Posts Tagged ‘rotator cuff injury’

Injury Insight: Manny Pacquiao’s Shoulder Injury

This past weekend’s boxing match between Floyd Mayweather, Jr. vs. Manny Pacquiao may have been the most-watched pay-per-view event of all time, but all eyes are now focused on Pacquiao’s reported shoulder injury. Battling through the twelve-round fight with Mayweather, Pacquiao suffered further injury to his already ailing shoulder. Reports released this week confirm the athlete will need shoulder surgery to repair a “significant tear” in his rotator cuff.

Emory Sports Medicine’s Dr. Jeff Webb stopped by CNN to shed some light about Pacquiao’s injury, possible treatment options and recovery time:

What is the rotator cuff?

The rotator cuff is made up of four muscles and their tendons that wrap around the ball-and-socket joint of the shoulder, attaching the upper arm to the shoulder socket. These tendons allow you to move and rotate your arm in wide range of motion. When the rotator cuff tendons are damaged or torn, the shoulder may become unstable and cause pain.

What causes rotator cuff tears?

A tear in the rotator cuff is the most common cause of shoulder pain. Most tears occur as a result of wearing down, or fraying, of the tendons over time. Overuse of the muscles, especially in a person’s dominant arm, increases the risk of tearing. Lack of blood supply and bone spurs due to age are other causes. Shoulder injuries, such as broken collarbone or a dislocated shoulder, can also cause a rotator cuff tear.

What are the symptoms of rotator cuff tear?

  • Patients with a rotator cuff tear usually experience a dull ache in their upper arm and shoulder. Other common symptoms include:
  • Pain or discomfort when lifting and lowering your arm
  • Weakness with rotating your arm
  • Pain extending down to the elbow (but usually not further)
  • Neck pain on the side of the affected shoulder; Low dull headaches
  • With sudden tears, patients may hear a cracking noise and experience intense pain and immediate weakness in the upper arm

How serious is Pacquiao’s injury?

It’s hard to definitely comment without evaluating him in person, but reports of a “significant tear” can mean one of a few types of rotator cuff injuries, including:

  • Tendonitis: a condition in which the tendon is inflamed, irritated and/or swollen. Tendonitis is common in athletes and can occur as the result of tendon overuse, injury, or because of age.
  • Complete tear: when the tendon splits into two pieces, sometimes separating off from the upper arm bone.
  • Partial tear: when there’s damage to the tendon, or tissue, but it is not completely split.

In Manny Pacquiao’s case, the tear is extensive enough that surgery has been recommended. The goal of surgery is to treat his pain and restore the function of shoulder, preventing further damage to those tendons. While some patients can return to regular activities after six months, but in the case of professional athletes, especially boxers, we can expect the recovery time to be around nine to twelve months to allow for ample healing.

About Dr. Jeff Webb

Jeffrey Webb, MDJeff Webb, MD, sees patients of all ages and abilities with musculoskeletal problems, but specializes in the care of pediatric and adolescent patients. He works hard to get players “back in the game” safely and as quickly as possible. During his training and practice he has provided medical coverage for division I college football and other sports, multiple high schools, ballet, the Rockettes, marathons, international track and field events, and the Special Olympics. He is a team physician for the NFL’s Atlanta Falcons and serves as the primary care sports medicine and concussion specialist for the team. He is also a consulting physician for several Atlanta area high schools, the Atlanta Dekalb International Olympic Training Center, Emory University, Oglethorpe University, Georgia Perimeter College and many other club sports teams.

He is active in the American Medical Society for Sports Medicine and American Academy of Pediatrics professional societies and has given multiple lectures at national conferences as well as contributed to sports medicine text books.

Related Resources

At Emory Sports Medicine Center, our shoulder experts specialize in advanced shoulder procedures, including Arthroscopic Rotator Cuff Repair, to treat and repair a wide range of shoulder injuries. Click to learn more about torn rotator cuff injury >>

Rotator Cuff Surgery

rotator cuffThe rotator cuff is a group of four tendons and their attached muscles that stabilize the shoulder and allow you to raise and rotate your arm. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). The rotator cuff helps keep the ball of the arm bone seated into the socket of the shoulder blade.

