The shoulder is an incredibly complex
mechanism that, because of its design, has the
greatest range of motion of any joint in the
body. It also can withstand tremendous stress
and exert great power.
The three bones that form the shoulder are the
collarbone, shoulder blade and upper arm bone.
The shoulder is a ball-and-socket joint. A
ball at the end of the upper arm bone fits into
a socket in the shoulder blade. The socket
is much shallower than the socket in the hip
joint, which allows the arm to move farther in
The shallow socket means the bone-tobone
connection in the shoulder is less stable.
But this instability is offset by tendons and
ligaments, which are strong, fibrous bands
that hold the bones together. Four tendons
that attach major muscles to the shoulder
bones form what is called the rotator cuff,
a protective covering that wraps around the
The surfaces of the ball and socket are
covered with cartilage, a smooth, firm tissue
that allows bones to move smoothly against
each other with a minimum of friction. Tiny
sacs called bursa, located inside the rotator
cuff, excrete a lubricating fluid that also helps
the joint move freely.
The four tendons that form a cuff
around the shoulder joint are
incredibly tough. They have to
They are subjected to a lot of pressure
and pulling as they connect the rotator
cuff muscles to the shoulder blade and
the upper arm bone. Sometimes they are
squeezed between the two.
“They live in a very harsh
environment,” says orthopaedic surgeon
Glen Subin, M.D., of the Mid-South
Orthopaedic Clinic in Pinehurst.
|Glen Subin, M.D.
|David Fedder, M.D.
Sometimes the environment is too
harsh and, over the years, one or more
of the tendons will start to fray. It is
similar to what happens with your
shoelaces, Dr. Subin says.
“The laces become frayed over time,
and then one day you’re tying your shoes
and one of the laces snaps,” he says.
Rotator cuff tendons seldom actually
snap, but they do develop painful tears.
The process that leads to a torn
rotator cuff tendon often starts with
inflammation, tendonitis, which can be
caused by overuse, says David Fedder,
M.D., an orthopaedic surgeon with
“With chronic overhead repetitive use
such as swimming or painting a ceiling,
a tendon can get jammed between the
bones in the shoulder, and that causes
inflammation and swelling,” Dr. Fedder
says. “But the tendon doesn’t have room
to swell, because it’s in such a tight
space. So it hurts.”
An inflamed or frayed tendon doesn’t
always lead to surgery.
“There are stages in the process
at which it is reversible,” Dr. Fedder
says. “You get the inflammation down
(sometimes with steroid injections), you
have therapy to work the muscles and
stop the pinching, and your problem is
likely to go away.”
Once a rotator cuff tendon is
damaged, it can take a long time to heal
and become strong again.
“You need blood to bring in the cells
that repair the tissue, and the blood
supply isn’t very good in that location,”
Dr. Subin says.
Bursitis, inflammation of a bursa, is
another common shoulder problem. It is
often caused by the bursa being jammed
between two bones, which is the same
thing that causes rotator cuff tendonitis.
Orthopaedic surgeons frequently
see people with dislocated shoulders.
If you take a hard fall on your arm or
outstretched hand, the ball at the top of
the arm bone can pop out of its socket.
It is quite painful, but relatively easy to
Gentle traction on the arm allows the
ball to be put back in place. Whether
it ever pops out again depends a lot on
“The younger a person is, the more
likely it is that the shoulder will dislocate
again,” Dr. Fedder says.
If it happens a second time, chances
are even greater that it will happen a
third time, and so on, because each
dislocation causes the shoulder to
become looser, Dr. Fedder explains.
However, if you are 50 when your
shoulder pops out, it probably isn’t
going to happen again.
“As we get older, our shoulders—like
the rest of our joints—become stiffer
and less supple,” Dr. Subin says.
Most shoulder problems are the
result of physical activity that causes the
joint to be pounded, twisted, jammed,
stretched or simply worn out. So most
people probably could avoid hurting
their shoulders if they didn’t swim, play
golf or tennis or participate in other
But, as Dr. Subin says, “They wouldn’t
have as much fun, either.”
|Peter Franklin finished a round of golf after suffering an injury that he later learned was a torn rotator cuff. Since having surgery to repair the injury, he is on the golf course about three times a week.
“There was no question about what I did or when I did it,” Peter Franklin says about tearing
the rotator cuff in his shoulder while playing golf. “It was on the second shot of the first day of
a member-guest tournament.”
Although he was in a lot of pain, he finished the round of golf before going to the Emergency
Department at FirstHealth Moore Regional Hospital.
“I asked the doctor to give me a shot so I could play the next day, and he just laughed,”
Franklin recalls. That was about six years ago.
Franklin knew he probably should get the rotator cuff fixed, but he kept putting if off. “I had
heard horror stories about recovery taking six months, and I figured that at my age, I didn’t have
six months to give,” he says.
But three years ago, when he was 77, there was leakage around the tear in his shoulder and an
abscess developed. David Fedder, M.D., an orthopaedic surgeon with Pinehurst Surgical, told
him he really needed to have the rotator cuff repaired.
Dr. Fedder performs orthopaedic procedures at FirstHealth Moore Regional Hospital.
“Within 10 days after the operation, I was able to raise my arm without any pain,” Franklin
says. “I was chipping within a month and playing full rounds of golf within two months. And I
take a lot of (golf) shots!”
Now, he typically plays at least three times a week.
“I may ache everywhere else,” he says, “but I have absolutely no pain in my shoulder.”
Joy Moser hurt her shoulder when she ran into a wall during a racquetball game more than
20 years ago. At the time, she was living in the Atlanta area, where she was a public school
Over the years, she went to see several doctors about her shoulder. “They would say it was
bursitis or something else, and they tried various treatments,” Moser says. “Finally, I went to a
doctor who said she thought it was a torn rotator cuff, but I just didn’t want to have surgery.”
Ten years ago, Moser remarried and moved to Laurinburg, but it wasn’t until 2004 that she
finally decided to have her shoulder fixed.
“It hurt every night, and I wasn’t sleeping well,” she says. “I had to sleep in different positions
with something under my shoulder, because I was so uncomfortable.”
Moser went to see Glen Subin, M.D., of the Mid-South Orthopaedic Clinic in Pinehurst,
who performs orthopaedic procedures at FirstHealth Moore Regional Hospital. He
discovered that Moser actually had four separate tears in her rotator cuff tendons that needed
to be repaired.
“I was a little concerned, because we had very good hospitals in Atlanta, and this one was
relatively small,” Moser says. “I considered going to Raleigh for the surgery, but I’m so glad I
decided to have it here.
“It was a perfect experience. I can’t imagine it could have gone any better. I never had any
trouble with my shoulder at all. Of course, I also had a wonderful physical therapist and I was
very good about doing my exercises.”
Moser, who is 62, says she has only one regret about her rotator cuff surgery.
“I wish I hadn’t waited so long to have it,” she says.