Weekend warriors’ watch out, rotator cuff injuries happen from simple yard work more often than they do from pitching nine innings
Rotator cuff injuries
The sharp pain in your shoulder that wakes you up when you roll over in the middle of the night might be your rotator cuff or several other things. Orthopedic Surgeon Dr. Gene DeMorat of Shore Orthopaedic University Associates, who works with local athletes and was a physician for the U.S. Olympic ski, snowboard and speed skating teams, works with many patients suffering with shoulder pain. “I work with athletes who have shoulder and rotator cuff problems due to injuries related to their sport. But more than athletes, I have weekend warriors who do a lot of damage to their shoulder in their own backyard,” said DeMorat.
Weekend Warriors are frequent patients
Spring is here and it is prime season for rotator cuff injuries according to Dr. DeMorat. “I see so many patients who come in with shoulder pain and it is not because they just pitched nine innings. It is because they have not done any exercise over the winter and there is a nice sunny day and they decide to go for a run even though they have been rather sedentary, not working out over the winter and they find themselves hurting. We see a lot of weekend warriors that come out with the good weather, doing a sudden burst of work, whether it is raking leaves, digging, lifting heavy objects or they decide to do some painting and they find themselves in some pretty significant discomfort.”
Rotator Cuff Mechanics
Dr. DeMorat explained that the shoulder has a great deal of mobility forward, backward and side to side and it relies on the ball socket joint to be held in place by four muscles that make up the rotator cuff. He indicated that the ball portion of the shoulder sits in a shallow base and the key to proper function is those four muscles squeezing the ball into place. Dr. DeMorat likened the joint to a golf ball sitting on a tee and the muscles hold it in place.
The mechanics of the shoulder, Dr. DeMorat said, is like a rope that over time and over use can fray and tear. In fact, the physician said that most of the pain associated with the shoulder and the rotator cuff are due to age. “As we age the tendons have some wear and small tears will occur. Like the rope that frays gradually over time, the holes or tears get larger and the blood supply is not as much as it had been in the past,” said Dr. DeMorat.
Going the physical therapy route
For small tears in the patient’s rotator cuff Dr. DeMorat said the choice is often to go with the non-surgical options before considering surgery. “We would likely look at an anti-inflammatory, add a cortisone injection in the affected area to help with the discomfort, and modify activities that involve that shoulder. We would also have the patient in physical therapy to strengthen the muscles around the shoulder and try to get the patient back to where they need to be without surgery.”
Dr. DeMorat said almost everyone has some kind of discomfort in their shoulders as they get to their 70s and 80s. “As we age, the wear and tear on the shoulder can cause some pain, but at a certain point we look at the risk versus reward and work with patients and how they can live with their rotator cuff injury by reducing inflammation and incorporating physical therapy to bring strength back to that joint.”
Surgery to repair the rotator cuff
Dr. DeMorat said shoulder surgery used to be done in an open manner but is now done arthroscopically, which is traditionally much better for the patient’s recovery and cuts down on the incidence of infection. It is same-day surgery and the surgeon will go in and put small anchors in the bone and then suture the tendon. Dr. DeMorat said the skin will heal within two weeks but the bone and tendon connection will require six to eight weeks.
“Recovery from rotator cuff surgery is a long process. The patient will be immobilized in a sling for six weeks and then they will slowly start activities and physical therapy. For most patients it is a four to five month recovery,” said Dr. DeMorat. He added that for a severe injury where the tendons and the tissue is not reparable then the option is to do a shoulder replacement. “That is a six to nine month recovery time,” said the physician.
But Dr. DeMorat suggested there are options available and to be smart about your body and your shoulders that do so much of the work for our bodies. “You can prevent stiffness by keeping fit, by keeping muscles stretched and strong. I see so many patients who mistake cardio as a complete workout. It’s not - everyone needs to stretch to be strong,” said Dr. DeMorat. “Maintain muscle and body tone with yoga and do strength training and cross fitness to get the heart rate up.”
Good advice for everyone
Dr. DeMorat said, “No one goes out and plans to overdo it but these sudden changes, especially as the weather changes can cause shoulder problems so my advice to my patients is look before you leap.”
To learn more about Shore Medical Center visit www.shoremedicalcenter.org to learn more about Dr. Gene DeMorat and the physicians at Shore Orthopaedic University Associates visit www.shoreorthodocs.com or call 609-927-1991.
Shore Orthopaedic University Associates
Stephen J. Zabinski, MD
John R. McCloskey, MD
Gene J. DeMorat, MD
Richard B. Islinger, MD
George C. Alber, MD
Thomas A. Barrett, MD
Stanley C. Marczyk, MD
Frederick G. Dalzell, MD
Damon A. Greene, MD
Charles N. Krome, DO
Ira M. Fox, DPM
Ted C. Lai, DPM