Timothy S. Ackerman, D.O. Arlington Orthopedics Harrisburg, PA

Transcription

1 Timothy S. Ackerman, D.O. Arlington Orthopedics Harrisburg, PA

2 Introduction We are reminded that the U.S. Population is growing older as the youngest of baby boomers will be turning 50 in Greatest percent increase = older individuals Longer life expectancies Several decades of lower birth rates Entrance of baby boomers > 50 years old

3 Introduction AARP 2003: 80% of boomers plan on working after retirement age U.S. Bureau of Labor Statistics: Percent of workers who were % in % in % in 2012 (31 million workers) 40 million workers expected by 2016

4 Introduction Most employers in the future will need to deal with an older work force Current workers electing to work beyond traditional retirement age Lack of readily available younger workers Relatively large and available labor force of older workers Issues Controlling workers compensation costs Accommodating return-to-work restrictions Prevention of work-related injuries

5 Both Sides of the Coin Older workers Report fewer injuries Less likely to return to work Have more lost time days For Supervisors and Employees Perceived as less productive (studies show not true) Not seen as flexible or as able to learn new skills Better attendance and less turnover

6 Aging : Musculoskeletal System Loss of lean muscle mass 40% decline between ages Reduction in flexibility Reduced range of motion Reduced ability to reach or bend Reduction of bone density Osteoporosis Increased stiffness, arthritic changes, tendon thinning Decreased total capacity Muscles tend to require a longer time to recover

7 Aging: Musculoskeletal System Osteoarthritis, cumulative trauma and aging All interact Difficult to discern what is normal and what is work-related Hip and Knee Arthritis: Diagnosable in 28% of humans over 55 39% of humans over 65 Shoulder Rotator Cuff Tears: Asymptomatic Shoulders in people >60 28% full thickness tears : 26% partial thickness tears

8 Young 55 vs Old 55

9 PA Work Comp Law Pennsylvania Workers Compensation Law Employers must provide medical care and wage benefits for aggravation of a pre-existing condition Previous Injury: shoulder, knee, back, carpal tunnel Existing Medical Condition: Arthritis, degenerative disc disease

10 PA Work Comp Law Pre-existing Condition Does NOT have to be related to current employment Genetic disease Incident at a previous job Old sports injury Car accident It does not matter whether or not the employer was aware of a previous condition. The new injury claim MUST be work-related

11 Knee

12 Degenerative Arthritis

13 Articular Cartilage Avascular No Blood Supply Born with life s supply

14 Work-related Injuries Work-related injuries can occur to any one of the structures within the knee. Articular Cartilage Any prior complaints / injury Mechanism of injury Current symptoms Treatment

15 Articular Cartilage Scenario 1: No previous arthritis tx Work related injury to the knee New clicking, catching, and popping Pain with walking, kneeling and squatting + signs of arthritis on xray and MRI Tx: injection, PT, NSAIDS, activity modification If tx fails = arthroscopy Expect full recovery a few months post op

16 Articular Cartilage Scenario 2: History of arthritis with treatments Flare-ups Injury with a twist of knee moving heavy equipment Complains of increased pain and soreness

17 Meniscus Another type of cartilage Shock absorber Twisting, squatting Pain, stiffness, swelling Locking, giving way Decreased ROM

18 Meniscus Asymptomatic tears Recent study of 100 patients with unilateral symptoms MRI of bilateral knees 57 had tears 36/57 (63%) had a tear on the contralateral nonsymptomatic knee Difficult to determine what is new and what is not!

19 Shoulder Injuries Complex Joint Four Rotator Cuff Muscles Subscapularis Supraspinatus Infraspinatus Teres Minor

20 Rotator Cuff Tendon tears from bone Partial Tears Heal, stay same, progress Full Tears Acute Traumatic Tear Degenerative Tear

21 Rotator Cuff??? Work-related or degenerative Work-related History No previous shoulder pain Specific injury + MRI Degenerative Low demand job No specific injury Increasing shoulder pain

22 Rotator Cuff Study: 411 volunteers with asymptomatic shoulders 23% incidence of RTC tears in ALL patients 13%: %: %: %: >80

23 Rotator Cuff Rotator Cuff Tears = Normal degenerative attrition How do we know if a patient had a RTC tear before a work-related injury? Small, Medium, some Large tears MRI cannot differentiate Large and Massive Tears MRI fatty degeneration

24 Labral Tears Superior Anterior (Inferior) Posterior

25 Superior Labrum Biceps tendon anchors to the glenoid via the Superior Labrum

26 Anterior Labrum Dislocation Bankart Tear Anterior-inferior

27 Labral Tears and Aging Becomes more brittle Fray and tearing occur

28 Prevention General Safety and Ergonomic Measures Eliminate slips and falls Older workers brittle bone Even flooring Eliminating objects that can contribute to calls Prompt cleaning of spills Concern for ladders and excessive heights

29 Prevention Ergonomic Principles Reduce the physical requirements of work Lifting devices, reconfigure work stations Perform work tasks mid-thigh to mid chest level Performing lifts close to the body Avoid above the shoulder work Eliminate squatting, stooping and kneeling Avoid awkward positioning

30 Thank You