Deep persistant pain in the shoulder can affect young and old alike. The causes, however, can be very different and require a thorough diagnostic process to understand the underlying problem and lead to a solution. Young, active patients often feel that there is an overuse syndrome. This may be the case, but it is important to understand why. Current exercise regimens usually emphasize strengthening the deltoid muscles, but the rotator cuff is largely ignored. This leads to an instability syndrome that can cause pain and even worse, a mechanical deficiency of the shoulder joint. If this is a chronic problem, with no history of a single traumatic event, the patient will usually respond to a strengthening therapy protocol that requires diligence on the part of the patient and therapist.
The most common cause of shoulder pain in older people is known as impingement syndrome. Bursitis is often an element of this syndrome and this frequently used term is much more accurate in depicting the problem than the term “arthritis”. Impingement refers to the mechanical process where the overlying bony arch of the shoulder (acromion of scapula and clavicle) is pressing on or rubbing on the underlying rotator cuff tendons and bursa. With age, the blood supply to the rotator cuff is diminished, and small microtears in the tendon leads to tendonitis and bursitis and even larger tears. This situation may respond to conservative treatment including a cortisone injection to reduce the bursitis, and shoulder therapy to improve the strength of the intact rotator cuff.
What does it imply to have a complete rotator cuff tear?
A complete rotator cuff tear implies that the torn tendon has pulled away from the bone and hence, cannot stabilize the head of the humerus against its cup joint (glenoid). The patient will either be unable to physically raise the arm or they can do this only with severe pain. This whole range of impingement problems is characterized by pain with elevation of the arm, pain worse at night, and inability to lie on the side of the affected shoulder. Once the pain is severe enough and does not respond to therapy and other conservative means, then surgery is indicated. Some smaller tears can be repaired through arthroscopic means, but larger tears are usually repaired through a traditional incision. Most repairs require a one month period of immobilization in a sling and several months of post-operative therapy closely directed by the surgeon. Local Barbadian, Karen Meakins, managed to win her 12th straight squash national singles title barely 6 months after similar arthroscopic rotator cuff repair, and then went on to take 4th in the world masters championship !! Many other citizens of Barbados also had arthroscopic rotator cuff repairs by Dr. Badia including local prominent physicians and community leaders. Shoulder pain should not be ignored and requires appropriate diagnostic studies and examination by a shoulder specialist. Dr. Alejandro Badia, Hand & Wrist Surgeon Miami, FL