When the tendons and muscles of the rotator cuff are overly stretched or damaged, the shoulder may begin to hurt. Patients with a rotator cuff tear usually have a dull ache in their upper arm in the area of the deltoid muscle. Neck pain on the same side may develop over time, as well as dull headaches. Patients may experience weakness or “popping” in the shoulder. and have difficulty with over-head shoulder activities (tennis, swimming, getting dressed). Night pain is a common finding with rotator cuff injuries, and may result in the inability to sleep.

If you’ve torn your rotator cuff, your doctor may recommend surgery if your pain does not improve with nonsurgical methods. These include exercises using light weights and rubber bands, anti-inflammatory medications and massage to relieve discomfort. Continued pain and inability to perform the activities of daily living are the primary indications for surgery, and if you’re very active and use your arms for overhead work or sports, your doctor may also suggest surgery.

Surgery to repair a torn rotator cuff most typically involves sewing the torn edges of the tendon to their insertion on the top of the humerus, but partial tears may only require a trimming or smoothing procedure (debridement) to remove loose fragments of tendon, thickened bursa, and other debris from around the shoulder joint.

In open shoulder surgery, a surgeon makes an incision in the shoulder to open it and view the shoulder directly while repairing it. However, most tears can be fixed via arthroscopic surgery. Arthroscopic rotator cuff repair is a minimally invasive technique for repairing a damaged rotator cuff. Using a small fiberoptic camera, the surgeon repairs the rotator cuff through 2-3 small incisions (portals) in the shoulder. Arthroscopic techniques result in less pain and stiffness, thus leading to a faster initial recovery time. Because arthroscopic tools are thin, your surgeon can use very small incisions, rather than the larger incision needed for standard, open surgery.

Surgery for rotator cuff repair requires significant recovery time. The patient will most likely wear a sling for four to six weeks. It will take approximately 3 months for initial healing of the tendon, but patients may begin light activities, such as writing and typing, almost immediately after surgery. Light weightlifting and shoulder strengthening begins 10-12 weeks post-operatively. You may not have significant pain relief or an increase in motion for several months following rotator cuff surgery. The healing process, coupled with physical therapy takes an extended period of time, sometimes up to six to nine months for a full recovery.

About Dr. Karas

Spero Karas, MDSpero Karas, MD,  is the Director of the Orthopaedic Sports Medicine Fellowship Program and an Associate Professor of Orthopaedic Surgery at Emory University. Dr. Karas is an internationally recognized expert in his field, which includes sports medicine, surgery of the shoulder and knee, and arthroscopic surgery. He has been recognized as one of America’s “Top Orthopaedic Doctors” in Men’s Health Magazine April 2007 and “Top Sports Medicine Specialists for Women” in Women’s Health Magazine. Atlanta Magazine has named him “Atlanta’s Most Trusted Sports Medicine Specialist” for the past eight years.

Dr. Karas came to Emory in 2005, after serving as Chief of the Shoulder Service and team physician at the University of North Carolina in Chapel Hill. He currently serves as team physician for the Atlanta Falcons, as well as a consulting team physician for Emory University and Georgia Tech athletics. He cares for patients and athletes of all levels: professional, collegiate, scholastic, and recreational.

Related Resources:

Do You Have Shoulder Instability?

Shoulder instability is caused when the head of the upper arm bone is forced out of the shoulder socket. Because the shoulder joint is the most mobile joint in our bodies, it is also the joint that is most frequently dislocated. Shoulder instability can develop in a variety of ways:

  • Shoulder InstabilityTrauma or injury, including labral tears and/or dislocations of the shoulder joint.
  • Repetitive motion injury, especially among athletes who would make the same overhead motions again and again, causing excessive wear and tear on the shoulder joint (as in baseball, tennis, swimming or volleyball
  • Genetic factors, which can cause general looseness in the joint and surrounding ligaments, tendons, and muscles, especially when the shoulder is put under strain or stress.

