New York State Medical Treatment Guidelines for Shoulder Injury in workers compensation patients

The guidelines formulated by the New York State Workers Compensation Board aim to assist healthcare professionals in providing appropriate treatment for shoulder injuries.

Designed for medical practitioners, these Workers Compensation Board guidelines offer support in determining the right course of action for individuals with shoulder injuries.

It’s important to emphasize that these guidelines do not replace clinical judgment or professional experience. The final decision on treatment for shoulder injuries should be a collaborative one, involving the patient and their healthcare provider in consultation.

History Taking and Physical Examination

Comprehensive Information Gathering:

  • The process of history taking and physical examination aims to collect information applicable to all injuries. Provider procedures discussed are meant to be universally applied to every patient, irrespective of the injury and diagnosis.

Systematic Review of Systems:

  • A systematic review of systems is a crucial component. This includes exploring signs or symptoms associated with various systems such as constitutional symptoms, eyes, ear-nose-throat, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, integumentary/breast, neurological, psychiatric, endocrine, hematologic/lymphatic, and allergic/immunologic.

Tailoring the Review of Systems:

  • Depending on the underlying condition and clinical judgment, the review of systems can be customized on a case-by-case basis. This ensures that the examination is both comprehensive and appropriately focused for addressing specific health concerns.



Specific Diagnoses, Testing and Treatment Procedures

Acromioclavicular (AC) Joint Sprains/Dislocations:

  • Unique information related to AC joint sprains and dislocations, including specific diagnostic, testing, and treatment procedures.

2. Adhesive Capsulitis/Frozen Shoulder Disorder:

  • Comprehensive details on the diagnosis, testing, and treatment procedures specific to Adhesive Capsulitis or Frozen Shoulder Disorder.

3. Bicipital Tendon Disorders:

  • Specialized insights into the diagnosis, testing, and treatment procedures for disorders related to the bicipital tendon.

4. Brachial Plexus Injuries:

  • A detailed breakdown of brachial plexus injuries, covering various nerves such as Brachial Plexus, Axillary Nerve, Long Thoracic Nerve, Musculocutaneous Nerve, Spinal Accessory Nerve, and Suprascapular Nerve.

5. Bursitis of the Shoulder:

  • Specific information concerning the diagnosis, testing, and treatment of shoulder bursitis.

6. Impingemoment Syndre:

  • Tailored guidance on addressing Impingement Syndrome, including precise diagnostic and treatment procedures.

7. Rotator Cuff Tears:

  • Unique insights into the diagnosis, testing, and treatment of rotator cuff tears.

8. Rotator Cuff Tendinitis:

  • Specialized information on diagnosing, testing, and treating rotator cuff tendinitis.

9. Shoulder Fractures:

  • Detailed information on specific fractures related to the shoulder, including Clavicular Fracture, Proximal Humeral Fracture, Humeral Shaft Fracture, Scapular Fracture, and Sternoclavicular Dislocation/Fracture.

10. Shoulder Instability:

  • Comprehensive details on the diagnosis, testing, and treatment procedures for shoulder instability.


Diagnosis Presentation Format: Each diagnosis is introduced in the subsequent structure:

History and Mechanism of Injury: The background and details of the injury’s mechanism are outlined.

Discussion of Relevant Physical Findings: A thorough examination and analysis of pertinent physical observations are provided.

Laboratory Tests: Details regarding any necessary laboratory tests are discussed.

Testing Procedures: The procedures involved in conducting tests are explained.

Diagnosis-based, Non-operative Therapeutic Treatment Procedures: Procedures for non-operative therapeutic treatment based on the diagnosis are outlined.

Options for Operative/Surgical Treatment: Possible approaches and choices for operative or surgical treatment are presented.

Options for Post-operative Rehabilitation/Treatment Procedures: Rehabilitation and treatment procedures following surgery are discussed.

Transition to Surgery after Conservative Management: In cases where non-operative treatment is initially recommended, surgery may be considered if conservative management proves ineffective.

Continued Criteria for Intervention: The patient should consistently display specified objective findings, subjective symptoms, and, where applicable, imaging findings to warrant intervention.


Therapeutic Procedures: Non-Operative (including medications)

Non-Operative Therapeutic Procedures: Common Information: In the realm of non-operative therapeutic procedures, comprehensive details on universally applicable aspects for all injuries are presented. This includes in-depth discussions on referenced medications, therapeutic procedures, and their indications. Information about the anticipated time for effects, recommended frequency, as well as optimal and maximum durations is provided.

Complex Nature of Shoulder Injuries: Given the intricate nature of shoulder injuries, a comprehensive approach is crucial. It is imperative to take into account the potential interplay among different components of the shoulder mechanism when embarking on both diagnostic assessments and therapeutic treatment planning.


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