Advertisement

Diagnosis and Management of Partial- and Full-Thickness Rotator Cuff Tears in Tennis Players

  • Christopher L. CampEmail author
  • David M. Dare
  • David W. Altchek
Chapter

Abstract

Tennis continues to be one of the most popular sports in the world, and as interest grows, our understanding of the physiologic demands of the sport also increases. During the course of a standard tennis match, players are required to repetitively exert themselves in short, but explosive, bursts of energy several hundred times [1]. This is especially true during the serve, but all types of strokes place very unique demands on the upper extremity [2–4]. To better understand the physiologic processes occurring during the serve, it has been broken down into five distinct phases: (1) windup, (2) early cocking, (3) late cocking, (4) acceleration, and (5) follow-through [4, 5]. In order to successfully execute these phases, energy must be transferred efficiently and effectively along the entire kinetic chain of motion. Although the greatest stress to the shoulder occurs during the cocking and acceleration phases, disruption of the kinetic chain at any point in the process can place the shoulder at risk for injury [6].

References

  1. 1.
    Kovacs MS. Applied physiology of tennis performance. Br J Sports Med. 2006;40:381–5; discussion 386.  https://doi.org/10.1136/bjsm.2005.023309.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Eygendaal D, Rahussen FTG, Diercks RL. Biomechanics of the elbow joint in tennis players and relation to pathology. Br J Sports Med. 2007;41:820–3.  https://doi.org/10.1136/bjsm.2007.038307.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kibler WB. Biomechanical analysis of the shoulder during tennis activities. Clin Sports Med. 1995;14:79–85.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Elliott B, Fleisig G, Nicholls R, Escamilia R. Technique effects on upper limb loading in the tennis serve. J Sci Med Sport. 2003;6:76–87.CrossRefGoogle Scholar
  5. 5.
    van der Hoeven H, Kibler WB. Shoulder injuries in tennis players. Br J Sports Med. 2006;40:435–40.  https://doi.org/10.1136/bjsm.2005.023218.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Dines JS, Bedi A, Williams PN, et al. Tennis injuries: epidemiology, pathophysiology, and treatment. J Am Acad Orthop Surg. 2015;23:181–9.  https://doi.org/10.5435/jaaos-d-13-00148.CrossRefPubMedGoogle Scholar
  7. 7.
    Pluim BM, Staal JB, Windler GE, Jayanthi N. Tennis injuries: occurrence, aetiology, and prevention. Br J Sports Med. 2006;40:415–23.  https://doi.org/10.1136/bjsm.2005.023184.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hutchinson MR, Laprade RF, Burnett QM, et al. Injury surveillance at the USTA Boys’ Tennis Championships: a 6-yr study. Med Sci Sports Exerc. 1995;27:826–30.PubMedGoogle Scholar
  9. 9.
    Winge S, Jørgensen U, Lassen Nielsen A. Epidemiology of injuries in Danish championship tennis. Int J Sports Med. 1989;10:368–71.  https://doi.org/10.1055/s-2007-1024930.CrossRefPubMedGoogle Scholar
  10. 10.
    Lehman RC. Shoulder pain in the competitive tennis player. Clin Sports Med. 1988;7:309–27.PubMedGoogle Scholar
  11. 11.
    Perkins RH, Davis D. Musculoskeletal injuries in tennis. Phys Med Rehabil Clin N Am. 2006;17:609–31.  https://doi.org/10.1016/j.pmr.2006.05.005.CrossRefPubMedGoogle Scholar
  12. 12.
