Description
Athletes from all sports and levels of competition frequently experience pain and dysfunction as a result of rotator cuff injuries. These injuries can also significantly affect an athlete's playing career and their capacity to compete in sports. An acute incident of trauma, such as a direct blow or falling on an extended arm, or chronic overuse and recurrent microtrauma can all cause rotator cuff problems in elite athletes. From rotator cuff contusions and tendinopathies to rotator cuff tears, injuries can manifest in a range of severity. In the near term, rotator cuff injury post-injury discomfort and inflammation can be managed with the prudent use of oral non-steroidal anti-inflammatory medicines (NSAIDS).
Résumé
- The shoulder is the most mobile but inherently unstable joint in the human body, relying heavily on ligaments and muscular control for stability. Scapular positioning is crucial for proper shoulder function. Movement predominantly occurs in the plane of the scapula, which is 30-45 degrees from the frontal plane. Common acute shoulder injuries include dislocations and rotator cuff ruptures, while chronic injuries often stem from repetitive microtrauma leading to tendinopathies and impingement syndromes. Factors like excessive range of motion, laxity, and inadequate rehabilitation contribute to shoulder instability.
- Clinical history is vital for diagnosis, with age often correlating with specific injury types. Instability is more common in younger individuals, while rotator cuff issues are prevalent in older populations. Pain location can indicate the source of the problem, with AC joint pain being localized and cervical pain radiating to the neck. Physical examination includes inspection, palpation, range of motion assessment, strength testing, and special tests. The integrity of neurovascular structures must also be evaluated.
- Force couples, such as the interaction between the serratus anterior and trapezius muscles, are essential for scapular rotation and stability. Scapulohumeral rhythm, the coordinated movement of the scapula and humerus, is critical for normal shoulder function. Disrupted rhythm can contribute to instability. Instability can be traumatic or atraumatic, with traumatic cases often requiring surgical intervention and atraumatic cases typically managed with rehabilitation.
- Non-operative management of anterior shoulder instability involves a phased approach. Phase one focuses on pain control, immobilization, and basic range of motion exercises. Subsequent phases progressively introduce shoulder motion, rotator cuff and scapular stabilizer strengthening, and closed/open kinetic chain exercises. Important rehabilitation goals include maintaining rotator cuff repair integrity, restoring dynamic humeral head control, and improving muscular balance.
- Return to sports criteria include full pain-free range of motion, normal shoulder strength, pain-free sport-specific activities, and the ability to protect the shoulder. Early active range of motion may be contraindicated in some patients following rotator cuff repairs dependent on size of tear, and a conservative approach is recommended to avoid re-injury. Various exercises focusing on strengthening scapular stabilizers, rotator cuff muscles and improving proprioception form an important component of injury prevention and rehabilitation.
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