Rotator cuff syndrome — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 109 of 2022

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting rotator cuff syndrome or death from rotator cuff syndrome with the circumstances of a person's relevant service:

1. (1)
   having an injury to the affected shoulder within the 3 months before the clinical onset of rotator cuff syndrome;

   Note: Examples of activities or circumstances that can cause an injury to the affected shoulder include a fall, a violent pull or sudden traction injury, sports injury, a blow or direct trauma to the shoulder, lifting weights, and improperly administered vaccination to the shoulder.

   Note: injury to the affected shoulder is defined in the Schedule 1 - Dictionary.

2. (2)
   undergoing a surgical procedure involving the affected shoulder joint before the clinical onset of rotator cuff syndrome;
3. (3)
   performing any combination of: (a) repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees; or (b) forceful activities with the affected upper limb; for at least 80 hours within a period of 120 consecutive days before the clinical onset of rotator cuff syndrome, and where the repetitive or sustained or forceful activities have not ceased more than 30 days before the clinical onset of rotator cuff syndrome;

   Note: forceful activities are defined in the Schedule 1 - Dictionary.

4. (4)
   performing repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees for at least 2,000 hours within the 10 years before the clinical onset of rotator cuff syndrome;

   Note: Sports that require overhead activities (for example, tennis, swimming, and volleyball) often involve abduction or flexion of the shoulder by at least 60 degrees.

5. (5)
   lifting or carrying loads of at least 20 kilograms using the upper limb of the affected side for at least 200 hours within the 10 years before the clinical onset of rotator cuff syndrome;
6. (6)
   using a hand-held, vibrating, percussive, heavy industrial tool with the affected upper limb, for at least 2,000 hours within the 10 years before the clinical onset of rotator cuff syndrome;
7. (7)
   having dialysis-related amyloidosis before the clinical onset of rotator cuff syndrome;

   Note: dialysis-related amyloidosis is defined in the Schedule 1 - Dictionary.

8. (8)
   regularly using the upper limbs for weight-bearing for a continuous period of at least the 1 year before the clinical onset of rotator cuff syndrome;

   Note: Examples of circumstances in which the upper limbs may regularly be used for weight- bearing include transfers from a wheelchair to a chair or bed, and the use of crutches or other walking aids.

9. (9)
   having anatomical narrowing of the subacromial space on the affected side at the time of the clinical onset of rotator cuff syndrome;

   Note: anatomical narrowing of the subacromial space is defined in the Schedule 1 - Dictionary.

10. (10)
    having joint instability of the affected shoulder, or dislocation or subluxation of the affected shoulder joint before the clinical onset of rotator cuff syndrome;
11. (11)
    having an infection of the subacromial bursa or subdeltoid bursa of the affected shoulder at the time of the clinical onset of rotator cuff syndrome;
12. (12)
    having an autoimmune disease from the specified list of autoimmune diseases, involving the shoulder joint or associated bursae of the affected side, before the clinical onset of rotator cuff syndrome;

    Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.

13. (13)
    having gout involving the affected shoulder at the time of the clinical onset of rotator cuff syndrome;
14. (14)
    having acquired scapular dyskinesis of the affected side at the time of the clinical onset of rotator cuff syndrome;

    Note: acquired scapular dyskinesis is defined in the Schedule 1 - Dictionary.

15. (15)
    having smoked at least 20 pack-years of tobacco products before the clinical onset of rotator cuff syndrome;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

16. (16)
    having diabetes mellitus before the clinical onset of rotator cuff syndrome;
17. (17)
    having dyslipidaemia before the clinical onset of rotator cuff syndrome;

    Note: dyslipidaemia is defined in the Schedule 1 - Dictionary.

18. (18)
    taking a glucocorticoid drug as specified before the clinical onset of rotator cuff syndrome;

    Note: taking a glucocorticoid drug as specified is defined in the Schedule 1 - Dictionary.

19. (19)
    taking a fluoroquinolone antibiotic within the 60 days before the clinical onset of rotator cuff syndrome;
20. (20)
    taking an aromatase inhibitor for at least 4 weeks within the 2 years before the clinical onset of rotator cuff syndrome;

    Note: Examples of aromatase inhibitors include anastrozole, exemestane and letrozole.

