Watch your swing

Experts say rotator cuff injuries are common

Experts say rotator cuff injuries are common

July 24, 2006|by JULIE E. GREENE

Major League Baseball pitchers do it.

National Football League quarterbacks do it.

Tennis players do it.

Even painters and stockboys do it.

You don't have to be a professional athlete or even an athlete to experience the pain and frustration of a torn rotator cuff.

These muscle tears in the shoulder are caused by repetitive overhead motion such as pitching, throwing, serving, painting and stocking shelves, says Dr. Bob Cirincione, an orthopaedic surgeon with Mid-Atlantic Orthopaedic Specialists in Hagerstown.


Diagnoses of rotator cuff injuries have become more common in the last 10 to 15 years as older people continue to remain active and MRI technology is used to confirm the diagnosis, Cirincione says.

According to the American Academy of Orthopaedic Surgeons, 35,000 people underwent rotator cuff surgery in 2003 and there were 4.4 million visits to physicians' offices due to rotator cuff problems.

The rotator cuff is a group of four muscles that cover the shoulder joint and connect the humerus (upper arm) to the scapula (shoulder blade).

With repetitive use, this muscle group or the related tendons weaken and can tear.

Rotator cuffs also can get hurt from simple activities such as lifting a gallon of milk or falling down, says Eric Sampsell, outpatient rehab coordinator at City Hospital in Martinsburg, W.Va. As people age, muscles and tendons can deteriorate, making them more apt to tear.

Cirincione says he diagnoses rotator cuff injuries two to three times a day and does one to two rotator cuff surgeries a month.

People who are now 55 to 75 years old are more active than people that age were 20 to 30 years ago, Cirincione says. People who injured their shoulder in the 1970s and 1980s were more likely to just stop whatever activity hurt.

Now people that age tend to seek out treatment for such injuries so they can maintain their active lifestyle, such as golfing, Cirincione says.

Recapturing an active lifestyle

Marcene Kipe, who lives near Williamsport, tore her left rotator cuff more than a year ago.

While she's not certain exactly what caused the injury, she said it was probably either waterskiing or snow skiing.

"I didn't want to move (my shoulder) a lot because it hurt so bad and at night it was causing me not to sleep. I knew something was wrong.

An X-ray didn't show the tear and a cortisone shot didn't relieve the discomfort, so an MRI image was taken of the shoulder and the tear was discovered last fall.

Kipe decided to see if she could get through the ski season without surgery, but found her quality of life wasn't improving.

She couldn't lift her arm over her head. She couldn't get it much higher that parallel to the ground. She couldn't help her husband in the yard, had trouble lifting objects and, when waterskiing, couldn't get out of the water half the time because the jolt from the yank of the tow-rope caused sharp shoulder pain.

Even more annoying was her inability to sleep through the night, because whenever she rolled onto that shoulder, she woke up.

So Kipe chose to have surgery on the shoulder in February. After two weeks of resting the shoulder, she began a lengthy rehabilitation, starting with passive therapy. Her therapist would manipulate her arm to prevent stiffness.

As she visited the rehab center during an eight-week period, Kipe's therapy became more aggressive. She lifted tiny weights - moving her arms in various directions and exercising by stretching big rubber bands to strengthen the muscles.

Her arm still isn't at full range; it's at about 90 percent. But she returned to waterskiing on the Fourth of July, the day after Cirincione gave her the OK.

Kipe, 59, who works in the records department at Maryland Correctional Institution, says she got discouraged during the long recovery period, but is glad she had the surgery.

Otherwise she'd still be frustrated at her inability to have an active lifestyle.


There is an individual tendency a person might have to developing a rotator cuff tear that a person has no control over, Cirincione says.

The only way to avoid injuring the rotator cuff is to change activities, which can be difficult for an athlete or person in a job that demands overhead activity, he says.

Sampsell recommends people stretch to loosen the shoulder and generate blood flow to the area before any repetitive activity. This enables the area to sustain more impact.

A weight-lifting program can be designed specifically for the rotator cuff muscles, but the best thing is to limit how that area is used.

"It's probably not a good idea to do eight hours of painting in a row or one hour of overhead painting," Sampsell says. Mix it up. Paint overhead for 10 minutes, then paint at a lower level. Ice the shoulder afterward to decrease inflammation and help the tissue heal.


Treatments for tears can include anti-inflammatory medications, physical therapy and surgery.

"Everybody that has a tear doesn't need to be operated on," Cirincione says.

The first step is to reduce the inflammation and soreness.

This can be done with medication and physical therapy. Patients limit the amount of overhead activity and use exercises to strengthen the muscles around the shoulder. Occasionally steroid injections are administered to reduce the inflammation caused by the tear, Cirincione says.

If all else fails, surgery is discussed.

When the tendon tears off the bone, surgery is needed to reattach it. This can be done with various sutures and metal or plastic anchors that look like wall fasteners. The anchor is bolted into the bone. Stitches attached to the anchor are woven through the tendon to tie it back to the bone.

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