Sports Medicine

, Volume 24, Issue 3, pp 205–220 | Cite as

Rotator Cuff Pathology in Athletes

  • Field T. BlevinsEmail author
Injury Clinic


The rotator cuff is the primary dynamic stabiliser of the glenohumeral joint and is placed under significant stress during overhead and contact sports. Mechanisms of injury include repetitive microtrauma, usually seen in the athlete involved in overhand sports, and macrotrauma associated with contact sports. Rotator cuff injury and dysfunction in the overhand athlete may be classified based on aetiology as primary impingement, primary tensile overload, and secondary impingement and tensile overload resulting from glenohumeral instability. A thorough history and physical examination are paramount in the evaluation, classification and treatment planning of the athlete with rotator cuff pathology. Imaging studies are a helpful adjunct to the history and physical.

Athletes with primary impingement are usually middle aged or older and often have chronic shoulder pain and sometimes weakness associated with overhand sporting activities. Night pain is typical of full thickness rotator cuff tears. Impingement signs are positive and strength of elevation and external rotation are often limited. They usually respond to a nonoperative rehabilitation programme centred on decreasing inflammation, restoring range of motion and strengthening the rotator cuff and scapular stabilisers. Depending on the degree of cuff pathology, acromioplasty, debridement of partial cuff tears, and repair of full thickness tears are usually successful in those who fail a rehabilitation programme.

Overhand athletes with cuff pathology secondary to subtle anterior instability are usually young and complain of pain and decreased throwing velocity. Instability may be so subtle that it is only detectable through a positive relocation test on examination. The majority of these athletes do not have a Bankart lesion on magnetic resonanace imaging or arthroscopic examination. Arthroscopic examination usually demonstrates anterior capsular laxity (positive ‘drive-through’ sign), as well as superior-posterior labral and cuff injury typical of internal impingement. If rehabilitation alone is not successful, a capsulolabral repair followed by rehabilitation may allow the athlete to return to their previous level of competition.

The athlete with an acute episode of macrotrauma to the shoulder resulting in cuff pathology usually presents with pain, limited active elevation and a positive ‘shrug sign’. Arthroscopy and debridement of thickened, inflamed or scarred subacromial bursa with cuff repair or debridement as indicated is usually successful in those who do not respond to a rehabilitation programme.


