Treating Injuries off the Cuff

New York Post—May 1, 2007

Rotator cuff injury—quick, what comes to mind?

If you thought disabled list, messed-up pitching rotation and "there go our chances," you'd be wrong. Try: "I can't quite get on top of my serve," "when did that shelf get so high?" and "guess I'm no longer the ace of the summer softball league."

It's called weekend warrior syndrome. That's when a game of pickup basketball on Saturday leaves you sore for a week, or when a few hours of tennis make it painful to turn off the alarm clock for five days running. That's when, even though you've been busy with job and family and just life, you want to push it on the court, links or field like you did when you were 20 and—ouch, my shoulder! And it's not necessarily something a couple Advil will make better.

Pain-relief options are many and growing, with the development of ever better anti-inflammatory or anti-arthritis creams to relieve aches and pains. These remedies, however, are only part of the solution.

"For the aging athlete in all of us, it is important to realize that a lot of the aches we feel are a result of not being in shape," says Stephen Fealy, M.D., sports orthopedic surgeon at Hospital for Special Surgery’s Sports Medicine and Shoulder Service in Manhattan. "But many of these symptoms may be due to something truly being inflamed, irritated or partially or completely torn."

How do you know when to worry?

"Movements of any extremity, whether they are day-to-day activities or serving a tennis ball, should not hurt. If they do, it is important to figure out why,” says Dr. Fealy.

For weekend warriors, the tricky part is distinguishing between totally normal sports-induced aches and a frank loss of motion in the shoulder.

"The shoulder offers us a lot of motion in many planes at the cost of stability," Dr. Fealy explains. To wit, it's a ball-and-socket joint, and the rotator cuff is a set of four muscles and tendons that attach the shoulder and arm.

"Shoulder instability manifests itself as either a complete dislocation or subtle micro-instability. A complete dislocation is an example of a traumatic event that occurs as a younger athlete is playing football, hockey or wrestling; whereas the aging athlete is more likely to get micro-traumatic or overuse injuries from repetitive motions such as those seen in tennis or golf," Dr. Fealy says.

Such micro-traumas result in what's known as impingement syndrome, where normal movement is interrupted. If it hurts to comb your hair, for example, or reach for something on the top shelf of the closet, then you've got impingement syndrome—and you're in luck. It often responds to traditional anti-inflammatories and physical therapy to strengthen the rotator cuff.

"Only for the most stubborn cases do doctors consider a steroid injection and possible surgery, which can be performed arthroscopically on an outpatient basis,” says Dr. Fealy.

Recognizing, evaluating and treating these weekend-warrior shoulder problems early is the best remedy. Playing and exercising through the pain is the quickest way to surgery—and the DL.

The author of this piece, Rock Positano, DPM, M.Sc., MPH, is the director of the Non-surgical Foot and Ankle Service at Hospital for Special Surgery in New York. His column appears every Tuesday in the New York Post.

Read this article at NYPost.com.