By Dr. Ben Zellner, hand-to-shoulder specialist, and OSMS physician owner
Dr. Ben Zellner is a board-certified, fellowship-trained orthopedic hand-to-shoulder specialist. He is seeing patients at our Green Bay and Marinette clinics. Request an appointment with him here.

Fewer things are more popular in Wisconsin than deer hunting and many hunters prefer bow hunting. If you think about the basic actions of shooting a bow – pull back with the fingers and arm, rotate through the shoulder, hold, and release – it becomes clear why upper extremity conditions are some of the most commonly diagnosed injuries among bow hunters.

The most common cause of injuries while deer hunting is falling out of tree stands. But for this blog, let’s focus on two commonly injured areas in bow hunters.

1. The Rotator Cuff

The rotator cuff is made up of muscles and tendons that cover the top of the upper arm bone and attach to the shoulder blade, keeping the arm in the shoulder socket. It is a common source of shoulder pain, especially in bow hunters or people who perform a lot of overhead lifting, pulling, or rotating of the shoulder.

Three common sources of rotator cuff pain include:

• Tendonitis: The rotator cuff tendons become irritated or damaged.
• Bursitis: The fluid-filled “pillow” that acts a cushion between the rotator cuff and shoulder blade becomes irritated or inflamed.
• Tears: Damage to the rotator cuff that results in significant pain and weakness. Tears can be caused by an acute injury, or the symptoms may gradually progress over time due to overuse.

Tendonitis, bursitis, and minor or partial rotator cuff tears can all typically be resolved non-surgically through the use of anti-inflammatory medications, rest, strengthening exercises, and possible injections.

A complete tear of the rotator cuff, or a partial tear that doesn’t respond to conservative treatment, will most likely require surgery. The procedure will reattach the torn tendon to the upper arm bone and help restore function.

There are two main options for surgically repairing rotator cuff tears: arthroscopic and mini-open repairs. While each of the methods available has its own advantages and disadvantages, both have the same goal – getting the tendon to heal. The type of repair performed depends on several factors, including the size of your tear, your anatomy, and the quality of the tendon tissue and bone.

• Arthroscopic Repair

During arthroscopy, a small camera called an arthroscope is inserted into your shoulder joint. The camera displays pictures on a television screen that the surgeon uses to guide miniature surgical instruments. Because the scope and surgical instruments are thin, very small incisions (cuts) can typically be used, rather than the larger incision needed for standard, open surgery.

• Mini-Open Repair
  Some surgeons will perform a mini-open repair through a small incision. The incision is typically 3 to 5 cm long. The surgeon repairs the rotator cuff through the mini-open incision. During the tendon repair, the surgeon views the shoulder structures directly, rather than through the video monitor.

A full recovery after either procedure will take several months, but the majority of patients report improved shoulder strength, decreased pain, and most are able to return to the activities they enjoyed before their injury.

One of the best ways to prevent these and other chronic shoulder conditions is through proper strength and conditioning of the shoulders. Check out the American Academy of Orthopaedic Surgeon’s Rotator Cuff and Shoulder Conditioning Program.

2. The Forearm

Medial Epicondylitis (Golfer’s Elbow). Pronator teres, Flexor carpi radialis, Radius, Ulna, Flexor carpi ulnaris, Palmaris longus, Medial epicondyle. MendMeShop® ©2011

Since bow hunters rely on the muscles, tendons, and nerves that run through the forearm and into the fingers to draw their bows back and accurately release them, this area of the upper body is easily susceptible to overuse injuries.

One type of overuse injury in the forearm is medial epicondylitis.

This condition results in inflammation of the tendons that attach the forearm muscles to the elbow. Two ways to help prevent this are:

• Proper rest time in between target practicing and hunting trips to allow the overused tendons to repair.
• Strengthening the forearm muscles.

Bow hunters might also experience median nerve compression in the wrist or elbow. The median nerve is one of three main nerves that run from the neck all the way into the hand. When this nerve becomes compressed as it travels through the elbow or wrist, it can cause pain, weakness, numbness, and tingling. Typically, symptoms are felt in the hands.

These forearm conditions can oftentimes be treated through non-surgical methods such as splinting, anti-inflammatory medications, rest, and activity modification.

The goal of any treatment plan is to relieve symptoms and restore function in the long-term so that patients can get back to the activities they enjoy. Therefore, if symptoms stop responding to treatments or quality of life is significantly affected by pain and limited function, surgical options may become the best solution.