Patterns and Trends of High-Cost Claims Involving Rotator Cuff Disorders

By Dongchun Wang, Randall Lea, M.D., Kathryn Mueller

July 8, 2025 Related Topics: Behavioral Health, Indemnity Benefits, Medical Costs, Physical Medicine, Rx Drugs and Opioids, Treatment Guidelines

This study examined the association between condition-specific factors and the likelihood of a claim becoming high cost (defined as medical payments exceeding $65,000 within 36 months of injury).

It provides a deeper understanding of how varying levels of rotator cuff tears and their surgical treatment patterns contribute to elevated medical costs. Given the clinical complexity and claims management challenges these injuries present, the findings can inform effective care strategies and resource utilization.

The analysis draws on nearly 50,000 rotator cuff disorder claims from a larger dataset of over 930,000 lost-time claims across 32 states. These claims involved injuries occurring between October 2015 and March 2019, with detailed medical billing and treatment data tracked for three years postinjury.

Patterns and Trends of High-Cost Claims Involving Rotator Cuff Disorders. Dongchun Wang, Randall D. Lea, and Kathryn L. Mueller. July 2025. WC-25-25.

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Research Questions:

  • What are the specific factors contributing to high medical payments for rotator cuff injuries?
  • Are patterns of medical care consistent with guideline recommendations and expected medical practice regarding timing of surgery and pre- and postoperative nonsurgical treatments?
  • To what extent do degenerative conditions and comorbidities influence treatment decisions and contribute to elevated costs?

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