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DURHAM, N.C. -- Many Baby Boomers swat tennis balls, swim or dribble basketballs for two reasons – the joy of physical activity and competition, as well as maintaining their cardiovascular fitness.

While exercise is a key factor in forestalling heart disease, Baby Boomers who are still young at heart should not neglect their musculoskeletal systems, especially if they want to maintain an active life style into their 60s and 70s, according to Claude T. Moorman, III, M.D., director of sports medicine at Duke University Medical Center. Failure to appreciate the musculoskeletal system can lead to injuries that could curtail favorite pastimes, he said.

"We know that exercise and physical activity is an important way to maintain our overall health. Many people, especially the Baby Boomers, don't seem to be paying as much attention to other parts of their bodies," Moorman said. "Over the past decade we have seen a dramatic increase in the number of patients over the age of 40 needing surgery to repair damage to their joints."

One area of particular interest to Moorman is the shoulder, a unique joint where four different muscles and their tendons form a "cuff" keeping the ball at the end of the arm bone inside the socket of the shoulder blade.

Moorman said that 10 years ago, most of the surgeries he performed on Baby Boomer weekend warriors involved the knee.

"Now, I'd say that about 60 percent of the cases I do involve the shoulder, with about 80 percent of those repairing injuries to the rotator cuff," Moorman said. "Over time, the tendon tends to break down, first as tiny tears. These tears can eventually coalesce into a much larger tear that needs treatment."

The key to prevention, Moorman said, is to recognize the early signs when the tears are small, such as pain that begins at the front of the shoulder and moves down the side of the arm, usually after such activities as reaching or lifting. Over time, the pain may increase, even when the joint is not being used.

Researchers in Duke's Michael W. Krzyzewski Human Performance Laboratory (K Lab) are currently evaluating different exercise and weight training regimes to determine those that can strengthen the rotator cuff without aggravating the joint. The researchers hope to develop a strategy that will help Baby Boomers preserve the integrity of their rotator cuffs as they exercise to strengthen their hearts.

When a tear in the rotator cuff occurs, either as a result of long-term wear-and-tear or an acute injury, surgery is often the only solution. Such surgeries are performed about 300,000 times each year in the US.

"Fortunately, we can perform most rotator cuff repairs safely and effectively with an arthroscopic approach, which means less pain and quicker recovery for patients," Moorman said. Moorman said that about 90 percent of the rotator cuff injuries he treats with an arthroscope.

Most patients receiving this minimally invasive approach are back to normal routine in three to four months, twice as fast as the traditional surgical approach, Moorman said.