With summer upon us, many of us start playing tennis, golf, office softball games and more after a winter of inactivity. Shoulder injuries are in the top five most common sports injuries for adults ages 25 to 40 years old, according to the Department of Health and Human Services. Dr. Thomas Burke, an orthopedic surgeon and sports medicine specialist at Mt. Auburn Hospital has tips on how to avoid some of the shoulder injuries that many weekend athletes experience when they become suddenly active again in the warmer weather.
Q: What shoulder injuries do you see from people who haven’t been active all winter, then begin playing sports on the weekends once the weather warms up?
A. Rotator cuff injuries, whether they are tears or just irritations of the rotator cuff tendons, are the most common injuries we see in the office as people start in on the summer sports. It’s also pretty common to see rotator cuff injuries as people start to get back into the gym and work out with weights as the summer approaches. Less frequently, we see younger athletes who dislocate their shoulders late in the Spring skiing season or lacrosse season.
Q: What makes the shoulder joint so susceptible to injury?
A: The shoulder is built for mobility and range of motion. Although it is a “ball and socket” joint the humeral head (the ball) is much larger than the glenoid (socket). Think of a golf ball of a tee. That difference in radius of curvature allows for much more range of motion than a joint like the hip which is more constrained and also more stable. The shoulder joint compensates for the lack of bony stability be relying on the ligaments and the stabilizing forces of the rotator cuff tendons and muscles. So although the shoulder is a very mobile joint it relies on our tendons for much of its stability. As we increase the stress on these muscles and tendons they can become irritated with overuse, or in the worst case scenario fail attritionally. Rotator cuff tears in younger patients (those people less than 60) usually occur as a result of trauma.
Q: What are the most common shoulder injuries and surgical procedures?
A: Arthroscopic rotator cuff repair is probably the most common shoulder procedure. For younger patients (those in the 20’s to 30’s) arthroscopic labral repair for shoulder instability problems (dislocations) is a more common procedure.
Q: Rotator cuff surgery is a common shoulder surgery. When is it best to just let the shoulder heal on its own rather than have surgery? If surgery is necessary, how long does the recovery normally take?
A: Rotator cuff tears don’t heal on their own. The rotator cuff is made up of four tendons. Tendons are the structures that connect a muscle to bone. When a rotator cuff tear occurs it is avulsed or pulled off the bone by the muscle. Muscles contract (shorten) and so there is no way for the tendon to get back to its original attachment site unless it is surgically attached.
Having said all of that not every rotator cuff tear needs to be fixed. Small tears of just a part of the rotator cuff that don’t cause weakness or pain can sometimes be rehabilitated with physical therapy. Physical therapy can get the remaining rotator cuff tendons that are intact to compensate for the torn one and your shoulder may not require surgery.
Q: What activities beyond tennis and golf can be potentially harmful for our shoulders? Anything one wouldn’t expect or should be extra careful while doing?
A: Actually, golf puts very little stress on the rotator cuff because most of the stress on the shoulder joint occurs while the hands are below shoulder height. So play golf as much as you want to!
Tennis and throwing activities, however, can irritate the rotator cuff. Serving (in tennis) and pitching are both among the most stressful activities we put our shoulders through in terms of the rotator cuff/shoulder activities. Always make sure to warm up properly before engaging in overhead athletics. Do some gentle arm circles at shoulder height for about a minute or maybe some jumping jacks to get some synovial fluid moving in your shoulders before hitting the courts. This will also encourage blood flow to the area so that your shoulder isn’t as stiff.
Q: How would you recommend people prevent shoulder pain and injuries?
A: While it’s difficult to completely prevent shoulder injuries we should avoid highly repetitive stressful forces on the shoulder. If you play tennis, it may be advisable to stay away from competitive matches multiple days in a row. Hit ground strokes on off days, but stay away from serving. The same philosophy should apply to throwing. If you are a pitcher for your high school or college team there should be an off season. Even professional pitchers take a certain amount of time off in the winter.
Q: Are there any other key tips and/or facts you would like to share with us?
A: Weight lifting is another activity that can irritate or damage the rotator cuff, especially pressing up overhead. It’s better to do high repetitions with lower weight that help stabilize your shoulder rather than doing high intensity, high weight exercises. Often times a focused physical therapy program can help with some general rotator cuff tendonitis pain.