Rotator Cuff Injury Management series (0/5) : Elite Athlete

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Before starts with the series quick over view of Rotator cuff muscles working. click here…

Injuries to the rotator cuff are a common across all sports and levels of competition. We also seen the same mechanisum  of injury of RC tear but the nature of injury is different.

Its broad spectrum of severity exists which ranging from Contusion and tendinopathies to tears and can be classified as either partial-thickness of full-thickness tear.

Injuries to the rotator cuff can be treated either conservatively or surgically. here are some factors which should be conside before treating RC tear.

  1. Sport & ADL                                                                                       
  2. Level of contact
  3. Positional demands
  4. Time of year

RELEVENT ANATOMY OF MUSCLES AND ITS ACTION (QUICK OVER VIEW):

  1. Supraspinatus: Abduction
  2. Infraspinatus and Teres minor: External rotators 
  3. Subscapularis: Internal rotation

A disruption or injury can affect glenohumeral joint dynamic stability and disrupt normal shoulder kinematics.

CLASSIFICATION:


Cassification of a rotator cuff tear is important to guide treatment. A tear may be classified based on size of the lesion, the number of tendons involved, and signal abnormality in the tendon on MRI. .

What RC dystruption means  ?

1) Rotator cuff inflamatory changes:
*Increased signal intensity in the tendon and overlying bursa, but no tear.
*Associated bone marrow edema
*Fluid collection in the subacromial/sub-deltoid region, suggestive of an acute bleed .

2) Tendinopathy:
*Abnormal signal intensity on MRI.
*Thickening of the tendon.
*Common in repetitive overhead athletes.

Tendonosis can also develop in football players from years of heavy weight lifting exercises. .Partial thickness tears may develop in tendons with underlying tendinosis. A full thickness tear in a young athlete is less common, but often seen with pre-existing tendonosis (acute on chronic presentation). .

What we conclude from study ?

  1. Those rotator cuff tears that do not respond to conservative management can be addressed operatively in the off-season or immediately based on the athlete’s current level of dysfunction and ability to meet the demands of their sport.
  2.  There are many newer & fancy treatment techniques  we all knows such as intramuscular dry needling, blood flow restriction therapy which have no effectivness evidance to support RC tear treatment.
  3. An early and accurate diagnosis followed by an tailored made protocol and comprehensive treatment program under sports medicine specialist required  to return the elite athlete back to competition following rotator cuff injury both expediently and safely.
Next Up:
1. Clinical Presentation 
2. Early Rehabilitation 
3. Intermediate Phase 
4. Advanced/Late Stage Rehabilitation 
5. Future Directions and Conclusions

Referance:
Weiss et al. 2018. Management of Rotator Cuff Injuries in the Elite Athlete.

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