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– If you play softball, baseball, tennis, basketball, golf, or even swim competitively, chances are you’re no stranger to shoulder injuries. Specifically, rotator cuff injuries are common in athletes who play overhead sports due to the constant overhead motion of throwing a ball or cutting through the water. Fortunately, UPMC has experts who are specifically trained in the prevention, diagnosis, treatment, and rehabilitation of athletic shoulder injuries, so you can get back to doing what you love sooner and safer. Hi, I’m Charlie Batch. Yes, that Charlie Batch, if the name is familiar to you, and I’m here with Dr. John Richmond, an orthopedic surgeon specializing in the shoulder at UPMC. Thanks for joining me today, Doc. How did you become a specialist in treating shoulder injuries?
– Similar to many other orthopedic surgeons, I was a former athlete. So I used to play baseball, and I played through the college levels. And I experienced and witnessed a lot of shoulder injuries. That’s what motivated me to enter orthopedic surgery. And after finishing my training, I wanted to subspecialize in sports medicine. So, in that field, we focus on the shoulder and knee and how to best treat them. In my training, I was fortunate to work under a lot of skilled surgeons. And since then, I’ve been able to really focus on treating high school, collegiate, and older age athletes.
– What type of common conditions that you treat in your athletes?
– Well, I’ll see two categories of patients. One will be overuse inflammatory injuries or issues, and the other will be traumatic injuries. So, for the inflammatory shoulder conditions, typically those diagnoses will end in the suffix itis, meaning inflammation. So, a lot of overhead athletes will experience rotator cuff tendonitis or biceps tendonitis. Older athletes might have symptoms of shoulder impingement or bursitis, and young kids that have growth plates might develop apophysitis, or inflammation in the growth plate. The other category of injuries involves trauma. That will either cause fractures, or injuries to the soft tissues. So, fractures, you might see the shoulder as a clavicle fracture, or the collarbone. We might see a fracture of the humerus or the upper arm. Other types of tears may occur to the ligaments that surround the shoulder. So, in contact sports, athletes will experience instability episodes, and they might tear their labrum. So, we might see traumatic, degenerative, or inflammatory-type conditions. We really see it all.
– And what type of athletes do you see most often and why?
– Well, now there’s athletes of all ages, so young to old. And there’s a lot of different sports that can cause shoulder pain or conditions. So, the overuse type sports, the overhead activities like baseball, softball, swimming, a difficult endurance sport in the shoulder. Also tennis, volleyball, gymnasts. You see injuries related to contact sports like hockey, football, basketball, and then in older patients, we might see occupational injuries. You might see somebody in a factory that’s performing repetitive overhead work, or a construction worker that had a fall from a height. So, we do see a wide breadth of shoulder-type pathologies.
– In terms of shoulder injuries, is there a difference between softball players and baseball players?
– There certainly is. As you know, a baseball pitcher throws overhead. Softball pitcher has a windmill underhand throw. So, when you’re throwing overhead, the injury tends to happen to the top of the shoulder at the rotator cuff. The shoulder will rub against the bones above and cause inflammation, fraying, or even tearing. In softball, the pitch is underhand, so injuries tend to be to the front of the shoulders. So you often see biceps tendonitis, or pain in the front of the shoulder.
– And you talk about what the injuries are. How can athletes prevent those types of injuries?
– Yeah, prevention is really the key. So, the most important thing is if an athlete notices pain in their shoulder, they should stop, assess why they’re having the pain, and kind of take some time to let the inflammation calm down. So, if they still feel persistent inflammation despite some rest, then some other treatments can be helpful. I mean, always start with ice. You can try topical anti-inflammatories, and then get in the medicines, such as Ibuprofen or Naproxen. More invasive treatments often are recommended in our office. Sometimes we consider injectable therapy, but it’s always important to stop when you feel the pain.
– Doc, you mentioned rotator cuff, and there are a lot of parents who throw that term around a lot. What is actually a rotator cuff?
