DR. HOOK- Twist 'n shout: Rotator cuff injury hurts!

Weight lifting used to be a passion of mine. As a "petite" Asian man, I used to be very self-conscious about my size. In elementary school, I was always chosen last to join a team in physical education. Even Gigi, a four-pound girl, was chosen before me (okay, I made that part up, but it was practically that way). So tennis and golf were my sports, and contact sports were like scenes from Gladiator for me.

When I was a freshman in college, another pre-med student taught me how to lift weights. It was a humiliating first experience because on the bench press I couldn't even lift the bar– without weights attached! (Wonder Woman and Superman never had to face this trauma.) I worked out five times a week and went from a 128-pound wimp to a 138-pound weakling. 

Through medical school and residency I kept lifting weights and got bigger. Everyone in my gym in Hollywood kept saying to me, "Wow, your shoulder are huge, but when you turn 30, you probably will have a rotator cuff injury like the rest of us." 

"Don't Rain on My Parade," said Barbra Streisand. They jinxed me, and I promptly got impingement syndrome of my left rotator cuff.

The shoulder doesn't have a "real" joint like the hip, knee, or elbow. It's a girdle (like Petticoat Junction) supported by muscles and tendons. The rotator cuff consists of four muscles that allow the shoulder to abduct (reach over your head from the side) and rotate the shoulder to put on your shirt.

You don't have to be a weight lifter to hurt your shoulder– in fact, most people aren't. Rotator cuff problems tend to come on inconspicuously due to repetitive motions like reaching over the head, pushing things, and pulling things (like Christmas shopping). If one or more of the four rotator cuff muscles or tendons become inflamed, or if the tendons get impinged under the shoulder bone (a.k.a. Impingement Syndrome), a nagging pain develops.

People with rotator cuff syndrome complain about pain when they sleep on that shoulder, and they end up throwing that arm over the edge of the bed to relieve the pain. Putting on a shirt or jacket is as much fun as banging your head against the wall. The pain of reaching for the stars makes you swear at the gods.

Construction workers, painters, and others who do manual labor find that lifting things and reaching up becomes more and more painful– and the situation doesn't improve with continued overuse of the shoulder. This stinks because their livelihoods are dependent on their physical abilities.

For those who don't raise their arms up because of the pain, a "frozen shoulder" can occur, and not even the Hulk can lift that person's arm above the head because it's scarred down.

Physical therapy is the best remedy for a rotator cuff strain. I show my patients some exercises to do with light weights or even a bottle of water to free the tendons and strengthen the rotator cuff muscles. NSAIDS can reduce the inflammation, but because it masks the pain, some people overuse their shoulder and never allow it to heal.  

Steroid injections can be very helpful (and I do them so often that some patients look like a water sprinkler shooting out steroids left and right), but the patient cannot lift heavy weights for a while after the shot to prevent actually tearing the rotator cuff.     

I begged and pleaded with my LA doctor to inject steroids into my left shoulder when I hurt it, but she also worked out at my gym and always caught me trying to bench press or do military presses. Foiled again! I gave up the weights for six months, did physical therapy, and I continue my shoulder exercises to this day. Now the only cuffs I worry about are on my pants or shirt sleeves.

Got a medical question? Dr. Hook wants to hear from you.



I read your weight lifting history with interest.
I am now 62 and have been lifting weights for 30 years. I have had rotator cuff surgery on both shoulders. Left shoulder less then a year ago.
I have switched to machines rather then free weights but my shoulders continue to hurt after a
work out. At age 62 with surgery what would be the best gym workout to get my muscle mass back.


I was injured in a motorcycle and auto wreck (I was on the motorcycle naturally). I ended up with multiple injuries. One of the injuries was a broken collar bone, which they had to put a plate and 8 screws in to repair it. During recovery
time my arm was in a sling and I was noticing that my deltoid muscle was bothering me a little. The doctor just wrote it off as muscle pain.Now two months after surgery my arm hurts all the time. I haven't been able to sleep for three nights due to pain in my arm. Motion in my arm is limited. After doing a little reading it sounds like the rotator cuff. I guess my question is do I pick surgery or therapy. The reason I ask is it sounds like with surgery I can go back to what I like to do, golf,weights, motorcycle eventually. But with therapy it will get better but not get as strong as it would with surgery. Am I WRONG IN MY THINKING
BARRY (05-07-07)