The most complicated joint in the body is the shoulder joint. It is also the most mobile and flexible joint. It is often injured in the motor vehicle accident, the pedestrian accident, or the slip and fall accident. When it is injured, it can have a significant impact on the person in terms of their daily activities. The shoulder can be injured when it is jammed, or impacted from the side, or top. Clearly when there is a fracture, these injuries are clear, and documented. However, it is the “soft tissue” injury, or the “tear” of a ligament, tendon or muscle where the litigation is generated. Often the defendants doubt, first the existence of the injury, second they doubt that it was caused in the accident, or they suspect that it was there already, and finally they doubt that it is as bad as is being claimed. Aside from the fracture, or dislocation, the typical shoulder injury is a torn rotator cuff, or a shoulder impingement. Shoulder Instability is also seen.
What is the Rotator Cuff
The rotator cuff is a group of 4 muscles that controls the movement of the arm and shoulder. This group is called the rotator cuff. Muscles are connected to bones by tendons. Bones are connected to other bones by ligaments. When there is a tear of one of the tendons, then it is said that there is a torn rotator cuff. The tear can be of one or more of the tendons that connect the muscle to the bone. When there is a blow to the area of the rotator cuff, or a fall onto an outstretched hand, or a fracture or dislocation of the shoulder joint, then a tear can occur. Tears can also occur from overuse, and/or from aging.
Different types of tears result if different types of symptoms, and different types of treatment. However, if the tear was either caused in the accident, or aggravated by the accident, it is important that it be documented. Too many cases are lost because the patient/client failed to mention that the shoulder hurt, or was in pain. The pain may not be the most significant pain from the accident, and therefore is overlooked. Again, it is imperative that all complaints, to all parts of the body be mentioned to not only the medical professional, but the attorney as well.
When a Shoulder Replacement Needs to be Considered
The shoulder impingement results when there is some compression of the rotator cuff tendon[s]. The compression can occur as a result of a traumatic event, such as an accident, or it is a result of a gradual process, like a rope fraying as it is being rubbed. In the shoulder impingement the tendon is being rubbed, and if not properly treated, or addressed, can result in a tear, i.e. a torn rotator cuff. When the tendon is inflamed, due to the continued rubbing, it is called tendonitis. In the rotator cuff (the area of the group of muscles that controls the movement of the shoulder) is a lubricating sack, called a bursa. There are many bursa sacks in the body, principally where a tendon rubs over a bone. The bursa acts like a lubricating fluid to help the rubbing, so it is less frictional, and smooth. When it becomes inflamed, then this is a condition called “bursitis”. It can become inflamed because of an impingement.
These three conditions, shoulder impingement, bursitis, and tendonitis, can occur as a result of similar conditions, and are often referred to interchangeably.
Shoulder impingements (along with tendinitis and bursitis) are treated with anti inflammatories, rest, ice, and injections. If these do not work then surgery is considered. The surgery can be the removal of part of the bone, called the acromion. This surgery is called a “acromioplasty”. This is done to create more room for the movement, and reduce, or eliminate the inflammation.
Here again all of these complaints need to be considered, and settlements need to take into consideration what treatments, and what surgeries may be required in the future.