July 15, 2013
By Dr. Dolf R. Ichtertz, Nebraska Hand & Shoulder Institute
I frequently treat golfers having difficulty with shoulder pain. In my last blog I wrote about delay in treatment and how it affects the outcome using nerve entrapment syndromes as an example. Another clear-cut example in how a person may regain normalcy in a part of their body where there is an injury is that which was pointed out by Michael J. Vives, M.D., et al. from the Department of Orthopaedic Surgery at Jefferson Medical College of Thomas Jefferson University in Philadelphia as reported in Arthroscopy, volume 17, No. 2 to 172, in their article entitled “Repair of Rotator Cuff Tears in Golfers”. Of 30 golfers who underwent 32 rotator cuff repairs, the average age at surgery was 60 years with a range of 39 to 76 years. At average follow-up of 3 years ranging from 2-5 years, of the 27 patients who were still playing golf there was no significant difference in handicaps or drive distances compared to pre-symptomatic handicaps and drive distances. Three of the patients reported playing at a lower competitive level than before and, logically therefore, Vives et al. concluded that acromioplasty (trimming of the prominent bone in the shoulder) and rotator cuff repair predictably allow for eventual return to pain-free golfing at a similar competitive level for most recreational level athletes.
The hazard of delaying treatment with rotator cuff tears lies in the fact that if the tear is large enough the muscle may irreversibly retract, scar down a new position, and prevent eventual late repair and, in a small percentage of these individuals, they will have progressive degeneration in the shoulder joint leading to what is known as cuff tear arthropathy and generally poor outcomes even if possibly offered a reverse total shoulder or latissimus dorsi muscle transfer. That is not to say that all rotator cuff tears need to be repaired, but early physician involvement is important to prevent catastrophic result.