Rotator Cuff Tears in Athletes

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Rotator cuff tears are common injuries in athletes and may occur as a result of acute trauma (such as a fall onto an outstretched arm) or, more commonly, as a result of chronic overuse with repetitive overhead activity. While traumatic conditions are generally treated surgically, chronic overuse injuries are more often treated using a conservative approach.

Overuse injuries of the shoulder are commonly related to microtrauma due to repetitive overhead activities, especially in throwing sports such as baseball or javelin. As these athletes progress to higher levels of competition, greater demands are placed on the glenohumeral joint with increased throwing velocities. Throwing velocity is maximized by increases in shoulder abduction and external rotation range of motion, which leads to anatomic bony and soft tissue adaptations that facilitate hyperabduction and external rotation over time. These anatomic changes can lead to contracture of the posterior capsule with subsequent posterosuperior humeral head migration. This is known as glenohumeral internal rotation deficit (GIRD), which in addition to restricted internal rotation can lead to tearing of the superior labrum (SLAP) via the “peel-back” mechanism. GIRD may also lead to posterosuperior glenoid impingement – an entity characterized by posterosuperior rotator cuff and/or labral tearing as a result of osseous impingement between the greater tuberosity and the glenoid rim in positions of abduction and external rotation (internal impingement). Additionally, muscle imbalances can produce scapular dyskinesis, which may decrease the space available for the rotator cuff tendons to pass beneath the acromion, thus lead- ing to fraying and partial-thickness tearing. The majority of throwing athletes have articular-sided, partial-thickness rotator cuff tears, most of which occur near the interval between the supraspinatus and infraspinatus tendons, presumably due to internal impingement.

Athletes who undergo surgery in the midst of a season are commonly excluded from play for the majority of the season. Even off-season surgical treatment may limit return to play or a return to the preinjury level. For efficient and successful treatment with physical therapy, it is important to keep in mind some basic considerations and to follow the basic principles of rehabilitation described below.

Although the pathomechanisms surrounding rotator cuff tears in overhead athletes are still heavily debated, conservative management remains a mainstay of treatment. Therefore, the purpose of this chapter is to review the basic principles of conservative management for rotator cuff tears in athletes with a focus on the over-head athlete.

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