21. (21)
    having an injury to the affected shoulder within the 3 months before the clinical worsening of rotator cuff syndrome;

    Note: Examples of activities or circumstances that can cause an injury to the affected shoulder include a fall, a violent pull or sudden traction injury, sports injury, a blow or direct trauma to the shoulder, lifting weights, and improperly administered vaccination to the shoulder.

    Note: injury to the affected shoulder is defined in the Schedule 1 - Dictionary.

22. (22)
    undergoing a surgical procedure involving the affected shoulder joint before the clinical worsening of rotator cuff syndrome;
23. (23)
    performing any combination of: (a) repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees; or (b) forceful activities with the affected upper limb; for at least 80 hours within a period of 120 consecutive days before the clinical worsening of rotator cuff syndrome, and where the repetitive or sustained or forceful activities have not ceased more than 30 days before the clinical worsening of rotator cuff syndrome;

    Note: forceful activities are defined in the Schedule 1 - Dictionary.

24. (24)
    performing repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees for at least 2,000 hours within the 10 years before the clinical worsening of rotator cuff syndrome;

    Note: Sports that require overhead activities (for example, tennis, swimming, and volleyball) often involve abduction or flexion of the shoulder by at least 60 degrees.

25. (25)
    lifting or carrying loads of at least 20 kilograms using the upper limb of the affected side for at least 200 hours within the 10 years before the clinical worsening of rotator cuff syndrome;
26. (26)
    using a hand-held, vibrating, percussive, heavy industrial tool with the affected upper limb, for at least 2,000 hours within the 10 years before the clinical worsening of rotator cuff syndrome;
27. (27)
    having dialysis-related amyloidosis before the clinical worsening of rotator cuff syndrome;

    Note: dialysis-related amyloidosis is defined in the Schedule 1 - Dictionary.

28. (28)
    regularly using the upper limbs for weight-bearing for a continuous period of at least the 1 year before the clinical worsening of rotator cuff syndrome;

    Note: Examples of circumstances in which the upper limbs may regularly be used for weight- bearing include transfers from a wheelchair to a chair or bed, and the use of crutches or other walking aids.

29. (29)
    having anatomical narrowing of the subacromial space on the affected side at the time of the clinical worsening of rotator cuff syndrome;

    Note: anatomical narrowing of the subacromial space is defined in the Schedule 1 - Dictionary.

30. (30)
    having joint instability of the affected shoulder, or dislocation or subluxation of the affected shoulder joint before the clinical worsening of rotator cuff syndrome;
31. (31)
    having an infection of the subacromial bursa or subdeltoid bursa of the affected shoulder at the time of the clinical worsening of rotator cuff syndrome;
32. (32)
    having an autoimmune disease from the specified list of autoimmune diseases, involving the shoulder joint or associated bursae of the affected side, before the clinical worsening of rotator cuff syndrome;

    Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.

33. (33)
    having gout involving the affected shoulder at the time of the clinical worsening of rotator cuff syndrome;
34. (34)
    having acquired scapular dyskinesis of the affected side at the time of the clinical worsening of rotator cuff syndrome;

    Note: acquired scapular dyskinesis is defined in the Schedule 1 - Dictionary.

35. (35)
    having smoked at least 20 pack-years of tobacco products before the clinical worsening of rotator cuff syndrome;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

36. (36)
    having diabetes mellitus before the clinical worsening of rotator cuff syndrome;
37. (37)
    having dyslipidaemia before the clinical worsening of rotator cuff syndrome;

    Note: dyslipidaemia is defined in the Schedule 1 - Dictionary.

38. (38)
    taking a glucocorticoid drug as specified before the clinical worsening of rotator cuff syndrome;

    Note: taking a glucocorticoid drug as specified is defined in the Schedule 1 - Dictionary.

39. (39)
    taking a fluoroquinolone antibiotic within the 60 days before the clinical worsening of rotator cuff syndrome;
40. (40)
    taking an aromatase inhibitor for at least 4 weeks within the 2 years before the clinical worsening of rotator cuff syndrome;

    Note: Examples of aromatase inhibitors include anastrozole, exemestane and letrozole.

41. (41)
    inability to obtain appropriate clinical management for rotator cuff syndrome;