Rotator Cuff Injury Follow-up

Updated: Oct 25, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Follow-up

Return to Play

Return to play criteria should be individualized for every player. [35] General criteria require the athlete to experience no pain with rest or activity, full strength in muscles across the affected joint, pain-free shoulder ROM with normal ST motion, and negative provocative tests (eg, Neer impingement test, Hawkins impingement test).

An athlete who returns to his or her sport too soon tends to alter throwing mechanics and risks injuries not only to the same shoulder, but also to the elbow, hip, and spine. Resumption of activities should be gradual, and activity intensity may need to be modified in response to recurrence of symptoms. Imaging findings alone should not be used to determine return to play.

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Complications

When treatment is delayed in rotator cuff injuries and shoulder discomfort persists, the patient can develop symptomatic stiffness of the GH joint, which is called adhesive capsulitis. In this condition, the patient consciously or subconsciously limits the use of the shoulder because of pain, leading to the development of soft-tissue tightness or stiffness in one or more planes. The chance of developing adhesive capsulitis can be minimized through prompt diagnosis of painful problems in the shoulder, such as rotator cuff injuries, and the institution of early shoulder ROM as part of the rehabilitation program.

Severe supraspinatus and infraspinatus muscle atrophy is often associated with massive rotator cuff tears, but an underlying entrapment of the suprascapular nerve should always be considered. Symptoms of suprascapular nerve entrapment include shoulder pain that is described as a deep dull ache localized to the posterolateral aspect of the shoulder. Weakness of the shoulder and arm is common, with visible wasting and atrophy of the supraspinatus and infraspinatus and normal bulk in the deltoid. Clinical differentiation of suprascapular nerve entrapment from rotator cuff injuries may be difficult, especially if both are present simultaneously. EMG is the single most helpful test for diagnosing this condition.

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Prevention

Following rotator cuff injuries, patients must pay careful attention to the use of proper mechanics during athletic activities and avoid harmful adaptations (eg, changing arm position when throwing a baseball). The nature of many overhead sports makes the athlete susceptible to injury and dysfunction because of the repetitive high-velocity stress that is required.

Athletes should maintain balanced shoulder ROM, paying particular attention to shoulder internal rotation, which can be limited by increased posterior capsular tightness. Dynamic stabilizers should be strengthened, including the rotator cuff muscles and the scapula stabilizers. This decreases demands on the static stabilizers (eg, bony structures, labrum, ligaments, capsule) and helps the athlete minimize the risk of injury. Maintaining proper trunk and lower extremity strength is also important, because these muscles generate significant force for athletes performing overhead motions and reduce stress on the shoulder girdle muscles.

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Prognosis

Most athletes with primary outlet impingement without full-thickness rotator cuff tears respond well to nonoperative treatment. Rehabilitation is also effective in the majority of athletes with rotator cuff pathology due to other causes (eg, instability), except when instability is caused by trauma. When surgery is performed for rotator cuff injuries not responding to conservative treatments, results vary depending upon patient age, size and pattern of the tear, degree of retraction, tissue quality, and quality of repair.

One study evaluated 51 patients, aged 60 years or younger, with nonoperatively treated rotator cuff tears and found that full-thickness rotator cuff tears tended to increase in size in about half of the patients. The study suggests that surgery be considered to prevent an increase in size tear, and those treated nonoperatively should be monitored for tear size increase. [36]

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Education

Proper sport technique can be of great importance in the prevention and rehabilitation of rotator cuff injuries. This includes proper hand position on water entry in swimming, changes in paddling technique in canoeing and kayaking, and evaluation of pitching mechanics by coaches and trainers in throwing athletes. Encourage the importance of maintaining proper trunk and lower extremity strengthening in athletes performing overhead motions, because these muscles generate significant force during overhead activities and serve to reduce stresses on the shoulder stabilizers.

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