Mr Tan is a 56-year-old bus driver who came to consult me about his right shoulder pain, which had been bothering him for about two months and made it impossible for him to drive for long periods.
He had first gone to a polyclinic, and the primary care physician there referred him to me, as his condition is one that requires treatment to help him cope with the pain. In addition, the management of his condition should seek to minimise the days he takes off work, and facilitate an early return to work.
Incorporating a return-to-work goal as part of the treatment plan may seem like a small thing, but is actually very important.
Work is an important source of individual identity. It is well accepted that prolonged absence from one's normal roles, including absence from work, is detrimental to the individual's physical, psychological and social well-being.
Work not only provides for our daily livelihood requirements, it also adds purpose and meaning to our lives.
Mr Tan was a carpenter from the late 1970s to the 1980s, when there was a housing boom in Singapore and therefore, a lot of carpentry work to be done.
When the demand for housing slowed, Mr Tan decided to be a bus driver for the job security, so that he could continue to provide for his wife and two children. He could not stand not being able to work.
When Mr Tan saw me, he had already been on medical leave for the past month. His company was initially unable to find alternative work placement for him. He was crestfallen and felt useless.
Mr Tan has adhesive capsulitis, or "frozen shoulder" as it is commonly known. This is an inflammatory condition of the shoulder, where the patient suffers from shoulder pain and stiffness, as well as a limited range of motion.
Mr Tan's right shoulder pain had started insidiously. He first noticed it at work. The pain would come on as he turned the steering wheel of the bus. It became more pronounced when he had to navigate the bus around sharp bends, which required the lifting and rotation of his right shoulder.
Over time, his right shoulder became stiff and he found it painful to sleep on his right side.
He also had difficulties with some daily tasks such as combing his hair, wearing and taking off a T-shirt, and reaching for the light switches at home, which were positioned at shoulder level.
Without intervention, frozen shoulder typically starts with diffused and severe pain of the shoulder, before progressing to stiffness and a loss of the range of shoulder motion. These symptoms can last for many months before they start to improve gradually.
While local data is limited, frozen shoulder is reported to affect between 2 and 5 per cent of the general population.
The exact cause of frozen shoulder is not well understood, though previous trauma to the shoulder and certain illnesses, such as diabetes and thyroid problems, may put individuals at a higher risk of developing this condition.
The condition is not linked to any occupation.
RETURNING TO WORK
While frozen shoulder may recover with time, it can take a long while. From an occupational health perspective, the therapeutic goal for Mr Tan is not only to aid him in recovery.
As occupational medicine specialists, we also seek to minimise life disruption due to his condition, minimise time away from work, and return to full work duties as soon as medically reasonable and safe.
I prescribed Mr Tan painkillers with anti-inflammatory properties for symptom relief.
He was also started on a course of physiotherapy and daily stretching exercises.
At the same time, I worked closely with his employer to find other forms of productive work for Mr Tan during his recovery period. He was assigned to supervise a group of new bus drivers and orientate them to their designated driving routes.
Occupational medicine specialists are well placed to manage patients across a range of medical conditions - such as musculoskeletal disorders as well as chronic heart and lung diseases - in conjunction with their primary physicians.
Our focus is to maximise their occupational fitness and allow them to return to work as soon as is reasonably practicable. We will often work with the employers to look at job reassignment, or work modifications to accommodate the functional capacity of our patients while they continue in their rehabilitation and recovery process.
Where necessary, we also play a key liaison role between our patients, their employers, and insurers or government agencies, especially in cases of occupational injuries where work injury compensation is involved.
Medical care that includes attention to occupational issues will help patients with their recovery.
Studies have demonstrated that those recovering from injuries who continue to fully participate in medically appropriate work activities benefit from positive health outcomes and they recover faster.
Indeed, Mr Tan made a very good recovery over the next three months without the need for surgery.
Importantly, he is able to retain meaningful work without any salary adjustment while recovering from his condition. He has now gone back to driving full-time and looks forward to clocking 25 years of service with his company.
Dr Gan Wee Hoe is the director of the Occupational and Environmental Medicine Unit at Singapore General Hospital.
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