Shoulder Pain?

Until recently, amateur and professional athletes were considered the primary recipients of surgery to repair an injured rotator cuff in the shoulder.

Now: As recent advances in technology have made the surgery safer and more effective than ever before, many people who have never stepped foot on a baseball field or tennis court are receiving the operation to repair ordinary wear and tear from heavy lifting and movements that require overhead extension of the arms.

Fortunately, many people can avoid rotator cuff surgery if they take the proper steps to prevent injury. If surgery is needed, most people are able to leave the hospital the same day as the procedure.

How Damage Occurs

A rotator cuff tear caused by a single traumatic injury, such as from a fall or lifting a heavy object, is rare. More commonly, years of minor wear and tear cause the tendons to become damaged and weak, much like a frayed rope. Doctors call this rotator cuff disease. With this condition, even a trivial trauma, such as one caused by swinging a golf club, can tear the tendon.

Rotator cuff disease is the third most common orthopedic complaint after low-back pain and knee pain. The condition usually is suspected when a patient feels pain when lifting an arm and/or during the night, when he/she may roll on to the injured shoulder, worsening the pain.

Risk Factors

Activities that can increase the wear-and-tear process of the rotator cuff include heavy lifting... performing overhead activities, such as assembly-line work...and overextending the shoulder during sports activities, such as tennis. Other risk factors…

• Family history. Genetics plays a role in the health of your body tissues, so if others in your family have had rotator cuff disease, your risk is increased.
  
• Smoking. Smoking has an effect on the blood supply everywhere in the body, including the tendons of the shoulder. Blood carries the cells that are necessary for healing minor injuries. Reduced blood flow slows healing and accelerates wear and tear on the rotator cuff.
  
• Aging and overuse. The more we use our shoulders, the greater the likelihood that the rotator cuff will "wear out." This happens through decades of normal use, or by intense overuse. That's why the risk increases as people get older...or if they engage in shoulder-heavy repetitive actions, such as swimming. Also vulnerable are people whose jobs involve heavy lifting, such as warehouse employees, or working with their arms overhead much of the time, such as electricians.
  

Preventing Damage

If you have a family history of rotator cuff disease, you cannot change that fact. However, there are steps you can take to minimize the effect of other risk factors…

• If you smoke, quit. There are many reasons to avoid tobacco. Increased risk for rotator cuff disease can be added to the list.
  
• Stretch the shoulder. Do this before sports, such as tennis, golf, swimming and softball, or before lifting a heavy object--especially if you are age 45 or older. Many effective stretches are difficult to learn from a book and can increase the risk for injury if performed incorrectly. Ask an exercise trainer or physical therapist for hands-on guidance.
  

For a good basic stretch: With one hand, grasp the other arm above the elbow and pull it across your chest. Hold for a count of 10, then switch arms. Repeat 10 times.

• Avoid certain shoulder movements. At the gym, do not perform exercises that require the elbows to be pulled back behind the shoulder in an extreme extension position.
  

Example: Bench presses in which you bring the bar all the way down to your chest hyperextend the shoulder.

For proper form: Lie on the floor and practice a bench press by holding a broom handle instead of a bar. Your elbows will be stopped at the correct level by the floor.

If you work out with weights, avoid excess wear and tear by doing more repetitions at lower weights, rather than fewer repetitions at higher weights.

A general rule is to use weights that enable you to do 10 repetitions of an exercise. If you can do only five or six repetitions before feeling muscle fatigue, the weights are too heavy.

Telltale Symptoms

The symptoms of rotator cuff disease vary, depending on the individual and the extent of damage. Some people experience agonizing pain, while others may have just a minor nagging ache. The pain usually is intermittent, but if it becomes constant, surgery is a reasonable treatment option.

Seek medical help for any shoulder pain that persists for longer than one week-or if you have pain while performing common tasks, such as reaching, dressing or playing your usual sports, or if the pain wakes you up at night.

Self-test: If you experience shoulder pain when pushing objects away from the body—but not when pulling objects toward you—your rotator cuff may be damaged.

