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Ask Dr. Gott 1/21
Exercise shift after rotator cuff injury
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   DEAR DR. GOTT: I am 82 years old. I walk, hike and swim every day. I’ve been having a lot of discomfort in my right shoulder, arm and hand. When I swim, I can hear and feel my shoulder grinding. A friend says it is my rotator cuff and that I just have to live with the pain. Did swimming cause the condition? Is exercise good for it?
    DEAR READER: The rotator cuff helps stabilize the shoulder. Consequently, it can be easily strained, irritated or torn in people who are physically active. Swimming and other forms of exercise can aggravate your shoulder and may be the cause of the rotator cuff problem, if that is what is causing your discomfort. If you gain pleasure from remaining fit, and it appears you do, I highly endorse the exercise. If, however, you feel you are damaging your shoulder every day, you might consider taking a few days or a couple of weeks off to determine whether the pain subsides. Settle for a brisk walk to get your daily exercise. If you remain pain-free, gradually introduce a modified hiking schedule that shouldn’t require much shoulder use. You can ultimately add a modified swim program once or twice a week, stepping the program up to your current daily regimen if you remain pain free.
    Treatment depends on the amount of damage. A strained cuff usually responds to rest and heat. An irritated cuff usually improves with rest and over-the-counter anti-inflammatory drugs such as Advil, Aleve and others, coupled with physical therapy. A torn cuff can be a real problem that may require surgery.
    You may need further testing, such as a CT scan or MRI, to determine the extent of the damage.
    Ask your primary care physician for a referral, because more than anything, you need a consultation with an orthopedic surgeon who is familiar with sports injuries. He or she may determine your pain isn’t related to your rotator cuff at all. The CT or MRI can provide vital information on this annoying problem.

    DEAR DR. GOTT: You recently responded to a letter from a wife who was concerned her 72-year-old husband was sleeping excessively.
    Bless his heart! He’s working 40 hours a week and comes home to a nag who can’t understand why he’s tired. If taking naps is ruining a 50-year marriage, let her go! He may just perk up when her negativity walks out the door.
    DEAR READER: I disagree with you. Sleepiness can be a symptom of depression, anemia and a host of medical conditions that should be addressed. Perhaps the husband needs a sleep study to determine whether his sleep pattern is disrupted several times a night.
    He should also have an exam by his primary care physician. If everything is normal, he may need counseling, but I don’t believe that breaking up a marriage is going to ease his wife’s anger and bring everything back to normal.
    To give you related information, I am sending you a copy of my Health Report “Sleep Wake Disorders.”
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