Rotator Cuff Rotator Cuff Tear Rotator Cuff Tendon Internal Impingement Subacromial Bursa 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Burnham RS, May L, Nelson E, et al. Shoulder pain in wheelchair athletes. Am J Sports Med 1993; 21(2): 238–42CrossRefPubMedGoogle Scholar
  2. 2.
    Rollins J, Puffer JC, Whiting WC, et al. Waterpolo injuries to the upper extremity. In: Zarins B, Andrews JR, Carson WG, editors. Injuries to the throwing arm. Philadelphia: WB Saunders Co., 1895: 311–7Google Scholar
  3. 3.
    Lehman RC. Shoulder pain in the competitive tennis player. Clin Sports Med 1988; 7: 309–27PubMedGoogle Scholar
  4. 4.
    Richardson AB, Jobe FW, Collins HR. The shoulder in competitive swimming. Am J Sports Med 1980; 8: 159–63CrossRefPubMedGoogle Scholar
  5. 5.
    Blevins FT, Hayes WM, Warren RF. Rotator cuff injury in contact athletes. Am J Sports Med 1996; 24: 263–7CrossRefPubMedGoogle Scholar
  6. 6.
    Hawkins RJ, Morin WD, Bonutti PM. Surgical treatment of full-thickness rotator cuff tears in patients 40 years of age and younger [abstract]. Orthop Trans 1993–1994; 17: 1024Google Scholar
  7. 7.
    Itoi E, Tabata S. Rotator cuff tears in the adolescent. Orthopedics 1993; 16: 78–81PubMedGoogle Scholar
  8. 8.
    Weaver JK. Skiing-related injuries to the shoulder. Clin Orthop 1987; 216: 24–8Google Scholar
  9. 9.
    Clark JM, Harryman DT II. Tendons, ligaments and capsule of the rotator cuff: gross and microscopic anatomy. J Bone Joint Surg Am 1992; 74: 713–25CrossRefPubMedGoogle Scholar
  10. 10.
    Berenson MC, Blevins FT, Plaas AHK, et al. Proteoglycans of human rotator cuff tendons. J Orthop Res 1996; 14: 518–25CrossRefPubMedGoogle Scholar
  11. 11.
    Riley GP, Harrall RL, Constant CR, et al. Glycosaminoglycans of human rotator cuff tendons: changes with age and in chronic rotator cuff tendinitis. Ann Rheum Dis 1994; 53: 367–76CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Blevins FT, Djurasovic M, Flatow EL, et al. Biology of the rotator cuff tendon. Orthop Clin North Am 1997; 28(1): 1–15CrossRefPubMedGoogle Scholar
  13. 13.
    Rothman RH, Parke WW. The vascular anatomy of the rotator cuff. Clin Orthop 1965; 41: 176–86CrossRefPubMedGoogle Scholar
  14. 14.
    Moseley HF, Goldie I. The arterial pattern of the rotator cuff and the shoulder. J Bone Joint Surg Br 1963; 45: 780–9CrossRefPubMedGoogle Scholar
  15. 15.
    Rathbun JB, Mcnab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br 1970; 52: 540–53CrossRefPubMedGoogle Scholar
  16. 16.
    Brooks CH, Revell WJ, Heatley FW. A quantitative histological study of the vascularity of the rotator cuff tendon. J Bone Joint Surg Br 1992; 74: 151–3CrossRefPubMedGoogle Scholar
  17. 17.
    Poppen NK, Walker PS. Forces at the glenohumeral joint in abduction. J Bone Joint Surg Am 1978; 58: 165–70Google Scholar
  18. 18.
    Bowen MK, Warren RF. Injuries of the rotator cuff. Oxford Textbook of Sports MedicineGoogle Scholar
  19. 19.
    Dillman C, Andrews JR. Sports medicine focus: the throwing athlete’s shoulder. Orthop News 1991; 13: 7Google Scholar
  20. 20.
    Jobe FW, Tibone JW, Perry J, et al. An EMG analysis of the shoulder in pitching: a secondary report. Am J Sports Med 1984; 12: 218–20CrossRefPubMedGoogle Scholar
  21. 21.
    Jobe FW, Tibone JW, Perry J, et al. An EMG analysis of the shoulder in throwing and pitching: a preliminary report. Am J Sports Med 1983; 11: 3–5CrossRefPubMedGoogle Scholar
  22. 22.
    Meister K, Andrews JR. Classification and treatment of rotator cuff injuries in the overhand athlete. J Orthop Sports Phys Ther 1993; 19(2): 413–21CrossRefGoogle Scholar
  23. 23.
    Jobe FW, Bradley JP. Rotator cuff injuries in baseball: prevention and rehabilitation. Sports Med 1988; 6: 378–87CrossRefPubMedGoogle Scholar
  24. 24.
    Neer CS II. Anterior acromioplasty for the chronic impingement syndrome in the shoulder. J Bone Joint Surg Am 1972; 54: 41–50CrossRefPubMedGoogle Scholar
  25. 25.
    Bigliani LV, Morrison SD, April EW. The morphology of the acromion and its relationship of rotator cuff tears [abstract]. Orthop Trans 1986; 10: 228Google Scholar
  26. 26.
    Blevins FT, Altchek DW. Arthroscopic subacromial decompression for impingement: chapter 5. In: Serge Parisien J, editor. Current techniques in arthroscopy. Philadelphia: Current Medicine, 1994: 52–64Google Scholar
  27. 27.
    Scarpinato DF, Bramhall JP, Andrews JR. Arthroscopic management of the throwing athlete’s shoulder: indications, techniques, and results. Clin Sports Med 1991; 10(4): 913–25PubMedGoogle Scholar
  28. 28.
    Jobe CM. Superior glenoid impingement. Clin Orthop 1996; 330: 98–107CrossRefGoogle Scholar
  29. 29.
    Warren RF. Subluxation of the shoulder in athletes. Clin Sports Med 1983; 2: 339–54PubMedGoogle Scholar
  30. 30.
    Jobe FW, Kvitne RS. Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff impingement. Orthop Rev 1989; 18: 963–75PubMedGoogle Scholar
  31. 31.
    Harryman DT, Sidles JA, Clark JM, et al. Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg Am 1990: 72(A): 1334–43CrossRefPubMedGoogle Scholar
  32. 32.
