Progressive Exercise in the Management of Rotator Cuff Injuries in Tennis Players
Rotator cuff injuries are a common occurrence affecting millions of people globally. The prevalence of these injuries increases with age and is associated with factors such as a history of trauma, limb dominance, contralateral shoulder, smoking status, hypercholesterolemia, posture, and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the practitioner in recognizing promptly the onset or aggravation of existing rotator cuff tears.
Prevalence and Predisposing Factors
Rotator cuff tears are prevalent in up to 39% of asymptomatic individuals. An age-related increase in incidence leaves one with the thought of whether the tears are a part of the normal aging process. Their overall prevalence in symptomatic individuals is up to 64%. Presence of pain and decreasing shoulder strength and scores, which increases with age, heralds the onset or increase in size of existing rotator cuff tears. The opposite shoulder must be evaluated in unilateral complaints to rule out bilateral rotator cuff tears.
Rotator cuff tears can be classified based on location into articular-sided tears and bursal-sided tears. These two varieties have differing properties and vasculature. The precarious vascularity of the articular side has been demonstrated by Lohr and Uhthoff who found the predominance of a zone of hypovascularity on the articular side.
Progressive Exercise in Management
Physical therapy along with activity modifications, anti-inflammatory, and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff.
Randomized Controlled Trials and Meta-analyses
A study by Sambandam et al. provides a comprehensive review of evidence-based concepts and present understanding of the epidemiology, etiopathogenesis, natural history, clinical evaluation, imaging, management, and healing of rotator cuff tears. The study suggests that early surgery should be considered in younger, active, and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff.
In conclusion, progressive exercise plays a crucial role in the management of rotator cuff injuries in tennis players. It is important to incorporate a comprehensive approach including early diagnosis, physical therapy, activity modifications, and regular monitoring in the treatment plan. Further research in the form of randomized controlled trials and meta-analyses is needed to establish the most effective treatment strategies for these injuries.
Sambandam, S. N., Khanna, V., Gul, A., & Mounasamy, V. (2015). Rotator cuff tears: An evidence based approach. World Journal of Orthopedics, 6(11), 902. Link to Full Text