Digital Image Grant Trouville  © nrlphotos.com :  : NRL Rugby League Round 21 - Cronulla Sharks V Parramatta Eels at Remondis Stadium Saturday 2nd of August 2014.

Dr George Pitsis from the Specialist Sports Medicine Centre located on the Kingsway at Miranda, deals with any injury and illness which may come the way of the Sharks playing group or staff.

A highly respected doctor and specialist adult and paediatric sport and exercise medicine physician, Dr Pitsis joined the medical staff at the Sharks during 2013. He is highly qualified with over 15 years experience as physician for many high calibre sporting associations and teams.

As a regular feature on the Sharks website, Sports Medicine – with Dr George Pitsis, explains some common and also not-so-common sporting injuries.

This week he takes a look at rotator cuff shoulder injuries, what they are, how they happen and the prognosis for those who suffer such an injury. Thankfully, while the Sharks have endured a horror run with injuries in 2014, rotator cuff injuries haven’t been a major concern.

Rotator Cuff Injuries

What is it?
The rotator cuff is a group of four muscles, namely Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis. They have many important functions including stabilising the true shoulder (gleno-humeral) joint, functioning as a counterforce balance to the deltoid muscle as a humeral head depressor, and rotating the shoulder.

How does it happen? (mechanism of injury)
Injuries to the rotator cuff occur either as an overuse (shoulder impingement syndrome) or acute injury (bruising, partial or complete tearing).

Shoulder impingement syndrome typically occurs from repetitive overhead activity such as throwing, tennis serving, and swimming.

Acute injuries can involve a direct blow to the rotator cuff causing bruising. Partial or complete tearing most commonly occur during a forced contraction against resistance e.g. breaking the impact during a fall, or lifting something heavy suddenly.

Symptoms
Pain is often felt over the upper area of the shoulder, and commonly refers down to the upper arm. A painful arc from horizontal upwards is common, with associated weakness.

Examination
Tenderness may be present over the rotator cuff. Invariably there is weakness of the affected component of the rotator cuff, with positive impingement signs.

Investigations
An X-ray may reveal a subacromial spur, calcification in the tendon, on an avulsion fracture. Variations of the acromion (curved, hooked, and os acromiale) may also predispose to impingement.

An ultrasound may reveal evidence of dynamic impingement, subacromial bursitis, tendonitis, or tearing.

An MRI is the gold standard investigation for diagnosing and grading injuries.

Treatment
Impingement syndrome requires rest from provocative activity, use of anti-inflammatory medications, and rehabilitation focusing of graded rotator cuff and scapular stability strengthening exercises. An ultrasound guided cortisone injection may be used to assist the process in a timely manner.

Partial rotator cuff tears can be treated as for impingement; however there is now strong level 1 evidence to show platelet rich plasma (PRP) injections are the treatment of choice to assist with healing and repair of tissue in lieu of use of anti-inflammatories and cortisone.

Complete rotator cuff tears can lead to ongoing pain and dysfunction. Depending on the person’s age and the demand on the shoulder definitive surgical repair may be required.

When can I play again (return to activity)
Impingement syndromes can be mild allowing continuing activity, to severe requiring a number of weeks rest from sport.

Partial rotator cuff tears typically take a number of months to completely settle.

Complete rotator cuff tears when operated on require a 6 month rehabilitation process.

What about the long term (prognosis)
It is important predisposing factors are addressed to assist with preventing recurrence. This may include posture, work ergonomics, muscle balance and strength, and biomechanics and technique in sport.

 

Dr Pitsis and his staff are available to look after the injuries and medical needs of people of all ages and backgrounds, from amateur and professional athletes, to the man, woman or child in need of his expert advice. Please see website www.specialistsportsmed.com.au for more information on practitioners, staff, and services available.

Contact the Specialist Sports Medicine Centre, located on the Kingsway at Miranda, on 02 9525 3444 for more information or to make an appointment.