Athletes can suffer both acute full thickness rotator cuff tears as a result of trauma, as well as chronic full and partial thickness tears as a result of overhead sports. The aetiology, assessment and treatment of these tears may bear little resemblance to the chronic tears so commonly seen in the elderly, sedentary population. Associated injuries in the shoulder must be assessed and managed con- comitantly, as failure to treat all pathologies can lead to poor results in the athlete. Non-operative and operative treatment must be specifically directed at the underlying causes and pathologies to allow a return to sporting activity as soon as possible.

1. shoulderdoc.co.uk
Rotator Cuff Tears
in Athletes
Lennard Funk

2. shoulderdoc.co.uk
QR Codes
• PDF files and web links for more info

3. shoulderdoc.co.uk

4. shoulderdoc.co.uk
Rotator Cuff
Infraspinatus
Teres Minor
Supraspinatus
Subscapularis
Long Head Biceps

5. shoulderdoc.co.uk
Contains/Controls Humeral Head
Sub
Ssp
Isp
TM
Sub
Ssp
Isp
TM

6. shoulderdoc.co.uk
Collagen
Type 1
Type 2
Type 3

7. shoulderdoc.co.uk
Stress Concentrations

8. shoulderdoc.co.uk
Rotator Cuff Tear Demographics
Symptomatic & Asymptomatic Tear Prevalence
Yamamoto, JSES, 2010

9. shoulderdoc.co.uk
Cuff Tears in Athletes
• Incidence (in my practice)
• 1392 patients from 2014 to 2024
• 449 Rotator Cuff Tears
• 77 Athletes (17%):
• Age = 37 (13-66)
• Contact = 29 (38%)
• Overhead = 33 (43%)
• Strength / Martial Arts = 15 (20%)

10. shoulderdoc.co.uk
Rotator Cuff Repair - Rugby
• 402 Rugby Surgeries over 10 years
• 38 Cuff repairs (11%)
• Majority not isolated
Torrence & Funk, 2016

11. shoulderdoc.co.uk
Cuff Tear Patterns
Non-athletes Athletes
0%
25%
50%
75%
100%
14
23
82 60
4
17
Posterior
Superior
Anterior
Casaletto & Funk, 2009

12. shoulderdoc.co.uk
Athlete
A P

13. shoulderdoc.co.uk
USS
Immediate
Cheap
Accurate
Not assoc.
injuries
MRI
Accessible
Expensive
Not assoc.
injuries
MRA
Most
Accurate
Expensive
Access
Skills
Investigations

14. shoulderdoc.co.uk
Treatment
• Repair – Arthroscopic
• Treat ALL pathologies
• Sports Specific Rehab
• Earlier repair = better outcomes

15. shoulderdoc.co.uk
Surgical Tips
1. Address All Pathologies
2. Prepare to fresh tissue
3. Strong, secure repairs
4. Repair in position of function for sport
5. Check repair integrity thro ROM
6. Sling in position to optimise recovery
7. Pain & Swelling Mx - multimodal
8. Allow Early ROM & Isometrics + Sports Specific

16. shoulderdoc.co.uk
Sports-Specific Rehab.
Rugby Rehab Protocol
Football Rehab Protocol
Overhead Athlete
Protocol

17. shoulderdoc.co.uk
Outcomes in Rugby
Pre-op 3m Final
CS 44 95 101
OS 34 18 12
Tambe & Funk, IJSS, 2008
Mean time of return to full match play = 4.8 months (3-8)
Tambe & Funk
IJSS 2009

18. shoulderdoc.co.uk
Overhead Athlete

19. shoulderdoc.co.uk
Postero-Superior Internal Impingement

20. shoulderdoc.co.uk
Cuff Damage
Internal Impingement Repetitive Torsional Forces

21. shoulderdoc.co.uk
Pathomechanics
Capsular
Imbalance
Muscular
Imbalance
Internal
Impingement Trauma
+/-
Labral Tear
Subacromial
Impingement
Rotator Cuff
Tear
+
{

22. shoulderdoc.co.uk
Diagnosis
• High Index of Suspicion
– Overhead athlete
– Pain on extremes & fatigue
– GIRD
– Cuff Signs
– Ultrasound Scan

23. shoulderdoc.co.uk
MR Arthrogram

24. shoulderdoc.co.uk
Non-Surgical Treatment
• Address Static imbalances:
• Soft tissue therapy
• Address Dynamic Stabilisers:
• Core Stability & Kinetic Chain
• Movement muscles
• Stabilising muscles (rotator cuff)
• Sports-specific

25. shoulderdoc.co.uk
https://www.shoulderdoc.co.uk/article/1718

26. shoulderdoc.co.uk
Injections
• Steroid - reduces inflammation only
• PRP - No conclusive evidence
• ? partial cuff tears?
• Prolotherapy - Never!
Xiang et al. 2021. Conservative treatment of partial-thickness rotator cuff tears and tendinopathy
with platelet-rich plasma: a systematic review and meta-analysis. Clinical Rehabilitation, 35(12),
pp.1661-1673
Andrews, J.R., Elbayar, J.H. and Jordan, S.E., 2021. Partial-Rotator Cuff Tears in Throwing Athletes.
Operative Techniques in Sports Medicine, 29(1), p.150799.

27. shoulderdoc.co.uk
PRP Injections

28. shoulderdoc.co.uk
< 50% Depth

29. shoulderdoc.co.uk
> 50% Depth

30. shoulderdoc.co.uk
Footprint Exposed?

31. shoulderdoc.co.uk
Key Points
1. Cuff tear in athletes may be traumatic as a result of contact
sports or chronic as a result of repetitive overhead sports.
2. Pain and weakness, with inability to return to play should arise
suspicion of a cuff tear.
3. Associated glenohumeral lesions are common in athletes
and best diagnosed with MR arthrogram + ABER.
4. Early, active intervention is essential for a rapid return to sports
- Non-Surgical +/- Surgery
5. All associated pathologies need to be addressed.
6. Early active Sports-specific Rehab is recommended

32. shoulderdoc.co.uk
British Journal Hospital Medicine, 2009

33. shoulderdoc.co.uk
Thank you !