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Medical Disability Advisor  >  Impingement Syndrome  >  Failure To Recover  see more: ACOEM - Shoulder Disorders

Impingement Syndrome

Related Terms

  • Internal Impingement
  • Rotator Cuff Impingement Syndrome
  • Subacromial Impingement Syndrome
  • Subcoracoid Impingement

Differential Diagnoses

Specialists

  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist
  • Physical Therapist
  • Rheumatologist

Comorbid Conditions

  • Musculoskeletal disorders
  • Rheumatologic disorders
  • Rotator cuff impingement
  • Tear in the contralateral shoulder

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Factors Influencing Duration

Duration depends on job requirements and whether the dominant or nondominant arm is involved. Duration and disability also depend heavily on whether the contralateral shoulder has similar problems. Disability may be longer for individuals who perform repetitive actions and/or overhead work as part of their work duties. The individual's age, occupation, response to treatment, and compliance with treatment recommendations and rehabilitation programs will influence the duration of disability. Osteoarthritis in the glenohumeral joint is uncommon but, if present, will significantly delay return to heavy work or shoulder-intensive work.

Duration Trends from Reference Data

DURATION TRENDS
 ICD-9-CM: 726.2  
CasesMeanMinMaxNo Lost TimeOver 6 Months
36216602970.2%3.8%
 
  
 
Percentile:5th25thMedian75th95th
Days:12305489172
 
  
 

Differences may exist between the duration tables and the reference graphs. Duration tables provide expected recovery periods based on the type of work performed by the individual. The reference graphs reflect the actual experience of many individuals across the spectrum of physical conditions, in a variety of industries, and with varying levels of case management. Selected graphs combine multiple codes based on similar means and medians.

Medical Codes

ICD-9-CM:
726 - Peripheral Enthesopathies and Allied Syndromes
726.2 - Other Affections of Shoulder Region, Not Elsewhere Classified; Periarthritis of Shoulder; Scapulohumeral Fibrositis
840 - Sprains and Strains of Shoulder and Upper Arm
840.9 - Sprains and Strains of Shoulder and Upper Arm, Unspecified Site of Shoulder and Upper Arm; Arm NOS; Shoulder NOS

Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have any risk factors or predisposing conditions such as work or sports that stress the shoulder, bone spurs, osteoarthritis, shoulder injuries, or degenerative disease?
  • Did the shoulder pain appear suddenly (suggests another diagnosis) or was the onset gradual and progressive (suggests impingement)?
  • Was there pain following an injury?
  • What symptoms does individual have?
  • What were the findings on physical exam?
  • Has individual undergone shoulder x-rays, MRI, ultrasound, or arthrography to establish the diagnosis?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has individual responded favorably to conservative treatment?
  • Did individual undergo shoulder manipulation under anesthesia for complicating adhesive capsulitis? Was surgery performed? What type? Were there complications from surgery?

Regarding prognosis:

  • Is recovery prolonged due to surgery?
  • Is individual active in physical therapy? In a home exercise program?
  • Is individual's employer able to accommodate the necessary restrictions?
  • Does individual have osteoarthritis, rheumatoid arthritis, shoulder injuries, shoulder instability, or shoulder degeneration?
  • Does individual have complications such as rotator cuff tear, biceps tendinitis, bursitis, or frozen shoulder?
  • Is the affected shoulder on the individual’s dominant or nondominant side?

Source: Medical Disability Advisor


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