Skip surgery for rehab

A torn rotator cuff is a fairly common injury among athletes and others these days, and doctors are exploring new ways to repair the problem

September 15, 2006|By Jeannine Stein | Jeannine Stein,Los Angeles Times

While Defense Secretary Donald H. Rumsfeld recovers from surgery to repair a torn rotator cuff, he can take solace in knowing that he has many fellow sufferers - among them sports pros, recreational athletes and weekend warriors. But if athletes (even occasional ones) play their cards right, surgery isn't always necessary.

Depending on the severity of the damage, a person's age and level of activity, the injury can be treated with rehab and time and might not cause a permanent benching.

The rotator cuff consists of four tendons that connect the humerus, or upper arm bone, with the shoulder blade, enabling the arm's range of motion. It is vulnerable to damage when used repetitively for activities that require reaching overhead, such as weight lifting, tennis, volleyball, baseball, water polo and golf. Even stocking shelves or doing construction work can cause damage.

High-profile surgeries get the most attention. St. Louis Cardinals pitcher Mark Mulder, for example, underwent surgery this week for rotator-cuff problems (what's described as "fraying" of the tendon).

Some injuries can be as mild as tendinitis (inflammation of the tendon) or tendon degeneration. Tears, whether partial or full, are more serious and can affect more than one tendon. The good news, according to Dr. Michael Pearl, an orthopedic surgeon with Kaiser Permanente in Los Angeles, is that "the majority of cases don't require surgery" and can stabilize with physical therapy and medication.

Middle age seems to be prime time for rotator-cuff troubles, Pearl says. Although Rumsfeld's press secretary put the blame on "an old athletic injury" (Rumsfeld wrestled in college and is said to love the game of squash), Pearl says the main culprit is often the body's normal wear and tear over time - and not shoring it up with stretching and strengthening exercises. Playing softball or doing another full-on activity once a month - and failing to warm up or stay fit between games - also can generate new injuries.

Even if surgery isn't required, physical therapy and medication usually are. Normal activities, including exercise, can't usually be resumed without three to six weeks of treatment and rest.

"I don't let my patients go back [to exercise] until they have all their strength back," says Dr. Sharon Hame, assistant professor of orthopedic surgery in the sports medicine division at the University of California, Los Angeles. "The biggest mistake people make is that they start to feel great, then go back and play two sets of tennis, which reirritates the shoulder."

Arthroscopic surgery to repair moderate to severe tears has gained in popularity over the past decade, although more invasive surgery might be required, depending on the type of injury. Recovery time can range from three to six months.

The likelihood of sustaining a rotator-cuff injury can be lessened with a regimen of stretching, although genetics and age play roles as well. "Prevention is a key thing," says Dr. Jonathan Chang, clinical assistant professor of orthopedics at the University of Southern California.

For those who are injury-free, a few exercises can shore up the rotator cuff. (Those who have sustained injuries should check with their doctors before exercising.) Lift the arms to the side to a little past 90 degrees, move them in front of the body about 20 degrees, then lower. This can be done with or without light weights, and the emphasis should be on higher repetitions and lower weight.

To stretch shoulder muscles before and after exercise, bring one arm straight in front and hold it against the chest with the other. To flex it the other way, extend the arm and place the hand against a door frame, gradually letting the arm go behind the body. Make sure to do it slowly to avoid injuring or dislocating the shoulder.

Jeannine Stein writes for the Los Angeles Times.

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