The rotator cuff entails four muscles around the shoulder which heavily contribute to shoulder stability.
These 4 muscles include the subscapularis muscle, which moves the arm by turning it inward.
The 2nd muscle is the supraspinatus muscle which is responsible for lifting up the arm and moving it away from the body.
The 3rd muscle is the infraspinatus muscle which helps with being able to turn the arm outward.
The fourth muscle is the teres minor muscle which assists also with the outward turning of the arm.
Athletes who do a lot of overhead activity such as baseball players, gymnasts, and swimmers placed significant demands on the rotator cuff.
With severe repetition of usage, the rotator cuff may undergo partial thickness tendon tears.
Full thickness tendon tears are fairly uncommon in a non-traumatic situation.
Rotator cuff disease can simply occur because of the generation due to aging or inflammation due to tendinitis, bursitis, or shoulder arthritis.
When a baseball pitcher throws, the arm is cocked and then accelerated significantly which places the rotator cuff under tremendous force in the deceleration phase after the ball is released.
This repetition of throwing can lead to inflammation of the rotator cuff, micro-damage, and eventually the tendon may lose its integrity.
This repetitive injury may result from problems with microtrauma along with contact on the joint side of the tendon as it rubs up against part of the bursa which is the soft tissue covering of the joint.
The two most common tendons to experience injury are the supraspinatus tendon along with the infraspinatus When athletes start to have pain due to tendon injury, the treatment is catered to the severity of the injury.
Physical therapy should focus on scapular stabilizer strengthening, rotator cuff strengthening, and on stretching of the posterior shoulder capsule.
An MRI scan can show the extent of the rotator cuff tendon injury and if intra-articular contrast is utilized it can actually show very specifically the extent of the injury.
People with rotator cuff disease typically find it hard to lift the arm away from the body fully.
If the patient has a full thickness rotator cuff tendon tear, the person may not be able to lift the arm up much at all because of the pain or dysfunction.
If the tendon has a partial thickness tear, treatment is controversial.
If the patient has lost significant internal rotation due to the injury, and the partial thickness tear is less than 25 to 50% of the thickness, the patient may undergo an arthroscopic procedure to debride the injured tendon and release the posterior capsule.
This surgery would not involve a tendon repair, but only a debridement.
If the tear is higher grade and evolves over 50% up to a full thickness tear, the surgeon will often perform a rotator cuff tendon repair.
When this is performed, it is uncommon for a high level baseball pitcher to return to full competitive throwing.