Workers Compensation for Rotator Cuff Injuries
What You Need to Know Before Asking for a Workers Comp Settlement for a Torn Rotator Cuff or Shoulder Impingement
Rotator cuff injury (including torn rotator cuff, impingement syndrome, and rotator cuff tendinitis) is the most common shoulder injury in workers compensation. About 80% of the shoulder claims I handle for injured employees involve rotator cuff tears.
The frequency of work-related rotator cuff injuries is not surprising, given their prevalence in the public. Over two million Americans annually seek medical help for a rotator cuff problem.
Regrettably, the high frequency of these injuries, especially as you get older, also explains why the insurance company or claim administrator may have denied your claim or offered a low settlement amount for a rotator cuff tear. Claims adjusters and their insurance defense attorneys often argue that repetitive motion or cumulative trauma caused the torn rotator cuff or that the tear results from degeneration due to age and overuse. If successful, these defenses prevent you from receiving lifetime medical treatment and wage loss payments for your rotator cuff tear.
Here is the good news.
With high-quality legal support, you can counter these defenses at trial or when negotiating a rotator cuff tear settlement under workers comp.
That is why I authored this article.
After reading this page, you will have the information to decide a fair settlement amount for a torn rotator cuff at work.
If you have questions or want to talk to one of Virginia’s top-rated workers comp attorneys, call (804) 251-1620 or (757) 810-5614 or complete a contact form here.
What is the Rotator Cuff?
The rotator cuff includes four muscles (and their tendons) that wrap over the upper arm and engulf it.
Your rotator cuff stabilizes the humeral head during arm motions and helps lift and move the shoulder and arm.
Rotator Cuff Muscles and Tendons
Referred to by the mnemonic “SITS,” the four muscles forming the rotator cuff include the following:
Supraspinatus
The supraspinatus is a muscle in the upper back that helps with shoulder abduction (lifting the arm up and out) and prevents the head of the humerus from slipping lower. Indeed, this muscle controls the first 15 degrees of shoulder abduction motion, and then the deltoid takes over.
Its tendon passes under the acromion’s cover and attaches to the greater tubercle of the humerus.
Many rotator cuff injuries involve the supraspinatus. Its location, under vascularization, and frequent use make it vulnerable to degenerative changes, impingement, and tearing.
Infraspinatus
The infraspinatus is a thick muscle shaped like a triangle that helps rotate the arm laterally (externally). Its tendon attaches to the middle part of the humerus’s great tubercle.
Teres Minor
The teres minor is a narrow muscle covered by the deltoid. Like the infraspinatus, the teres minor helps the arm rotate laterally.
Subscapularis
The subscapularis muscle rotates the arm inward (medial rotation). Its tendon is the only rotator cuff tendon that does not attach to the greater tuberosity of the humerus. Instead, it attaches to the humeral head’s lesser tuberosity near the long head of your biceps tendon.
Blood Supply to the Rotator Cuff
Multiple arteries from the axillary nerve provide the blood supply to the rotator cuff:
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- Suprascapular artery: This artery starts at the base of the neck, enters the scapula, and supplies the supraspinatus and infraspinatus with blood and oxygen.
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- Subscapular artery: This artery starts from the axillary artery and supplies the subscapularis muscle.
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- Posterior circumflex humeral artery: This artery starts from the axillary artery before entering the quadrangular space and supplying the teres minor.
Your rotator cuff injury will take longer to heal if the occupational trauma damages these arteries, increasing the likelihood you will suffer permanent impairment to the upper extremity and miss time from work.
Nerves in the Rotator Cuff Area
Several nerves carry messages between the rotator cuff and the central nervous system (spinal cord and brain).:
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- The subscapular nerve originates from the posterior cord of the brachial plexus (C5, C6, C7) and innervates the subscapularis. Suprascapular nerve injury is a leading cause of shoulder pain and arm weakness reported by employees.
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- Axillary nerve: Like the subscapular nerve, the axillary nerve starts from the posterior cord of the brachial plexus and innervates the teres minor.
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- The suprascapular nerve originates from the superior trunk of the brachial plexus and innervates the infraspinatus and supraspinatus muscles.
You can learn more about nerve damage from occupational injury here.
Common Work-Related Rotator Cuff Injuries
The rotator cuff muscles and their tendon attachments experience stress whenever you lift, rotate, or move your arm.
Degeneration, repetitive movement, or overexertion (tension overload) may irritate a muscle or tendon, causing inflammation or tearing.
