Rotator cuff injury
Rotator cuff tear after a motor accident
A rotator cuff tear claim turns on whether the crash caused or materially aggravated a tendon injury and what permanent function remains after treatment. A tear on MRI is not a percentage, and shoulder strength testing cannot be used as a shortcut under CTP.
Motor accident injury
How can this injury happen?
Car or passenger collision
Bracing on the wheel, a shoulder belt load or forceful traction can injure or aggravate the supraspinatus, infraspinatus, subscapularis or teres minor tendons.
Motorcycle accident
Landing on an outstretched arm or the shoulder can create an acute tear or extend a pre-existing partial tear.
Pedestrian or cyclist impact
A direct blow or fall may combine cuff injury with fracture, dislocation or AC joint trauma.
Injuries that can occur
- partial-thickness or full-thickness cuff tear
- tendon retraction or muscle atrophy
- traumatic aggravation of degenerative cuff disease
- associated bursitis, impingement, biceps or labral injury
Symptoms and functional problems
- painful overhead reach and lowering the arm
- night pain and sleep interruption
- difficulty carrying, pushing, steering or sustained arm use
- loss of active movement that may exceed passive restriction
Clinical evidence
What findings matter?
The file should identify the tendon, tear depth, acute features, prior condition, active movement and treatment response. A reasoned specialist opinion is important where degeneration is present.
| Record or examination | What it may establish | What it cannot prove alone |
|---|---|---|
| MRI or ultrasound | Defines tendon, tear depth, retraction, muscle quality and associated pathology. | It does not show the permanent UEI or prove the accident caused every finding. |
| Active and passive shoulder examination | Distinguishes active functional loss from capsular stiffness and records reliable ROM. | Manual strength grading is not a separate upper-limb WPI method. |
| Operative and rehabilitation records | Show repaired tendons, surgical findings, complications and the post-treatment plateau. | Repair surgery does not create a fixed impairment. |
Movement in daily life
How movement affects real activities
Cuff failure often affects active elevation and rotation used for lifting, grooming, dressing and lowering an object safely. The assessor still measures the permitted active planes rather than estimating impairment from weakness.
Flexion
Lifting the arm forward and overhead, including reaching a shelf or putting on a shirt.
Active flexion and extension are rated through AMA4 shoulder Figures 36 to 38 when reliable.
Abduction
Lifting the arm sideways, including reaching away from the body or fastening a seat belt.
Active abduction and adduction are addressed by Figures 39 to 41.
External rotation
Washing hair, reaching behind the head and positioning the arm to put on a jacket.
Active external rotation is read with the shoulder rotation figures, not estimated from pain severity.
Internal rotation
Reaching behind the back for dressing, hygiene or fastening clothing.
Active internal rotation is addressed with Figures 42 to 44 and must be measured consistently.
Threshold injury is a separate question: a verified partial or complete tendon rupture is excluded from the statutory soft tissue definition. Tendinopathy, strain, bursitis or impingement without rupture may remain threshold. That classification does not set WPI.
Part 6 permanent impairment
How is CTP WPI assessed?
Clause 6.57 expressly states that a rotator cuff injury may be assessed by shoulder range of movement or another upper-extremity disorder method where justified. The choice must reflect the residual impairment and avoid duplication.
Measurement rules that apply
- Clause 6.50 requires active, not passive, range of motion for the impairment calculation. A goniometer should be used where clinically indicated, and unreliable movement should be repeated consistently before it is accepted.
- Clauses 6.51 and 6.52 permit a contralateral baseline only where the uninjured joint is a fair estimate of pre-accident mobility. The total upper-extremity impairment for each comparable joint is subtracted before conversion to WPI.
- Clause 6.67 prohibits upper-limb strength evaluation and AMA4 Table 34. A genuine peripheral nerve or muscle-bulk injury must use another permitted method without double counting.
| Method | CTP source | When it is relevant | Important limit |
|---|---|---|---|
| Active shoulder ROM | Clauses 6.50-6.52; Figures 36-44 | Permanent measurable loss after treatment or stabilisation. | Only reliable active measurements are used. |
| Analogous upper-extremity disorder | Clauses 6.24 and 6.57; AMA4 pages 58-64 | A residual cuff disorder not adequately represented by ROM, with reasons. | No row value is stated without the readable AMA4 Chapter 3 source. |
| Table 3 conversion | Clause 6.56 | Converts final UEI to WPI. | The tendon tear and surgery are not added again. |
- Use the current post-treatment findings, not the pre-operative scan alone.
