A lifetime in the outdoors can take a toll on hips, knees, ankles and shoulders.

Problems may develop from decades of walking over uneven ground, overuse, repetitive motion or degeneration of the joints due to aging.

No injury is more debilitating than a tear of the rotator cuff, which weakens the shoulder.

Strong, healthy shoulders are imperative to enjoying the outdoors, but a lifetime of carrying heavy backpacks, pulling a bowstring back thousands of times, and making thousands more overhead casts with a fishing rod, can cause pain and diminished use over time.

Sometimes it's an accident that's the cause of rotator cuff injuries, a fall in the woods, slipping in the boat, or lifting or pulling an object that's too heavy, like dragging a big buck deer out of the woods.

Sometimes, it's just degeneration from old age that brings on the shoulder pain, caused by the wearing down of the rotator cuff tendon slowly over time. Bone spurs may contribute to the problem. When the arm is lifted, the spur rubs on the rotator cuff tendon, weakening it and making it more likely to tear.

Rotator cuff tears are more common in a person's dominant arm.

You know you got a problem when it's harder and harder to pull back the string of your hunting bow during pre-season practice, despite lowering the bow's draw weight, or coming home from a day of bass fishing with a sore shoulder, after hours of casting.

How to sleep without pain may also become an issue. It becomes impossible to sleep on the side of the damaged shoulder, and sleeping on your "good side" may prove difficult too, if your damaged shoulder is not at the right angle and your arm is not supported by a pillow.

It's not just outdoors enthusiasts that are at risk for this injury.

Athletes that play sports where they repeatedly use their arms in raised and lowered positions, such as baseball players, golfers, swimmers, tennis players, weightlifters and football players, are often sidelined by rotator cuff issues.

According to orthoinfo.org, a website devoted to helping persons make informed healthcare decisions about musculoskeletal problems, each year about two million adults in the U.S. visit their doctors because of a rotator cuff problem.

Shoulder Anatomy and Rotator Cuff Tears

Here's some basic information developed and reviewed by the American Academy of Orthopaedic Surgeons:

• The shoulder is made up of three bones, the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle). The shoulder is a ball-and-socket joint, with the ball, or head, of your upper arm bone fitting into a shallow socket in your shoulder blade.

• The arm is kept in the shoulder socket by the rotator cuff, which attaches the humerus to the shoulder blade, and enables the arm to be lifted and rotated.

• The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus. There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder. The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, the bursa can also become inflamed and painful.

• When one or more of the rotator cuff tendons are torn, the tendon is no longer fully attached to the head of the humerus. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes by lifting a heavy object.

• A partial tear is "incomplete," it damages the tendon, but does not completely sever it. A full-thickness tear is a "complete" tear, separating all of the tendon from the bone. With a full-thickness tear, there is basically a hole in the tendon.

Diagnosis and Treatment

Diagnosis begins with an examination, which usually includes measuring the range of motion in your shoulder, x-rays and magnetic resonance imaging (MRI).

Nonsurgical treatments, to relieve pain and improve function, include strengthening exercises, physical therapy and steroid injections.

It's possible that a slight tear may heal itself, but in general rotator cuff tears do not heal unless repaired by surgery.

Arthroscopic surgery is an outpatient procedure and is the least invasive method to repair a torn rotator cuff.

Recovery includes the immobilization of the tendon, to allow it to start healing, by placing the patient's arm in a sling for three to four weeks, and rehabilitation sessions, several times a week, for several months.

Becoming too active, too soon, can lead to a new tear or other injuries. Full recovery from rotator cuff surgery can take six months to a year.

Shoulder issues related to the degeneration of a rotator cuff typically begin when a person reaches age 40. An acute rotator cuff tear from a fall should be treated immediately.

Go to the doctor if you notice shoulder pain or a diminished range of motion. Don't let a bum shoulder compromise your outdoors fun.

Art Lander Jr. is outdoors editor for KyForward.

He is a native Kentuckian, a graduate of Western Kentucky University and a life-long hunter, angler, gardener and nature enthusiast.

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