Common Symptoms of Shoulder Instability

  • Pain in shoulder caused by injury
  • Dislocated shoulders due to sports, vehicular, or other types of injury
  • History of shoulder “slipping” in and out of socket
  • Acquired shoulder laxity from repetitive activities such as throwing or swimming.

Diagnosing Shoulder Instability

Shoulder instability can be diagnosed with a careful and thorough physical examination. Imaging tests such as x –rays or a magnetic resonance imaging (MRI) help confirm the diagnosis and locate the exact area of injury. MRIs show the soft tissues a bit better than traditional x-rays.

Treatment of Shoulder Instability

Typically shoulder instability is treated with nonsurgical options. If non-operative treatments don’t relieve the pain and instability, surgery is often necessary. If surgery is required to treat shoulder instability, the goal should be to render the shoulder more stable without sacrificing motion. Whenever possible, minimally invasive surgery is done to repair shoulder instability. Minimally invasive arthroscopic surgery is generally less painful, less likely to cause complications, and enables a rapid early recovery process compared to traditional open surgery. Minimally invasive surgery does not require large dissections and splitting muscle layers; as a result the pain from shoulder stabilization surgery is decreased.

The surgery is carried out under general and regional anesthesia. A small fiber optic scope allows the physician to see inside the joint, and instruments are inserted through two small incisions in the joint to repair the ligaments and the labrum. Depending on the severity of the damage inside the shoulder, surgery may involve labral repair, ligament tightening or both.

Recovery from Shoulder Instability

If surgery is required, the patient may need to wear a sling for a few days or weeks. When the sling is removed, the patient will begin physical therapy. The exercises will improve the range of motion and gradually increase the strength in the shoulder. Physical therapy usually lasts 12-16 weeks.

About Spero Karas, M.D.

Dr. Spero Karas Dr. Karas joined the Emory Orthopaedic & Spine Center physician team in 2005. Dr. Karas is a recognized expert in the field of shoulder surgery, knee surgery, and sports medicine, and has been awarded numerous grants for research and product development. A frequent speaker throughout the United States and internationally, his work has been featured in Ski Magazine, Men’s Health, and on NBC, FOX, and CNN network television. He is also active in quality musculoskeletal research, and has been honored by his peers with nominations for numerous research awards. He actively collaborates with medical corporations by developing cutting-edge technology to improve the instruments and techniques in orthopedic surgery.

Dr. Karas received his undergraduate degree from the University of Notre Dame, and his Doctor of Medicine degree from Indiana University School of Medicine. After medical school, he completed a residency in Orthopedic Surgery at Duke University Medical Center. After residency, Dr. Karas completed a Knee, Shoulder, and Sports Medicine Fellowship at the prestigious Steadman Hawkins Clinic in Vail, Colorado. While in Colorado, he served as an Associate Team physician for the Denver Broncos and Colorado Rockies professional sports teams.

In addition his role as an Emory Sports Medicine Center physician, he currently serves as the head team physician for the Atlanta Falcons, a consulting team physician for Georgia Tech University, Emory University, Oglethorpe University, Georgia Perimeter College, and Lakeside High School. Prior to this, he served as chief of the Shoulder Service, team physician, and director of the Orthopaedic Sports Medicine Fellowship at the University of North Carolina at Chapel Hill Department of Orthopaedics. Dr. Karas was selected as one of America’s “Top Sports Medicine Specialists” in Men’s Health Magazine. He has also been named one of the “Top Sports Medicine Doctors for Women” by Women’s Health magazine, “Best Orthopaedic Surgeons in America” by Castle Connolly, and the most trusted sports specialist in Atlanta, Georgia by Atlanta Magazine.
Dr. Karas was a varsity letterman in wrestling at the University of Notre Dame and continues to participate in sports such as golf, skiing, snowboarding, and fitness training. He also coaches little league sports, and is an active member of his church and community. Dr. Karas and his wife, Johanna, are blessed with three very active and beautiful children – Gus, Elena, and Nicholas.