Diagnosis: If there is obvious injury or if pain is severe, more immediate medical attention is needed. During the pandemic, this has usually been an emergency room visit. For milder cases, an initial consult by phone or in person with your family physician is warranted. Doctors will take a history to identify any precipitating causes and may order some initial investigation, such as an X-ray. Ultrasound examination is now being used to diagnose rotator cuff tears. A physical examination is the most helpful and can suggest more specific medications and diagnostic tests. If there is still doubt about the cause of the pain or failure to respond to conservative treatment, more sophisticated testing may be indicated and an orthopaedic specialist may be recommended. Further imaging fromMRI or CT scans, blood tests and even surgical examination of the shoulder (arthroscopy) may be necessary. Treatment: Treatment will be based on the diagnosis. For acute injuries to the shoulder, hospitalization and surgery may be indicated. For the more chronic conditions, home treatment will be most important, with other medical measures and physiotherapy warranted if symptoms become more severe or persistent. More than 80% of cases of shoulder tendinitis get better over time without the need for surgical intervention. During that time, the physicianmay recommend an injection of cortisone in the joint − but this can be done only a few times at most. Physiotherapy is recommended for almost every shoulder problem, especially rotator cuff tendinitis and frozen shoulder. It helps to ensure continued range of motion − thereby reducing the risk of developing a frozen shoulder – as well as to help with pain. Physiotherapy also helps maintain strength and function in the shoulder muscles. Home exercises will be taught by the physiotherapist and should be followed diligently. Some individuals claim relief with acupuncture. Surgery is often urgently needed for severe shoulder injuries such as fractures or certain dislocations, but is rarely indicated with other causes of shoulder pain. Where there is more serious damage to the rotator cuff tendons and when medical management and physiotherapy have made no improvement, the orthopaedic surgeon may recommend surgical repair. This operation should be considered carefully before being done, as it is not always successful. Prevention: As cases of shoulder tendinitis are far more common in seniors, it is important to be aware of the precipitating factors in many of the cases. This is especially important for snowbirds who, once arriving in the sunny south, often participate more actively in activities such as golfing, pickle ball and swimming. It is recommended that such activities be initiated slowly, withmodifications in the type or intensity of the actions involving the shoulder if symptoms of discomfort arise. Overuse of the shoulder in any activity may increase the likelihood of symptoms. Nevertheless, good posture, daily physical exercise, avoiding heavy lifting and keeping your arms moving in a full range of motion will help avoid − as well as manage − shoulder tendinitis. 34 | www.snowbirds.org Health
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