Wave Your Hands in the Air for Your Shoulders, Part 1
Your shoulders are some of the most complex joints in your body, but unless you’re a baseball pitcher, you probably don’t think about them much. When your shoulder starts hurting, though, even the most common daily activities can be painful. The good news is that there are steps you can take to prevent shoulder injuries, and treatments to heal or minimize most shoulder issues. In this three-part series, Torrance Memorial orthopedic surgeon Dr. Brian Magovern discusses common shoulder ailments, treatment and recovery, along with an ounce of prevention. Most shoulder conditions are injury- or age-related (or both) and include rotator cuff tears, dislocations, fractures, arthritis and frozen shoulder. In Part 1 we’ll look at the Big R: rotator cuffs.
Your shoulders are ball-and-socket joints involving three large bones: the humerus (upper arm), scapula (shoulder blade) and clavicle (collarbone). The ball at the end of your humerus fits into a shallow socket in your shoulder blade. Your rotator cuff is a group of four tendons that stretch from your shoulder over that ball, holding it in place, Dr. Magovern explains. They also help you lift and rotate your arm. When one of those tendons is torn, it no longer fully attaches to the humerus. Rotator cuff tears usually affect one or two of the four tendons, and while tears are most often associated with pitchers and other athletes, they can also result from wear and tear. Such degenerative rotator cuff injuries may begin as a fraying of the tendon, which then tears when a stress is applied – say, when you lift a heavy weight.
Acute (sudden) rotator cuff tears are very painful. Patients with a degenerative tear “typically have a slow onset of worsening pain in their shoulder. It’s often worse at night, and when reaching overhead,” Dr. Magovern says. Rotator cuff frays and tears get worse without care, but they can often be diagnosed with a simple office visit and physical exam. (An MRI scan, if needed, can provide a definite diagnosis.)
Dr. Magovern usually recommends surgery for younger or more active patients who have a torn rotator cuff. The surgery itself is an arthroscopic, outpatient procedure lasting less than an hour. During the surgery, the orthopedic surgeon inserts small surgical anchors into the ball of the humerus. The torn tendons are attached to those anchors; as they heal, they attach to the bone itself. Post-surgical rehabilitation can last four to six months, beginning with immobilization of the shoulder, followed by physical therapy to gradually reintroduce movement and strengthen the shoulder.
Older patients with small tears can often be treated with physical therapy. This doesn’t heal the tear, Dr. Magovern explains, but it “can essentially make your shoulder feel normal, so the condition is asymptomatic.” The patient is also monitored to ensure the condition doesn’t worsen.
While frayed or torn rotator cuffs can be treated, they are painful and of course the best option is to avoid these injuries if at all possible. Fortunately, the preventive measures you can take are fundamental and apply to a healthy lifestyle generally. Smoking and diabetes are risk factors: they constrict blood flow, which means that over time your rotator cuff tendons (along with the rest of your body) won’t receive optimal blood to keep them healthy and strong. High cholesterol also increases the risk of rotator cuff tears, possibly due to cholesterol infiltrating and weakening the tendons. So: lay off the cigarettes, maintain a healthy weight and adopt a healthful diet. One more preventive measure: age-appropriate exercise and workout routines. You can still powerlift when you’re 50 (or 60), but listen to your body and your primary care physician, and don’t try to show up the 20-somethings. And reaching for that case of bottled water on the top shelf at the store? That’s what employees with stepladders are there for.
In our next blog, we'll discuss two additional traumatic conditions: dislocations and fractures.
View Part 2
To schedule an appointment with a Torrance Memorial orthopedic specialist, call 310-517-4700. To reach Dr. Magovern, call 310-316-6190.