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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 12^th straight squash national singles title barely 6 months after similar arthroscopic rotator cuff repair, and then went on to take 4^th 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

Gym and fitness injuries in the hand and wrist are often misdiagnosed and undertreated for a variety of reasons. Chronic and overuse injuries often go untreated due to the athlete’s reluctance to seek medical attention. This is because in many sports, the athlete can compensate with some of these injuries while this may be more difficult in weight bearing joints such as the knee and ankle. However, a more preventable issue may be the inaccurate diagnoses and inadequate treatment often afforded the hand and upper extremity in athletes. This is particularly true in weightlifters, Cross fit athletes and bodybuilders since these athletes often rely upon allied health professionals such as chiropractic physicians, physical therapists and athletic trainers to make the diagnosis and recommend treatment. This is where the physician and ancillary health specialist can improve their management of these challenging and often obscure injuries.

The common injuries in the hand and wrist

In many instances, the hand surgeon should be involved at an early stage of treatment and to ensure an accurate diagnosis.   The common injuries in the hand and wrist are often sports specific and often aptly named. For example, jersey finger is an avulsion of the flexor profundus tendon that occurs when the athlete grabs the opponents jersey as they pull away. In rare cases, this can be seen in doing excessively heavy wrist curls where a great stress is placed on the insertion of the tendon on the distal phalanx at the tip of the finger. This leads to a sudden and resisted hyperextension force that avulses the tendon at its insertion site. A strong surgical repair is necessary followed by appropriate therapy to maximize the passive range of motion and later the active flexion. Subsequent strengthening is of obvious particular importance in the competitive athlete and weightlifter.

Blunt injuries can occur to the extensor mechanism as well and the wide range of complex joints in the hand and wrist. Much more common, however, is the chronic and overuse injury in the weightlifter. Repetitive heavy strain on a muscle/tendon unit can lead to microtears in this tissue and lead to the common entity known as tendonitis. This is a very general term and it is important to understand the specifics and severity of the particular lesion. Injuries as common as tennis/golf elbow, wrist tendonitis and rotator cuff strain must be evaluated by a specialist so that the more severe injury can be recognized early and treatment instituted by appropriate health care professional. At that point, the therapist, chiropractor or athletic trainer may be the most apt person to bring the fitness enthusiast back to full gym readiness !!   Dr. Alejandro Badia, Hand & Wrist Surgeon Miami, Florida.

With great joy Karen Meakins recently wrote Dr. Alejandro Badia, to let him know of her recent athletic achievements. Karen won her 12th National Title, a record for this sport. This amateur athlete and squash coach from Barbados suffered from a partially torn shoulder tendon that prevented her from playing. On October of 2011 she decided to get it corrected after her local physician recommended she see Dr. Alejandro Badia, upper body orthopedic surgeon in Miami. After the procedure she had intense occupational therapy for 3 months followed by gym work with a trainer. She says the success of the procedure has resulted in her being able to get back to competitive squash. Karen is grateful for Dr. Badia’s surgical skills and for his open communication style. His habit of returning emails promptly and answering her questions has given her tremendous comfort during the recuperation stages. She tells us “I think I am very lucky because I had a great surgeon, a great therapist and a great trainer. I am back to 90% mobility right now and my shoulder is stronger than it has ever been because of all the hard work in the gym. I plan to play in the World Masters in July which was always my goal post surgery. I wasn’t sure even 2 weeks ago that I would be ready to play but I am extremely satisfied with where my shoulder is right now so I have decided to enter.” Go team Karen!

Please call (305) 227-4263 to request an appointment with Dr. Alejandro Badia.

Read also: Thumb arthritis is the most common form of osteoarthritis affecting the hand

Miami – Dr. Alejandro Badia, MD, FACS, and world-renowned Hand & Upper Limb Surgeon, President of the ISSPORTH (International Society for Sport Traumatology of the Hand), will visit Barbados the first week of December. Dr. Badia will offer a free Medical Conference for local medical professionals and another one for patients and professional athletes.

Dr. Badia has recently performed a shoulder surgery on Karen Meakins, a famous Senior Squash player in Barbados only weeks ago.

