Shouldering the pain: Rotator cuff problems increase with age

NEXT Step/Better Living

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About 4 million Americans, most of them middle-aged or older, will seek medical treatment this year for shoulder pain.

The number's been increasing.

"It's a pretty big deal," said Dean Sotereanos, an orthopedic surgeon at Allegheny General Hospital. "With older folks being as active as they are, there is a lot of stress on the joints." He said that comes with other medical conditions people have at the same time.

You are more likely to experience problems with your shoulder than with other joints because the shoulder is the most movable joint in the body. The joint is unstable because the ball of the upper arm is larger than the shoulder socket that holds it. To remain stable, the shoulder must be anchored by its muscles, tendons and ligaments. Most shoulder pain arises from disruption of these soft tissues.

The most common problem is bursitis or tendonitis of the rotator cuff, four muscles that act to stabilize the shoulder. Bursitis is inflammation of the bursa, a fluid-filled sac that lies between tendon and skin, or between tendon and bone. Tendonitis is inflammation of the tendon, the fibrous tissue that connects muscles to bone.

Rotator cuff tendons weaken with age, said Robin West, an orthopedic surgeon at the University of Pittsburgh Medical Center.

"After the age of 50, the incidence of rotator cuff tears goes up significantly," she said. "It can't be stopped, but the symptoms can be helped."

The rotator cuff can be torn by a single traumatic injury. But, said Dr. West, most rotator cuff tears are the result of overuse over a period of years.

The people who are most likely to suffer rotator cuff tears are those whose work causes them to lift heavy objects over their heads, or swimmers, weight lifters and those who play racket sports.

"The patients I typically treat with rotator cuff injuries are overhead workers or overhead athletes -- construction workers, swimmers, volleyball players," Dr. West said.

You can reduce the symptoms of rotator cuff tendonitis or a rotator cuff tear by strengthening the other rotator cuff muscles that stabilize the shoulder, she said.

"By strengthening these other muscles, you can minimize the forces across the injured tendon and reduce the pain," Dr. West said.

But be careful how you exercise. Some weightlifting exercises increase risk.

"For weightlifting, the biggest strain would be military presses," Dr. Sotereanos said. "Bench presses should be used in moderation. Do more repetitions with less weight as you age."

"I see probably the most injury from the bench press, from people doing it with too heavy a weight," agreed Dr. West.

And if you play tennis or racquetball, be sensible in your exercise pattern.

"A lot of people I see are doing fine, and then they go out and play tennis for five days straight after not having played for a year," Dr. West said.

Swimmers who do the Australian crawl will lessen the odds they will suffer a rotator cuff tear if they mix it up with the breast stroke, Dr. Sotereanos said.

How can you know if you have a rotator cuff tear?

"The symptom I worry about most is night pain," Dr. West said. "Night pain and weakness are strong predictors of a rotator cuff tear in a patient over the age of 50."

"If you are experiencing pain, the first thing you should do is lay off the activity that is causing the pain," Dr. Sotereanos said. "But don't quit exercising."

The second step is to take an anti-inflammatory medication such as Advil or Motrin, the doctors said.

Milder rotator cuff tears will heal if these steps are followed, but if pain persists or worsens, see a physician and discuss with him or her whether you need a cortisone shot or physical therapy.

"Usually I give the cortisone injection and the physical therapy concurrently so that it reduces the pain while the patient is rehabilitating," Dr. Sotereanos said.

Surgery ought to be a last resort, both doctors said.

"There should always be a trial of conservative methods before surgery," Dr. Sotereanos said.

How long will you be laid up if you have rotator cuff surgery?

"It takes about five months to get back to everything after rotator cuff repair," Dr. West said.


Jack Kelly: jkelly@post-gazette.com or 412-263-1476.


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