New York State Medical Treatment Guidelines for Shoulder

Impingement Syndrome 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 Charcot Joint.

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.

Impingement Syndrome of Shoulder Injury

A grouping of symptoms rather than a pathological diagnosis. The acromion, coracoacromial ligament, coracoid process, and/or the AC joint encroach on the rotator cuff mechanism as the shoulder moves, which causes the symptoms.

The coracoacromial arch is closely related to the cuff mechanism. Compression and friction, which are only separated by the bursar’s tiny lubricating surfaces, can be reduced in a number of ways, including:

  • The coracoacromial arch’s shape, which permits the adjacent rotator cuff to pass;
  • Normal AC joint undersurface;
  • Normal bursa;
  • Normal capsular laxity; and
  • Coordinated scapulothoracic function.

Adhesive capsulitis/frozen shoulder, partial- and full-thickness rotator cuff tears, AC joint arthritis, and the impingement syndrome are all possible concomitants. The rotator cuff mechanism and biceps tendon should both be functioning normally to lessen impingement syndrome.

History and Mechanism of Injury of Impingement Syndrome

Mechanism of Injury: Overuse of the upper extremity due to established repetitive behaviour; this is typically seen with repetitive overhead action.

History may include:

  • Delayed presentation: Since the syndrome is typically not an urgent issue, individuals will seek medical attention if their symptoms do not go away after resting, giving it some time, and “trying to work it out”;
  • Complaints of functional impairment brought on by discomfort, stiffness, weakness, and catching when the arm is flexed and internally rotated; and
  • Poor sleep is typical, and pain is frequently felt along the anterior proximal humerus or down the lateral aspect of the upper arm, close to the deltoid insertion.

Physical Findings of Injury of Impingement Syndrome

Physical Findings may include:

  • Deltoid and rotator cuff atrophy may be found during a shoulder examination;
  • Range of motion is constrained, especially in cross-body adduction and internal rotation;
  • Pain and crepitus may accompany passive motion over the 60 to 90 degree arc of flexion; this is intensified as the shoulder is moved into and out of internal rotation;
  • In general, active shoulder elevation causes more discomfort than passive elevation;
  • Impingement syndrome typically manifests as pain on maximum active forward flexion, however this pain is not diagnostic;
  • Testing your strengths could uncover weaknesses. This weakness could be brought by by discomfort, inactivity, tendon damage, or improper scapulothoracic mechanics;
  • A weakening of the posterior scapular stabilisers may also be considered as a contributing factor to impingement syndrome by affecting the mechanics of the glenohumeral joint. Pain during resisted external rotation or abduction may also signal that the rotator cuff tendons may be weakened.

Laboratory Tests of Injury of Impingement Syndrome

Laboratory Tests of Injury of Impingement Syndrome is recommended – When a systemic illness or disease is suspected in a subset of patients.

Testing Procedures of Impingement Syndrome X-Ray

Testing Procedures of Impingement Syndrome X-Ray is recommended – Clinically appropriate in a subset of patients.

Indications: Calcification of bone spurs may be visible.

Subacromial Space Injection of Impingement Syndrome

Subacromial Space Injection of Impingement Syndrome is recommended- Clinically appropriate in a subset of patients.

Indications: injecting anaesthetic can be used as a diagnostic procedure, xylocaine or sensorcaine solutions, for example, into the area. If the discomfort is The injection provides relief, and the diagnosis is verified.

Non-Operative Treatment Procedures may include:

  • Medicines like analgesics and nonsteroidal anti-inflammatory drugs

Subacromial Space Injection of Impingement Syndrome

Subacromial Space Injection of Impingement Syndrome is recommended clinically appropriate in a subset of patients.

Indications: If the patient responded favourably to an anaesthetic injection given for diagnostic purposes, a subacromial area injection of steroids might be therapeutic. Direct steroid injections into the tendons are not advised.

Frequency: Not more often than twice or three times per year. One or two injections are typically sufficient. It is advised to wait at least three weeks between injections.

Local anaesthetics take immediate impact, but corticosteroids take three days to start working.

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

Considerations should be given to relative rest, immobilisation, thermal treatment, ultrasound, therapeutic exercise, physical medicine, and rehabilitation.

Operative Procedures of Subacromial Space Injection
Before a sufficient trial of physical therapy that involves direction and supervision by a suitable, licensed practitioner and active patient participation, surgical procedures for impingement syndrome should not be considered. A minimum of six weeks should typically pass during such a trial.

Post-Operative Procedures of Subacromial Space Injection

Individualised rehabilitation plans based on collaboration between the doctor, the surgeon, and the therapist could include the following:

  • Abduction splint or sling;
  • Vigorous posterior scapular stabilising training, passive glenohumeral range of motion, and gentle pendulum exercise can be implemented;
  • Start isometric exercises and taking part in ADLs four weeks after surgery; or
  • Consider starting light resistive exercise at six weeks after surgery, depending on the patient’s functional recovery; concurrently, returning to a light or limited duty may be feasible given the ability to handle “no repetitive overhead activity.”
  • All active non-operative methods specified in Section E, Therapeutic Procedures: Non-Operative, should be taken into consideration. These include progressive resistive exercise starting at two months with a gradual return to full activity starting at 5-7 months.
  • During the post-operative recuperation and rehabilitation, work restrictions should be assessed every four to six weeks with appropriate written notifications to the patient and the employer. If the patient’s progress stagnates, the provider should reassess the patient’s health and modify the treatment plan as necessary.

What our office can do if you have shoulder Impingement Syndrome

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.

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No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
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23:31 19 May 22
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Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
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17:26 17 Nov 20
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Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

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