Skip to main content
SpringerLink
Log in

Débridement of Small Partial-thickness Rotator Cuff Tears in Elite Overhead Throwers

  • Symposium: New Approaches to Shoulder Surgery
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Elite overhead throwing athletes with rotator cuff tears represent a unique group of patients with an ultimate goal of returning to their previous level of competition. We hypothesized débridement of small partial-thickness rotator cuff tears would return the majority of elite overhead throwing athletes to their previous level of competition. Preoperative and intraoperative findings on 82 professional pitchers who had undergone débridement of partial-thickness rotator cuff tears were evaluated using our database. We obtained return to play data on 67 of the 82 players (82%); 51 (76%) were able to return to competitive pitching at the professional level and 37 (55%) were able to return to the same or higher level of competition. Of the 67 patients, 34 pitchers returned a questionnaire with a minimum followup of 18 months (mean 38 months; range 18 to 59 months). SF-12 scores were above average with a mean PSF-12 and MSF-12 of 55.04 and 56.49 respectively. An Athletic Shoulder Outcome Rating Scale score of greater than 60 was found in 76.5% of pitchers. Débridement of small partial-thickness rotator cuff tears allowed a majority of elite overhead throwing athletes to return to competitive pitching, however, returning to their previous level of competition remains a challenge for many of these players.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Altchek DW, Carson EW. Arthroscopic acromioplasty: current status. Orthop Clin North Am. 1997;28:157–168.

    Article  PubMed  CAS  Google Scholar 

  2. 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;1:117–122.

    Article  PubMed  CAS  Google Scholar 

  3. Andrews JR, Carson WG. The arthroscopic treatment of glenoid labrum tears in the throwing athlete. Orthop Trans. 1984;8:44.

    Google Scholar 

  4. Budoff JE, Nirschl RP, Guidi EJ. Debridement of partial-thickness tears of the rotator cuff without acromioplasty: long-term follow-up and review of the literature. J Bone Joint Surg Am. 1998;80:733–748.

    PubMed  CAS  Google Scholar 

  5. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology, part 1: pathoanatomy and biomechanics. Arthroscopy. 2003;19:404–420.

    Article  PubMed  Google Scholar 

  6. Conway JE. Arthroscopic repair of partial-thickness rotator cuff tears and SLAP lesions in professional baseball players. Orthop Clin North Am. 2001;32:443–456.

    Article  PubMed  CAS  Google Scholar 

  7. Cordasco FA, Backer M, Craig EV, Klein D, Warren RF. The partial-thickness rotator cuff tear: is acromioplasty without repair sufficient? Am J Sports Med. 2002;30:257–260.

    PubMed  Google Scholar 

  8. Davidson RA, ElAttrache NW, Jobe CM, Jobe FW. Rotator cuff and posterior-superior glenoid labrum injury associated with increased glenohumeral motion: a new site of impingement. J Shoulder Elbow Surg. 1995;4:384–390.

    Article  PubMed  CAS  Google Scholar 

  9. Dugas JR, Campbell DA, Warren RF, Robie BH, Millett PJ. Anatomy and dimensions of rotator cuff insertions. J Shoulder Elbow Surg. 2002;11:498–503.

    Article  PubMed  Google Scholar 

  10. Esch JC, Ozerkis LR, Helgager JA, Kane N, Lilliott N. Arthroscopic subacromial decompression: results according to the degree of rotator cuff tear. Arthroscopy. 1988;4:241–249.

    PubMed  CAS  Google Scholar 

  11. Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995;23:233–239.

    Article  PubMed  CAS  Google Scholar 

  12. Gartsman GM. Arthroscopic acromioplasty for lesions of the rotator cuff. J Bone Joint Surg Am. 1990;72:169–180.

    PubMed  CAS  Google Scholar 

  13. Gartsman GM. Arthroscopic treatment of rotator cuff disease. J Shoulder Elbow Surg. 1995;4:228–241.

    Article  PubMed  CAS  Google Scholar 

  14. Gartsman GM, Milne JC. Articular surface partial-thickness rotator cuff tears. J Shoulder Elbow Surg. 1995;4:409–415.

