SPRING SHOULDER PAINS

Why do we see so many shoulder pains in the spring of the year? Think about what we all start doing that is so different in the Spring. The ski season and basketball seasons are closing, the house needs repair and cleaning, the car needs waxing, softball season begins and all of us jump into the new activities as though we were 18 years old again. Most of these Spring pains come from overuse of the muscles we have been using, or not using, for other activities, such as too much sitting with the TV remote control.

Throwing the softball, places different stresses on the muscles and ligaments of the shoulder, especially the rotator cuff tendons, biceps tendon and the superior and posterior labrum, a heavy ligament around the shoulder socket. If you continue to stress these structures by throwing too much, too soon, a chronic pain develops. The only solution is to start slowly, strengthen the muscles and thus and avoid these injuries. Waxing the car, cleaning windows and painting the ceiling all require you to put force on the shoulder muscles, especially the rotator cuff, with the arm stretched out forward and pressing down or overhead. This motion causes the rotator cuff to impinge against the acromion, resulting in pain.

The rotator cuff is made up of four muscles, the subscapularis, supraspinatus, infraspinatus and teres minor. These muscles help move the arm around in rotation from inward to outward (shown in red). They also serve to hold the upper end of the arm down (depress the humerus) when we lift the arm up sideways (abduction) or forward. When the arm is to lifted upward it tends to pinch the rotator cuff muscles between the upper end of the humerus and the underneath side of the shoulder blade, an area called the acromion.

Rotator cuff impingement syndrome (shoulder tendenitis, also called "bursitis" ) is a result of allowing our shoulder muscles to become imbalanced so the larger muscles, such as the deltoid, can overpower the weaker rotator cuff muscles. This imbalance results in rubbing (impingement) of the cuff muscles against the acromion, inflammation and pain. We see this in people who throw too hard early in the season or any repetitive activity where the arm is pressed down or used in the overhead position.

Treatment of the painful shoulder due to tendenitis includes resting the shoulder by stopping or modifying the activity, applying ice, taking anti-inflammatory medications (ibuprofen, naproxen), carefully designed "cuff" exercises, and sometimes cortisone injections. The injections do not go into the shoulder, but into the area above the rotator cuff. X-rays are useful to determine if the acromion bone is hook shaped, a condition which may cause cuff tendenitis. Arthroscopic surgery and acromioplasty can usually help this condition. The success rate in our series of more than 200 cases is 89.5%. This is a relatively simple outpatient procedure.

Prevention of rotator cuff tendenitis involves planning ahead. When Spring rolls around and you start new activities, you should start a rotator cuff exercise program to strengthen the muscles before they become sore. These exercises are designed to avoid impingement and strengthen the muscles. In the early phases of exercise the focus is toward stretching the shoulder ligaments and capsule to increase motion while doing light rotator cuff strengthening. Throwing must be kept to a minimum at first until the muscles have strengthened. Exercises start with the arm below the shoulder level to prevent impingement. As the program progresses and the shoulder gains strength, weight lifting and resistance exercises are heavier and throwing is increased. The same concepts are used for people doing non-throwing work and recreational activities. You need to start slowly and increase arm exercise over several days. If you jump into Spring cleaning too fast you may end up with "tendenitis" and a sore shoulder. It is easier to prevent than treat.

Important Notice To King County Medical SELECTIONS Patients: We are very pleased to announce that we now participate in the King County Medical Blue Shield SELECTIONS plan. If you switched to this coverage prior to the fall of 1996, you probably found that your SOFC doctor was not on the list, but that is no longer the case. We have been working with King County Medical and we now are participating physicians.

Kirk J. Anderson, M.D.

We regret to inform you that our friend and colleague, Kirk Anderson died on March 7, 1997 at age 76.

Kirk worked at SOFC for 35 years, from 1950 until his retirement in 1985. He was well known for his many scientific achievements and his humane sense of concern and feeling for patients.

Among his scientific accomplishments was an early research project with bone graft material which brought him international recognition and a very prestigious Kappa Delta Award, and membership in the American Orthopaedic Association. He was involved in hip replacement during its infancy, enzyme treatment of ruptured disks and was an outstanding arthroscopic surgeon.

Kirk remained active in many areas of orthopaedics after his retirement. Our office, the physicians and many of Kirk's patients fondly remember his kind personality and humor. We will miss him.