Anatomy of the shoulder.

One of the most complex joints in the body, the shoulder provides nearly 360 degrees of motion. This high range of motion is, however, offset by the decreased stability of the joint which is prone to dislocation and traumatic injury.

Not surprisingly, complex parts of the body often attract great scientific inquiry. Interestingly, the evolutionary transformation of the shoulder has been an area of significant academic research. Here, for example, in joint research between the University of California and Harvard University it was found that a sustained shift occurred in the shape of the shoulder during the evolution from an African ape-like ancestor to our modern genus, Homo. This period of evolution involved a long and gradual move out of trees and increased reliance on tools as our ancient ancestors became more terrestrial. Charles Darwin was fascinated by this particular evolutionary journey and once remarked that “apes are quite unable, as I have myself seen, to throw a stone with precision”. It has been argued that the modern human shoulder was of critical importance in human evolution as the ability to throw helped early humans to win scare resources from other competing hominids.

The earliest modern studies into the anatomy of the shoulder began in the 1880’s. In much cited research, published in the American Journal of Physical Medicine & Rehabilitation, these early studies by Cleland (1881), Cathcart (1884) and Braune and Fischer (1888) focused on how the humerus, scapula and clavicle are able to move in a smooth and integrated motion. Much contemporary research has focused on the bio-mechanical components of the shoulder, their relationship with anatomical structures surrounding the shoulder and how treatment can best create a bio-mechanically favorable environment for shoulder repair.          

The shoulder is one of the most freely moveable components in the human body. This movement is enabled by the articulation of the glenohumeral joint. The shoulder provides much of the strength and function of the upper body allowing us to lift, push and pull and provide a stable base for the many actions of the arms and hands.

The shoulder is a complex structure of bones, joints and ligaments, the shoulder capsule, rotator cuff, subacromial bursa, muscles, arteries, veins, nerves and more specifically the median, radial and ulnar nerves.        

Shoulder Bones

• Head of the humerus.
• Scapula.
• Clavicle or collarbone.
• Acromion or scapula roof.
• The humerus and the scapula fit together to form a ball and socket joint.
  

Shoulder Joints and Ligaments

• Acromioclavicular (AC) joint which is formed by the acromion or the roof of the scapula.
• Sternoclavicular (SC) joint which is located under the center of the throat where the clavicle bones meet and form the breastbone.
• Glenohumeral joint is the main joint of the shoulder and is formed by the humerus fitting into the clavicle.

Shoulder Capsule

• The shoulder capsule comprises of strong and flexible tissue and the glenohumeral ligaments.
• These tissues and ligaments encase the shoulder joint and keep the humerus attached to the scapula.   

Rotator Cuff

• Is a group of four muscles (subscapularis, infraspinatus, supraspinatus and teres minor) that help to stabilise the glenohumeral joint and the connection of the humerus.
• The rotator cuff muscles are key to the shoulder’s range of movement as they facilitate abduction, medial rotation and lateral rotation.

Subacromial Bursa

• Is a fluid filled sac enclosed by a robust membrane which helps to prevent friction between tendon and bones during motion.
• The subacromial bursa separates the supraspinatus tendon from the acromion, the coracoid and the coraco-acromial ligament.

Shoulder Muscles

• The shoulder muscles help to anchor the elements forming the shoulder joint.
• The deltoid, coracobrachialis, serratus anterior, pectoralis major and pectoralis minor muscles assist the scapula to adduct and the humerus to move anteriorly.
• The trapezius, romboid major and levator scapulae muscles enable the scapula to rise.

Shoulder injuries – what are they and how do they occur?

Shoulder injuries tend to fall into two distinct categories. These are injuries caused by overuse and injuries caused by a traumatic event or accident.

Shoulder Injuries Caused by Overuse

Shoulder injuries involving overuse often include tendonitis, bursitis, frozen shoulder and degenerative or post traumatic arthritis. Many of these injuries are caused by workers having to complete repetitive overhead tasks where tools, equipment, materials or stock have to be lifted, held, positioned, maneuvered or moved in or into overhead positions. These actions place great strain on the shoulder and when they are carried out repetitively the likelihood of an overuse type shoulder injury increase dramatically. This type of injury occurs in many Western Australian workplaces and commonly result in workplace compensation claims. Scaffolders, plasterers, painters, builders, carpenters, electricians, brick layers, boiler makers, trades assistants, chefs and cooks, retail workers and mechanics frequently suffer shoulder overuse injuries due to having to repetitively complete tasks overhead.                        

