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Shoulder injuries are a risk for "weekend warriors".

Older adults are staying active for longer, and that's a good thing--physical activity benefits cardiovascular, brain, and bone health, and also increases opportunities for social interactions as we age. But while it boosts strength and flexibility, exercise also exerts wear and tear--and one joint that is particularly vulnerable to injury is the shoulder, and the rotator cuff that keeps it in place.

Rotator cuff issues The rotator cuff is a group of muscles that raise and rotate the arm. "In older adults it's susceptible to damage from bone spurs, which develop with age and press on the rotator cuff, fraying it," says Bradford Parsons, MD, associate professor of orthopaedics at Mount Sinai. "It also can be weakened by age-related deterioration of tiny blood vessels in the tendons."

Up to 40 percent of adults age 70 and older demonstrate rotator cuff tears on MRI. A tear occurs when the tendons that attach the rotator cuff to the ball of the shoulder joint (the humeral head) are pulled away. This can result from wear, or from a sudden force on the shoulder (for example, if you fall on your arm). The injury typically results in weakness and tenderness when using your shoulder or if pressure is put on it (for example, if you lie on that side in bed). The stability of the shoulder also can be impacted. "This can potentially place an elderly patient at slightly higher risk for dislocation following injury, compared to a middle-aged adult," Dr. Parsons notes.

Physical therapy may help Many small or partial rotator cuff tears can be managed with physical therapy, which helps strengthen the intact cuff muscles in order that range of motion is maintained. Simple exercises, such as bending over and swinging your arm like a pendulum, or slowly rotating your shoulder in large circles are the first step (see What You Can Do, below), before progressing to strength training using lightweight dumbbells and then heavier weights. Ice packs and painkillers taken under the guidance of your doctor can help ease discomfort (see page 7 for information on complementary pain relief).

Surgery an option If a rotator cuff injury is severe or doesn't respond to exercise, surgerical repair may be an option. The procedure reattaches the rotator cuff tendon to the humeral head using sutures. A recent small study (.American Journal of Sports Medicine, July) suggests that it can improve function, reduce pain, and help older "weekend warriors" continue activities they enjoy. The study looked at data on 44 patients (49 shoulders) age 70 and older, who underwent minimally invasive repair of their rotator cuff tears. About 75 percent were able to return to the same or a higher intensity of sports after surgery. They also experienced significant improvement when it came to pain affecting their activities of daily living, and sleep.

Adults over age 70 typically aren't treated surgically for rotator cuff issues, because circulation and bone quality are poorer, and they also may have diseases that impede healing. However, the researchers say these data indicate that it may be worth assessing each case individually and suggesting a surgical approach to seniors who are in overall good health. Dr. Parsons emphasises that there needs to be a sufficient quantity of healthy tendon to reattach to the bone, and the bone also needs to be healthy. "It also is best if you are a nonsmoker," he adds, "since there is evidence that smoking can affect the success of the procedure." Patients also need to adhere fully to their post-surgical rehabilitation program. "Expect a complete recovery to take several months," Dr. Parsons adds. "Most patients have a functional range of motion and adequate strength by four to six months after the operation."


* Bend at the waist, while holding on to a table or chair for support, and let your arm dangle down. Gently rotate your shoulder so you're drawing circles in the air with your arm--start with small circles and work up to bigger ones.

* Holding a lightweight (2 lb) dumbbell, lie on your stomach on a bed or table. Stretch out your arm so your elbow bends at the edge of the bed and the hand holding the dumbbell hangs down. Slowly raise your hand, stopping when it's level with your shoulder, then lower it slowly. Repeat until your arm is tired, then switch sides. As your muscles strengthen, progress to using heavier dumbbells.
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Title Annotation:BONES & JOINTS
Publication:Focus on Healthy Aging
Date:Nov 1, 2015
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