Archive for July, 2013

Rotator Cuff Care: You May Only Need Physical Therapy

Most patients with rotator cuff injuries respond well to physical therapy and don’t need surgery, according to new research into repairing shoulders.

Every year, about 200,000 Americans undergo shoulder surgery related to repairing the rotator cuff, a set of four small muscles in the shoulder that helps to lift and rotate the arm.Tennis serve

Treatments to repair the rotator cuff include anti-inflammatory agents, steroid injections, surgery, physical therapy, or a combination of the above.

The best option may simply be physical therapy, says John E. Kuhn, MD, Chief of Shoulder Surgery at Vanderbilt University Medical Center.

After surgery “it usually takes people about four months before they can even think to get back to any kind of labor-type work and it usually takes a year to get a full recovery,” says Kuhn, who is the director of the Moon Shoulder Group, a network of doctors researching the best options for repairing shoulders.

“We found exercise programs were effective at treating rotator cuff disease and we consolidated them into one physical therapy program,” says Kuhn.

The program focuses on range of motion, flexibility, and strengthening.

The therapy program doesn’t necessarily heal the rotator cuff, but it does take the pain away, he says.

Kuhn led a new study of 452 rotator cuff tear patients and found the exercise program helped 85% avoid surgery.

The study appeared in the May issue of the Journal of Shoulder and Elbow Surgery.

The effect lasted for 2 years, and only 2% of the patients opted for surgery.

The study also suggests that pain may be a less suitable indication for surgery than weakness or loss of function.

The entire rotator cuff home exercise program is available for free online.

Kuhn suggests you talk to your physician before starting it.

When to see your doctor

Here are some indications you may need to see your doctor for a rotator cuff problem, says Jeffrey H. Yormak, MD, a board-certified orthopaedic surgeon with Somers Orthopaedic Surgery & Sports Medicine Group:

• Pain in the front of your shoulder that radiates down the side of your arm.

• Weakness in your arm and difficulty with routine activities.

• Difficulty with routine activities, including combing your hair or reaching behind your back.

“If you’ve injured your shoulder or experience chronic, lasting shoulder and arm pain, it’s best to see an orthopedic surgeon,” Yormak says.

“Only then can you receive a definitive diagnosis and begin treatment.

Early diagnosis and treatment of a rotator cuff tear may stop symptoms, such as loss of strength and motion, from setting in.”

Did Wimbledon’s Courts Wreck Players’ Knees?

The slippery grass courts at Wimbledon led to injuries and the withdrawal of 7 top tennis players on Day 3 from the prestigious tournament last Wednesday.

Four players injured their knees – Victoria Azarenka, John Isner, Marin Cilic, and Jo-Wilfried Tsonga.

Prominent players, such as Maria Sharapova and Caroline Wozniacki, who both lost their matches, criticized the condition of the courts.

One of Maria Sharapova's spills at Wimbledon.

One of Maria Sharapova’s spills at Wimbledon.

But it’s more likely that the rigors of the game, rather than the courts, were to blame.

No matter what the surface, knee injuries are quite common in tennis players because of the sharp side-to-side movements required.

Azarenka hurt her right knee on Monday when she slipped on Court One.

Tsonga, Isner, and Cilic mostly blamed pre-existing physical problems or one-off injuries that were not caused specifically by slipping on the grass.

Most of us never get a chance to play tennis on grass courts and so will never know how slick the courts can be.

I once played on a grass court on vacation in Hawaii, and didn’t find it particularly slippery, although the skidding ball made me bend me knees more than usual.

Knee Cartilage Tears

One of the most prevalent knee injuries among players in their 40s and 50s is a knee cartilage tear, particularly among those who play intensely.

The basic problem is that the aging knee cartilage loses some of its water content and elasticity and, consequently, some internal strength.

These changes make tears more likely.

Tears occur when you land, anchor your foot, and then attempt an inward or outward pivoting motion.

Most players experience some pain and may feel tearing within the knee, although some feel no tearing and have relatively little, if any pain.

A swollen knee on the day following a painful episode is a good indication that you have damaged your knee.

Medial cartilage tears, on the inside of the knee, are more common than lateral cartilage tears, on the outside of the knee.

Many tennis players simply live with a cartilage tear that does not bother them too much.

Even a highly active player, who is much more likely to have symptoms, may only feel intermittent pain.

If you have a cartilage tear and it remains painful even after conservative treatment with anti-inflammatory agents, decreased activity, and quadriceps-strengthening exercises, then arthroscopic surgery can remove the torn portion of cartilage.

Then you should rehabilitate your leg muscles to help regain full range of motion in the knee.

Like most tennis players, if you have torn cartilage you can likely return to play at the same level, even if you need surgery more than once for tearing knee cartilage.