- Do not infer WPI from tear size, tendon count or repair technique.
- Clause 6.67 excludes strength evaluation and Table 34.
What cannot be combined?
- ROM with an analogous method that rates the same cuff consequence
- prohibited strength impairment with shoulder ROM
- a nerve value unless a separate peripheral nerve injury is established
What does not establish WPI by itself?
- MRI tear size
- painful arc alone
- surgery recommendation or repair alone
- subjective weakness without a permitted method
Motor accident examples
Rear impact followed by delayed MRI
Early shoulder complaints and examinations are needed to connect the later tear diagnosis to the accident, particularly where the scan describes degeneration.
Repair with persistent active restriction
The operation report explains treatment, but reliable post-operative active ROM or a justified analogous method determines the permanent impairment.
Claim file preparation
Evidence checklist
Practical next steps
What should you do next with a rotator cuff tear claim?
Start with the insurer's most recent written decision and identify what is actually disputed: treatment, weekly payments or work capacity, threshold injury, permanent impairment, causation, or damages. These are separate questions and may require different evidence and review procedures. Record the date of the decision and every review deadline shown before gathering further material.
- 01
Preserve the claim and the decision under review
Keep the claim number, accident date, insurer letter, certificate of fitness and any internal review or Personal Injury Commission correspondence together. Do not assume that a treatment approval or payment of statutory benefits decides fault, damages eligibility or WPI.
- 02
Obtain evidence that answers the disputed issue
For this injury, the useful starting material includes MRI/ultrasound images and report identifying the tendon and tear depth and pre-accident shoulder records where degeneration is alleged. Clinical testing may include MRI or ultrasound and Active and passive shoulder examination. Ask the treating practitioner to record the diagnosis, accident causation, objective findings, treatment response and current functional limits rather than symptoms alone.
- 03
Use the correct review process
Compare the insurer's reasons with the records it relied on. A threshold-injury decision, treatment refusal, weekly-payment decision and WPI assessment do not all follow the same review process. The decision letter should identify available internal review or dispute steps and the applicable deadline.
If the decision, medical material or deadline is unclear, send the key documents for a focused review before lodging a broad objection. See the CTP disputes guide or contact NSW CTP Claim. Advice depends on the facts, evidence and current law; a review cannot guarantee a claim outcome.
Assessment source
Rotator cuff WPI assessment source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.24, 6.47-6.57 and 6.67; AMA4 shoulder Figures 36-44, other upper-extremity disorders pages 58-64 and Table 3.
Threshold injury: A medically verified partial or complete tendon rupture is excluded from soft tissue injury; tendinopathy or strain without rupture may be threshold. WPI is assessed separately.
What the assessor checks
- rotator cuff ROM or analogous method
- active ROM rules
- Table 3 conversion
- strength prohibition
What does not establish the result by itself
- tear size
- pain
- weakness
- surgery
Official sources
Related NSW CTP guides
Free claim check
Review the medical evidence and insurer decision together
Send the accident date, insurer letter, scans or reports and any deadline shown. NSW CTP Claim is a specialised service of Stephen Young Lawyers. Legal services are provided by Stephen Young Lawyers.
Frequently asked questions
- Does a full-thickness cuff tear have a fixed WPI?
- No. Part 6 does not assign one percentage by tear label. The assessor applies reliable ROM or another justified upper-extremity method.
- Can degeneration defeat the claim?
- Not automatically. The medical evidence must address the pre-accident condition and whether the crash caused a new tear or materially aggravated it.
- Can cuff weakness be converted to WPI?
- Not through upper-limb strength Table 34, which clause 6.67 prohibits.
- Does surgery increase WPI?
- Not automatically. Assessment is based on the permanent condition after treatment, including reliable residual findings.
- Can a partial tear be non-threshold?
- A verified partial tendon rupture is excluded from the soft tissue definition, but diagnosis and accident causation still need evidence.