Essentials in Return to Work Issues: A Tale of Two Shoulders

Abstract

Musculoskeletal disorders are common in the workplace and often respond to first-aid treatment. Worker education combined with precise management of precautionary restrictions by occupational health nurses can decrease employees’ recovery time and lower risk of complications.

Employee A was on his hands and knees to check a tank. When he “pushed off” the ground with his hands, he felt a sharp pain in his shoulder that did not resolve. Employee B was walking along a fence line when he caught his foot on a rock, slipped and fell, catching himself with his left arm and shoulder. He felt a sudden, severe pain in his shoulder that did not resolve. Both workers had immediate evaluations of similar clinical presentations; they had negative X-rays and were placed on “precautionary restrictions” (i.e., allowed by Occupational Safety and Health Administration [OSHA] with certain injuries and proper documentation; does not require OSHA log entry; OSHA, n.d.), pending further evaluation and treatment. Anti-inflammatory over-the-counter medications were prescribed for both injured employees along with instructions to apply ice to the affected shoulder 3 times a day. Both workers received simple massage (also not recordable) and, not surprisingly, both workers reported significant pain during the first 2 weeks after their injuries. Both men had similar activity levels and health at the time of their injuries and both injuries were managed aggressively. Both gentlemen worked for the same company and were offered modified duty while they healed.

However, the two workers differed in their attitudes toward surgical intervention, acceptance of various treatment modalities, and pain tolerance. Employee A elected to have surgery 5 weeks after he was injured; Employee B opted for nonsurgical treatment (e.g., ice and heat, over-the-counter medications, simple massage, and routine stretching) while his shoulder healed. Employee A returned to work at full duty a little over 8 months after injury and said he would never have had surgery if he had known how painful the postoperative period would be. Employee B’s preventive restrictions were lifted within 2 weeks, he was careful how he used his arm and shoulder at work, and he felt almost fully recovered 6 weeks after the injury. He was delighted he did not require surgery (L. Price, personal communication, January 16, 2016).

Workers’ attitudes cannot be underestimated. Occupational health nurses can assist injured workers to understand surgical procedures and recovery expectations, including postoperative pain. Simple modalities such as mild sleep agents, gentle stretching, and careful movement may result in less treatment and less complicated recovery. Occupational health nurses should educate workers about treatment options and offer encouragement and support as they determine the best course of action in consultation with their health care providers.

Occupational health nurses should assess workers and the work environment. They can also educate workers and their supervisors about workplace accommodations after injury to increase the likelihood of successful return to work. Making adjustments in the workplace, limiting physical job demands, and encouraging workers to take frequent short breaks can contribute to early successful return to work (Dellve, Fallman, & Ahlstrom, 2016). Hoefsmit, Houkes, and Nijhuis (2012) found that employees who return to work within the first 6 weeks after injury, have consistent contact with their employers (often the occupational health nurse), and gradually increase their workforce participation to full duty were most successful.

Occupational health nurses should tailor interventions to meet the needs of individual workers. They should also contact injured workers who are recuperating at home at least weekly to express concern and offer assistance as needed. After returning to work, workers may need ongoing monitoring to determine whether any adjustments to the work situation are necessary. Collaboration with employees and managers to achieve successful return to work is a win for the employee and the company.