Athlete Rotator Cuff Tears 2024 Lennard Funk

Athletes can suffer both acute full thickness rotator cuff tears as a result of trauma, as well as chronic full and partial thickness tears as a result of overhead sports. The aetiology, assessment and treatment of these tears may bear little resemblance to the chronic tears so commonly seen in the elderly, sedentary population. Associated injuries in the shoulder must be assessed and managed con- comitantly, as failure to treat all pathologies can lead to poor results in the athlete. Non-operative and operative treatment must be specifically directed at the underlying causes and pathologies to allow a return to sporting activity as soon as possible.

1. Rotator Cuff Tears in Athletes Lennard Funk

2. QR Codes PDF files and web links for more info

3. Rotator Cuff Infraspinatus Teres Minor Supraspinatus Subscapularis Long Head Biceps

4. Force Couples Infraspinatus Subscapularis JRF

5. Contains/Controls Humeral Head Sub Ssp Isp TM Sub Ssp Isp TM

6. Collagen Type 1 Type 2 Type 3

7. Stress Concentrations

8. Rotator Cuff Tear Demographics Symptomatic & Asymptomatic Tear Prevalence Yamamoto, JSES, 2010

9. Typical Cuff Tear

10. Cuff Tears in Athletes Incidence (in my practice) 1392 patients from 2014 to 2024 449 Rotator Cuff Tears 77 Athletes (17%): Age = 37 (13-66) Contact = 29 (38%) Overhead = 33 (43%) Strength / Martial Arts = 15 (20%)

11. Rotator Cuff Repair - Rugby 402 Rugby Surgeries over 10 years 38 Cuff repairs (11%) Majority not isolated Torrence & Funk, 2016

12. Cuff Tear Patterns Casaletto & Funk, 2009

13. Associated Injuries

14. Athlete A P

15. USS Immediate Cheap Accurate Not assoc. injuries MRI Accessible Expensive Not assoc. injuries MRA Most Accurate Expensive Access Skills Investigations

16. Treatment Repair – Arthroscopic Treat ALL pathologies Sports Specific Rehab Earlier repair = better outcomes

17. Surgical Tips Address All Pathologies Prepare to fresh tissue Strong, secure repairs Repair in position of function for sport Check repair integrity thro ROM Sling in position to optimise recovery Pain & Swelling Mx - multimodal Allow Early ROM & Isometrics + Sports Specific

18. Sports-Specific Rehab. Rugby Rehab Protocol Football Rehab Protocol Overhead Athlete Protocol

19. Outcomes in Rugby Pre-op 3m Final CS 44 95 101 OS 34 18 12 Tambe & Funk, IJSS, 2008 Mean time of return to full match play = 4.8 months (3-8) Tambe & Funk IJSS 2009

20. Overhead Athlete

21. Postero-Superior Internal Impingement

22. Cuff Damage Internal Impingement Repetitive Torsional Forces

23. Static Excess Humeral Translations Micro-Instability Anterior Posterior Dynamic Scapula Dyskinesis Accelerators Decelerators Control Proprioception Kinetic Chain Pathomechanics

24. Pathomechanics Capsular Imbalance Muscular Imbalance Internal Impingement Trauma +/- Labral Tear Subacromial Impingement Rotator Cuff Tear + {

25. Diagnosis High Index of Suspicion Overhead athlete Pain on extremes & fatigue GIRD Cuff Signs Ultrasound Scan

26. Swimmer

27. Partial Cuff Tear

28. Treatment

29. MR Arthrogram

30. Non-Surgical Treatment Address Static imbalances: Soft tissue therapy Address Dynamic Stabilisers: Core Stability & Kinetic Chain Movement muscles Stabilising muscles (rotator cuff) Sports-specific

31. https://www.shoulderdoc.co.uk/article/1718

32. Injections Steroid - reduces inflammation only PRP - No conclusive evidence ? partial cuff tears? Prolotherapy - Never! Xiang et al. 2021. Conservative treatment of partial-thickness rotator cuff tears and tendinopathy with platelet-rich plasma: a systematic review and meta-analysis. Clinical Rehabilitation, 35(12), pp.1661-1673 Andrews, J.R., Elbayar, J.H. and Jordan, S.E., 2021. Partial-Rotator Cuff Tears in Throwing Athletes. Operative Techniques in Sports Medicine, 29(1), p.150799.

33. PRP Injections