Shoulder Injury — Superinsight Authority Library

Shoulder Injury MTG § A.1 — Medical Care

NY WCB Shoulder Injury MTG, 4th ed., § A.1

NY WCB Shoulder Injury Medical Treatment Guidelines, Fourth Edition (January 26, 2021), effective for treatment on or after 2022-05-02 — governing edition per 12 NYCRR § 324.2(a)(4).

§ A.1 — Medical Care · page 6 of the guideline.

The guideline text is published by the Workers' Compensation Board and is not reproduced here. Read the section in the WCB PDF (link above). Care that departs from the guideline requires a variance under 12 NYCRR § 324.3; procedures over $1,000 that follow it are pre-authorized under § 324.2(d).

Shoulder Injury MTG § A.2 — Rendering Of Medical Services

NY WCB Shoulder Injury MTG, 4th ed., § A.2

Shoulder Injury MTG § A.1 — Medical Care

Shoulder Injury MTG § A.2 — Rendering Of Medical Services

Shoulder Injury MTG § A.3 — Positive Patient Response

Shoulder Injury MTG § A.4 — Re-Evaluate Treatment

Shoulder Injury MTG § A.5 — Education

Shoulder Injury MTG § A.6 — Acuity

Shoulder Injury MTG § A.7 — Initial Evaluation

Shoulder Injury MTG § A.8 — Diagnostic Time Frames

Shoulder Injury MTG § A.9 — Treatment Time Frames

Shoulder Injury MTG § A.10 — Delayed Recovery

Shoulder Injury MTG § A.11 — Active Interventions

Shoulder Injury MTG § A.12 — Active Therapeutic Exercise Program

Shoulder Injury MTG § A.13 — Diagnostic Imaging And Testing Procedures

Shoulder Injury MTG § A.14 — Surgical Interventions

Shoulder Injury MTG § A.15 — Pre-Authorization

Shoulder Injury MTG § A.16 — Psychological/Psychiatric Evaluations

Shoulder Injury MTG § A.17 — Personality/Psychological/Psychosocial Intervention

Shoulder Injury MTG § A.18 — Functional Capacity Evaluation (FCE)

Shoulder Injury MTG § A.19 — Return To Work

Shoulder Injury MTG § A.20 — Job Site Evaluation

Shoulder Injury MTG § A.21 — Guideline Recommendations And Medical Evidence

Shoulder Injury MTG § A.22 — Experimental/Investigational Treatment

Shoulder Injury MTG § A.23 — Injured Workers As Patients

Shoulder Injury MTG § A.24 — Scope Of Practice

Shoulder Injury MTG § B.1 — History Taking and Physical Examination

Shoulder Injury MTG § B.2 — Specific Diagnoses, Testing and Treatment Procedures

Shoulder Injury MTG § B.3 — Therapeutic Procedures: Non-Operative (including medications)

Shoulder Injury MTG § C.1 — History Taking

Shoulder Injury MTG § C.1.c — History of non-occupational injury and avocational pursuits need to be specifically documented.

Shoulder Injury MTG § C.1.e — A review of systems should be conducted, the elements of which

Shoulder Injury MTG § C.2 — Physical Findings

Shoulder Injury MTG § C.3 — Red Flags

Shoulder Injury MTG § C.4 — Follow-Up Diagnostic Imaging / Testing

Shoulder Injury MTG § D.1 — Acromioclavicular (AC Joint Sprains / Dislocations An acute acromioclavicular (AC) joint injury is frequently referred to as a shoulder

Shoulder Injury MTG § D.1.a.i — Mechanism of Injury (AC Joint Sprains/Dislocations): generally,

Shoulder Injury MTG § D.1.b — Physical Findings

Shoulder Injury MTG § D.1.b.i — Tenderness at the AC joint, at times with contusions and/or abrasions

Shoulder Injury MTG § D.1.b.iii — Positive piano sign produced with downward traction on the extended

Shoulder Injury MTG § D.1.c — Laboratory Tests

Shoulder Injury MTG § D.1.d — Testing Procedures

Shoulder Injury MTG § D.1.d.ii — AP radiograph of the shoulder with the beam angled 10 degree

Shoulder Injury MTG § D.1.d.iv — Stress view; side-to-side comparison with 10-15 lbs. of weight in each

Shoulder Injury MTG § D.1.e — Non-Operative Treatment Procedures

Shoulder Injury MTG § D.1.e.i — Procedures such as patient-directed thermal treatment and immobilization (up to six weeks for Type I-III AC joint separations).

