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with moderation and stretching

Ask the Doctor: Avoid shoulder pain
with moderation and stretching

We present a monthly question-and-answer session with a Henry Ford Cottage Hospital physician on a specific health issue. This month, Dr. Terrence Lock, on the senior staff at Henry Ford Cottage Hospital, talks about shoulder injuries. These injuries affect young, middle-aged and older people, whether active or sedentary.

First off, what are some common shoulder injuries?

Shoulder injuries can often be divided by age. Younger people and young athletes frequently have instability of the shoulder. Dislocation of the shoulder in young patients often requires surgery. Young athletes, such as pitchers, sometimes tear their labrum, which is the rim of cartilage around the shoulder socket. Those in their 40s and 50s are mostly affected by rotator cuff problems, including tendinitis and tears. The rotator cuff is the group of four muscles with tendons that surround the upper arm or ball of the shoulder. When the tendons are inflamed or torn, they cannot function properly and cause pain.

What causes these injuries?

Younger and older people get these injuries because of overuse and general wear and tear. Young people often develop pain from overuse or specific traumatic episodes. Wear and tear plays a greater role in people over 50. Arthritis can develop in the shoulder joint, usually in older patients, but can form at the end of the clavicle or collarbone in much younger athletes, often related to weightlifting.

How do you treat these conditions?

For most people with an overuse condition, we recommend rest from the activity. Anti-inflammatory medication, such as Motrin, and physical therapy can help. With many rotator cuff problems, people don’t require surgery.

Are baby boomer rotator cuff issues a result of them refusing to act their age?

Rotator cuff problems typically impact those older than 50.

What is a frozen shoulder? It sounds scary.

It is a strange condition that primarily affects those in their 40s and 50s. It tends to be a little more common in women, diabetics and those with thyroid conditions. The onset is heralded by pain and with pain comes a decrease in the range of motion. There can be significant discomfort. It is characterized by three phases: a freezing phase often associated with pain and decreasing range of motion, a frozen phase characterized by less pain but poor motion, and a thawing phase that provides improved motion. The entire process can take two years to go away. Most cases resolve without surgery but some may require manipulation or surgically cutting the contracted capsule of the shoulder joint. For some people, it comes on for no apparent reason, or someone may fall and break their wrist and frozen shoulder develops.

How do you treat it?

Treatment early on is anti-inflammatory drugs and general motion exercises. Some patients don’t make progress and sometimes require surgery that involves gentle manipulation.

How can people prevent shoulder injuries?

As we get over 50, we need to maintain flexibility by stretching and staying fit. Warm your shoulder muscles in the shower. Stay fit by walking, using a treadmill, playing tennis, whatever works for you.

What is the most common surgery you do?

Arthroscopic rotator cuff repair is my most common procedure.

Are shoulder conditions more common in active than sedentary adults?

They can occur in both groups. Injuries and overuse conditions can occur in active patients, but rotator cuff disease is common in sedentary individuals as well. Rotator cuff disease, in general, is a degenerative condition most often in the over-50 group. Forty percent of these patients with rotator cuff tears have no recollection of trauma.

What is the toughest procedure to recuperate from?

Rotator cuff repair takes a long time to heal. Patients are generally in a sling for four to six weeks with passive motion only. The next four to six weeks involve active motion followed by strengthening. The entire process can take more than six months. Recuperating from this takes a substantial commitment from the patient. It requires a lot of physical therapy. Getting back to normal may take six to nine months.

What’s new in treating and preventing shoulder injuries?

In the last 10 years, there’s been an explosion in the development of minimally invasive arthroscopic repair techniques. A lot of research is being done now on biologic treatment to enhance the body’s ability to heal. The use of these biologic agents, such as platelet-rich plasma, likely will increase dramatically over the next five to ten years.  

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