Rotator cuff (RC) injuries have been classified as intrinsic when that tendon injury results from direct tendon overload, intrinsic degeneration, or other insult. RC injury mechanisms are Case Report AbstractEvidence for work-related exposure as a cause of shoulder tendinopathy is updated. Previous studies indicated that forceful movements combined with hands above head increases the likelihood of shoulder disorders. Hands above the shoulder and arm flexion or abduction at greater than 60° combined with forceful or repetitious motions results in significantly increased occurrence of shoulder tendinopathy. Shoulder disease is multifactorial with genetics, age, and bodyweight correlated with increased occurrence though they are minor factors for young workers. Normal aging of the rotator cuff may underlie much of shoulder disease for individuals older than 60 thereby presenting a complication for the determination of work-related rotator cuff tears in this group. In contrast, there is sufficient evidence to support work-related musculoskeletal disorders of the shoulder in younger individuals who have not undergone the aging processes. Numerous reviews along with individual cross sectional and longitudinal studies conclude that shoulder tendinopathy can result from work-related exposures based on the odds and relative risks of occurrence in a working population compared to a group that has not been similarly exposed to comparable manual effort.

Comparison of a novel triple-row (NTR) rotator cuff repair (RCR) was made to single row (SR) and double row (DR) repairs as measured by gap formation, Ultimate Failure Load (UFL), and mode of failure. Porcine humeri were divided into three groups of forty and the infraspinatus tendons were completely released and then repaired using generic (PEEK) anchors. Biomechanical testing of RCRs consisted of 3500 cycles of a load varied from 10 to 180 Newtons (N). Gap size at all cycle counts was significantly larger for SR and DR than NTR RCRs. 84% of NTR repairs completed the 3500 cycle test versus 66% of DR and 61% of SR repairs. The tendon pulled from the sutures 60%, 49% and 33% of the time for SR, DR and NTR RCRs respectively. UFLs were 464 N for the NTR repairs, 394 N for DR and 414 N for SR repairs. In summary, NTR repairs resulted in smaller gap formation, higher UFLs, and fewer instances of tendons tearing at the sutures than SR or DR repairs. Results of NTR repairs demonstrate that the tendon footprint is securely restored with small gap formation for the range of forces that a shoulder will be subjected to in normal use.

Background: We have found that, in certain social climates, barriers to care prevent the appropriate implementation of the spirit and legislative intent of the Workers Compensation system. It is our belief that procedural delays are used to limit access to care in certain environments that ultimately increases the cost to the system. Methods: TMMI for workers exposed to heavy manual tasks given early medical access is compared to workers denied access with workers' comp savings demonstrated. Results: Workers that lacked access to a physician at the time of declaring that they were unable to perform their job function due to upper extremity pain reached MMI (case closed) on average in 47 months and would have collected over $250,000 as the state of Illinois pays 66% of the employee's salary during the TTD period resulting in $64,636/year for a worker with a $100,000/yr salary. In contrast, workers that were provided with early access to a physician achieved MMI on average within 5.7months, would collect around $30,700 on average and be able to return to work in some capacity. Therefore, shortening TTD time by providing rapid medical access would appear to be fiscally sound (>$200,000 TTD cost savings). Conclusion: Removal of barriers to medical care should be considered in cases of severe upper extremity musculoskeletal disorders. Everyone benefits from the financial savings while workers have reduced surgical stress and recovery time.

The three D's of insurance: delay, deny and do not pay analysis of collection rates for Illinois workers' compensation patients 268

Rotator cuff injuries that result from work exposure, sport, trauma, or due to tendon degeneration with increasing age currently are preferentially repaired arthroscopically. Healing of the repaired rotator cuff often requires 6 to 12 months or longer depending on several conditions. Tear size, patient age, sex, return to work or sport participation, social and economic environment, and the rehabilitation program that includes physical therapy (PT). The cost of PT has become an issue that is largely driven by the number of PT sessions required to achieve the desired patient outcome. This is a study of the number of PT sessions necessary to achieve return-to-work status for workers comp patients that underwent arthroscopic rotator cuff repair by a single surgeon. A Medline search of the literature resulted in few studies that even mention the number of PT sessions. The usual conclusion reached is that further study is required and in the few studies that provide a PT session count there is no breakdown based on the tear characteristic or patient goals and no guidance based on Random Controlled Trials (RCTs). Presently, there is no scientifically supported PT session count that can be applied to individual patients and in particular workers. Clinicians must remain responsible for determining the extent and duration of therapy based on their knowledge of the characteristics of the rotator cuff tear, its repair, and patient' goals.

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Purpose: Test the durability of molded-generic poly ether ether ketone (PEEK) anchors designed for rotator cuff repair in comparison to brand-name anchors.Methods: 5.5 mm PEEK rotator cuff (RC) anchors double loaded with #2 ultrahigh molecular weight polyethylene (UHMWPE) sutures were inserted into porcine humerus cortical or cancellous bone.

We performed a retrospective case series that examined efficiencies that accrue by virtue of triple loading rotator cuff anchors with suture. Patients were divided into two groups: 34 patients had rotator cuff tears arthroscopically repaired using double-loaded anchors and 34 patients had rotator cuff tears repaired using triple-loaded anchors using double row repair techniques. Based on number of anchors used per repair and the number of suture passes through the tendon, triple-loaded anchors were 30% more efficient than double loaded while using 15% fewer anchors per unit area. Stable technology implants were used and demonstrated to offer substantial cost savings relative to branded commercial anchors. Level of evidence IV.