From the Guidelines
Work modifications for rotator cuff injuries should prioritize reducing overhead activities and heavy lifting to allow healing while maintaining productivity, as recommended by the most recent and highest quality study 1.
Key Recommendations
- Employees should avoid lifting objects heavier than 5-10 pounds, particularly above shoulder level, and eliminate repetitive overhead reaching or sustained arm positions above shoulder height.
- Workstations should be adjusted to keep frequently used items between waist and shoulder height, and computer monitors positioned at eye level to prevent shoulder strain.
- Regular breaks every 30-60 minutes are essential to perform gentle stretching exercises.
- Job duties may need temporary reassignment to avoid activities that aggravate symptoms, with a gradual return to full duties over 6-12 weeks depending on injury severity.
- Ergonomic tools like document holders, headsets for phone calls, and adjustable chairs can reduce shoulder strain.
Rationale
The most recent study 1 provides strong evidence supporting the improvement of patient-reported outcomes (PROs) with physical therapy in symptomatic patients with full-thickness rotator cuff tears. However, it also notes that the rotator cuff tear size, muscle atrophy, and fatty infiltration may progress over 5 to 10 years with nonsurgical management. Another study 1 recommends offering evidence-informed non-surgical care prior to surgery, including exercise, psychological therapy, information/education, and activity advice.
Implementation
To implement these modifications, employers and employees should work together to identify and reduce overhead activities and heavy lifting, and provide regular breaks for stretching exercises. Ergonomic assessments and adjustments can be made to workstations to reduce shoulder strain. By prioritizing these modifications, employees with rotator cuff injuries can maintain productivity while allowing their injuries to heal, reducing the risk of chronic problems and improving their quality of life 1.
From the Research
Work Modification Recommendations for Rotator Cuff Injury
- The management of rotator cuff-related shoulder pain often involves pharmacologic treatment, including acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 2.
- Intra-articular injection therapy is a common conservative treatment for rotator cuff injury, with corticosteroid injections combined with hyaluronic acid injections recommended for non-surgical conservative clinical management 3.
- Corticosteroid injection(s) may be effective in rotator cuff tendinopathy for pain and function at short term, especially in combination with physical therapist interventions, but the evidence is of moderate to mostly very low certainty 4.
- Corticosteroid injections may have a short-term benefit (up to 8 weeks) over local anaesthetic injections alone in the management of rotator cuff-related shoulder pain, but there is no evidence to suggest a benefit beyond 8 weeks 5.
Rehabilitation Protocols
- Rehabilitation protocols for rotator cuff disease should be tailored based on the different phases of tendon healing 6.
- Wearable devices hold promise for long-term follow-up during the postoperative period, providing information to the clinician about the patient's status 6.
- Physical therapist interventions may be an important stand-alone treatment option for rotator cuff tendinopathy, considering the potential adverse events associated with injections 4.
Treatment Options
- Ibuprofen and acetaminophen provide benefits to patients suffering from rotator cuff-related pain, but the type of improvement perceived by patients differs between these two medications 2.
- Platelet-rich plasma injection therapy, hyaluronic acid injection therapy, and prolotherapy therapy are other treatment options for rotator cuff injuries, with corticosteroid injection therapy combined with hyaluronic acid injection recommended as the most effective treatment 3.