    Abrams GD, Renstrom PA, Safran MR. Epidemiology of musculoskeletal injury in the tennis player. Br J Sports Med. 2012;46:492–8.  https://doi.org/10.1136/bjsports-2012-091164.CrossRefPubMedGoogle Scholar
  13. 13.
    Economopoulos KJ, Brockmeier SF. Rotator cuff tears in overhead athletes. Clin Sports Med. 2012;31:675–92.  https://doi.org/10.1016/j.csm.2012.07.005.CrossRefPubMedGoogle Scholar
  14. 14.
    Reynolds SB, Dugas JR, Cain EL, et al. Débridement of small partial-thickness rotator cuff tears in elite overhead throwers. Clin Orthop Relat Res. 2008;466:614–21.  https://doi.org/10.1007/s11999-007-0107-1.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Andrews JR, Broussard TS, Carson WG. Arthroscopy of the shoulder in the management of partial tears of the rotator cuff: a preliminary report. Arthroscopy. 1985;1:117–22.CrossRefGoogle Scholar
  16. 16.
    Walch G, Boileau P, Noel E, Donell ST. Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study. J Shoulder Elb Surg. 1992;1:238–45.  https://doi.org/10.1016/S1058-2746(09)80065-7.CrossRefGoogle Scholar
  17. 17.
    Neri BR, ElAttrache NS, Owsley KC, et al. Outcome of type II superior labral anterior posterior repairs in elite overhead athletes: effect of concomitant partial-thickness rotator cuff tears. Am J Sports Med. 2011;39:114–20.  https://doi.org/10.1177/0363546510379971.CrossRefPubMedGoogle Scholar
  18. 18.
    Conway JE. Arthroscopic repair of partial-thickness rotator cuff tears and SLAP lesions in professional baseball players. Orthop Clin North Am. 2001;32:443–56.CrossRefGoogle Scholar
  19. 19.
    Reilly P, Amis AA, Wallace AL, Emery RJH. Supraspinatus tears: propagation and strain alteration. J Shoulder Elb Surg. 2003;12:134–8.  https://doi.org/10.1067/mse.2003.7.CrossRefGoogle Scholar
  20. 20.
    Reilly P, Amis AA, Wallace AL, Emery RJH. Mechanical factors in the initiation and propagation of tears of the rotator cuff. Quantification of strains of the supraspinatus tendon in vitro. J Bone Joint Surg Br. 2003;85:594–9.CrossRefGoogle Scholar
  21. 21.
    Bey MJ, Song HK, Wehrli FW, Soslowsky LJ. Intratendinous strain fields of the intact supraspinatus tendon: the effect of glenohumeral joint position and tendon region. J Orthop Res. 2002;20:869–74.  https://doi.org/10.1016/S0736-0266(01)00177-2.CrossRefPubMedGoogle Scholar
  22. 22.
    Clark JM, Harryman DT. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg Am. 1992;74:713–25.CrossRefGoogle Scholar
  23. 23.
    Nakajima T, Rokuuma N, Hamada K, et al. Histologic and biomechanical characteristics of the supraspinatus tendon: reference to rotator cuff tearing. J Shoulder Elb Surg. 1994;3:79–87.  https://doi.org/10.1016/S1058-2746(09)80114-6.CrossRefGoogle Scholar
  24. 24.
    Bey MJ, Ramsey ML, Soslowsky LJ. Intratendinous strain fields of the supraspinatus tendon: effect of a surgically created articular-surface rotator cuff tear. J Shoulder Elb Surg. 2002;11:562–9.  https://doi.org/10.1067/mse.2002.126767.CrossRefGoogle Scholar
  25. 25.
    Nho SJ, Yadav H, Shindle MK, Macgillivray JD. Rotator cuff degeneration: etiology and pathogenesis. Am J Sports Med. 2008;36:987–93.  https://doi.org/10.1177/0363546508317344.CrossRefPubMedGoogle Scholar
  26. 26.
    Hegedus EJ, Goode AP, Cook CE, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46:964–78.  https://doi.org/10.1136/bjsports-2012-091066.CrossRefPubMedGoogle Scholar
  27. 27.