When To Try Physical Therapy

If you think your rotator cuff may be damaged, see a doctor, preferably an orthopedist. If you get prompt attention, you may be able to avoid surgery by getting physical therapy.

Physical therapy can strengthen the rotator cuff and reduce pain by changing the shoulder mechanics. This means that both your flexibility and shoulder strength will be improved, allowing the shoulder to move in a way that doesn't irritate the rotator cuff.

A tear indicates advanced rotator cuff disease and usually is identified by a magnetic resonance imaging (MRI) scan. Once the tendon is torn, surgery is the only way to fix it-but the operation is not always recommended.

For example, if you are relatively inactive, with only mild pain and good function, you may do well with physical therapy and corticosteroid injections, which help reduce pain. Moreover, surgery has risks and entails a long recovery.

Some patients can modify their activities and experience minimal pain-without surgery.

If You Must Have Surgery...

A year after rotator cuff surgery, 90% of patients report that they can participate in activities they could not do before surgery because of shoulder pain.

Whenever possible, choose arthroscopic surgery, in which the repair is performed through keyhole-sized incisions using surgical instruments, tiny lights and video cameras. During this procedure, the surgeon removes excess bone fragments from the shoulder to create more space for the rotator cuff. The alternative is open surgery, which carries a greater risk for infection as well as longer hospitalization.

If you need surgery, choose a surgeon who has performed arthroscopic rotator cuff repairs for at least three years, and who does at least LWO per week. (The surgery generally is coered by insurance) Highly qualified surgeons are elected by their peers to American Shoulder and Elbow Surgeons, a professional society. To search the group's membership, call 847-6981629 or check www.ases-assn.org.

Recovery from rotator cuff surgery can last a few months to a year. Physical therapy can be a prolonged and sometimes uncomfortable process, usually involving twice weekly sessions plus daily at-home therapy done by the patient. But if you are committed to the postoperative therapy program, you will have a more complete recovery.

What Is the Rotator Cuff?

The rotator cuff consists of four muscles (and their tendons) that hold the upper arm in the shoulder joint. The rotator cuff compresses the ball (head of the humerus) into the socket so that shoulder rotation can occur. It acts like an intricate pulley mechanism, allowing the arm to move in every direction. Certain overhead arm movements can injure the rotator cuff by tearing fibers of the tendon.

Three Great Ways to Help Stop Bruising

Apply ice to the sore spot—use an ice bag or a package of frozen vegetables wrapped in a towel. Don't leave it on for more than 15 minutes at a stretch.

• Sit as much as possible for the next few hours so that your body pumps less blood to the injured area.
  
• If the injury is on a thigh, put on support hose or spandex shorts-this applies mild pressure to broken blood vessels and further reduces the flow of blood.
  
• If the injury is elsewhere, wrap the area with a wide elastic bandage, but not too tightly -you should be able to slip a finger under the bandage.
  

Also: Applying Arnica Montana cream, available at health-food stores, has been shown in some studies to help reduce bruising.

Blood Test May Soon Prevent Carpal Tunnel Syndrome

A simple blood test may someday be the first A step to preventing carpal tunnel syndrome, tendonitis and other painful overuse injuries. For the first time, researchers have detected that the human body pumps out certain chemicals that indicate early stages of these injuries.

That could be significant, because doctors currently have to rely on physical examinations and reported symptoms to diagnose repetitive motion injuries.

Problem: Most people don't suffer pain or other symptoms until the damage has already started and by then it may be too late.

In a small study, Temple University researchers analyzed blood samples in 22 people. They found that the body's immune system pumps out these biomarkers—specific substances—as the body begins to suffer damage due to repetitive stress.

"While not a diagnostic test, because the biomarkers could also indicate another type of injury, they do provide a red flag where before there was none," says Ann Barr, associate professor of physical therapy at Temple's College of Health Professions. This could lead to taking preventative measures before it becomes long-term or permanent damage and disability.