Torn Rotator Cuff in NFL Players

imageedit_4_4053006943By Mary Larkin

PT and Senior Sports Injury Analysis

 

 

What is a Rotator Cuff?

The rotator cuff is a group of four muscles that attach to different boney locations about the shoulder, enabling the shoulder to move in multi-directional planes of motion. It also helps with the stability of the shoulder joint. The muscles are attached to bone by tendons, and it is usually these tendons that are inflamed or torn in an injury. Most of the time, it is overhead athletes that have injuries to these tendons, due to repetitive use. In the NFL, repetitive trauma and high stress forces also contribute to these injuries

 

Function of the Rotator Cuff

The rotator cuff is a group of four muscles that attach to different boney locations about the shoulder, enabling the shoulder to move in multi-directional planes of motion. Each muscle has a specific motion it performs:

  • Supraspinatus: attaches to the top of the humeral bone and moves the arm into abduction (out to the side) The most commonly irritated or injured of the four tendons (90%)
  • Infraspinatus: attaches to the back of the humeral head and moves the shoulder into external rotation (rotating out and away from the body) Second most commonly injured tendon
  • Teres Minor: attaches to the back of the upper part of the humerus and moves the shoulder into external rotation (rotating out and away from the body) and assists with shoulder extension (moving straight back).
  • Subscapularis: attaches to the front of the humeral bone and performs internal rotation (rotating inward towards the body)

 

Injuries to the Rotator Cuff

Rotator Cuff Tendonitis: Irritation of the tendon, causing pain, weakness, and sometimes loss of motion.  Cause: repetitive overhead use (ie- throwing), repetitive trauma or strain (stress of lineman blocking); Conservative Treatment: anti-inflammatories, therapy, limited activity until pain subsides, possible steroid injections.

Rotator Cuff Tendonitis Return to Play: Varies most positional players will play through this pain and will not be sidelined. This can be a nagging injury all year. For QB’s, pain may sideline for 1-2 weeks.

rotator cuff injuries nfl football playerRotator Cuff Impingement: Pinching of the Supraspinatus tendon by the acromion (bone that sits on top of the shoulder and sandwiches the tendon between the humeral(shoulder) bone.)  Cause: Thickening of the bone over time and poor shoulder mechanics; Treatment: usually  conservative with anti-inflammatory meds, therapy, and possible steroid injections if needed.

Rotator Cuff Impingement Return to Play: Varies – most positional players will play through this pain and will not be sidelined. This can be a nagging injury all year. For QB’s, pain may sideline for 1-2 weeks, but if symptoms remain and a QB is unable to perform, he will undergo surgery to shave down the bone. Return to play after surgery: 2-4 weeks for position players, 4-6 weeks for QB.

 

Bursitis: Inflammation of the bursa (fluid filled sac that decreases tendon friction.). Overuse/overstress             injury. Conservative Treatment: anti-inflammatories, therapy, limited activity until pain subsides, possible steroid injections.

Return to Play: Varies – most positional players will play through this pain and will not be sidelined. This can be a nagging injury all year. For QB’s, May sideline for 1-2 weeks. Bursectomy(removal of bursa) will be performed if symptoms disable a player. Return to play = 1-3 weeks. QB = 3-6 weeks.

 

Rotator Cuff Tear: Partial or complete tear of one or more of the four cuff tendons. The most commonly injured or torn tendon is the supraspinatus (90% of the time). The injured tendon will limit the  specific activity it is meant to perform.

Treatment Non-Surgical: Positional players will usually return to play much quicker than a wide receiver.

Return to play in any position depends on strength and active motion. A lineman may return 1-2 weeks after sustaining a cuff tear, where as a QB may take about 4-6 weeks to heal and resume the ability to throw. Healing time also depends on how big the tear is, and how many tendons were torn.

Treatment Surgical Repair: Depending on the size of the tear, the surgeon and player may opt to have the torn tendon sewn back to its original place on the bone. This usually occurs when conservative treatment fails. A player could have a small or partial tear (10-50% of the tendon) that remains nagging or limiting, or a large or massive tear (<75%) that creates a loss of tension relationship with the muscle, which causes loss power or use of the arm.

Surgical Repair Return to Play: For a small tear, a lineman may be able to return in 4-6 weeks. For a large tear, or an overhead position player like a wide receiver or a QB, the chances of them returning within the current season is unlikely. Medium to large tears usually take about 4-6 months for a lineman, and anywhere from 6-12 months for a QB or receiver. Multiple tendon repairs may take longer to rehab and may sideline a player for a longer period.

 

Recovery time for NFL player who has Torn Rotator Cuff?

Although there are general time-frames for return to play after a repair, NFL players tend to return sooner than the average athlete. QB’s generally take to longest to return due to their position requirement.

NFL Rotator Cuff Study Results:

About 90 percent of NFL players who suffer shoulder dislocation are eventually made whole again, playing at least one regular-season game following shoulder stabilization surgery, researchers said at the American Orthopaedic Society for Sports Medicine’s annual meeting in 2014.

“Our study highlighted the success rate of return to play following shoulder stabilization surgery,” lead researcher Matthew J. White said in a press statement. “Age, number of games before surgery, and career length were not statistically different between those that returned and those that did not.”

Sixty NFL players participated in the study after undergoing shoulder stabilization at the American Sports Medicine Institute in Birmingham, Ala. After performing “chart review” and analyzing follow-up data from an NFL statistics database, White and his colleagues determined the 90 percent rate of return as well as factors influencing the recovery.

Among the 90 percent who returned to the playing field, recovery time averaged 8.6 months. Forty-five of the players underwent the arthroscopic procedure while 11 opted for open surgery, with recovery rates of 92 percent and 82 percent, respectively.

 

References:

  • Gartsman GM, Khan M, Hammerman SM. Arthroscopic repair of full-thickness tears of the rotator cuff. J Bone Joint Surg Am 1998;80:832-840.
  • Gerber C, Schneeberger AG, Beck M, Schlegel U. Mechanical strength of repairs of the rotator cuff. J Bone Joint Surg Br 1994;76:371-380.
  • Altchek DW, Warren RF, Wickiewicz TL, Skyhar MJ, Ortiz G, Schwartz E. Arthroscopic acromioplasty: Technique and Results. J Bone Joint Surg Am 1990;72:1198-1207.
  • Neer CS II. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: A preliminary report. J Bone Joint Surg Am 1972;54:41-50.
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