A commonly seen injury in the field of workers’ compensation is a torn rotator cuff. The rotator cuff is comprised of four tendons around the shoulder socket and it is particularly important to the function of “abduction”—i.e. being able to raise your arm. Frequent overhead reaching, strenuous lifting, a slip-and-fall, and any other number of mishaps can cause injury to the rotator cuff.

These claims are often denied after the injured party undergoes radio diagnostic testing. This is because, as many doctors will tell you, in the majority of individuals over 40, at least a partial tear in the rotator cuff will show up on MRI. This is true even for people who have no symptoms whatsoever. The reason has to do with the anatomy of the human shoulder. The supraspinatus tendon (the one that sits directly on top of the shoulder socket) runs between the acromion bone and the humeral head. This narrow opening becomes even narrower as a person reaches overhead, causing the tendon to be pinched between the two bones. Over the course of a person’s life, that tendon will eventually fray and separate from the humeral head. Think of a butter knife running across a rope for years and years; eventually, that rope will start to fray.

So, when degenerative findings inevitably present themselves in an older person who hurts her shoulder on the job, her claim can often be denied. However, doctors will also tell you that it is possible to have an “acute-on-chronic” tear in the rotator cuff, and in fact, this happens quite frequently. After all, a worn out, frayed tendon is more vulnerable to acute injury.

There are several important identifiers of an acute-on-chronic tear. Probably the most important is the report of symptoms. If a person claims to have sudden pain from lifting a heavy object overhead and seeks treatment right away, that is very important evidence. Clinical examination is also important. Difficulty with smoothly lifting and lowering the arm is a classic sign of an acute rotator cuff tear; but patients with chronic tears that developed over many years don’t have the same level of difficulty with abduction because their surrounding muscles (like the deltoid muscles) slowly adapt and make up for the insufficient cuff. Finally, edema, bursitis, labral tears, and similar acute findings on MRI can be helpful in identifying an acute-on-chronic tear.

If you suffer a work-related shoulder injury, being thorough and detailed when describing your injury and symptoms your doctors is very important. It is equally important to find an attorney who understands the anatomy of the shoulder and can present your medical evidence to the judge in the best possible light. Taking these steps can make all the difference when it comes to finding a successful resolution of a difficult workers’ compensation claim.

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