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By focusing on arthroscopic rotator cuff repair in a worker’s compensation patient population that are without personal injuries, previous ipsi-lateral shoulder injury, any concomitant pathologies or being federal employees, the rate of return-to-work (RTW) can be better isolated as an outcome of the surgery. RTW rate for a consecutive 50 patient cohort was 98% with 58% achieving full duty. A single patient with a frozen shoulder was unable to return to work at any level. These RTW rates contrast with several previous studies that reported significantly lower RTW rates for workers with compensation than workers without compensation. All but three patients improved their UCLA scores after the repair.

Work-related aspects of carpal tunnel syndrome (CTS) have engendered considerable research and debate resulting from its frequent occurrence in the population along with the cost of addressing it in the work place. Some studies have gone so far as to deny that CTS has any relation to work exposure, rather it largely results from predisposition of individuals. As such, the condition is non compensable leaving workers without any benefits due to their condition. This is despite the fact that high force and repetition of hand movements have been identified as CTS causes for years. As computer use has become endemic in recent years, several studies have concluded that the resulting exposures are insufficient to attribute any occupational causation to it. Rather, it is argued that genetic or worker pre-existing conditions are responsible for CTS development. This review analyses the existing literature to assess occupational carpal tunnel causation arising out of exposure to highly manual and repetitive jobs as well as intense exposure to keyboarding. We believe the literature supports a strong causal connection to carpal tunnel causation when exposed to highly repetitive and forceful jobs and a causal connection to keyboarding when the exposure dose is sufficient.

Evidence for work-related exposure as a cause of shoulder tendinopathy is updated. Previous studies indicated that forceful movements combined with hands above head increases the likelihood of shoulder disorders. Hands above the shoulder and arm flexion or abduction at greater than 60° combined with forceful or repetitious motions results in significantly increased occurrence of shoulder tendinopathy. Shoulder disease is multifactorial with genetics, age, and bodyweight correlated with increased occurrence though they are minor factors for young workers. Normal aging of the rotator cuff may underlie much of shoulder disease for individuals older than 60 thereby presenting a complication for the determination of work-related rotator cuff tears in this group. In contrast, there is sufficient evidence to support work-related musculoskeletal disorders of the shoulder in younger individuals who have not undergone the aging processes. Numerous reviews along with individual cross sectional and longitudinal studies conclude that shoulder tendinopathy can result from work-related exposures based on the odds and relative risks of occurrence in a working population compared to a group that has not been similarly exposed to comparable manual effort.

After carpal tunnel syndrome, cubital tunnel syndrome (CuTS) is the 2 nd most frequent upper extremity musculoskeletal disorder resulting from ulnar nerve entrapment at the elbow. Insurance companies often deny that this condition results from exposure at work labeling it idiopathic despite numerous studies that support a causal relation between high repetitions and force the occurrence and CuTS. Odds Ratios for work-related CuTS are significantly higher than would be expected if there were no work factors associated with the condition. Reviews of the literature by several noteworthy scientific organizations support workrelatedness of CuTS. While additional study of the work-relatedness of CuTS is frequently suggested, significant support for this relation already exists.

Comparison of a novel triple-row (NTR) rotator cuff repair (RCR) was made to single row (SR) and double row (DR) repairs as measured by gap formation, Ultimate Failure Load (UFL), and mode of failure. Porcine humeri were divided into three groups of forty and the infraspinatus tendons were completely released and then repaired using generic (PEEK) anchors. Biomechanical testing of RCRs consisted of 3500 cycles of a load varied from 10 to 180 Newtons (N). Gap size at all cycle counts was significantly larger for SR and DR than NTR RCRs. 84% of NTR repairs completed the 3500 cycle test versus 66% of DR and 61% of SR repairs. The tendon pulled from the sutures 60%, 49% and 33% of the time for SR, DR and NTR RCRs respectively. UFLs were 464 N for the NTR repairs, 394 N for DR and 414 N for SR repairs. In summary, NTR repairs resulted in smaller gap formation, higher UFLs, and fewer instances of tendons tearing at the sutures than SR or DR repairs. Results of NTR repairs demonstrate that the tendon footprint is securely restored with small gap formation for the range of forces that a shoulder will be subjected to in normal use.