Management of In-Season Concurrent Rotator Cuff Tear With Shoulder Instability in Professional Contact Football Athletes; Respect the Career Goals!

Objective: The aim of this study was to investigate whether there are glenohumeral morphological differences between normal population, glenohumeral instability, and rotator cuff pathology. Method: In this study, shoulder magnetic resonance (MR) images of 150 patients were evaluated. Patients included in the study were studied in three groups of 50 individuals: patients with anterior shoulder instability in group 1, patients with rotator cuff tear in group 2, and control subjects without shoulder pathology in group 3. Results: There were statistically significant differences between groups in evaluations for glenoid version, glenoid coronal height, glenoid coronal diameter, humeral axial and coronal diameters, and coracohumeral interval distances. Significant differences were observed between groups 2 and 3 in glenoid axial diameter, glenoid coronal height, glenoid depth, humeral coronal diameter, and coracohumeral distances. Conclusion: The results obtained in this study suggest that glenoid version, glenoid coronal height and diameter, humeral diameter, and coracohumeral interval parameters in glenohumeral morphology-related parameters in patients with anterior instability are different from those of normal population and patients with rotator cuff pathology. In cases where there is a clinically difficult diagnosis, these radiological measurements will be helpful to clinicians in diagnosis and treatment planning, especially in cases of treatment-resistant cases.

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Shoulder Instability in Patients Over 40 Years Old: Is Concomitant Rotator Cuff Tear Determinant for Shoulder Function and Quality of Life?

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2021.03.085 ◽

2021 ◽

Vol 30 (7) ◽

pp. e452

Author(s):

Fernando Garcia Seisdedos ◽

Ivan Rodrigo Diaz ◽

Antonio M. Foruria ◽

Diana Morcillo ◽

Maria Valencia ◽

...

Keyword(s):

Quality Of Life ◽

Rotator Cuff ◽

Rotator Cuff Tear ◽

Shoulder Instability ◽

Shoulder Function ◽

Cuff Tear ◽

Over 40 Years

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Treatment of a rotator cuff tear combined with iatrogenic glenoid fracture and shoulder instability: A rare case report

World Journal of Orthopedics ◽

10.5312/wjo.v11.i11.516 ◽

2020 ◽

Vol 11 (11) ◽

pp. 516-522

Author(s):

Chen-Hao Chiang ◽

Ting-Chien Tsai ◽

Kuan-Kai Tung ◽

Wei-Hsing Chih ◽

Ming-Long Yeh ◽

...

Keyword(s):

Case Report ◽

Rotator Cuff ◽

Rotator Cuff Tear ◽

Shoulder Instability ◽

Rare Case ◽

Glenoid Fracture ◽

Cuff Tear ◽

Rare Case Report

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Return to Play After Arthroscopic Management of Rotator Cuff Tears in Professional Contact Athletes (245)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00353 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0035

Author(s):