Shoulder Injury MTG § D.1.e.ii — Medication, such as nonsteroidal anti-inflammatories and analgesics,

Shoulder Injury MTG § D.1.e.ii.a — Subacromial Space Injection with Steroids

Shoulder Injury MTG § D.1.e.iv — Physical medicine interventions should emphasize a

Shoulder Injury MTG § D.1.f.i — With a Type III AC joint injury, an appropriate orthopedic

Shoulder Injury MTG § D.1.f.ii — With a Type IV-VI AC joint injury, an orthopedic

Shoulder Injury MTG § D.1.g — Post-Operative Procedures

Shoulder Injury MTG § D.2 — Adhesive Capsulitis / Frozen Shoulder Disorder

Shoulder Injury MTG § D.2.a.i — Mechanism of Injury: There often is some history of prior injury to the shoulder, shoulder tendon, ligament

Shoulder Injury MTG § D.2.a.ii — Patient will usually complain of pain in the sub-deltoid

Shoulder Injury MTG § D.2.b — Physical Findings

Shoulder Injury MTG § D.2.c — Laboratory Tests

Shoulder Injury MTG § D.2.d.i — X-Ray or MRI

Shoulder Injury MTG § D.2.d.ii — Arthrography

Shoulder Injury MTG § D.2.e — Non-Operative Treatment Procedures

Shoulder Injury MTG § D.2.e.i — Physical medicine interventions are the mainstay of treatment

Shoulder Injury MTG § D.2.e.ii — Medications, such as NSAIDs and analgesics, may be

Shoulder Injury MTG § D.2.e.iii — Subacromial or Intra-articular space injection with steroids

Shoulder Injury MTG § D.2.e.iv — Distension Arthrography or "Brisement"

Shoulder Injury MTG § D.2.e.v — Manipulation

Shoulder Injury MTG § D.2.f.i — Manipulation Under General Anesthesia (MUA)

Shoulder Injury MTG § D.2.g — Post-Operative Procedures

Shoulder Injury MTG § D.3 — Bicipital Tendon Disorders

Shoulder Injury MTG § D.3.a.i — Mechanism of Injury: Bicipital tendon disorders may

Shoulder Injury MTG § D.3.a.ii — Disorders of the biceps tendon may accompany

Shoulder Injury MTG § D.3.a.iii — Symptoms may include aching, burning and/or stabbing

Shoulder Injury MTG § D.3.b — Physical Findings

Shoulder Injury MTG § D.3.b.i — If continuity of the tendon has been lost (biceps tendon rupture), inspection of the shoulder would reveal

Shoulder Injury MTG § D.3.b.ii — Palpation demonstrates tenderness along the course

Shoulder Injury MTG § D.3.b.iii — Pain at end range of flexion and abduction as well as

Shoulder Injury MTG § D.3.b.iv — Provocative testing may include:

Shoulder Injury MTG § D.3.c — Laboratory Tests

Shoulder Injury MTG § D.3.d.i — X-Ray

Shoulder Injury MTG § D.3.d.ii — Sonography, MRI or arthrography (Adjunctive testing)

Shoulder Injury MTG § D.3.e — Non-Operative Treatment Procedures

Shoulder Injury MTG § D.3.e.i — Benefit may be achieved through rest followed by

Shoulder Injury MTG § D.3.e.ii — Medications, such as nonsteroidal anti-inflammatories