New York State Medical Treatment Guidelines for History Taking and Physical Examination for Shoulder Injury in workers compensation patients

The guidelines established by the New York State Workers Compensation Board are crafted to assist healthcare professionals in conducting thorough history taking and physical examinations for shoulder injuries.

Tailored for medical practitioners, these Workers Compensation Board guidelines offer support in determining the appropriate approach for gathering relevant medical history and performing a comprehensive physical examination in cases of shoulder injuries.

It’s crucial to note that these guidelines do not replace clinical judgment or professional experience. The ultimate decision regarding the assessment of shoulder injuries through history taking and physical examination should be a collaborative one, involving the patient and their healthcare provider in consultation.

Standard Procedures for Work-Related Shoulder Instability Diagnosis:

When initiating the diagnosis of work-related shoulder instability, two established procedures should be employed. These procedures serve as the cornerstone, guiding all subsequent stages of diagnostic and therapeutic processes.


History Taking

Preference for Objective Clinical Findings: In cases where findings from clinical evaluations and other diagnostic procedures diverge, priority should be given to the objective clinical findings.

Documentation Requirements in Medical Records: Comprehensive documentation in medical records is essential, covering the following aspects under History Taking ):

Thorough Medical History : A detailed exploration of the patient’s medical history is a crucial component.

Occupational Relationship : The patient’s occupation and its potential relation to the shoulder injury should be clearly documented.

Non-Occupational and Avocational History : Any history of non-occupational injuries and avocational pursuits should be specifically recorded.

Prior Conditions in Neck, Shoulder, and/or Arm : Previous conditions pertaining to the neck, shoulder, and/or arm should be documented.

Review of Systems : A systematic review of various bodily systems is necessary, encompassing constitutional symptoms, eyes, ears, nose, mouth, throat, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, integumentary/breast, neurological, psychiatric, endocrine, hematologic/lymphatic, and allergic/immunologic. The scope of the review can be adjusted based on the specific condition and clinical judgment on a case-by-case basis.


Physical Findings

The examination of Physical Findings is tailored to address the unique characteristics of each shoulder injury diagnosis mentioned in this section. Due to the intricate nature of the shoulder mechanism, it is crucial to consider an assessment for concurrent injuries.


Red Flags

“Red flags” are specific findings that heighten concerns about potential severe medical conditions. The assessment, comprising history and physical examination, should encompass an evaluation for these red flags in the shoulder. These indicators may encompass fractures, infections or inflammation, subdiaphragmatic issues, and cardiac disease. The New York Shoulder Injury Medical Treatment Guidelines incorporate alterations to clinical management prompted by the identification of “red flags,” which may necessitate further evaluation, consultation, or urgent/emergency intervention.


Follow-Up Diagnostic Imaging / Testing

As elucidated in the General Principles section A-13, the choice of diagnostic imaging studies relies on the case-specific clinical presentation and clinical judgment. There might be instances where it is clinically necessary to repeat or use alternate diagnostic imaging. Examples include situations where a prior test yields poor quality or nondiagnostic results, there is a change in the clinical scenario (e.g., emergence of new or worsening symptoms, preparation for surgery or therapeutic injections), or monitoring clinical progress (e.g., post-operatively) or deterioration over time is essential.

To ensure maximum diagnostic accuracy, minimize adverse effects on patients, and enhance clinical efficiency, it is crucial to make prudent choices regarding procedure(s) or establish a proper sequential order when multiple procedures are involved. The repetition of procedures leads to an escalation in cumulative radiation dose and associated risks.

Variability in Diagnostic Imaging Procedures

Diagnostic imaging procedures exhibit varying degrees of sensitivity and specificity for any given diagnosis. The foundation for selecting and interpreting imaging studies should be built upon clinical history, physical examination, and clinical judgment.

While plain X-rays commonly serve as a valuable initial step, they may not always suffice. Other imaging modalities such as Magnetic Resonance Imaging (MRI), arthrography, or computed axial tomography (CT) scanning following arthrography can offer valuable insights into many shoulder disorders. Under certain circumstances, as mentioned earlier, there may be a need for repeat or alternative imaging.

The choice of one procedure over others typically hinges on multiple factors, emphasizing the importance of considering the specific clinical context.



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