The most common rotator cuff injuries include the following:
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- Rotator cuff tendinitis/tendinosis: Inflammation of one or more rotator cuff tendons due to an acute injury or chronic overuse. The supraspinatus is the rotator cuff tendon most affected by this condition, followed by the subscapularis tendon.
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- Rotator cuff bursitis: Your shoulder has bursae that cushion the area between the top of the arm bone and the shoulder’s tip, where your tendons lie. A shoulder injury may irritate the bursa, causing these fluid-filled sacs to become inflamed. If this happens, your rotator cuff tendons have less space to move.
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- Rotator cuff impingement syndrome: Doctors often diagnose this condition whenever a patient has pain with overhead activities. It develops when workplace trauma causes swelling that limits your rotator cuff’s ability to fit between the bones. Shoulder impingement is either internal impingement (occurs where the rotator cuff abuts the glenoid rim and labrum in maximum abduction and external rotation) or external impingement (occurs when external sources, like the acromion, compress the cuff).
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- Rotator cuff strain: A single, acute injury to one or more rotator cuff muscles
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- Torn rotator cuff: A partial thickness or complete rupture of the rotator cuff muscle or tendon
Our law firm has negotiated workers comp settlements for every type of rotator cuff injury.
Types of Rotator Cuff Tears
The type of rotator cuff tear you have will affect the settlement value of your workers compensation case in two ways.
First, the extent of the tear is crucial in predicting if you are a candidate for rotator cuff repair surgery or may suffer a retear if you return to work.
Second, whether you have an acute or chronic rotator cuff tear affects the strength of the insurer’s compensability defense.
Partial Thickness vs. Full Thickness Tears
The orthopedic surgeon will diagnose your rotator cuff tear as partial thickness or complete.
Partial tears do not go through the entire rotator cuff. Types of partial rotator cuff tears include:
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- Partial-thickness articular-side tear.
- Partial-thickness bursa-side tear.
- Partial-thickness interstitial tear.
- Partial-thickness articular surface supraspinatus avulsion.
- Partial-thickness articular-side tear with an intramuscular cyst.
In contrast, full-thickness rotator cuff tears puncture a hole in the entire cuff. Some full-thickness tears are called massive rotator cuff tears because of the surface area affected.
A confirmed diagnosis of a partial-thickness tear instead of a full-thickness tear does not mean your rotator cuff injury is worth less money. Many partial-thickness tears cause as much (or more) pain and disability from work as complete tears.
Acute vs. Chronic Tears
In addition to classifying the tear as partial or complete, the orthopedic doctor will diagnose you as having a chronic or acute rotator cuff tear.
An acute rotator cuff tear diagnosis will make qualifying for workers compensation benefits easier because it proves the tear resulted from a specific, discrete event—a requirement in states like Virginia.
In contrast, repetitive use causes chronic tears. And the use of this word signals a rotator cuff tear present before your occupational injury.
You can still recover benefits or negotiate a workers comp settlement for a rotator cuff tear that is chronic; however, you will likely need a doctor to write a disability letter on causation to show that the work injury aggravated, exacerbated, or flared the chronic tear or accelerated the need for surgery for the torn rotator cuff.
For example, a partial tear of one tendon or muscle from overuse can develop into a full-thickness rotator cuff tear affecting multiple muscles or tendons.
With this evidence, you can avoid losing at trial based on a finding that the tear resulted from repetitive movement.
Who is at the Greatest Risk of Suffering a Torn Rotator Cuff at Work?
Several factors increase the risk of a work-related rotator cuff tear.
These risks include the following:
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- Age: Rotator cuff tears are more common in people over 40. Studies have shown that close to half of individuals over age 60 have a torn rotator cuff tear, with this age group more likely to have partial-thickness tears that progress to total ruptures. However, the data did not show a correlation between age and rotator cuff tear size
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- Poor posture predicts rotator cuff disease, making you more susceptible to work-related tears.
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- Occupation: Manual laborers (electricians, warehouse workers, forklift operators, painters, construction workers, truckers, etc.) doing overhead work are likelier to have a rotator cuff tear.
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- Sex: Men are more likely than women to have a torn rotator cuff. However, the increased presence of men in jobs requiring frequent lifting or overhead work may explain this.
How is a Rotator Cuff Tear Diagnosed?
Confirming the diagnosis of a rotator cuff tear involves three parts: patient history, clinical examination, and diagnostic imaging.
