THE PAIN Treating soft tissue injuries

“Initially, I thought the pain was tendonitis, but after a few weeks of rest, the pain returned and I knew it was more serious.” Shouldering the College standPAIN out Joe Savery is considered a prospect for the 2007 Major League Baseball draft. The Rice University junior has racked up numerous accolades in his college career including the 2005 Baseball America National Freshman of the Year, but his future in baseball came into question this past summer when he experienced a sudden sharp pain in his shoulder during practice. “Initially, I thought the pain was tendonitis, but after a few weeks of rest, the pain returned and I knew it was more serious,” Savery said. The Rice team physician referred Savery to Dr. David Lintner, the head team physician for the Houston Astros. Lintner, an orthopedic surgeon with The Methodist Hospital since 1992, has focused most of his practice on treating shoulder injuries. Lintner examined Savery and discovered a tear in his labrum, the rim of cartilage that surrounds the shoulder joint. The tear, which was caused by a bone calcification in Savery’s shoulder, is the most common shoulder injury in people from late adolescence through age 40. In athletes, the labrum wears down with repetitive overhead use, such as pitching, weight lifting or throwing. The injury also is commonly found in people whose jobs require heavy lifting, such as parcel deliveries; or those who work in industrial or chemical plants, where

“Most people notice the pain of a labrum tear when they reach for something overhead or stretch the arm to the side.”

repetitive turning of valves is involved. “Most people notice the pain of a labrum tear when they reach for something overhead or stretch the arm to the side when reaching into the backseat of a car,” Lintner said.

No age discrimination

Shoulder injuries vary with the age of the patient. Children through early adolescence usually experience problems with the growth plates, the area of growing tissue near the end of the long bones, or stress fractures from repetitive use. The classic example is a Little League pitcher who plays on several teams simultaneously throughout the year. They tend to develop shoulder pain from a growth plate problem, which will almost always improve with rest.

Unfortunately, many times athletes, coaches or parents are unwilling or not interested in rest for the patient, Lintner said. “Our goal is to make sure that recreationaland professional athletes of all ages can enjoy activities that are important to them. Sometimes this means altering a practice schedule or playing a different position until the shoulder has had time to heal,” he said. Less frequently, the athlete will need to temporarily stop play altogether. In children, relative rest almost always works; in high school age and older, sometimes surgery is needed.

Savery considers himself fortunate that his surgery took place during the off-season. “I really appreciated that Dr. Lintner didn’t rush me into surgery. He took into account that my pitching was important to me,” said Savery, who is now in recovery and visiting the Methodist Center for Sports Medicine twice a week for rehabilitative physical therapy. He said he expects to be pitching at 100 percent before the season starts in January.

A Houston native who has played baseball his entire life, Savery is excited about being a prospect for the pros. “If it weren’t for my surgery with Dr. Lintner, I could have exacerbated the injury and lost my chance at the professional draft next year. He operated on me with enough time to recover and begin playing next season — just in time for draft picks,” he said.

Dr. Bruce Moseley, a Methodist orthopedic surgeon who specializes in sports medicine, treats many young athletes with shoulder injuries.He explained that while a labrum injury can be treated without surgery, it probably will reoccur if the ligament has been damaged.“In most cases, we will allow the athlete to finish the season with the understanding that their shoulder is unstable. Post-season surgery to repair the ligament and labrum is ideal to remain injury free,” Moseley said.

Labrum injuries are diagnosed with a medical history review and physical exam because X-rays do not show damage to soft tissue. A magnetic resonance imaging scan (MRI) is required to fully reveal the damage.

Labrum treatment options depend on the condition of the rotator cuff — the four muscles and tendons that secure the arm to the shoulder joint and control rotation and stability of the arm. Moseley said that if the rotator cuff is healthy, the patient can often compensate for the injured labrum by strengthening the rotator cuff.

It this fails, the labrum is mended with suture anchors or dissolvable screws to secure the labrum in place. Following surgery, it is critical to protect the shoulder as it heals and begin gentle physical therapy. Once the repair is solidified, the patient can undergo more aggressive strengthening therapy and return to regular activity in three months.

“Our goal is to make sure that recreational and professional athletes of all ages can enjoy activities that are important to them.”

Rotator cuff tears

Rotator cuff tears typically occur in patients over 40. Most rotator cuff tears happen when the tendon is pinched between two bones. “This condition, called impingement, can cause the rotator cuff tendon to naturally deteriorate, tearing fiber by fiber, in much the same way a rope frays,” Moseley said.

Moseley performed two rotator cuff surgeries on now retired WNBA sensation Cynthia Cooper. “The first injury occurred when I collided with a team player during practice,” said Cooper, who led the Houston Comets to four consecutive WNBA championships. “I experienced a great deal of pain but tried to play through it. The next day I could barely raise my right arm, and I was told surgery was necessary to repair the rotator cuff.”

Most people notice the pain of rotator cuff injuries when lifting their hands over their head, such as shampooing their hair or reaching up to a shelf. Some even experience pain at night, awakening them from their sleep, which can be the most common complaint.

An MRI also is used to diagnose rotator cuff injuries, but Moseley and Lintner recommend surgery sooner rather than later because rotator cuff tears will only enlarge and not heal, and small tears are much easier to repair than larger ones.

Cooper again injured her left shoulder the next year with a rotator cuff tear resulting in the second surgery. “The most difficult part of having successive injuries was not being able to hold my twin baby boys for so long,” said Cooper, who is now in her second year as head coach for the Prairie View A&M University women’s basketball team.

“I’m very thankful the surgeries resulted in a complete recovery,” she said. Moseley added, “Cooper’s injuries were unique in that she had a slight deformity in the shoulder, and when impacted, a bone spur actually split her rotator cuff in half. We were able to remove the bone spur as well as repair the rotator cuff, to ensure this never happens again.”

Cynthia Cooper

“In most cases, we will allow the athlete to finish the season with the understanding that their shoulder is unstable. Post-season surgery to repair the ligament and labrum is ideal to remain injury free.”

To download a copy of Methodist’s Sports Injury Prevention Guide, logon to www.methodistorthopedics.com.