    Drakos MC, Rudzki JR, Allen AA, et al. Internal impingement of the shoulder in the overhead athlete. J Bone Joint Surg Am. 2009;91:2719–28.  https://doi.org/10.2106/JBJS.I.00409.CrossRefPubMedGoogle Scholar
  28. 28.
    Pearsall AW, Bonsell S, Heitman RJ, et al. Radiographic findings associated with symptomatic rotator cuff tears. J Shoulder Elb Surg. 2003;12:122–7.  https://doi.org/10.1067/mse.2003.19.CrossRefGoogle Scholar
  29. 29.
    Umans HR, Pavlov H, Berkowitz M, Warren RF. Correlation of radiographic and arthroscopic findings with rotator cuff tears and degenerative joint disease. J Shoulder Elb Surg. 2001;10:428–33.  https://doi.org/10.1067/mse.2001.117123.CrossRefGoogle Scholar
  30. 30.
    Tirman PF, Smith ED, Stoller DW, Fritz RC. Shoulder imaging in athletes. Semin Musculoskelet Radiol. 2004;8:29–40.  https://doi.org/10.1055/s-2004-823013.CrossRefPubMedGoogle Scholar
  31. 31.
    Parker BJ, Zlatkin MB, Newman JS, Rathur SK. Imaging of shoulder injuries in sports medicine: current protocols and concepts. Clin Sports Med. 2008;27:579–606.  https://doi.org/10.1016/j.csm.2008.07.006.CrossRefPubMedGoogle Scholar
  32. 32.
    Lee SY, Lee JK. Horizontal component of partial-thickness tears of rotator cuff: imaging characteristics and comparison of ABER view with oblique coronal view at MR arthrography initial results. Radiology. 2002;224:470–6.  https://doi.org/10.1148/radiol.2241011261.CrossRefPubMedGoogle Scholar
  33. 33.
    Meister K, Thesing J, Montgomery WJ, et al. MR arthrography of partial thickness tears of the undersurface of the rotator cuff: an arthroscopic correlation. Skelet Radiol. 2004;33:136–41.  https://doi.org/10.1007/s00256-003-0688-z.CrossRefGoogle Scholar
  34. 34.
    Tirman PF, Bost FW, Steinbach LS, et al. MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm. Radiology. 1994;192:851–6.  https://doi.org/10.1148/radiology.192.3.8058959.CrossRefPubMedGoogle Scholar
  35. 35.
    van der Zwaal P, Thomassen BJW, Urlings TAJ, et al. Preoperative agreement on the geometric classification and 2-dimensional measurement of rotator cuff tears based on magnetic resonance arthrography. Arthroscopy. 2012;28:1329–36.  https://doi.org/10.1016/j.arthro.2012.04.054.CrossRefPubMedGoogle Scholar
  36. 36.
    Teefey SA, Rubin DA, Middleton WD, et al. Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am. 2004;86-A:708–16.CrossRefGoogle Scholar
  37. 37.
    Teefey SA, Hasan SA, Middleton WD, et al. Ultrasonography of the rotator cuff. A comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases. J Bone Joint Surg Am. 2000;82:498–504.CrossRefGoogle Scholar
  38. 38.
    Iannotti JP, Ciccone J, Buss DD, et al. Accuracy of office-based ultrasonography of the shoulder for the diagnosis of rotator cuff tears. J Bone Joint Surg Am. 2005;87:1305–11.  https://doi.org/10.2106/JBJS.D.02100.CrossRefPubMedGoogle Scholar
  39. 39.
    Lenza M, Buchbinder R, Takwoingi Y, et al (2013) Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane database Syst Rev CD009020. doi:  https://doi.org/10.1002/14651858.CD009020.pub2.
  40. 40.
    Wilk KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med. 2002;30:136–51.CrossRefGoogle Scholar
  41. 41.
    Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19:641–61.CrossRefGoogle Scholar
  42. 42.
    Kibler WB, McMullen J, Uhl T. Shoulder rehabilitation strategies, guidelines, and practice. Orthop Clin North Am. 2001;32:527–38.CrossRefGoogle Scholar
  43. 43.