    Article  PubMed  CAS  Google Scholar 

  15. Gross ML, Brenner SL, Esformes I, Sonzogni JJ. Anterior shoulder instability in weight lifters. Am J Sports Med. 1993;21:599–603.

    Article  PubMed  CAS  Google Scholar 

  16. Jobe CM. Posterior superior glenoid impingement: expanded spectrum. Arthroscopy. 1995;11:530–537

    Article  PubMed  CAS  Google Scholar 

  17. Jobe CM. Superior glenoid impingement: current concepts. Clin Orthop Relat Res. 1996;330:98–107.

    Article  PubMed  Google Scholar 

  18. Jobe FW, Kvitne RS. Shoulder pain in the overhead or throwing athlete: the relationship of anterior instability and rotator cuff impingement. Orthop Rev. 1989;18:963–975.

    PubMed  CAS  Google Scholar 

  19. Jobe FW, Pink M. Classification and treatment of shoulder dysfunction in the overhead athlete. J Orthop Sports Phys Ther. 1993;18:427–432.

    PubMed  CAS  Google Scholar 

  20. Lyons TR, Savoie FH, Field LD. Arthroscopic repair of partial-thickness tear of the rotator cuff. Arthroscopy. 2001;17:219–223.

    Article  PubMed  CAS  Google Scholar 

  21. Major League Baseball Web site. Available at: http://www.mlb.com. Accessed May 3, 2007.

  22. McConville OR, Iannotti JP. Partial-thickness tears of the rotator cuff: evaluation and management. J Am Acad Orthop Surg. 1999;7:32–43.

    PubMed  CAS  Google Scholar 

  23. Meister K. Injuries to the shoulder in the throwing athlete. Part two: evaluation/treatment. Am J Sports Med. 2000;28:587–601.

    PubMed  CAS  Google Scholar 

  24. Meister K, Andrews JR. Classification and treatment of rotator cuff injuries in the overhead athlete. J Orthop Sports Phys Ther. 1993;18:413–421.

    PubMed  CAS  Google Scholar 

  25. Millstein ES, Snyder SJ. Arthroscopic management of partial, full-thickness, and complex rotator cuff tears: indications, techniques, and complications. Arthroscopy. 2003;19:189–199.

    PubMed  Google Scholar 

  26. Minor League Baseball Web site. Available at: http://www.minorleaguebaseball.com. Accessed May 3, 2007.

  27. Nirschl RP. Shoulder tendonitis. In: Pettrone, ed. American Academy of Orthopaedic Surgeons, Symposium on Upper Extremity Injuries in Athletes. St Louis, MO: CV Mosby; 1986:322–337.

  28. Ogilvie-Harris DJ, Wiley AM. Arthroscopic surgery of the shoulder: a general appraisal. J Bone Joint Surg Br. 1986;68:201–207.

    PubMed  CAS  Google Scholar 

  29. Paley KJ, Jobe FW, Pink MM, Kvitne RS, ElAttrache NS. Arthroscopic findings in the overhead throwing athlete: evidence for posterior internal impingement of the rotator cuff. Arthroscopy. 2000;16:35–40.

    Article  PubMed  CAS  Google Scholar 

  30. Payne LZ, Altchek DW, Craig EV, Warren RF. Arthroscopic treatment of partial rotator cuff tears in young athletes. Am J Sports Med. 1997;25:299–305.

    Article  PubMed  CAS  Google Scholar 

  31. Riand N, Levigne C, Renaud E, Walch G. Results of derotational humeral osteotomy in posterosuperior glenoid impingement. Am J Sports Med. 1998;26:453–459.

    PubMed  CAS  Google Scholar 

  32. Rogers R, Onge J, Witnauer W. Baseball career length in the twentieth-century: the effects of age, performance, and era. University of Colorado and State University of New York at Buffalo. Available at: http://paa2006.princeton.edu/download.aspx?submissionId=61286. Accessed May 4, 2007.

  33. Ryu RKN. Arthroscopic subacromial decompression: a clinical review. Arthroscopy. 1992;8:141–147.

    PubMed  CAS  Google Scholar 

  34. Schall T, Smith G. Career Trajectories in Baseball. Pomona College Economics Department. Available at: http://www.economics.pomona.edu/GarySmith/BBcareers/careers.html. Accessed May 4, 2007.

