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Shoulder Pain

While the shoulder is the most movable joint in the body, it is an unstable joint because of the range of motion allowed.

The shoulder is subject to injury because the ball of the upper arm is larger than the shoulder socket that holds it. To remain stable, the shoulder must be anchored by muscles, tendons, and ligaments. Some shoulder problems arise from the disruption of these soft tissues as a result of injury or from overuse or underuse of the shoulder. Other problems arise from a degenerative process in which tissues break down and no longer function well. There are a handful of causes of shoulder pain commonly seen as the result of injury, such as in a car accident or serious fall.

These include:

Rotator cuff tear: This is the most common type of shoulder injury. The rotator cuff is comprised of four muscles that surround the shoulder. The tendons of these muscles join near their attachment point, creating a broad singular tendon called the rotator cuff tendon. The tendons, not the muscles, are most commonly torn in this type of injury. Many rotator cuff tears occur without the presentation of any symptoms whatsoever. However, they can become quite symptomatic. Moreover, rotator cuff tears most frequently occur with overuse and age, and less frequently with trauma. Falling is the most common cause of trauma induced rotator cuff tears. Surgery is oftentimes performed to treat a rotator cuff tear, though not always a necessity.

Unfortunately, insurance companies often minimize rotator cuff tears, usually arguing that they pre-existed the injury. However, even if this were the case, it is the symptoms that are key in determining whether the treatment is legally attributable to the injury or not. Even if pre-existing, the law protects folks with such underlying conditions, also known as prior infirm conditions. Experienced personal injury attorneys know how to apply the law to fully compensate their clients.

SLAP tear: A SLAP (superior labrum anterior to posterior) tear occurs when the cartilage of the shoulder joint (labrum) separates from the bone surface within the shoulder joint. This causes instability of the shoulder, typically with overhead movements. Symptoms generally include severe weakness with overhead work, as well as a constant and deep ache in the shoulder joint. Most cases require surgery to regain full mobility and strength.

The value of a SLAP tear depends on numerous factors, including the type of surgery performed, the extent of the tear, the prior condition of the shoulder joint, the ultimate outcome of treatment or surgery, and any permanent restrictions. Insurance companies often hire doctors to say that the injured person would have had the surgery at some point in their life anyway, particularly where their past or present job required overhead lifting. Only an attorney specializing in the field of personal injury has the background to properly evaluate this type of injury and defend against such arguments.

Impingement: When the rotator cuff tendon becomes inflamed (tendinitis) or thickened, it can get trapped under the acromion (the end of the collarbone), causing pain and a catching sensation. This is referred to as rotator cuff impingement, and has many causes, including swelling from acute trauma, overuse, or degeneration; thickening of the rotator cuff tendon from overuse, degeneration, or scar tissue, or even lengthening (spurring) of the acromion process. Treatment includes the use of ice to decrease swelling, anti-inflammatory medication, steroid injections, or even surgery.

Because shoulder impingement often occurs as a result of degeneration, overuse, and old age, it is often difficult to relate it to an injury. However, a good doctor can often determine if it was caused by a traumatic event, such as a car accident, based on imaging studies, age of the person, and timing of symptoms. A good doctor, coupled with an experienced personal injury attorney, will improve the probability of connecting this type of injury to the traumatic event.

Dislocation: Because the shoulder is the most moveable joint in the body, it is the most prone to becoming dislocated. In fact, over half of the dislocations seen in emergency rooms across the country per year involve the shoulder. While the most common is a frontward (anterior) dislocation, the shoulder can also be dislocated rearward (posterior) or downward (inferior). Shoulder dislocations are extremely painful, but often resolve without surgery. In some cases, the shoulder is dislocated so severely that it damages the surrounding ligaments and tendons, leaving the shoulder unstable and prone to frequent dislocation. It is in those cases that surgery to tighten the shoulder capsule may be performed. Surgery may also be necessary to address additional injury caused by the dislocation, such as a SLAP tear.

Insurance companies often argue that, while a dislocated shoulder might hurt, it resolves quickly. They will then try to low-ball the injured person with their settlement offers. An experienced personal injury attorney can improve the chance of success by proving not only what the injured person has already gone through, but what they might face in the future on account of the weakened shoulder joint.

Separation: A shoulder separation occurs where the collarbone (clavicle) meets the shoulder blade (scapula). When ligaments that hold the AC (acromioclavicular) joint together are partially or completely torn, the outer end of the clavicle may slip out of place, preventing it from properly meeting the scapula. Most often the injury is caused by a blow to the shoulder or by falling on an outstretched hand. This type of injury usually takes two or three months to resolve with conservative treatment, and rarely requires surgery.

Simply put, insurance companies greatly minimize the pain and agony associated with a shoulder separation. Only experienced personal injury attorneys know how to use medical evidence to maximize the value of this type of injury claim.

Fracture: This is a partial or total crack through one of the three bones that make up the shoulder: the clavicle (collar bone), scapula (shoulder blade), and humerus (upper arm). The break usually occurs because of an impact, such as a high-speed car accident or serious fall. The clavicle is most commonly fractured, followed by the upper humerus. People with osteoporosis or osteopenia (reduced bone density) can experience multiple fractures in a single incident, which can be serious and cause complications. Minor fractures can be treated non-operatively, while major fractures may require surgery.

Insurance adjusters tend to minimize shoulder fractures, particularly those not involving surgery. Also, underlying disease, such as osteoporosis, can make these fractures more serious. However, insurance adjusters may try to argue that they shouldn’t be fully responsible, as the injured party was fragile. Again, the law protects people with such underlying conditions, also known as prior infirm conditions. Experienced personal injury attorneys have the background to properly evaluate this type of injury and defend against such arguments.

Adhesive capsulitis: As the name implies, movement of the shoulder is severely restricted in people with adhesive capsulitis (“frozen shoulder”). This condition is frequently caused by injury that leads to lack of use due to pain. Arthritic disease progression and recent shoulder surgery can also cause frozen shoulder. Adhesions (abnormal bands of tissue) grow between the joint surfaces, restricting motion. There is also a lack of synovial fluid, which normally lubricates the gap between the arm bone and socket to help the shoulder joint move. People with diabetes, stroke, lung disease, rheumatoid arthritis, and heart disease, particularly after being injured in an accident, are at a higher risk for frozen shoulder. The condition rarely appears in people under the age of 40. While surgery is generally not necessary, painful physical therapy is often mandatory.

Because this condition is most commonly caused by lack of use of the shoulder due to pain, insurance adjusters are very good at assigning blame to the injured person. They argue that the injured party did not try hard enough in their physical therapy, or perhaps didn’t go to the doctor to check the condition of the shoulder as often as they should have. They also undervalue how painful the condition really is. Only an experienced personal injury attorney knows how to defuse such arguments that are designed to confuse a jury.