ROTATOR CUFF PATHOLOGY IN ATHLETES

The rotator cuff is the primary dynamic stabiliser of the glenohumeral joint and is placed under significant stress during overhead and cont act sports. Mechanisms of injury include repetitive microtrauma, usual ly seen in the athlete involved in overhand sports, and macrotrauma as sociated with contact sports. Rotator cuff injury and dysfunction in t he overhand athlete may be classified based on aetiology as primary im pingement, primary tensile overload, and secondary impingement and ten sile overload resulting from glenohumeral instability. A thorough hist ory and physical examination are paramount in the evaluation, classifi cation and treatment planning of the athlete with rotator cuff patholo gy. Imaging studies are a helpful adjunct to the history and physical. Athletes with primary impingement are usually middle aged or older an d often have chronic shoulder pain and sometimes weakness associated w ith overhand sporting activities. Night pain is typical of full thickn ess rotator cuff tears. Impingement signs are positive and strength of elevation and external rotation are often limited. They usually respo nd to a nonoperative rehabilitation programme centred on decreasing in flammation. restoring range of motion and strengthening the rotator cu ff and scapular stabilisers. Depending on the degree of cuff pathology , acromioplasty, debridement of partial cuff tears, and repair of full thickness tears are usually successful in those who fail a rehabilita tion programme. Overhand athletes with cuff pathology secondary to sub tle anterior instability are usually young and complain of pain and de creased throwing velocity. Instability may be so subtle that it is onl y detectable through a positive relocation test on examination. The ma jority of these athletes do not have a Bankart lesion on magnetic reso nanace imaging or arthroscopic examination. Arthroscopic examination u sually demonstrates anterior capsular laxity (positive 'drive-through' sign), as well as superior-posterior labral and cuff injury typical o f internal impingement. If rehabilitation alone is not successful, a c apsulolabral repair followed by rehabilitation may allow the athlete t o return to their previous level of competition. The athlete with an a cute episode of macrotrauma to the shoulder resulting in cuff patholog y usually presents with pain, limited active elevation and a positive 'shrug sign'. Arthroscopy and debridement of thickened, inflamed or sc arred subacromial bursa with cuff repair or debridement as indicated i s usually successful in those who do not respond to a rehabilitation p rogramme.