Patient History
The first workers comp doctor you see will ask for a history of the accident and what symptoms you felt.
Most employees with acute rotator cuff tears describe sudden pain in the shoulder or neck when lifting an object overhead or breaking a fall from a height or floor level, followed by discomfort, stiffness, upper extremity weakness, and swelling. Overhead activities worsen the pain.
Employees with chronic rotator cuff tears may describe similar symptoms, including increased pain and arm weakness after a work-related task.
No matter the type of tear, you may also have increased shoulder pain at night that disrupts sleep.
Your age and description of the work accident are the two most critical factors in diagnosing a rotator cuff injury.
Physical Exam
Clinical tests that gauge your pain and reaction when the doctor places your arm in different ranges of shoulder motion or offers resistance predict if you have a torn rotator cuff.
Standard tests to assess work-related rotator cuff injury include the following:
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- Jobe test: This exam evaluates the supraspinatus muscle.
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- Hawkins test
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- Drop-arm test
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- Impingement sign
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- Hornblower’s test: This test evaluates the teres minor muscle.
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- Lateral rotation against resistance: This test evaluates the infraspinatus.
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- Liftoff test: This test evaluates the subscapularis.
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- Bear-hug test: This exam evaluates the subscapularis.
Diagnostic Tests
Many orthopedic surgeons can diagnose a torn rotator cuff based on the physical examination and range of motion testing.
However, you will likely undergo one or more imaging tests to confirm the diagnosis and exclude other injuries.
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- X-rays rarely show rotator cuff tears. But you will likely have one because these tests can exclude fractures of bones in the shoulder and show inflammation.
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- MRI or CT scan are the tests most often used to define the type of rotator cuff tear you have. An MRI can also show whether you have tendon retraction and muscle atrophy, key factors when planning rotator cuff repair surgery. This is why MRI is the gold standard for assessing rotator cuff injury.
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- Ultrasound can show rotator cuff pathology with dynamic movements.
In addition, your doctor may perform a diagnostic arthroscopy to evaluate the rotator cuff and other shoulder structures after an acute occupational injury.
Treatment for a Torn Rotator Cuff
A rotator cuff tear cannot heal on its own.
Those with partial-thickness tears will likely start with conservative treatment.
Conservative treatment includes rest, ice, high-dose nonsteroidal inflammatory drugs (NSAIDs), physical therapy, and corticosteroid injections into the subacromial space. Your doctor should avoid injecting the rotator cuff tendon directly, as this may cause weakness or rupture.
Conservative treatment and rehabilitation aim to decrease pain and reduce stress on the tendon or muscle to prevent further tearing or degeneration.
If conservative treatment does not relieve your pain and improve function, or if you have a complete tear, you may need shoulder surgery to repair the rotator cuff.
Common rotator cuff surgeries include:
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- Debridement: Cleaning a partial tear by removing the ragged edges of the muscle or tendon and inflamed soft tissue.
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- Open repair of the rotator cuff requires partial detachment of your deltoid muscle.
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- Mini-open repair of the rotator cuff
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- Arthroscopic repair of the rotator cuff may include debridement or subacromial depression (removal of part of the acromion) to reduce the likelihood of future tears.
Those of you who decide not to undergo surgery for your rotator cuff tear may try to manage your symptoms with activity modification, steroid injections, stretching, and other types of rehabilitation.
How Long Will Reaching Maximum Medical Improvement (MMI) for a Rotator Cuff Tear Take?
The time it takes for your torn rotator cuff to stabilize and treatment to plateau orthopedically depends on the size of the tear, your pre-injury general health, and complications.
Generally, reaching MMI for rotator cuff injuries treated conservatively will take three to six months.
If you need surgery for a torn rotator cuff, the time to reach MMI often extends to 10 to 15 months.
Reaching MMI is one of the times workers comp may offer to settle.
What is the Average Workers Comp Settlement Amount for a Rotator Cuff Tear?
In my experience, $50,000 to $75,000 is the starting point for a work-related rotator cuff tear settlement.
This settlement range increases to $75,000 to $145,000 or more if you have complications from a rotator cuff repair or also hurt your biceps tendon or neck in the same accident.
Top Seven Factors Affecting the Workers Comp Settlement Amount for a Rotator Cuff Tear
This section explains seven questions to answer before deciding a fair workers compensation settlement amount for a torn rotator cuff.
How large is the rotator cuff tear?
