Shoulder conditions that can be treated by Dr Rory Harvey

This article originally appeared in the Cape Argus

Shoulder Problems in Athletes - The Rotator Cuff

Introduction

The "rotator cuff" is just a fancy name for the 4 tendons which attach to the head of the humerus. These tendons lie just underneath the main shoulder muscle, called the deltoid muscle and are responsible for all the important shoulder movements, such as rotation and lifting above shoulder height. The commonest tendon injured in young sportsmen is the supraspinatus, which lies on top of the shoulder and is responsible for lifting the arm up.

Athletes at risk

Any young athlete who plays contact sport (rugby, soccer, hockey) or an overhead sport (tennis, javelin, kayaking, throwing eg cricket) is at risk of tearing the shoulder tendons.

Warning signs

Any athlete who complains of pain when lifting the arm more than 2 weeks after injuring his shoulder should consult his GP or physio and if necessary be referred to a Shoulder Specialist.

Making the diagnosis

This is usually done on the history and examination, but further testing may be necessary. These include ultrasound and MRI scan. Below are examples of tears using both of these investigations.

Treatment

Immediately after the injury one can use ice packs, anti-inflammatories etc, but in cases where a tear has been diagnosed on ultrasound or MRI scan and the patient has ongoing symptoms, the best treatment option is surgical repair of the tear. This can either be done by open or arthroscopic surgery.

Arthroscopic Repair

This involves making 4 holes,5mm in diameter to enable the tendon to be reattached to raw bone, by means of tiny anchors and sutures. Below are pictures of what it looks like at the time of the operation: Post operative stay and rehab. Although it is theoretically possible to go home on the same day, 70 – 80% of patients stay overnight. A sling is worn for 4-6weeks after the operation. The rehab is broken down into three 6 week periods: The first 6 weeks is for tendon healing, the next is for regaining range of movement and the last is for gradual strengthening exercises.

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