Reconstr Surg. 2017;139:923. doi: 10.1097/PRS.0000000000003154.
-
49.
Dabija DI, Gao C, Edwards TL, et al. Genetic and familial predisposition to rotator cuff disease: a systematic review. J Shoulder Elbow Surg. 2017;26(6):1103–1112. doi: 10.1016/j.jse.2016.11.038.
-
50.
Longo UG, Candela V, Berton A, et al. Genetic basis of rotator cuff injury: a systematic review. BMC Med Genet. 2019;20:149. doi: 10.1186/s12881-019-0883-y.
-
51.
Tashjian RZ, Farnham JM, Albright FS, et al. Evidence for an inherited predisposition contributing to the risk for rotator cuff disease. J Bone Joint Surg Am. 2009;91:1136–1142. doi: 10.2106/JBJS.H.00831.
-
52.
Harvie P, Ostlere SJ, Teh J, et al. Genetic influences in the aetiology of tears of the rotator cuff. J Bone Joint Surg Br. 2004;86:696–700. doi: 10.1302/0301-620X.86B5.14747.
-
53.
Andrews, JR, Carson WG, Mcleod WD, et al. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985;13(5):337–341. doi: 10.1177/036354658501300508.
-
54.
Hawkins RJ, Misamore GW, Hobeike PE. Surgery for full-thickness rotator-cuff tears. J Bone Joint Surg Am. 1985;67(9):1349–1355.
-
55.
Forsythe B, Guss D, Anthony SG, Martin SD. Concomitant arthroscopic SLAP repair and rotator cuff repair. J Bone Joint Surg Am. 2010;92:1362–1369. doi: 10.2106/JBJS.H.01632.
-
56.
Oh JH, Lee YH, Kim SH, et al. Comparison of treatments for superior labrum-biceps complex lesions with concomitant rotator cuff repair: a prospective, randomized, comparative analysis of debridement, biceps tenotomy, and biceps tenodesis. Arthroscopy. 2016;32(6):958–967. doi: 10.1016/j.arthro.2015.11.036.
-
57.
Schrøder CP, Skare Ø, Reikerás, et al. Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder. Br J Sports Med. 2017;51(24):1759–1766. doi: 10.1136/bjsports-2016-097098.
-
58.
Erickson J, Lavery K, Monica J, et al. Surgical treatment of symptomatic superior labrum anterior-posterior tears in patients older than 40 years: a systematic review. Am J Sports Med. 2015;43(5):1274–1282. doi: 10.1177/0363546514536874.
-
59.
Wang J, Ma JX, Zhu SW, et al. Does distal clavicle resection decrease pain or improve shoulder function in patients with acromioclavicular joint arthritis and rotator cuff tears? a meta-analysis. Clin Orthop Relat Res. 2018;476:2402–2414. doi: 10.1097/CORR.0000000000000424.
-
60.
Yiannakopoulos CK, Vlastos I, Gheotokatos G, Galanis N. Acromioclavicular joint arthritis is not an indication for routine distal clavicle excision in arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2021;29:2090–2095. doi: 10.1007/s00167-020-06098-y.
-
61.
Bismuth Y, Deckers J, van Rooij F, et al. Outcomes of secondary arthroscopic distal clavicle resection for shoulders with symptomatic acromioclavicular joint arthropathy after isolated rotator cuff repair with complete tendon healing. Orthop J Sports Med. 2023;11(4). doi: 10.1177/23259671231163143.
-
62.
Gil JA, Goodman AD, Mulcahey MK. Psychological factors affecting outcomes after elective shoulder surgery. J Am Acad Orthop Surg. 2018;26:e98–e104. doi: 10.5435/JAAOS-D-16-00827.
-
63.
Vogel M, Binneböse M, Wallis H, et al. The unhappy shoulder: a conceptual review of the psychosomatics of shoulder pain. J Clin Med. 2022;11:5490. doi: 10.3390/jcm11185490.
-
64.
Sansone V, Bonora C, Boria P, Meroni R. Women performing repetitive work: is there a difference in the prevalence of shoulder pain and pathology in supermarket cashiers compared to the general female population? Int J Occup Med Environ Health. 2014;27(5):722–735. doi: 10.2478/s13382-014-0292-6.
-
65.
Thorpe AM, O'Sullivan PB, Mitchell T, et al. Are psychologic factors associated with shoulder scores after rotator cuff surgery? Clin Orthop Relat Res. 2018;476:2062–2073. doi: 10.1097/CORR.0000000000000389.
| All Time | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1362 | 1362 | 328 |
| Full Text Views | 33 | 33 | 0 |
| PDF Downloads | 0 | 0 | 0 |
