New York City—December 13, 2010
“The most common injuries are soft-tissue shoulder injuries such as tendinitis, labral tears and torn rotator cuff,” says Dr. Stephen Fealy, an orthopedic surgeon in the Sports Medicine and Shoulder Service at Hospital for Special Surgery in New York. Dr. Fealy, along with his colleagues, sees a spike in office visits the Monday after Thanksgiving each year. These recreational injuries are usually associated with repetitive overhead movements, such as throwing a basketball, making a pass in flag football and swinging a tennis racket.
The rotator cuff is the network of tendons that provides stability in the shoulder. A tear can be caused by an isolated traumatic incident but more commonly results from repetitive wear and tear. “Rotator cuff tears are more common in our 50s, when the tendons in our arm become more brittle,” says Dr. Fealy. “If a recreational athlete in this age group experiences pain after overhead activity, I would suspect that a torn rotator cuff is at play.”
Rotator cuff tears are less common among younger recreational athletes in their 30s and 40s, says Dr. Fealy. Instead, tendinitis and labral tears are the more likely culprits among weekend warriors in that age group.
Tendinitis is caused by general inflammation of the shoulder tendons, including inflammation of the rotator cuff. “Like a torn rotator cuff, tendinitis results from extensive use over a period of time. It causes pain, swelling and tenderness but doesn’t usually restrain everyday activities,” says Dr. Fealy.
A torn shoulder labrum is a tear in the thick tissue or cartilage located at the shoulder socket, which becomes more brittle with age. In middle-aged athletes, this injury is typically associated with frequent participation in higher-energy overhead sports, such as volleyball and baseball.
Only a small number of soft tissue shoulder injuries require surgery. In general, non-traumatic shoulder injuries can be treated conservatively with physical therapy that is focused on stretching and strengthening.
Should recreational athletes experience shoulder pain and swelling, Dr. Fealy recommends asking the following questions to determine whether to seek medical assistance:
• If the shoulder is sore, can you still engage in normal movements? If so, it could be tendinitis that may not require medical assistance. A week of anti-inflammatory medication such as ibuprofen could do the trick.
• If it is more difficult to move your arm, are you currently unable to perform an activity that you could do before? If so, you should seek medical attention. Your doctor might recommend an MRI to diagnose tears and possible shoulder separations.
Nonsurgical treatment of tendinitis, rotator cuff and labral tears typically consists of organized physical therapy, anti-inflammatory medication, rest, and, in some cases, an in-office Cortisone injection. Dr. Fealy offers the following recovery tips and advice to prevent further injury:
• For tendinitis and rotator cuff tears, conduct in-home or in-office physical therapy once or twice a week for a month. For labral tears, conduct in-office physical therapy for up to two months.
• Focus on regaining full range of motion.
• Do not “baby” your shoulder lest the whole shoulder system tightens.
• Return to play no more than once a week during recovery periods.
• Ice is the cheapest and most effective anti-inflammatory. Apply ice twice a day for 20 minutes after any big game.
• Prevent future injury by instituting good ergonomic practices at your desk during the work week.
• Keep your shoulder relatively still at the office. Place your mouse beside your hand so that you don’t have to reach for it and potentially aggravate the shoulder.
• Break a sweat pre-game. Take a short jog around the field to warm up your entire body.
• Practice yoga to develop core strength and flexibility. Dr. Fealy sees fewer breakdown injuries in people who practice yoga.
With proper nonsurgical treatment and rehabilitation, most athletes can expect to return to pre-injury levels of play. But it is important to remember that more serious injuries of the labrum and rotator cuff could require surgery. So before you participate in recreational sports this holiday season, please visit www.hss.edu/sportsmedicine for more information on shoulder tendinitis, labrum tears and rotator cuff tears.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.