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Treatments for common injuries to mature athletes’ shoulders

Mobility of shoulder declines with age and sports participation

The shoulder is the most mobile joint in the human body, and it's specifically activated to a great extent in sports like swimming, baseball and tennis. Age and long-term sports participation are largely responsible for an eventual decline in the shoulder's ability to move properly. As a result, over time, the aging shoulder in mature athletes is more prone to injuries like rotator cuff tears, osteoarthritis (OA) and adhesive capsulitis, or frozen shoulder. For many reasons, effectively treating these injuries is challenging for medical professionals. The details of each relevant injury are reviewed here.

Rotator cuff injuries can range in severity

Injuries to the rotator cuff, a group of muscles and tendons surrounding the shoulder joint, are the most prevalent of these injuries. They can range from basic tendinitis (inflammation of tendons) to massive tears. Many treatment options are available for tears and the treatment decision should be based on the age, level and sport of the athlete. Debridement, which removes unhealthy tissue from the shoulder, may be effective for minor tears but not as much for more advanced cases. Surgical repair has been proven effective for older baseball pitchers and tennis players, but doesn't produce the same results in elite professional pitchers.

OA treatment decisions also affected by age

In shoulder OA, the protective cartilage wears away, causing pain. For older, non-active patients, a surgical procedure called arthroplasty that replaces part of the surface of a joint, is a strong option supported by evidence that allows a return to sports. For younger mature athletes, arthroplasty is considered an overly aggressive treatment and the best intervention is yet to be determined.

Frozen shoulder should be treated conservatively first

Frozen shoulder is characterized by reduced range of motion and is particularly prevalent in patients older than 40. Conservative, or non-surgical strategies, especially physical therapy, have been found to produce positive results and should be used as the first-line treatment for these patients. Only in cases that don't respond well to conservative treatment should surgery be considered.

Taken together, this review shows how common shoulder injuries are in aging athletes and that treatment options should be primarily based on age, with those under 50 being approached differently than those over 65.

-As reported in the January '14 issue of Sports Health

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