“Earlier this year I was experiencing a lot of pain in my shoulder. As a competitive squash player I continued playing but the pain got worse. An MRI showed a torn tendon. At first I was reluctant to have surgery but talking to Dr Badia put my mind at rest and I decided to go ahead with the surgery in October. The care I received at the Badia Hand and Shoulder Centre was fantastic. I met with Dr. Badia the day before the surgery and he explained everything in detail. The staff was all excellent, very helpful and the Badia Hand to Shoulder Center is an amazing facility. The surgery was successful and Dr. Badia repaired the torn tendon. My rehabilitation is going well and I expect to be back on the squash court ready to play in the World Masters next July. One thing I have to mention is the excellent after care I have received from Dr. Badia. Since I do not live in the US I email him with any queries or concerns that I have and he always emails me back on the same day. Quite remarkable knowing how busy he is!” – Karen Meakins.

Karen Meakins

Karen is currently Barbados Sports Personality of the year, the 2010 squash silver medalist at the World Masters Over 35 event and the silver medalist at the Central American and Caribbean (CAC) Games. Meakins is also the number 2 female player in the Caribbean and 11 (eleven) time Barbados National Champion.

“It is extremely satisfactory when a professional athlete come to see me. It is imperative for them to be appropriately treated, to heal and go back to their intense routine. It is my challenge and my passion to succeed, says Dr. Badia.”

Badia has a long history of treating high level tennis and golf competitors, NFL and NBA athletes. Dr. Badia has just been nominated one of the top 45 great hand and upper extremity surgeons to know by Becker’s Orthopedic & Spine Review. Alejandro Badia is in conversations with leading Brazilian medical authorities to organize a sports medicine conference prior to the 2016 Olympic games in Rio de Janeiro.

This free conference for patients and professional athletes will be held on Wednesday, December 7th 2011 at 6pm at the Barbados Olympic Association – Olympic Centre, Garfield Sobers Sports Complex, Wildey, St. Michael, BB15094 and the conference for doctors (general, OTs and PTs) will be held on Thursday, December 8th at 5pm at Queen Elizabeth Hospital Martindalis Road, Bridgetown at the Lecture Amphitheater

Please call (305) 227-4263 to request an appointment with Dr. Alejandro Badia.

Read also: Thumb arthritis is the most common form of osteoarthritis affecting the hand

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Severe, unremitting pain in the shoulder can affect young and old alike. Young, active patients often feel that shoulder pain stems from overuse such as seen in Karen Meakins, local squash champion and international competitor. Current exercise regimens usually emphasize strengthening the deltoid muscles, but the rotator cuff is largely ignored. If the pain is a chronic problem, with no history of a single traumatic event, the patient will usually respond to strengthening therapy. Persistent symptoms may require imaging studies such as an MRI and occasionally arthroscopic procedure to diagnose and repair the problem via mini incisions and surgery via a fiberoptic camera. Occasinally SLAP or labral tears can be seen that also require repair in the vigorous athlete or younger patients. However, arthroscopic repair can lead to rapid recovery as seen in Ms. Meakins 4^th place international Masters squash championship in Europe when only 6 months after surgical repair !!

Suffering from partial or complete rotator cuff tear

Older patients often suffer from a bursitis stemming from a partial or complete rotator cuff tear. On occasion a primary osteoarthritis may be the cause and shoulder replacements are now as successful as hip or knee. Barbados patients have actually had this done on outpatient basis in Miami due the teams experience and anesthesia techniques. Despiter the cause, shoulder pain deserves evaluation by an orthopedic surgeon, particularly a hand and upper extremity specialist in order to make the clear diagnosis and speed recovery.     Alejandro Badia, MD, FACS Miami Shoulder Surgeon Badia Hand to shoulder Center 305 227- HAND (4263) www.drbadia.com

Dr. Alejandro Badia, MD, FACS, and world-renowned Hand & Upper Limb Surgeon, President of the ISSPORTH (International Society for Sport Traumatology of the Hand), will visit Barbados the first week of December. Dr. Badia will offer a free Medical Conference for local medical professionals and another one for patients and professional athletes.