Posterior shoulder pain caused by swinging a racket

Patient

Q: What kind of damage is caused in the shoulder when swinging a racket as in racquetball? I felt the instance that something happened, and I am wondering if I tore a tendon or ligament, or if it is just a muscle sprain or pull. I've often times played for a couple of hours and had soreness in the posterior-medial part of the muscle just below the acromium, but it has always gone away. This time it seems to be sticking with me and is quite a bit more severe.

Doctor

A:    Well, most of the time the structures that have more chance to be injured during the kind of physical activity that you described in your question are the tendons of the Rotator Cuff, this group of tendons that support the shoulder may be injured during weight lifting, when playing sports with a lot of throwing and swinging (racquetball, tennis, baseball/softball, basketball, swimming) that entail repetitive use over a long time or suffer degenerative changes with the aging process. The lesions of the rotator cuff represent a wide variety of diseases, from acute reversible tendinitis to massive tears involving the supraspinatus, infraspinatus, and subscapularis, these are the muscles of the rotator cuff. The diagnosis is often made through detailed history and physical examination, and confirmed by imaging studies. Sometimes the healing process takes longer than expected and this depends on each patient in particular. It is very important before to do any exercise or straining physical activity to have an initial warm-up and stretching of the muscles, also when you start an exercise routine the demands have to be progressive and gradual, and the time and days that you dedicate to exercise must be consistent and regular to avoid injuries. There is a very well described entity in the medical literature called: Overuse Syndrome, which can affect any part of the body that is over stressed with movements or activities in a repetitive way, including occupational, recreational, and habitual activities. Repetition is part of the definition of overuse injury. The concept is that overuse injury is associated with repeated challenge without sufficient recovery time, and this is true for Tennis, Raquetball, Body Building, Running, Jogging or any other sport or activity in which you exceed the guidelines and your own limits or capacities. Conservative treatment of the Rotator Cuff tendonitis involves: physical therapy to control pain and keep range of motion of the shoulder, avoidance of painful movements and activities; anti-inflammatory drugs (i.e.: “Advil”, “Aleve”). If the patient shows poor or no improvement, then, local corticosteroid injection may be considered.

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