Gautam Yagnik ◽

Jacob Seiler ◽

Luis Vargas ◽

John Zvijac ◽

John Uribe

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Surgical Intervention ◽

Return To Play ◽

Rotator Cuff Tears ◽

Football Players ◽

Arthroscopic Management ◽

Cuff Tear ◽

Hockey Players ◽

Professional Contact

Objectives: Rotator cuff tears are rare injuries in professional contact athletes and there is limited data to help guide players and team physicians regarding outcomes after surgical management. The purpose of this study was to report on the clinical outcomes and return to play rates of professional contact athletes that underwent arthroscopic management of rotator cuff tears at our institution. Methods: A retrospective review was performed on 10 rotator cuff tears in 9 professional contact athletes that underwent arthroscopic management of a rotator cuff tear from 2002-2019 at our institution. 8 tears occurred in elite American football players, 7 from the NFL and 1 from the CFL. The remaining 2 rotator cuff tears were identified in professional hockey players from the NHL. The average age of the players was 28.7 ± 4.8 years. Patient information included age, sport, position played, date of injury, date of surgery and length of time from surgery to return to play. Surgical data included tear size, acuity and pattern as well as procedure performed (debridement vs repair). Both intra and post-operative complications were documented. The primary outcome measure was the ability to return to play and the number of games played after surgery was documented. As in other similar studies, return to play was defined as the ability to participate in at least 1 full regular-season game after surgery. Return to play and career length data were collected through publicly available internet sources (NFL, CFL and NHL statistical websites) as well as from the team’s medical staff. Results: 80% of the professional contact athletes that underwent arthroscopic management of a rotator cuff tear in this study were able to return to play at the same professional. The average age of the players that returned to play was 27.3 ± 4.2 years and the average time to return to play was 7.9 ± 1.9 months. 8 of the 10 tears occurred in professional football players and the majority of these injuries (6 of 8) occurred in defensive players. 2 of the 10 tears occurred in professional hockey players from the NHL and both were offensive players. All of these players regained sufficient range of motion, strength and function to pass a pre-participation physical performed by their team’s medical staff and all participated in at least one regular season game. For the football players, the average playing experience after surgery was 32 ± 25 games played. For the hockey players, the average playing experience after surgery was 22 ± 11games played. 9 of the 10 tears were full thickness tears that underwent arthroscopic single row repair while 1 was a partial tear that was debrided. The average tear size was 1.95 ±0.9 cm. The average number of suture anchors used was 1.35 ± 0.7. All tears involved the supraspinatus rotator cuff tendon and 4 were classified as small tears (<1cm), 3 as medium tears (1-3cm) and 2 as large tears (3-5cm). 7 of the 10 tears underwent acute surgical repair (<2 weeks from date of injury), while 3 players underwent delayed surgical intervention at the end of the season. The delay in surgical intervention did not appear to negatively impact healing rates or the ability to return to play. Other factors that did not appear to influence return to play included type of sport, position, type of procedure (debridement vs repair) or the number of suture anchors used in the repair. Post-operative imaging was available in 8 of the 10 tears and 7 of 8 (88%) demonstrated a healed repair. No intra-operative complications were noted. 2 veteran players with large (3-5cm) full thickness tears did not return to play. The average age of these players was 34.5 years and both had > 10 years of professional playing experience. One of these players was an NFL player that demonstrated a repair failure at 6 months on post-operative imaging and elected to retire rather than undergo revision surgery. The second was an NHL player that retired for reasons unrelated to his shoulder, despite a good clinical outcome and a healed repair on post-operative imaging. To our knowledge, none of the remaining players have undergone subsequent surgical intervention or revision surgery on their injured shoulder. Conclusions: This is one of only a few studies since 1996 to report on the clinical outcomes after operative management of rotator cuff tears in elite professional contact athletes. The majority (80%) of the professional contact athletes in this series were able to return to play at the same professional level after arthroscopic management of a symptomatic rotator cuff tear. Older players with > 10 years of professional experience and large rotator cuff tears were less likely to return to play after surgical intervention.

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Case Example 2: Combined Massive Rotator Cuff Tear and Recurrent Shoulder Instability

Massive and Irreparable Rotator Cuff Tears ◽

10.1007/978-3-662-61162-3_39 ◽

2020 ◽

pp. 361-366

Author(s):

Benjamin Marjanovič ◽

Marko Nabergoj ◽

Boris Poberaj

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Shoulder Instability ◽

Massive Rotator Cuff Tear ◽

Cuff Tear ◽

Recurrent Shoulder Instability

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Arthroscopic Treatment of Combined Shoulder Instability and Rotator Cuff Tear

Rotator Cuff Injuries ◽

10.1007/978-3-319-63668-9_7 ◽

2017 ◽

pp. 119-136 ◽

Cited By ~ 2

Author(s):

Aharon Z. Gladstein ◽

John D. A. Kelly

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Shoulder Instability ◽

Arthroscopic Treatment ◽

Cuff Tear

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Management of a Patient With an Isolated Greater Tuberosity Fracture and Rotator Cuff Tear

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2005.1723 ◽

2005 ◽

Author(s):

Linda E. Arslanian

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Greater Tuberosity ◽

Greater Tuberosity Fracture ◽

Cuff Tear

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Accuracy of Rotator Cuff Tears and Tendinosis Diagnoses on Shoulder Ultrasound Performed by a Short-experienced Operator

American Journal of Sonography ◽

10.25259/ajs-22-2018 ◽

2018 ◽

Vol 1 ◽

pp. 9

Author(s):

Harshad Arvind Vanjare ◽

Jyoti Panwar

Keyword(s):

Rotator Cuff ◽

Negative Predictive Value ◽

Rotator Cuff Tear ◽

Predictive Value ◽

Rotator Cuff Tears ◽

Mri Findings ◽

Cuff Tear ◽

Experienced Operator ◽

Magnetic Resonance Imaging Mri ◽

Sensitivity Specificity

Objective The objective of the study was to assess the accuracy of ultrasound examination for the diagnosis of rotator cuff tear and tendinosis performed by a short experienced operator, compared to magnetic resonance imaging (MRI) results. Method A total of 70 subjects suspected to have rotator cuff tear or tendinosis and planned for shoulder MRI were included in the study. Shoulder ultrasound was performed either before or after the MRI scan on the same day. Ultrasound operator had a short experience in performing an ultrasound of the shoulder. Ultrasound findings were correlated to MRI findings. Results Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of tendinosis were 58%, 84%, 63%, 80%, and 75%, respectively, and it was 68%, 91%, 73%, 88%, and 85%, respectively, for the diagnosis of rotator cuff tear. Conclusions Sensitivity for diagnosing rotator cuff tear or tendinosis was moderate but had a higher negative predictive value. Thus, the ultrasound operator with a short experience in performing shoulder ultrasound had moderate sensitivity in diagnosing tendinosis or tears; however, could exclude them with confidence.

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