Another common type of shoulder overuse injury is caused by tasks that involve the worker having to complete repetitive strenuous activities. These activities involve having to regularly carry or maneuver heavy articles, having to push, pull, drag or lever heavy items or having to regularly use tools like spades, shovels, picks, axes, crowbars, rakes, mops or brooms. Workers that suffer these injuries often include removalists, landscapers, demolition workers, plumbers, labourers, stone masons, heavy diesel mechanics, farm hands, process operators, cleaners, store people, baggage handlers, nurses, disability support workers, truck drivers and delivery drivers.

Shoulder Injuries Caused by Trauma

Traumatic shoulder injuries are classified as contusions, dislocations, fractures, separation, subluxation and impingement. These injuries often occur in car crashes, work accidents and accidents in public places where a sudden and unexpected fall or slip occurs. In road accidents shoulder injuries often occur in side on and head on collisions. Here, extreme force either propels the victim into parts of a vehicle or propels parts of the vehicle, or parts of another vehicle or other outside objects like trees or road barriers into the victim. Motorcyclists, cyclists and pedestrians often suffer traumatic shoulder injuries due to collisions with cars that cause them to fall to the ground with great force. In a significant American study that analysed 54,076 cases of traumatic shoulder injury 68.5% of these accidents were caused by road accidents. Motorbike, bicycle and pedestrian accidents were particularly prevalent in this study.      

As specialist work injury lawyers we unfortunately see a very large number of traumatic shoulder injuries occur in West Australian workplaces. These types of work injuries often occur when workers fall from heights, are hit by operating plant or mobile machinery, strain to lift a heavy object, attempt to stop an item from falling or moving, have to brace themselves to avoid a fall or potential hazard or have to lift or restrain a patient or inmate.         

Traumatic shoulder injuries also often occur in public or private places where the injured person slips, trips or falls. In many cases these accidents involve the victim slipping on wet floors or food or drink in grocery stores, restaurants and shopping centres. Another common scenario here is where the victim trips or falls due to stairs, curbs, ramps, handrails or traffic humps or stops that have not been constructed in accordance with required safety standards.        

In extremely comprehensive American research it was found that the most common traumatic shoulder injuries included:        

• Shoulder dislocation and associated shoulder instability    
• Rotator cuff tears
• Proximal humerus fractures
• Humeral shaft fractures
• Glenoid and other scapula fractures
• Clavicle fractures
• Acromioclavicular joint injuries
• Sternoclavicular joint injury
• Floating shoulder
  

Shoulder injuries – how are they treated?

Given the shoulder’s complex anatomy and the number of different injuries that can occur, treatment for such injuries can be varied.  

Often minor shoulder injuries can be effectively treated with rest, pain relief and physical therapies like physiotherapy, chiropractic threapy, hydrotherapy and massage.    

More traumatic shoulder injuries can require surgery to repair ligaments, tendons and muscles, anchor broken bones, clear nerve impingement and strengthen joints. In the most serious cases a full shoulder replacement may be required.   

Compensation claims for shoulder injuries.

Work Accidents

If you suffer a shoulder injury at work it is important to understand that you will most likely be able to make a workers’ compensation claim. The West Australian workers’ compensation system provides a range of protections to injured workers and is based on a ‘no-fault’ principle. The operation of this principle ensures that even if you were at fault and caused your work accident you are still entitled to claim for workers’ compensation. You are also able to make a workers’ compensation claim if you work part-time or causally or if you have been terminated or made redundant after the accident.

Shoulder injuries and particularly shoulder dislocations have a very high rate of re-occurrence. Here, for example, a long-term study of 1,324 people who had suffered a shoulder dislocation found that 39% of these patients reported another dislocation or shoulder injury. Shoulder injuries are also notorious for requiring meticulous diagnosis, highly skilled surgical intervention, a cautious rehabilitation program and a very careful return to work. Often workers with shoulder injuries are rushed back to work by the insurer, employer or rehabilitation agent. This can have a disastrous impact on the injury and often result in the original injury re-occurring, other injuries being suffered or the injury becoming a chronic and ongoing complaint. Given the complications that workplace shoulder injuries can cause it is very important that you obtain advice from an expert work injury lawyer as soon after the accident as possible.                 

