Recently I represented a man in his fifties who was a union laborer for a large package delivery service. His injury occurred in an unexpected manner when a piece of moving equipment he was working with gave way and he suffered an injury to his rotator cuff, as well as an aggravation of pre-existing osteoarthritis in his shoulder. After conservative treatment, and a surgery to repair his rotator cuff, the client ultimately needed a shoulder replacement.
According to the Agency for Healthcare Research and Quality about 53,000 people in the U.S. have shoulder replacement surgery each year. Although, this number is dwarfed by the 900,000 people who have knee and hip replacement annually in the United States, shoulder replacement is becoming a feasible option to restore quality of life to those that have suffered shoulder injuries.
There are several conditions that will call for the need for a shoulder replacement. In the field of workers compensation the conditions that we experience the most are an aggravation of osteoarthritis (also known as Degenerative Joint Disease), severe fractures and rotator cuff injuries.
Osteoarthritis is an aged related, degenerative problem that occurs most frequently in individuals over 50 years of age. In workers compensation practice we will often see a worker aggravate this condition, which is usually caused by “wear and tear,” when they are injured on the job. Severe fractures can occur in a machinery accident, automobile accident or from a fall on the job site. Finally, rotator cuff tears can lead to arthritis and damage to the cartilage of the shoulder joint necessitating replacement.
The injured worker who undergoes a shoulder replacement can expect to be placed in an immobilizer for 5-7 days. According to the Medical Disability Advisor, those with replacements can expect to have up to 24 physical or occupational therapy visits in the 12 weeks following the replacement. From experience, I have represented workers that required even more physical therapy that, and many workers will supplement their PT visits with home exercises.
Shoulder replacement surgery typically costs $7,000 -$21,000 or more, depending on the type of implants used and the hospital in which the procedure is performed. According to a 2007 study by researchers from Johns Hopkins University, total costs, on average, are $10,351. A more recent report by Zimmer, a manufacturer of orthopedic prosthetics, notes that in 2011 Medicare typically paid between $10,919 and $13,413 for total, partial and reverse shoulder replacements.
Workers, such as construction workers and laborers, whose jobs require heavy lifting or strenuous activities involving the arm, will have permanent restrictions placed on them by their surgeons. Light duty and sedentary workers may be able to enjoy a full return to work following their rehabilitation
Very often, due in large part to the associated costs of the procedure and the potential of long term wage loss, insurance companies may try to avoid paying for shoulder replacement or may challenge the need for the shoulder replacement. To avoid this uncertainly, you should speak to an experienced workers compensation attorney immediately.