Rotator Cuff Tears in Athletes

Authors:

Simon A. Euler, Dirk Kokmeyer, and Peter J. Millett

Abstract:

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.

For the complete study: Rotator Cuff Tears in Athletes

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Rotator Cuff Tears in Athletes

Authors:

Abstract:

About the Author: Peter Millett, MD