    Gowan ID, Jobe FW, Tibone JE, et al. A comparative electromyographic analysis of the shoulder during pitching: professional versus amateur pitchers. Am J Sports Med 1987; 15: 586–90CrossRefPubMedGoogle Scholar
  33. 33.
    Walch G, Boileau P, Noel E, et al. Impingement of the deep surface of the supraspinatus tendon on the posterior glenoid rim: an arthroscopic study. J Shoulder Elbow Surg 1992; 1: 238–45CrossRefPubMedGoogle Scholar
  34. 34.
    Liu SH, Boynton E. Posterior superior impingement of the rotator cuff on the glenoid rim as a cause of shoulder pain in the overhead athlete. Arthroscopy 1993; 9(6): 697–9CrossRefPubMedGoogle Scholar
  35. 35.
    Jobe CM, Sidles J. Evidence for a superior glenoid imingement upon the rotator cuff [abstract]. J Shoulder Elbow Surg 1993; 2 Suppl.: S19Google Scholar
  36. 36.
    Jobe FW, Pink M. The athlete’s shoulder. J Hand Ther Apr Jun 1994: 107–9Google Scholar
  37. 37.
    Davidson PA, Elattrache NS, Jobe CM, et al. Rotator cuff and posterior-superior glenoid labrum injury associated with increased glenohumeral motion: a new site of impingement. J Shoulder Elbow Surg 1995; 4(5): 384–90CrossRefPubMedGoogle Scholar
  38. 38.
    Altchek DW, Dines D. Shoulder injuries in the throwing athlete. J Am Acad Orthop Surgeons 1995; 3(3): 159–65CrossRefGoogle Scholar
  39. 39.
    Hawkins RJ, Bell RH, Hawkins RH, et al. Anterior dislocation of the shoulder in the older patient. Clin Orthop 1986; 206: 192–5Google Scholar
  40. 40.
    Neviaser RJ, Neviaser TJ, Neviaser JS. Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient. J Bone Joint Surg Am 1988; 70A: 1308–11CrossRefGoogle Scholar
  41. 41.
    Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. J Bone Joint Surg B 1991; 73: 389–94CrossRefGoogle Scholar
  42. 42.
    Ferretti A, Cerullo G, Russo G. Suprascapular neuropathy in volleyball players. J Bone Joint Surg Am 1987; 69: 260–3CrossRefPubMedGoogle Scholar
  43. 43.
    Jobe FW, Bradley JP, Pink M. Impingement syndrome in overhand athletes: Part I. Surg Rounds Orthop 1990; 4(8): 19–24Google Scholar
  44. 44.
    Speer KP, Hannafin JA, Altchek DW, et al. An evaluation of the shoulder relocation test. Am J Sports Med 1994; 22(2): 177–83CrossRefPubMedGoogle Scholar
  45. 45.
    Miniaci A, Fowler PJ. Impingement in the athlete. Clin Sports Med 1993; 12(1): 91–109PubMedGoogle Scholar
  46. 46.
    Blevins FT, Warren RF. Diagnostic arthroscopy and arthroscopic management of rotator cuff tears: chapter 21. In: Craig EV, editor. Master techniques in orthopaedic surgery. New York: Raven Press: 319–416Google Scholar
  47. 47.
    Pagnani MJ, Warren RF. Arthroscopic shoulder stabilization. Oper Techniques Sports Med 1993; 1: 276–84Google Scholar
  48. 48.
    Montgomery WH, Jobe FW. Functional outcomes in athletes after modified anterior capsulolabral reconstruction. Am J Sports Med 1994; 22: 352–8CrossRefPubMedGoogle Scholar
  49. 49.
    Hawkins RJ, Abrams JS. Impingement syndrome in the absence of rotator cuff tear (stages 1 and 2). Orthop Clin North Am 1987; 18: 373–382PubMedGoogle Scholar
  50. 50.
    Hawkins RJ, Brock RM, Abrams TS, et al. Acromioplasty for impingement with an intact rotator cuff. J Bone Joint Surg Br 1988; 70(B): 795–7CrossRefPubMedGoogle Scholar
  51. 51.
    Morrison DS, Frogamoni AD, Woodworth R Non-operative treatment of subacromial impingement syndrome. J Bone Joint Surg Am 1997; 79(5): 732–7CrossRefPubMedGoogle Scholar
  52. 52.
    Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med 1980, 8: 151–8CrossRefPubMedGoogle Scholar
  53. 53.
    Jackson DW. Chronic rotator cuff impingement in the throwing athlete. Am J Sports Med 1976; 4(6): 231–40CrossRefPubMedGoogle Scholar
  54. 54.
    Bigiliani LU, Kimmel J, McCann PD, et al. Repair of rotator cuff tears in tennis players. Am J Sports Med 1992; 20(2): 112–7CrossRefPubMedGoogle Scholar
  55. 55.
    Kuhn JE, Hawkins RJ. Surgical treatment of shoulder injuries in tennis players. Clin Sports Med 1995; 14(1): 139–59PubMedGoogle Scholar
  56. 56.
    Flatow EL, Connor PM, Levine WN, et al. Coracoacromial arch reconstruction for anteriosuperior instability [abstract]. Annual Meeting of the American Shoulder and Elbow Surgeons: 1997 Feb 16; San FranciscoGoogle Scholar
  57. 57.
    Tibone JE, Elrod B, Jobe FW. Shoulder impingement syndrome in athletes treated by anterior acromioplasty. J Bone Joint Surg Am 1986; 68: 887–91CrossRefPubMedGoogle Scholar
  58. 58.
    Andrews JR, Broussard TS, Carson WG. Arthroscopy of the shoulder in the management of partial tears of the rotator cuff: preliminary report. J Arthroscopy 1985; 1(2): 117–22CrossRefGoogle Scholar
  59. 59.
    Ogilvie-Harris DJ, Wiley AM. Arthroscopic surgery of the shoulder. J Bone Joint Surg Br 1986; 68: 201–7CrossRefPubMedGoogle Scholar
  60. 60.
    Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop 1990; 254: 64–74Google Scholar

Copyright information

© Adis International Limited 1997

Authors and Affiliations

  1. 1.Department of Orthopaedics, Division of Sports MedicineUniversity of New Mexico Medical SchoolAlbuquerqueUSA

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