Orthopaedic Research, Alberta Health Services-Capital Health Region, 1F1.52, 8440 - 112 Street, Edmonton, Alberta T6G 2B7, Canada.
Occup Med (Lond). 2011 Dec;61(8):556-62. doi: 10.1093/occmed/kqr068. Epub 2011 Oct 19.
The burden imposed by workplace rotator cuff (RC) injuries has been reasonably defined. However, literature associated with the demographic characteristics and 'best practices' to manage such injuries among workers' compensation (WC) patients is scant.
To consolidate the existing literature on full-thickness RC tears among WC patients. Subject, shoulder and injury characteristics were examined to determine if and how WC recipients may differ from their non-compensable counterparts.
A systematic search (databases, clinical practice guideline web resources, conference proceedings and reference lists) revealed 450 abstracts. Two blinded reviewers independently assessed abstracts for inclusion. Sixty abstracts were subsequently included in a blinded full manuscript review. Seventeen of these manuscripts (3.8% of sample; 11 intervention and 6 determinant) were included in the present review.
Previous studies demonstrate that operative interventions are appropriate for full-thickness RC tears as substantial gains in range of motion, strength and quality of life were witnessed within the first post-operative year. Non-operative interventions, including workplace-based work hardening, physical therapy and the use of an early referral system, were shown to improve outcomes. Conflicting results exist with respect to determinants such as age and sex. Importantly, WC patients had consistently poorer outcomes than non-WC patients.
Our results show that although WC patients experience substantial benefits from various treatments for full-thickness RC tears, disparities exist between them and their non-WC counterparts. The lack of WC-specific literature limited our results. Larger studies, particularly ones comparing WC patients with their non-compensable counterparts, are crucial to allow for future evidence-based recommendations.
工作场所肩袖（RC）损伤带来的负担已经得到了合理的定义。然而，关于工人赔偿（WC）患者中 RC 损伤的人口统计学特征和“最佳实践”的文献却很少。
整合有关 WC 患者全层 RC 撕裂的现有文献。检查受试者、肩部和损伤特征，以确定 WC 接受者是否以及如何与非赔偿者有所不同。
系统搜索（数据库、临床实践指南网络资源、会议记录和参考文献列表）显示了 450 篇摘要。两名盲审员独立评估摘要以确定是否符合纳入标准。随后有 60 篇摘要进行了盲法全文献审查。其中 17 篇（占样本的 3.8%；11 篇干预和 6 篇决定因素）的文献纳入本综述。
先前的研究表明，手术干预对全层 RC 撕裂是合适的，因为在术后第一年，运动范围、力量和生活质量都有显著提高。非手术干预，包括基于工作场所的工作强化、物理治疗和早期转介系统的使用，都显示出改善结果。年龄和性别等决定因素的结果存在冲突。重要的是，WC 患者的结局始终不如非 WC 患者。
我们的结果表明，尽管 WC 患者从各种全层 RC 撕裂治疗中获益匪浅，但他们与非 WC 患者之间存在差异。缺乏专门针对 WC 的文献限制了我们的结果。更大的研究，特别是比较 WC 患者和无赔偿对应者的研究，对于未来基于证据的建议至关重要。