  35. Singh A, Gnanalingham K, Casey A, Crockard A. Quality of life assessment using the Shot Form–12 (SF-12) questionnaire in patients with cervical spondylotic myelopathy: comparison with SF-36. Spine. 2006;31:639–643.

    Article  PubMed  Google Scholar 

  36. Snyder SJ, Pachelli AF, Del Pizzo W, Friedman MJ, Ferkel RD. Partial thickness rotator cuff tears: results of arthroscopic treatment. Arthroscopy. 1991;7:1–7.

    Article  PubMed  CAS  Google Scholar 

  37. The Baseball Cube Web site. Available at: http://www.thebaseballcube.com. Accessed May 3, 2007.

  38. Tibone JE, Bradley JP. Evaluation of treatment outcomes for the athlete’s shoulder. In: Matsen FA, Fu FH, Hawkins RJ, eds. The Shoulder: A Balance of Mobility and Stability. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1993:519–529.

    Google Scholar 

  39. Tibone JE, Jobe FW, Kerlan RK, Carter VS, Shields CL, Lombardo SJ, Yocum LA. Shoulder impingement syndrome in athletes treated by an anterior acromioplasty. Clin Orthop Relat Res. 1985;198:134–140.

    PubMed  Google Scholar 

  40. 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 Elbow Surg. 1992;1:238–245.

    Article  Google Scholar 

  41. Ware JE, Kosinski M, Keller SD. SF-12: How to Score the SF-12 Physical and Mental Health Summary Scales. 2nd ed. Boston: Health Institute, New England Medical Center; 1995.

    Google Scholar 

  42. Ware JE, Kosinki M, Keller SD. A 12-item short form health survey: construction of scales and preliminary test of reliability and validity. Med Care. 1996;34:220–233.

    Article  PubMed  Google Scholar 

  43. Weber SC. Arthroscopic debridement and acromioplasty versus mini-open repair in the management of significant partial-thickness tears of the rotator cuff. Orthop Clin North Am. 1997;28:79–82.

    Article  PubMed  CAS  Google Scholar 

  44. Weber SC. Arthroscopic debridement and acromioplasty versus mini-open repair in the treatment of significant partial-thickness rotator cuff tears. Arthroscopy. 1999;15:126–131.

    Article  PubMed  CAS  Google Scholar 

  45. Wilk KE, Harrelson GL, Arrigo C, Chmielewski T. Shoulder rehabilitation. In: Andrews JR, Harrelson GL, Wilk KE, eds. Physical Rehabilitation of the Injured Athlete. Philadelphia: WB Saunders Co; 1998:478–553.

    Google Scholar 

  46. Wolff AS, Magit DP, Miller SR, Wyman J, Sethi PM. Arthroscopic fixation of bursal-sided rotator cuff tears. Arthroscopy. 2006;22:1247e1–e4.

    Article  Google Scholar 

  47. Wright SA, Cofield RH. Management of partial-thickness rotator cuff tear. J Shoulder Elbow Surg. 1996;5:458–466.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Kevin Wilk, Andrea Dickie, and Gisela Westerkamp for their involvement and assistance with this project.

Author information

Authors and Affiliations

  1. American Sports Medicine Institute, Birmingham, AL, USA

    Scott B. Reynolds MD, Jeffrey R. Dugas MD, E. Lyle Cain MD, Christopher S. McMichael MPH & James R. Andrews MD

  2. Nebraska Orthopaedic Associates, 2725 S. 144th St. #110, Omaha, NE, 68144, USA

    Scott B. Reynolds MD

Authors
  1. Scott B. Reynolds MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey R. Dugas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Lyle Cain MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher S. McMichael MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James R. Andrews MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Scott B. Reynolds MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.

About this article

Cite this article

Reynolds, S.B., Dugas, J.R., Cain, E.L. et al. Débridement of Small Partial-thickness Rotator Cuff Tears in Elite Overhead Throwers. Clin Orthop Relat Res 466, 614–621 (2008). https://doi.org/10.1007/s11999-007-0107-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-007-0107-1

Keywords

Search

Navigation