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Shoulder Injuries

Q. I noticed a twinge in my left shoulder at the end of the summer triathlon season. When I started playing league tennis, a chronic pain developed on top of this 54-year-old lefties' tennis shoulder, and it seems to be getting worse. The usual icing does not seem to help. Should I get this looked at? I'm down to an hour of tennis a week. Any info would be greatly appreciated.

A. Yes, this is something that you should get checked out by an orthopedic physician. It sounds like classic rotator cuff impingement syndrome, which will probably require some form of pain management and strengthening in physical therapy.

But first, you need to find out if the cause is your swim/tennis technique or something structural inside your shoulder and the doctor can take x-rays to find that out.

As an aside, both swimming and tennis place the rotator cuff at risk for injury/ impingement if proper technique is not used. Until you identify the cause of the pain, continue icing and your doctor may recommend you take an anti-inflammatory medication.

Also, consider completely stopping the activities that cause the pain until you have seen the doctor. If you continue you will just be doing further damage.

Q. I would like to know about rotator cuff injuries, things such as prevention and treatment.

A. Injuries to the rotator cuff in tennis players typically occur from overuse. The 4 tiny rotator cuff muscles are responsible for the huge task of stabilizing your shoulder and both accelerate your shoulder during internal rotation as well as decelerate your shoulder after ball impact on the serve. This creates a significant amount of fatigue particularly in players who do not have adequate amounts of strength in their rotator cuff muscles.

Research done by members of the USTA sport science committee show that the rotator cuff muscles do not get stronger simply by just playing tennis. Instead supplemental exercises are needed to improve both the strength and endurance of these important muscles.

We therefore recommend doing rotator cuff exercises using a light weight or elastic tubing several times per week. Avoid doing the exercises before tennis play as you don't want to play with a fatigued rotator cuff. These exercises can be done using three sets of fifteen or twenty repetitions. Performing these on a regular basis will help to prevent rotator cuff injury.

Q. My 9 year old son just separated his shoulder. It has been 12 days since the injury and they told us that he couldn't play any sports for 4 weeks. When is a good time to start a slow fitness routine so he can keep his fitness level up? What about rehab? He really loves to play tennis & wants to get back on the court as soon as possible. Thanks for your help!

A. Not enough information is provided to accurately answer this question. It is unclear what was separated - 2 bones or the growing point on one bone. A precise diagnosis is needed in this situation because this may be as simple as resting for several weeks, or may require more x-rays and further treatment or restriction of activity before the injury has healed.

Also, it is important to know how the injury occurred. Was it direct trauma or overuse? That also plays a major role in determining the treatment plan.

Consultation with a sports medicine shoulder specialist is often the best course. Proper treatment now can allow him to return to the court as soon as possible but also with the best chance of not re- injuring himself.

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