– The rotator cuff is a group of four muscles. They surround the shoulder to give you rotation, to enable to throw, to enable to lift and reach behind your back. And that group of muscles is notorious for developing degeneration and wear and tear and experiencing injury to any sort of trauma. In general, it affects all age groups. In the younger ages, typically you’ll see tendonitis, which is inflammation. That typically gets better with rest and anti-inflammatories. In older individuals, they’ll develop tearing. There’s degenerative tearing in older patients. And, in those cases, if there’s tearing that doesn’t respond to conservative management, surgical intervention is often beneficial.
– You have a lot of young athletes now that are specializing in one sport. Do you see the overuse of shoulder injuries for athletes coming into your office?
– Yeah, it’s definitely becoming more prevalent. It’s great so many kids are playing sports nowadays, but there’s almost been a professionalization of youth sports, where parents, coaches are so focused on young, talented kids. And the American Academy of Orthopedic Surgery and Sports Medicine has actually defined overuse, use sport injuries. And it’s in kids that are younger than 12, if they spend more than eight months, or they spend year-round time playing a single sport, that really has detrimental effects on young, growing joints.
– And what are some of the non-surgical treatments that you are seeing?
– The standard treatments are rest, ice, compression, anti-inflammatories. Often we will utilize an exercise program. Supervised physical therapy can be really beneficial. Physical therapists are really skilled at identifying muscle asymmetries and imbalances of the shoulder mechanics, to help retrain the shoulder to function better with overhead, underhand, or any impact contact sports.
– Do you collaborate with a lot of your colleagues if surgery is necessary?
– Of course. So, generally we talk to partners in complex cases, and we also collaborate with the physical therapist who’s working with our injured patients. Physical therapists can give us great insight as to how their motion’s responding to certain treatments. Also, we utilize physical medicine rehabilitation specialists. They can provide a lot of benefit and diagnosis. Often neurologic testing can be beneficial, or also use certain types of injections under fluoroscopy, or ultrasound-guided injections.
– And as a former athlete, we all hate surgery, but surgery is needed at some point. What does that all evolve if the athlete needs surgery?
– Right. It’s really a collaborative effort. The parents have to be involved. Coaches need to understand what their athlete’s undergoing. The athletic trainers, physical therapists. So, it’s important to have an initial discussion before surgery, but surgery can be very effective to get patients back out there. So, after the initial discussion, typically surgery is an outpatient procedure. That means the patients go home after that surgery. We try to use the latest, minimally invasive techniques to limit pain and to limit kind of longterm discomfort, to facilitate faster return with rehab.
– And you mentioned faster return. Part of that is post-op. What does that look like for an athlete?
– That’s always the goal, but shoulders are tough. The soft tissues need to really heal, so that takes time. So, after surgery, we typically place patients in slings for a period of time. That could range from two to six weeks, and then we’ll initiate some supervised therapy. That will typically start within that first month or two. You want to regain that motion first, and then you want to build the strength. So, if you repair tissues, it typically takes about three months to get those tissues to heal. So, you really don’t want to start that hardcore strengthening until about three months after surgery.
– And every athlete is different. They heal differently. Some are a little faster, some are longer, and those types of recovery times, but how do you know when an athlete is ready to be cleared to return to play?
– Right, well, one you see it in their eye when they come in the office. You can tell they’re itching to get back out there, but really you’re looking for full strength, nice fluid motion. And you want full strength. I mean five out of five. They’ve got good resistance that can take impact out there on the field.
– And when you’re watching them and you see that smile when they’re walking into your office, knowing that they’re ready to be returned, what is one of the most fulfilling things for your job, and why do you do what you do?
– Right, it really is fulfilling to say, “All right, you’re cleared. You can get back to sport.” And then you’ll see the athletes. You’ll be on the sideline. You see them playing. It just warms your heart that you facilitated them getting back out there.
– Dr. Richmond, we covered a lot of great information here today. So thank you very much for joining us. And if you are an athlete feeling discomfort in your shoulder, don’t wait. Contact the experts at UPMC Sports Medicine today. With decades of experience in individualized shoulder treatment and recovery, the team will work with you to meet your specific goals. To learn more about shoulder injuries and treatment at UPMC Sports Medicine, visit upmcsportsmedicine.com.