Dr. Selene Parekh
Tennis Leader Novak Djokovic Quits with Shoulder Pain
The world’s highest ranked men’s tennis player, Novak Djokovic was forced to retire in Sunday’s match against Andy Murray. He was suffering from right should pain. What can cause this kind of pain?
ANATOMY
The shoulder is a complex joint. The bone anatomy is made up of three bones: the humerus (arm bone), scapula (shoulder blade), and clavicle (collar bone).
Furthermore, there is a complicated set of muscles and tendons that run into and attach in the shoulder, giving it the stability, strength, and range of motion needed to perform overhead activites. The most noteworthy of these groups is the rotator cuff muscles. The rotator cuff is made up of: the supraspinatus, infraspinatus, subscapularis, and teres minor muscles. These msucles are extremely important in overhead activities, such as throwing or serving in tennis.
CAUSES
The rotator cuff muscles can be irritated (tendonitis) or torn due to issues with the tendon itself or a bone spur rubbing on the tissues (impingement syndrome). This can be seen in older individuals, people who suffer a trauma to the shoulder joint, or athletes who participate in overhead activities, like throwing or serving.
SYMPTOMS
Individuals usually experience a gradual increase in pain in the shoulder. Usually the pain is worse at night, but can be there throughout the day. Over head activities become painful, raising the arm to comb the hair or place a wallet in the back pocket of pants can become painful as well. The patient may notice weakness in the shoulder, pain, or popping as well.
WHEN TO SEEK MEDICAL CARE
If you suspect that you have a rotator cuff problem, you should seek medical attention to be evaluated. A physical exam and x-rays are usually performed, however often times an MRI may be needed to evaluate the shoulder.
TREATMENT
Treatment for rotator cuff tendonitis and small tears is often initially managed with non-surgical options. These include the use of anti-inflammatories (pills or topical creams), physical therapy to stretch and strengthen the rotator cuff, and at times an injection of steroids with numbing medication.
If nonsurgical treatments fail or there is a large tear , surgical options are explored. These include arthroscopic rotator cuff repairs, mini-open repairs with small incisions, or open repairs. In all of these cases, the rotator cuff tendon is reattached to the bone where it was originally attached. A lot of physical therapy is required to regain the strength and motion of the shoulder.
OUTCOMES
Most patients with rotator cuff tendonitis and tears do well with conservative care. If surgery is required, 6-9 months are needed to regain the skills to get back to the playing field.
RETURN TO ACTIVITIES
It is unclear how long Djokovic will have difficulties with his shoulder. It is likely that he will need some tests, such as an MRI to evaluate the shoulder better.
VIDEO/ANIMATIONS
Animated videos can be seen below:
Dr. P
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