The prospect of tearing your rotator cuff becomes more likely as you age. For athletes, it can be the kiss of death. But now the science has advanced to speed recovery.
Ann Geisler's right shoulder hurt, and she figured she'd pulled a muscle. As the months went by, she shrugged off the pain when she helped her husband haul logs around their rural property or when she lifted boxes of printer paper at Dean Insurance Agency in Altamonte Springs, where she's CEO.
She tried massage, chiropractic, an orthopedic doctor, ibuprofen and even wine. At night, she was unable to sleep, lying on her left side with pillows propping up her right arm. Nothing worked. The tingling in her fingers became almost constant. To use her right arm, she began holding it up with her left hand.
A friend suggested she look for a specialist, so she called the RDV Sportsplex in Maitland, training site for the Orlando Magic NBA team, and asked for the best shoulder doctor there. The doctor immediately sent her for an MRI, and the results were alarming. The tendon had torn completely away from the bone on both sides of her right shoulder. She'd need to undergo rotator cuff surgery.
"I was so relieved when I did the MRI and knew what was wrong with me," she says. "So now they could come up with a treatment plan."
Geisler, 55, had suffered for a year and a half, and she's amazed she was still able to function. Most surprising to her was the absence of any visible trauma. "You don't realize how much damage has been done," she says. "The weirdest thing is, you can still lift things ... but when you try to do anything overhead, you know something is seriously wrong."
Because of the extensive damage, her surgery earlier this year was complicated. The doctor had to cut a four-inch incision on top of her shoulder and pull up her tendons through her arm, the way someone might tighten a shoelace through an entire sneaker.
Afterward, she wore a sling on her right arm for six weeks and used her left hand for everything: Driving, cooking, grooming, computer work. She went to physical therapy twice a week for three months. "My problem is, I waited too long and it tore. If I'd been on a mission to get this done sooner rather than later, I probably wouldn't have had to go through that major surgery." Still, she expects to fully recover with full range of motion within a year.
A tear in the rotator cuff is common among athletes and older individuals, says Dr. John Uribe, chairman of orthopedics for Florida International University's College of Medicine and medical director for Doctors Hospital's Center for Orthopedics and Sports Medicine in Coral Gables. But it can happen to anyone, especially baggage handlers, mail carriers, hairstylists and frequent fliers who lift their luggage into overhead compartments.
"As you get older, there's a slow breakdown of the rotator cuff, so one day you might be reaching into the refrigerator for milk and, boom, your shoulder starts to hurt," Uribe says.
Things have changed dramatically in recent years in the treatment of injuries like Geisler's. For baseball players and other athletes, a torn rotator cuff used to be the kiss of death, says Uribe, team physician for the Florida Panthers ice hockey team and the University of Miami athletics department, and formerly with the Tampa Bay Buccaneers.
"Rotator cuff surgery used to have a bad reputation," he says. "People often came out of the surgery worse off than when they went into it."
Today, surgeons don't always have to cut through the patient's deltoid muscles to get to the torn rotator cuff, a practice that used to result in a double set of repairs and lengthy recovery time.
Instead, they poke small holes in the muscle, pass sutures through it, sew it to the bone and restore the anatomy. In a surgery Uribe performed in June that was broadcast in real time on OR-Live.com, he used a device that produced a pattern stitch in the tissue, similar to a miniature sewing machine. He used an anchoring device, which works like a molly bolt in drywall, to attach the end of the sutures to the bone. An operation that used to take three or four hours now takes about 30 minutes, he says.Other advances on the horizon: Using a sheath of manufactured collagen to weave into the patient's rotator cuff tendon; sewing the injury with sutures made from collagen tissue; and injecting growth factors such as stem cells into the area to stimulate the body to produce better collagen, which enhances healing.