    Brockmeier SF, Dodson CC, Gamradt SC, et al. Arthroscopic intratendinous repair of the delaminated partial-thickness rotator cuff tear in overhead athletes. Arthroscopy. 2008;24:961–5.  https://doi.org/10.1016/j.arthro.2007.08.016.CrossRefPubMedGoogle Scholar
  44. 44.
    Greiwe RM, Ahmad CS. Management of the throwing shoulder: cuff, labrum and internal impingement. Orthop Clin North Am. 2010;41:309–23.  https://doi.org/10.1016/j.ocl.2010.03.001.CrossRefPubMedGoogle Scholar
  45. 45.
    Gonzalez-Lomas G, Kippe MA, Brown GD, et al. In situ transtendon repair outperforms tear completion and repair for partial articular-sided supraspinatus tendon tears. J shoulder Elb Surg. 2008;17:722–8.  https://doi.org/10.1016/j.jse.2008.01.148.CrossRefGoogle Scholar
  46. 46.
    Park MC, Tibone JE, ElAttrache NS, et al. Part II: Biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elb Surg. 2007;16:469–76.  https://doi.org/10.1016/j.jse.2006.09.011.CrossRefGoogle Scholar
  47. 47.
    Park MC, Elattrache NS, Ahmad CS, Tibone JE. “Transosseous-equivalent” rotator cuff repair technique. Arthroscopy. 2006;22:1360.e1–5.  https://doi.org/10.1016/j.arthro.2006.07.017.CrossRefGoogle Scholar
  48. 48.
    Millett PJ, Mazzocca A, Guanche CA. Mattress double anchor footprint repair: a novel, arthroscopic rotator cuff repair technique. Arthroscopy. 2004;20:875–9.  https://doi.org/10.1016/j.arthro.2004.07.015.CrossRefPubMedGoogle Scholar
  49. 49.
    Davidson J, Burkhart SS. The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis. Arthroscopy. 2010;26:417–24.  https://doi.org/10.1016/j.arthro.2009.07.009.CrossRefPubMedGoogle Scholar
  50. 50.
    Payne LZ, Altchek DW, Craig EV, Warren RF. Arthroscopic treatment of partial rotator cuff tears in young athletes. A preliminary report. Am J Sports Med. 1997;25:299–305.CrossRefGoogle Scholar
  51. 51.
    Snyder SJ, Pachelli AF, Del Pizzo W, et al. Partial thickness rotator cuff tears: results of arthroscopic treatment. Arthroscopy. 1991;7:1–7.CrossRefGoogle Scholar
  52. 52.
    Wright SA, Cofield RH. Management of partial-thickness rotator cuff tears. J Shoulder Elb Surg. 1996;5:458–66.CrossRefGoogle Scholar
  53. 53.
    Deutsch A. Arthroscopic repair of partial-thickness tears of the rotator cuff. J Shoulder Elb Surg. 2007;16:193–201.  https://doi.org/10.1016/j.jse.2006.07.001.CrossRefGoogle Scholar
  54. 54.
    Shin S-J. A comparison of 2 repair techniques for partial-thickness articular-sided rotator cuff tears. Arthroscopy. 2012;28:25–33.  https://doi.org/10.1016/j.arthro.2011.07.005.CrossRefPubMedGoogle Scholar
  55. 55.
    Ide J, Maeda S, Takagi K. Arthroscopic transtendon repair of partial-thickness articular-side tears of the rotator cuff: anatomical and clinical study. Am J Sports Med. 2005;33:1672–9.  https://doi.org/10.1177/0363546505277141.CrossRefPubMedGoogle Scholar
  56. 56.
    Mazoué CG, Andrews JR. Repair of full-thickness rotator cuff tears in professional baseball players. Am J Sports Med. 2006;34:182–9.  https://doi.org/10.1177/0363546505279916.CrossRefPubMedGoogle Scholar
  57. 57.
    Tibone JE, Elrod B, Jobe FW, et al. Surgical treatment of tears of the rotator cuff in athletes. J Bone Joint Surg Am. 1986;68:887–91.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Christopher L. Camp
    • 1
    Email author
  • David M. Dare
    • 2
  • David W. Altchek
    • 2
  1. 1.Sports Medicine CenterMayo ClinicRochesterUSA
  2. 2.Sports and Shoulder ServiceHospital for Special SurgeryNew YorkUSA

Personalised recommendations