ENQUIRER: Shoulder pain? Activity and age can wear on you Wednesday November 7, 2012 To download a pdf of this article, please click here. Enquirer By: R. Michael Greiwe, M.D. Enquirer contributor Shoulder problems are a timeless complaint. The body hasn’t changed, and people will continue to do activities that can affect the shoulder. Over the past five years I have seen an increase in patients with shoulder complaints, but it’s mainly because of awareness of problems and treatment available. People want to feel better. The most common of all shoulder injuries is the rotator cuff tear. It affects all ages, can be very painful and may also be difficult to diagnose because small tears appear similar to rotator cuff tendinitis. While rotator cuff tendonitis almost always can be successfully treated non-surgically, rotator cuff tears frequently require surgical repair. They don’t heal and have been shown to increase in size over time. Who are prime candidates for rotator cuff tears? “Overhead athletes,” like tennis, softball, baseball and volleyball players, as well as swimmers. People over 50 years old (30 percent have rotator cuff tears). People whose work requires repetitive lifting and overhead actions. Reaching overhead, especially with the arm outstretched, is a problem for patients with rotator cuff tears and tendonitis. However, weakness usually signals that the culprit is a rotator cuff tear. These patients will often tell me that they have difficulty getting the milk jug from the fridge, an action which requires stabilizing an object with an outstretched arm. Rotator cuff injuries occur by either a traumatic injury, like a fall, or as the result of a chronic injury over time. Natural healing doesn’t occur with rotator cuff tears because there’s a poor blood supply to the area and the tendon edge retracts from its attachment to the bone. Surgery remedies this situation by increasing blood supply to the area and reattaching the rotator cuff to its normal insertion. The rotator cuff surgery is an outpatient procedure that is performed arthroscopically and takes about 1 to 1½ hours. Scars following arthroscopic surgery usually involve three to four small incisions around the shoulder. Many people find that sleeping in a recliner is easier for a week or two following surgery. Rehabilitation begins three to 10 days following your surgery and should be personalized by your surgeon for the particular tear pattern. Recovery from rotator cuff surgery typically lasts anywhere from three to four months but can be as long as six months for some patients. Most patients will find excellent pain relief and return of strength. However, shoulder weakness can persist in large, chronic tears. This is why a weekly exercise routine is recommended following shoulder surgery to maintain the strength of your shoulder. Rotator cuff pain can be very debilitating; especially for patients who find they cannot dress or handle personal hygiene. Older people may report tightness in the shoulder or arm and limited range of motion in the shoulder. In these cases, you should perform daily physical therapy routines to make sure you don’t develop a frozen shoulder. Those exercises can include: Stretching. Light weights to strengthen the shoulder muscle. Exercises to strengthen the upper back. Chest exercises. Some patients can live without significant pain or limitations despite having rotator cuff tears. In such cases, surgery isn’t recommended. However, close monitoring and annual follow-up is advised. Unfortunately, research shows that rotator cuff tears won’t heal and typically get larger over time. If a larger tear is ignored, the patient may end up losing the ability to lift the arm or develop rotator cuff-deficient arthritis. The goal is to prevent long-term disability in the shoulder, so it is important to see an orthopaedic specialist to properly diagnose your symptoms and determine the course of treatment. Most common shoulder injuries Rotator cuff tendinitis: Inflammation of the rotator cuff tendons and the surrounding tissues. Rotator cuff tear: Varies from partial tearing to complete tearing of the rotator cuff muscles or tendons. Labral tears: Labral tissue (surrounding lip of cartilage around the socket which provides the attachment of the ligaments in the shoulder). Usually torn by dislocation but can sometimes become injured from overuse. Frozen shoulder: When the shoulder becomes painful and loses motion due to inflammation; no specific injury is required. Preventing shoulder injuries Do Maintain a regular shoulder workout routine. Warm up before overhead activities. Maintain shoulder flexibility through stretching exercises. Don’t Perform repetitive overhead activities while shoulder is painful. Perform heavy overhead lifting. Ignore subtle symptoms such as lateral arm pain – they might indicate a rotator cuff issue. Signs you should see a doctor Inability to sleep because of the pain. A ripping or tearing sensation after a fall or lifting. Pain that radiates down the arm. Weakness with lifting or stabilizing an object with the arm outstretched. Shoulder pain that persists despite anti-inflammatories. Inability to raise the arm above the shoulder level due to pain or weakness. Dr. Greiwe is an orthopaedic surgeon with Commonwealth Orthopaedic Centers and is on staff at St. Elizabeth Healthcare and Cincinnati Children’s Hospital.