Symptoms & Treatments

Shoulder Problems

Many health and fitness magazines have reported on the incidence of rotator cuff problems in the senior athlete and older patient. Repetitive and overhead use of the arm was once thought to be the sole underlying problem in rotator cuff disease. It is now known that several shoulder types are present in the general population. The anatomy of some shoulders may predispose an individual to rotator cuff problems. The spectrum of rotator cuff tendinitis encompasses a simple strain from repetitive use to an acute tear from lifting a heavy object overhead or throwing too hard.

A rotator cuff tendinitis and bursitis often exist together. The bursa is a small sack of fluid which exists between the tendon and the undersurface of the shoulder bone known as the acromion. Shapes of the acromion vary in individuals, predisposing a select group of people to rotator cuff problems. It is now accepted that there are four types of shoulder bones varying in their shape and contour. The most common, Type I, usually does not result in any impingement on the underlying rotator cuff muscle. Types II and III have a projection of bone which is directed down and forward. This enters into the space normally occupied by the rotator cuff tendon and bursa. With overhead use of the arm, the tendon is pulled up against the undersurface of the bone, resulting in chronic irritation. A fourth type of acromion, which represents a thickened Type I bone is also seen. In this variant, the acromion bone itself is quite wide and thick, resulting in a decreased space available for the underlying rotator cuff. Although the classic downward projecting hook is not present, the thickness of the bone itself compromises the space available for the rotator cuff.

Individuals with a Type I or Type II shoulder who have rotator cuff symptoms usually respond well to anti-inflammatories, activity restrictions, and physical therapy. Individuals with Type III or Type IV may be resistant to therapy and eventually require a surgical decompression of the shoulder. In this type of surgery, usually performed as an outpatient, the downward projection of bone or the thick shoulder bone itself is thinned using a saw, high-speed burr, and bone file. When it sounds a little bit like carpentry, the results are actually very good. Providing more space for the underlying rotator cuff allows for the soft tissues to heal. If a rotator cuff tear was noted at the time of surgery, it can usually be approximated with sutures and will go on to heal if the proper postoperative rehabilitation routine is followed closely.

Physical therapy is usually started on the first postoperative day and consists of regaining range of motion and flexibility. A careful postoperative program of flexibility and stretching is necessary to prevent a future recurrence. After several weeks a strengthening program can be implemented. Later, sports-specific skills are developed. After rehabilitation, most individuals are able to return to their pre-injury level of activities. Golf, tennis, and other sports usually can be resumed after two to three months.