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Active Seniors Can Stay Active, Even with Rotator Cuff Injuries
by Nancy Kennedy

In the spring of 2005, 11,000 senior citizens descended upon Pittsburgh. They came for a two-week long event known as the National Senior Games Association, also known as the "Senior Olympics." Ranging in age from 50 to 103, these elite older athletes came to compete in 18 different sports ranging from archery to volleyball. It was the largest gathering in the twenty-year history of the organization and it generated a lot of regional interest.

Patrick J. McMahon, M.D., was among those happy to see this convocation of healthy, vibrant older adults. As an orthopaedic surgeon and sports medicine specialist who treats problems of the shoulder, elbow and knee, he has a clinical interest in this population and he took advantage of the opportunity to conduct a study of rotator cuff injuries among the senior athletes. "We know that rotator cuff injuries are common in people over 60," he says. "Approximately 25 percent of them have a full-thickness rotator cuff tear. We wanted to find out if these very active seniors had more severe rotator cuff injuries than the general population of seniors, or did they have fewer, because they are elite athletes?"

Dr. McMahon and his colleagues found plenty of volunteers among the athletes, who had a median age of 70. "We assessed pain and shoulder function in 141 elite athletes at the Senior Olympics who volunteered to participate in the study. An ultrasound evaluation of the rotator cuff of the dominant shoulder was performed on each of them by an experienced musculoskeletal radiologist. We then determined the relationship between ultrasound findings and shoulder pain and function."

To Dr. McMahon's surprise, only 14 percent had normal rotator cuffs. Full thickness tears were present in 21 percent and of that group, just 25 percent reported experiencing pain. The other 75 percent had tears that were asymptomatic.

"The people who did report having pain were able to tolerate it and did not let it keep them from being active. I met a woman who was the shortstop on the '80 and older' softball team who had a rotator cuff tear but she coped with it and continued to play. My conclusion was that rotator cuff injuries do not preclude you from participating in sports, even at the elite, competitive level. These people are proof of that."

The study, which was published in the Journal of Clinical Orthopaedics and Research, proves that pain is not always present with a rotator cuff tear, and that when there is pain, it is not predictive of the severity of an injury. Although rotator cuff tears are common, one does not necessarily need surgical repair in order to participate in sports.

Rotator cuff injuries may cause pain, weakness and sometimes loss of motion, Dr. McMahon says. Many injuries will heal on their own, and physical therapy can be helpful. "Just about 10 percent will need surgery," he says. "If you know you have a rotator cuff injury, you need to monitor your pain and if it gets worse, come in to be re-evaluated with strength testing and perhaps an MRI. Don't dismiss aches and pains if you have a tear and have chosen to not get it fixed, because they might mean your tear is worsening."

Rotator cuff repairs are generally done arthroscopically in an outpatient surgery setting. Dr. McMahon performs a range of shoulder surgeries as well as knee arthroscopy and other orthopaedic procedures at St. Clair Hospital. He is board-certified in orthopaedic surgery and is a fellow of the American Academy of Orthopaedic Surgeons. He is a graduate of Temple University School of Medicine and completed an internship at New York University Medical Center, followed by a residency in orthopaedic surgery at UPMC and a sports medicine fellowship at the Kerlan Jobe Orthopaedic Clinic in California. Dr. McMahon has a solo practice, McMahon Orthopaedics and Rehabilitation, and serves as an adjunct associate professor in the department of bioengineering at the University of Pittsburgh.

Shoulders are easily injured, he says, and those injuries seem to be more prevalent in the U.S. "It may be that Americans participate in more 'overhead' sports, such as tennis, football, basketball and baseball. An injury sustained at a younger age can become a problem once you reach middle age; it can take years for a rotator cuff injury to get worse. You have to use common sense: for example, baseball players have to monitor their pitch count and not exceed about 100 pitches per week. Coaches need to be more vigilant with kids."

Seniors, says McMahon, have changed – for the better. "Most seniors over 50 are doing something to stay in shape and that's a very positive trend. Be active, but be reasonable; if you get injured, it can be quite a setback. You don't do yourself any favors by overdoing it. But the overall health benefits of doing something are significant. Even walking has tremendous benefits for your heart and lungs."

To make an appointment with Dr. McMahon, call (412) 431-7342.

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