The Specialist:
As the system-wide chairperson of orthopedic surgery at Mount Sinai,
Dr. Leesa Galatz has been practicing as a shoulder and elbow specialist
for 16 years. Ninety percent of the surgeries she performs are for
shoulder injuries.
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| Dr. Leesa Galatz. |
Who’s at risk:
Rotator cuff disease is extremely prevalent, especially in older individuals.
“If you take 100 people off the street who are over the age of 60 and
who experience no pain, about 30% will have a rotator cuff tear and not
even know it. Not all tears are symptomatic,” Galatz says. “Rotator cuff disease is
so common because of the way our shoulders are made. These muscles are
in constant use, and our arms require a wide range of motion. So the
muscles and tendons of the shoulder experience a lot of wear and tear
over the years.”
The rotator cuff is
a cluster of muscles and tendons that keep the ball of the arm bone in
the socket joint of the shoulder. “There are four small muscles that
come from your shoulder blade to the outside of your shoulder, forming a
cuff or hood over the ball of your shoulder,” Galatz says. “The rotator cuff has a crucial role to play: it both stabilizes the shoulder and allows for a wide range of arm movement.”
Because the rotator cuff can be under many kinds of stress, it is prone to degenerate over time. “Rotator cuff disease is
an umbrella term for problems ranging from tendonitis (accumulated
inflammation) to partial thickness tears to full thickness tears, which
can be the result of injury, long-term overuse or simple wear and tear,”
Galatz says. “The most frequent cause of tendonitis in the shoulder is
the rotator cuff.”
Even just working in an office can contribute to your risk of rotator cuff disease.
“The problem is that a lot of us have poor posture while we’re sitting
at a desk. We slump over and then have to hold our arms up to type,
which can lead to shoulder pain,” Galatz says. “Some healthy workplace
tips include watching your posture, lowering your keyboard, sitting
close to your keyboard and being careful to take breaks, get up and walk
around.”
The good news is that taking small steps to protect your shoulder
health can go a long way. “Any form of exercise is helpful, but
especially anything that works posture and the muscles of the upper back
— things like rowing, dance, yoga, barre class,” Galatz says. “What you
want to be careful about is very heavy overhead lifting and
bench-pressing. Those activities can make things worse.”
Doctors have identified a set of risk factors that contribute to rotator cuff disease.
“Anything that impacts your overall health and circulation takes a toll
on the shoulder as well — smoking, diabetes and many other chronic
illnesses increase your risk,” Galatz says. “For younger people and
generally healthy people, rotator cuff disease is usually related to exercise and overdoing it.” Men and women are pretty equally affected.
Signs and symptoms:
Rotator cuff disease
often presents with a set of textbook symptoms. “The classic signs are
shoulder pain at night, especially if you’re lying on your back, and
resulting sleep disturbance,” says Galatz. “The pain radiates down the
side of your shoulder and arm, but only rarely reaches below the elbow.”
Doctors speculate that the pain is worse at night because your body
posture is finding ways to compensate during the day.
Traditional treatment:
The first step is getting the right diagnosis. “We can usually diagnosis rotator cuff disease
with a good physical exam. There are maneuvers that suggest if pain is
coming from your shoulder or somewhere else,” Galatz says. “Then we
usually take an x-ray to make sure there isn’t something else there, and
to rule out arthritis.”
If the x-ray results find that the shoulder muscles are strong, most
patients will start out with conservative treatment. “Really the primary
treatments are exercise and behavior modification — helping patients to
stop doing the activities that are damaging the cuff,” Galatz says. “We
often start off by prescribing anti-inflammatory medications and
physical therapy, so you can learn exercises that help your shoulder
rather than hurting it.” Postural exercises and workplace modification
can also be part of the treatment.
If someone isn’t responding to nonoperative treatment, they may be a
candidate for cortisone shots or surgery. “If the cause of the pain is
tendonitis with no tear, we will usually counsel patients to try six
months of therapy before they consider surgery,” Galatz says. “But if
there’s a tear, we’re more likely to intervene earlier, because tears
can get larger with time.” The decision about whether or not to pursue
surgery also depends on the age and activity level of the patient.
Shoulder pain isn’t something you have to suffer in silence. “So often,
tendonitis is a problem we can fix without surgery. And sometimes it’s
just a question of fixing a simple thing, like how you sit at a desk,
how you carry a bag,” Galatz says. “Paying attention to these little
behaviors, to how you’re sitting and moving, can make a big difference.”
Research breakthroughs:
Thanks to a proliferation of studies, some exciting potential
breakthroughs are coming down the pike. “There’s a lot of attention
being paid to what we can do to help the process of surgical repair,”
Galatz says. “Adults generally heal with a scar, rather than
regenerating new tissue. We’re looking at things like administering
growth factors, stem cells and implantable devices that we can use to
physically assist and accelerate the repair process.”
Questions for your doctor:
If you’re experiencing shoulder pain, lead off by asking, “How can I
modify my activities and exercise?” Follow up with, “What are tips I can
use in my daily life and work space?”
“You only go to therapy for a few hours a week, but the rest of the
time you spend at your desk, in your car, at home,” Galatz says. “You
want to be able to modify those daily activities to contribute to
shoulder health.” If your pain is slow to respond to therapy, don't
hesitate to ask, “Is a cortisone shot appropriate?” And, “Am I a
candidate for surgery?”
“We use our shoulders everyday, and it takes a lot of wear and tear
over time,” Galatz says. “You can benefit your long-term health greatly
by paying attention to your posture when you’re walking and lifting, and
by adding some upper-body exercise into your regime.”
What you can do:
Get informed. For reliable and vetted health information, Galatz recommends the American Academy of Orthopaedic Surgeons (aaos.org/) and Mount Sinai (mountsinai.org/).
Get moving. All exercise promotes circulation and rotator cuff health, but it’s even better to include some exercises that target the shoulder.
Promote a healthy work space. Be conscious of your posture: aim to sit
up straight, with your shoulders rolled back. And be sure to take
frequent breaks from the desk, and walk around at least every hour or
hour and a half.
Don’t smoke. The connection might not be obvious, but it turns out that
smoking affects the circulation, which is why people who smoke have a
higher incidence of rotator cuff tears.
By the numbers:
— 30% of Americans over the age of 60 have a rotator cuff tear and don’t even know it.
— Patients over 60 who have a tear on one side have a 40-45% chance of a tear on the other side.
—Americans suffer more than three million rotator cuff tears a year.
Source: Dr. Leesa Galatz.
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