Small tears are more likely to respond to conservative treatment or surgery, allowing you to return to work sooner and have less permanent impairment.
In contrast, large tears have worse outcomes, even with rotator cuff repair. Indeed, large and massive rotator cuff repairs have high failure rates.
You must know the rotator cuff tear size to include exact estimates of permanent impairment and disability from work in your settlement demand.
Did you injure the rotator cuff on your dominant side?
Other factors kept equal, a torn rotator cuff on the dominant side is more likely to lead to a higher settlement because it will be more difficult to return to work if you cannot use your dominant arm.
Do you need rotator cuff repair surgery?
Needing surgery for a torn rotator cuff increases the potential settlement value in two ways.
First, surgery is expensive.
In my experience, workers comp insurers must pay $15,000 to $40,000 or more for rotator cuff repair surgery, including follow-up treatment.
Second, the data shows workers’ compensation patients are susceptible to poor outcomes after primary rotator cuff repair, even with small tears.
Poor outcomes result in more time out of work, permanent restrictions that prevent a return to your pre-injury job, or the need for revision rotator cuff surgery, which increases medical expenses for the injury.
How long will the rotator cuff tear cause days away from work based on your pre-injury job duties?
You will likely have work restrictions between the industrial accident and reaching MMI. For example, your doctor may limit the use of the injured shoulder or tell you to limit the frequency and amount of lifting, pushing, or pulling after a torn rotator cuff.
You may even have permanent work restrictions after reaching MMI and completing a functional capacity evaluation (FCE).
In my experience, rotator cuff injuries requiring surgery result in three to six months of total disability from work, followed by at least another three to six months of light-duty restrictions.
The experience of injured workers I have represented is consistent with one study I reviewed. The study involved primarily middle-aged men with a history of rotator cuff tear in occupations involving manual labor. Nearly half never returned to full-duty work after a torn rotator cuff. And those who returned to work took more than six months (on average).
You may qualify for temporary total (TTD) or partial disability (TPD) benefits if your employer cannot accommodate restrictions related to the rotator cuff tear. Your employer’s inability to find a job you can do will increase your case’s settlement value.
This situation often occurs when the pre-injury job involves heavy, physically demanding work. Few employers will find a lighter job for you to transition into because of permanent restrictions from a torn rotator cuff.
What is your permanent impairment rating for the rotator cuff tear?
In addition to an FCE, your doctor may prescribe a permanent impairment evaluation when you reach MMI for a torn rotator cuff.
This evaluation calculates a permanent impairment rating, which decides compensation for permanent loss of use of the upper extremity due to the rotator cuff tear. Permanent partial disability (PPD) is the name for this benefit.
Generally, you will receive a PPD rating of 5% to 25% to the upper extremity for a rotator cuff tear, depending on which formula the permanency examiner uses.
Full-thickness tears requiring surgery and leaving residual pain and decreased range of motion will fall on the higher end of this impairment range. Partial-thickness tears treated conservatively will usually result in lower rotator cuff impairment ratings.
You can negotiate a higher settlement for a rotator cuff tear if you have a higher upper extremity impairment rating.
Did you suffer a biceps tendon tear or cervical spine injury in the same accident that tore your rotator cuff?
I have negotiated countless workers compensation settlements for rotator cuff tears and biceps tendon tears occurring in the same workplace incident.
Further, the trauma that tore your rotator cuff may cause a SLAP tear or neck pain radiating into your arms (cervical radiculopathy) and worsen pre-existing degenerative disc disease of the cervical spine.
These added injuries increase the potential settlement amount for a torn rotator cuff claim.
Did you develop complications?
A rotator cuff tear increases the chances of developing post-traumatic arthritis, frozen shoulder (adhesive capsulitis), osteoporosis of the humerus, or chronic impingement syndrome.
In addition, you may suffer rotator cuff retearing when you return to work or while performing activities of daily living (ADLs).
Each of these medical impairments requires treatment and can limit your capabilities. Include this possibility in your rotator cuff settlement demand.
Our Workers Comp Lawyers Have Obtained Millions of Dollars in Rotator Cuff Tear Settlements for Injured Employees
Knowing that rotator cuff injuries happen to others will not make you feel better when you face lost wages, medical bills, and permanent disability.
But our familiarity with these injuries can help you negotiate a fair rotator cuff settlement.
Call now to start. See why other attorneys and past clients regularly name us some of Virginia’s best injury lawyers.
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