Shoulder and knee problems Understanding the difficulties. What you - - PowerPoint PPT Presentation

Shoulder and knee problems

Understanding the difficulties. What you can do to assist.

Dr Mary W y Wyatt

RTWMatters rs.org rg

MUSCULOSKELETAL PROBLEMS

Shoulders

INTRO

Rotator cuff conditions

• Most common cause of shoulder pain (60-

70%)

• Common in younger people, overhead

sports, middle and older age

• Many different terms used for this condition

– Painful arc – Impingement – Rotator cuff tendinitis – Supraspinatus tendinopathy – Subacromial bursitis – Calcific tendinitis

Contributing factors

Wear and tear Repetitive microtrauma Impact on blood supply Narrowing of subacromial space Diabetes

Contributing factors from work

• Intrinsic strain: sustained high intramuscular

pressure of the rotator cuff muscles impairs the microcirculation, leading to tendonitis and later degeneration

• Extrinsic strain: Elevation of the arm may tear
• r squeeze the subacromial structures

between humeral head and the acromion

Work activities that may contribute

• Physical work with a heavy load
• Awkward postures (working with trunk

forward)

• Hand above shoulder level

There is a dose response relationship – ie the more time on above shoulder height activities the greater the chance of rotator cuff problems

Degeneration Tendinitis Tears 40 60 80 Years 100%

Incidence of asymptomatic tears

4% 50% 80%

What happens

• 50% better by a year
• Often goes away in younger years but might

recur

• Symptoms often persist in older age groups
• A significant number of asymptomatic tears

become symptomatic over time (?50% within 5 years)

Treatment

• Analgesia, anti-inflammatories
• Subacromial steroid injection – dr’s rooms or

now most commonly through radiology service

• Manual therapy and exercise may improve

function and strength

• Surgery

Other shoulder disorders

• Frozen shoulder (adhesive capsulitis)
• Labral tear
• Dislocation

Work restrictions

• When the elbow is sitting close to the body

the shoulder is not generally under load

• Lifting the arm away from the body uses the

shoulder

• Generally for shoulder problems minimising
• utreaching and above shoulder height helps

Knees

Patellofemoral problems

• Tend to occur if the knee is bent for long

periods or repeatedly, eg squatting, sitting with knee bent more than 90 degrees

• Key aspects of management include
• Quad strengthening
• Avoid bending the knee

Meniscal or cartilage tear

• Tends to be acute and immediately painful
• Often with twisting injury
• Surgery needed in many cases

Knee osteoarthritis

• Common
• Weight correlates with increased risk
• Typically comes on over time, but can start

quickly

• Prior injury, eg

meniscal or cruciate tear

Treatment for knee OA

• Strengthen the quads
• Analgesics
• Avoid demanding work
• Strapping or support bandage
• Joint replacement surgery
• Controversy about ‘clean up’ arthroscopies

Bursitis

• More common with kneeling jobs
• Eg housemaids knee
• Can drain the fluid if large, but mostly

treatment is to avoid activities that contribute to the problem

• Antinflammatories can also help

Early care of knee injuries

• Support employee to obtain medical care

within short time frame

• If there is swelling with acute pain then early

MRI is sensible

• X-ray if thought to be arthritis
• Ultrasound if thought to be bursitis

Work restrictions

• The knee is loaded while standing, walking

and particularly kneeling and squatting

• Depending on the condition, sitting at work

may give the knee a break

• Avoid heavy lifting, stairs, squatting, and

maybe walking over uneven ground

• Limiting the amount of time standing may

help

Questions

❹ Work