Features October 2004 Issue

The Rocky Road To Shoulder Woes

With time, age, and overuse, the probability of developing a rotator- cuff injury increases. What to watch for and how to avoid trouble.

When something goes wrong in your shoulder over a long period of time, it is not usually an isolated event. It is more likely to have been a progression of events involving the four muscles that make up the rotator cuff. Each condition is a little more painful or restrictive than the previous one, but there are some common measures you can take to deal with all of them.

“Tendinitis is the mildest form of an overuse injury, is reversible in most cases, and does not require surgery,” says Dr. Joseph Iannotti, chairman of the department of orthopaedic surgery at The Cleveland Clinic. Rotator-cuff tendinitis is an inflammation of one or more of the tendons that keep the ball of the shoulder joint firmly in place against the socket. It often develops along with impingement syndrome, which occurs when a shoulder muscle, tendon, and bursa rub against the shoulder blade.

“Pain in the front and top of the shoulder that extends down the outside of the arm is the most common symptom of tendinitis,” explains Dr. Iannotti, “but less severe pain may also occur in the shoulder blade area. Movement may be restricted because the patient may be trying to protect the affected arm.”

You may hear a minor clicking sound with overhead motion. Pain is worse with lifting or reaching, especially when it’s above the shoulder. In severe cases, the arm cannot be raised to shoulder height.

A bursa is a sac filled with lubricating fluid located at various joints in the body. Shoulder bursitis (an inflamed, swollen bursa) is not likely to occur by itself. It will probably develop as a result of damage to a rotator cuff tendon or some form of shoulder impingement. People who overuse their shoulder joints are particularly susceptible to bursitis.

The symptoms of bursitis usually develop gradually. The shoulder is especially painful when the arm is extended, then raised or lowered. In addition to the loss of motion, the affected area can be painful to the touch and slightly swollen.

Sooner or later, the rubbing action of the ligament will cause tears in the tendon that attaches one of the four rotator cuff muscles to the bone. If the tendon has been completely separated, a large incision will be necessary to re-attach the tendon to the bone. The surgery is complicated and the recovery period could be six months or longer. Arthroscopic surgery can repair a partial tear or, to prevent a tear, increase the space between the acromion (one of the bones that forms the top of the shoulder) and the rotator cuff through shaving the bony material and removing the bursa.

“In the case of a torn tendon,” warns Dr. Iannotti, “again look for pain in front and on top of the shoulder that extends midway down the outside of the arm or, less often, pain around the shoulder blade. There can be a noticeable loss of motion and strength, clicking, or grinding during an overhead motion. It is particularly noticeable when lifting or reaching and when the arm is lowered from an elevated position.”

Preventing injury
You can reduce the probability of sustaining shoulder impingement problems by participating in a strength and flexibility program. Once you are used to doing the stretches outlined on the previous page, consider moving on to lightweight (3-8 lbs.) resistance exercises. Be careful not to do too much, too soon.

If you’re already experiencing pain, stop or at least limit the movement that is causing the pain. Continue the activity if you can modify the motion so that it doesn’t hurt. If it persists, stop altogether. Rest, apply ice three times a day for 20-minute periods, and use ibuprofen or another oral anti-inflammatory for treatment of the pain. If you don’t get relief within two weeks, see your doctor, who can prescribe stronger medications. Gentle stretches and exercises will help maintain flexibility and strengthen the rotator-cuff muscles.