By Tedman L. Vance, MD
Millions of people play tennis in the United States and that number is growing every year. As a sport that can be enjoyed by people of all ages, a growing number of baby boomers are picking up the racquet. But while the sport’s popularity among seniors increases, so does the chance for sustaining injuries.
Repetitive use injuries to the upper limb (wrist, elbow and shoulder) are common in tennis, and while they are less acute than lower limb injuries, they can re-occur and take longer to heal. For the average tennis player, bursitis and tendinitis in the elbow (tennis elbow) is the most common condition causing pain and swelling and preventing them from playing the game. However, in athletes over 60, shoulder pain related to rotator cuff issues keeps many more from hitting the courts.
Why Rotator Cuff Tears Are Common in Seniors
Degeneration and fraying of the tendons can be a natural part of aging and can lead to rotator cuff tears. Degenerative rotator cuff tears in senior athletes can be caused by reduced blood supply in the tendons that prevents the body from healing damage naturally. Tears can also occur from repetitive use or during a jarring tennis serve that jerks the arm at an unnatural angle.
Understanding the Shoulder and Rotator Cuff
The shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The shoulder is a ball-and-socket joint. The arm is kept in the shoulder socket by the rotator cuff. The rotator cuff is a group of four muscles that surround the shoulder joint. These muscles work to provide rotation and elevate the arm and give stability to the shoulder joint. There is a bursa (sac) between the rotator cuff that allows the muscles to glide freely when moving. When rotator cuff tendons are injured or damaged, the bursa can becomes inflamed and painful. Irritation or injury can cause tendons of the rotator cuff to tear. Surgery may be recommended if a tear occurs. However, many injuries can be treated successfully through non-surgical approaches.
What are the Symptoms?
- Pain when raising and lowering the arm
- Pain at night, especially when lying on the injured shoulder
- Weakness when lifting or rotating the arm
Physicians diagnose shoulder pain through a complete physical examination. To confirm the diagnosis and help determine the severity of the injury, x-rays and other imaging tests are typically used.
The First Line of Treatment
The first line of treatment for shoulder injuries includes rest, physical therapy and medications. Applying ice packs and taking anti-inflammatory medicine will help reduce pain and swelling.
If the pain persists, a steroid injection can reduce pain and inflammation enough to allow physical therapy to continue.
Less Invasive Arthroscopic Surgery
If the rotator cuff has sustained a complete tear, or if the symptoms persist despite therapy, surgery may offer the best chance for healing. Small tears can be treated arthroscopically. In arthroscopic surgery, an orthopedic surgeon makes a small incision and inserts an arthroscope about the size of a pencil to see inside the joint. A small camera on the end of the device transmits images onto a monitor. Viewing inside the joint on the screen, surgeons can determine the severity of the injury. Frequently, the doctor can correct the problem at the same time.
Traditional Open Surgery
If the tear is large or complicated, a traditional, open surgery will be required. This surgery requires a longer incision, takes longer to perform and was the first technique used to treat torn rotator cuffs. However, over the years, the introduction of new technology and physician experience has led to improvements and less invasive measures.
An Ounce of Prevention
To help reduce the risk of sustaining an injury, always stretch the arms and shoulders before activity. Strengthening the muscles in the arm and rotator cuff will help reduce the likelihood for incurring an injury. The American Academy of Orthopedic Surgeons offers an illustrated, easy to follow rotator cuff and shoulder conditioning program orthoinfo.aaos.org that can be used either preventatively or after surgery or injury (with approval from your doctor or physical therapist).
Recovering from surgery can take 4 to 6 months, so be patient. To support the arm, a sling will be used for several weeks. Taking pain medications and entering physical therapy can help regain motion and strengthen the shoulder.
Long-term results of this surgery are good, but many factors affect its success, including the extent of the injury, the person’s age and their willingness to properly follow rehabilitation instructions.
Tedman L. Vance, MD is a board-certified orthopaedic surgeon, fellowship trained in orthopaedic hand and upper extremity surgery. He earned his doctorate of medicine from Louisiana State University and completed his residency at the University of New Mexico. Vance served in the United States Navy and Navy Reserves. The majority of his practice was sports medicine, trauma and activity-related problems in young athletic patients. He joined Perimeter Orthopaedics in 2005. He has performed hundreds of rotator cuff repairs. Learn more at perimeterortho.com.