New York State Medical Treatment Guidelines for
Rotator Cuff Tendinitis in workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Rotator Cuff Tendinitis.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Rotator Cuff Tendinitis of Shoulder Injury

An inflammation of one or more of the four musculotendinous structures that insert on the lesser or larger tuberosity of the humerus and emerge from the scapula. One internal rotator, the subscapularis, two external rotators, the infraspinatus and teres minor, as well as the supraspinatus, which aids with abduction, are among these structures.

History and Mechanism of Injury of Rotator Cuff Tendinitis

Mechanism of Injury: based on repetitive overhead motions with internal or external rotation or acute overuse injuries to the shoulder.

Physical Findings of Rotator Cuff Tendinitis

Physical Findings may include:

• Palpable shoulder discomfort associated with active or passive shoulder abduction and external rotation (painful arc);
• Impingement symptoms together with pain; or
• Pain brought on by specifically activating the affected muscles

Laboratory Tests of Rotator Cuff Tendinitis

Laboratory Tests of Rotator Cuff Tendinitis is recommended when a systemic illness or disease is suspected in a subset of patients.

Testing Procedures of Rotator Cuff Tendinitis X-Ray

Testing Procedures of Rotator Cuff Tendinitis X-Ray is recommended clinically appropriate in a subset of patients.

• AP lateral, axial, 30 degrees, 50 caudally angulated AP, outlet view on plain x-ray films for shoulder injury;
• If after four to six weeks of nonoperative treatment, shoulder pain persists and the diagnosis is difficult to make using conventional radiography techniques.

Supplemental Testing (MRI, Sonography Arthrography or MRI)

Supplemental Testing (MRI, Sonography Arthrography or MRI) is recommended – in a few patients when clinically necessary to rule out a rotator cuff tear.

Indications: Standard radiographic techniques cannot reliably diagnose shoulder pain after four to six weeks of nonoperative treatment.

Subacromial Space Injection of Rotator Cuff Tendinitis

Subacromial Space Injection of Rotator Cuff Tendinitis is recommended – By injecting an anaesthetic, such as sensorcaine or xylocaine solutions, into the area, a diagnostic technique can be performed on a small number of patients as clinically appropriate. The diagnosis is verified if the injection reduces the pain.

Non-Operative Treatment Procedures

Non-Operative Treatment Procedures may include:

• medications such as oral steroids, nonsteroidal anti-inflammatory drugs, and analgesics.

Subacromial Space Injection with Steroids

Subacromial Space Injection with Steroids is recommended clinically appropriate in a subset of patients.

Indications: Possibly helpful if the patient had a positive reaction to a diagnostic anaesthetic injection. Direct steroid injections into the tendons are not advised.

Frequency: Local anaesthetics take immediate impact, but corticosteroids take three days to take effect.

Maximum duration: Three injections to the same place each year are permitted.

During the first two to three weeks of the acute phase of shoulder discomfort, non-operative treatment techniques/modalities like relative rest, immobilisation, thermal treatment, ultrasound, therapeutic exercise, physical therapy, and rehabilitation should be used in conjunction with active therapies as soon as these are appropriate.

Operative Procedures of Subacromial Space Injection

For the majority of individuals, surgical interventions are not recommended for this diagnosis. They’re recommended for tendinitis that has modest partial thickness tears and has been resistant to non-operative treatment for four to six months.

What our office can do if you have workers compensation injuries

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.