Road Accidents

If you suffer a shoulder injury in a road accident you may be able to make a compensation claim for your damages. This applies if you were injured as a driver, passenger, pedestrian or cyclist. It is important to note that you may be able to make a claim even if you contributed to your own accident.  

Accidents in Private or Public Places

A shoulder injury that occurs in a public or private place may enable the victim to make a compensation claim on the insurance policy of the proprietor or owner of the property or premises. For a public liability claim to be successful it must be established that the owner or proprietor should have provided a duty of care and but did not do so. It must also be proved that the owner or proprietor’s negligence caused the accident.

Each of these claim types involve particular legislation and legal processes specific to Western Australia. It is therefore critical that you get legal support from an expert injury lawyer based in Western Australia.    

Shoulder injuries - recent legal decisions.

The case of Hollier v Bettesworth [2017] WADC 108 clearly illustrates how a traumatic shoulder injury can have an extremely negative impact on one’s home and work life. The plaintiff was riding a Harley-Davidson motorcycle on Abernethy Road in Byford and was approaching the South West Highway intersection. The defendant drove their car onto the road without giving way and the plaintiff's motorcycle collided with the car. The accident caused Ms Hollier to be thrown onto the road where she suffered a dislocated shoulder and soft tissue damage to her neck, nose and chin. The medical evidence presented to the court confirmed that the plaintiff was unfit for her pre-accident work as an education assistant, since the accident and was likely to remain so indefinitely. After the accident and associated surgical treatment the plaintiff struggled to complete basic domestic tasks that required her to raise her right arm. Despite Ms Hollier earning a modest pre-accident income, being a poor witness and the plaintiff’s case being poorly prepared Judge Staude DCJ awarded Ms Hollier the following damages: 

Non-pecuniary loss:                                        $81,300

Past loss of earning capacity:                         $92,000

Interest on past loss of earning capacity:         $5,900

Past loss of superannuation:                            $8,800

Interest on past loss of superannuation:             $560

Future loss of earning capacity:                   $131,400

Future loss of superannuation:                       $14,610

Past services (paid):                                         $4,200

Interest on past services (paid):                          $420

Past gratuitous services:                                $10,160

Interest on past gratuitous services:                 $1,710

Future gratuitous services:                              $13,000

Future treatment expenses:                             $10,000

TOTAL:                                                          $374,060

Judge Staude DCJ also noted that Ms Hollier had previously received $35,965.86 as an advanced compensation payment of lost earnings.

Separovic Injury Lawyers – how can we help you?

The shoulder is extremely susceptible to injury and effective diagnosis and treatment can be difficult to obtain. Successful treatment, rehabilitation and return to work outcomes involving shoulder injuries are often compromised by the victim being rushed back to work before they have reached maximum medical improvement. Over the years Separovic Injury Lawyers have successfully represented hundreds of compensation claimants with shoulder injuries. We treat shoulder injuries very seriously as we are acutely aware of the dangers they pose to a client’s ability to successfully return to a normal home and work life. Compensation claims involving shoulder injuries can become complex legal cases particularly where there is a re-occurrence of the original injury or the development of a secondary condition involving the other shoulder. If you suffer a shoulder injury at work, in a road accident or in a public place it is crucial that you obtain legal advice from a specialist injury solicitor based in Western Australia. What’s more you need to find an injury lawyer who understands how people suffering shoulder injuries need to be supported through the treatment, rehabilitation and return to work phases of their compensation claims.    

Separovic Injury Lawyers understand exactly how debilitating and restrictive shoulder injuries can be and how critical it is that the injury is properly treated. It is vital that the injured person is given every possible opportunity to make a successful recovery. With shoulder injuries the stakes are very high - imagine never being able to hang out the washing again or wash your hair or put on a top without someone’s assistance. Don’t take a chance on your shoulder injury and get clear information on exactly what treatment, rehabilitation and support may be available to you. You will need an expert West Australian accident lawyer to tell you exactly what compensation you may be able to win, how long the claim process is and how to negotiate the best lump sum payment. Get on top of the risks posed by a shoulder injury and call us now on 9227 1000 for free and down to earth legal advice.