Shoulder injuries

Three things compound.

Check your operative report for one procedure: distal clavicle resection — also written as “Mumford,” “distal clavicle excision,” or “co-planing.” It carries a fixed 10% upper extremity impairment, combined with any motion loss on top of it, and is frequently the largest single component of a shoulder rating. It is routinely omitted, because surgeons often perform it at the same time as a cuff repair and it gets buried in the middle of the operative report.

And if you had a reverse replacement: reverse total shoulder arthroplasty was not in general use when the Fifth Edition of the Guides was published, and the text does not address it. The procedure deliberately trades motion for stability — so rating it on motion alone badly understates what happened. This is one of the cleanest arguments in California for a physician to give the strict rating, explain why it fails, and provide an alternate rating under Almaraz/GuzmanAlmaraz/Guzman The doctrine permitting a physician to depart from the strict AMA rating where it does not accurately reflect the impairment, using another method inside the “four corners” of the Guides.. If you were rated on range of motion alone, that is worth a second look.

The shoulder guideline was replaced effective January 2, 2026. Anything written about California shoulder treatment standards before that date describes a guideline that no longer applies.

The epidemiology is real. Asymptomatic cuff tears genuinely are common with age, and they are frequently bilateral. But the literature cuts both ways, and this is the strongest single argument in a shoulder case. If more than half of people over sixty have asymptomatic cuff tears and are not disabled, then the tear by itself does not produce disability. What produced disability was the industrial event that converted an asymptomatic tear into a symptomatic, function-limiting one. Apportionment is to disability, not to pathology.

WHAT THE DEFENSE EVALUATOR WRITES

“MRI of the uninjured shoulder demonstrates a partial-thickness tear. The literature establishes that the prevalence of asymptomatic rotator cuff tears exceeds 50% in individuals over 60. The applicant’s tear is degenerative rather than traumatic. I apportion 60% to pre-existing degenerative disease.”

Shoulder cumulative traumaCT — Cumulative trauma Injury from repeated exposure over time. The largest injury category in California and the least claimed. comes from sustained or repeated work at or above shoulder height, and from load-bearing on a raised arm: warehouse order-selectors and stockers reaching to upper racks; painters, drywall finishers, electricians, HVAC and overhead installers; auto mechanics working under a lift; grocery clerks stocking upper shelves; nurses, CNAs, and caregivers lifting and repositioning patients; hotel housekeepers — bed-making, high dusting, curtains and linen; assembly and packing lines with elevated conveyors; longshore and baggage handling; hairstylists and barbers; firefighters and law enforcement.

The mechanism is repeated compression of the supraspinatus tendon during elevation, producing degeneration inside the tendon and eventually a partial and then full-thickness tear — with secondary arthritis at the AC joint from repeated load.

If your shoulder wore out over years rather than in one moment, that is a cumulative trauma claim.

• Was the upper extremity number converted? — 100% upper extremity equals 60% whole person. 20% UE is 12% WP.
• Search the operative report for four phrases — Mumford · distal clavicle resection · distal clavicle excision · co-planing. Any of them means a fixed 10% upper extremity that belongs in your rating.
• If you had a reverse replacement, was it rated on motion alone? — The Guides do not address the procedure. There is a recognized route to a more accurate rating.
• Does the apportionment opinion do more than cite a study? — Prior records reviewed, a reason for the percentage, and the imaging signs of chronicity actually present.