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PubMed1997

Special considerations in the athletic throwing shoulder.

Overhead athletes are susceptible to a number of shoulder problems due to the repetitive nature and force needed to perform at a competitive level. Frequently, the rotator cuff becomes injured due to primary or secondary impingement. In young athletes, subtle instability is often the cause of rotator cuff tendinitis, but will frequently respond to a coordinated rehabilitation program. Older athletes are more likely to have rotator cuff injuries due to anatomic changes in the coracoacromial arch. This article outlines the mechanism of injury to the rotator cuff and our approach in dealing with shoulder problems in the overhead athlete.

Biomechanical Phenomena↗
PubMed2026

The impact of an intact rotator cuff on the outcomes of reverse shoulder arthroplasty: a meta-analysis of 20,924 patients.

BACKGROUND: While reverse shoulder arthroplasty (rTSA) is commonly utilized for rotator cuff tear arthropathy, indications have expanded to include, primary glenohumeral osteoarthritis (GHOA) with intact cuff. The presence of an intact cuff may influence outcomes after rTSA because preserved cuff musculature can contribute to shoulder stability and force which could potentially improve postoperative function and reduce complication rates. However, studies have reported contradictory results on whether or not an intact cuff would provide better outcomes in patients receiving an rTSA. METHODS: This is a systematic review and Meta-analysis performed according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane, Embase, and Google Scholar (pages 1-20) were queried through December 2025. Inclusion criteria consisted of studies comparing the outcomes of rTSA based on whether patients had a diagnosis of GHOA with intact cuff, or had a deficient rotator cuff (ie had a diagnosis of rotator cuff tears without OA, or cuff tear arthropathy). Extracted data included adverse events, improvement in patient reported outcome measures, and improvement in range of motion. RESULTS: Eleven retrospective articles and 1 prospective article met the inclusion criteria with 4,542 in the GHOA with intact cuff group and 16,382 in the cuff-deficient group (cuff tear arthropathy: 15,423 patients; rotator cuff tear: 959 patients). Patients undergoing rTSA for GHOA and intact cuff had a lower rate of revisions (odds ratio [OR] = 0.53; 95% CI: 0.41- 0.68, P < .001; I2 = 0%), overall complications (OR = 0.57; 95% CI: 0.46-0.71, P < .001; I2 = 0%), acromial stress fracture (OR = 0.22; 95% CI: 0.08- 0.59, P = .003; I2 = 0%), infection (OR = 0.43; 95% CI: 0.26- 0.73, P = .002; I2 = 37%), and instability (OR = 0.60; 95% CI: 0.40- 0.90, P = .01; I2 = 0%). In addition, GHOA patients had a better improvement in both American Shoulder and Elbow Surgeons scores (mean difference = 7.17; 95% CI: 2.13- 12.21, P = .005; I2 = 81%) without exceeding the minimal clinically important difference, and external rotation (mean difference = 12.00&#xb0;; 95% CI: 9.63- 14.37, P < .001; I2 = 38%). CONCLUSION: Rotator cuff-deficient patients undergoing rTSA have a higher risk of postoperative complications compared to patients undergoing rTSA for GHOA with an intact cuff. They also showed less improvement in American Shoulder and Elbow Surgeons scores and external rotation. However, the clinical significance of these differences should be interpreted with caution, as not all improvements exceeded established thresholds for clinical importance.

Humans↗
PubMed2026

Application of musculoskeletal ultrasound in postoperative rehabilitation assessment and monitoring after rotator cuff repair: A systematic review.

BACKGROUND: The development of rehabilitation protocols after rotator cuff repair has long lacked objective benchmarks. Traditional time&#x2011;based regimens are limited by considerable inter&#x2011;individual variability and an increased risk of re&#x2011;tear. Musculoskeletal ultrasound allows dynamic assessment of tendon healing and muscle morphology, yet evidence for directly linking its use to rehabilitation decisions remains scarce. OBJECTIVE: To systematically synthesize the evidence on the use of musculoskeletal ultrasound monitoring to inform rehabilitation decision&#x2011;making after rotator cuff repair. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta&#x2011;Analyses (PRISMA) guidelines, we searched PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Data from January 2020 to April 2026. Original studies were included if they involved patients who had undergone rotator cuff repair, used musculoskeletal ultrasound (including gray&#x2011;scale ultrasound, elastography, etc.) to evaluate the rotator cuff tendons or shoulder muscles, and reported at least one parameter related to rehabilitation decision-making or functional outcomes. RESULTS: Eleven studies were included. Shear wave velocity (SWV), cross&#x2011;sectional area (CSA), and echo intensity (EI) were the most frequently reported ultrasound parameters. Available evidence indicated that SWV increased progressively after surgery, with an overall increase of approximately 22% to 25% from one week to 12 months postoperatively. This dynamic trajectory may serve as a reference baseline for judging rehabilitation progress. An abnormally elevated SWV in the early postoperative period was associated with an increased risk of re&#x2011;tear, suggesting that a more conservative rehabilitation strategy should be adopted. Tendon stiffness measured at 12 weeks after surgery independently predicted long&#x2011;term return to sport. Regarding muscle parameters, changes in CSA and EI were positively correlated with shoulder function scores, and the combination of these two parameters effectively identified patients with rehabilitation bottlenecks. CONCLUSION: Musculoskeletal ultrasound parameters are associated with the initiation of active movement, adjustment of exercise load, prediction of return&#x2011;to&#x2011;sport prognosis, and identification of retear risk. Among these, SWV shows particular promise as an objective monitoring parameter for supporting rehabilitation assessment after rotator cuff repair. Future randomized controlled trials are needed to determine whether ultrasound-informed assessment can improve rehabilitation outcomes compared with traditional time-based regimens, and to establish standardized measurement protocols and clinically applicable reference values. Key findings of this review are summarized in S1 File.

Humans↗
PubMed2006

Reliability, validity, and responsiveness of the simple shoulder test: psychometric properties by age and injury type.

The purpose of this study was to measure the reliability, validity, and responsiveness of the Simple Shoulder Test (SST) scale and to examine these in patients stratified by age and injury type. Test-retest reliability, content validity, criterion validity, construct validity, and responsiveness were determined for the SST. The study population comprised 1077 patients with shoulder instability and rotator cuff injuries, ranging in age from 14 to 85 years. The SST demonstrated acceptable test-retest reliability (intraclass correlation coefficient >0.90) and content validity (floor and ceiling effects <10%). Correlations with the physical functioning component of the Short Form 12 were significant (r = 0.439, P < .05); however, the correlations were not significant when stratified by age group (>60 years) (r = 0.271, P = .349) and injury type (rotator cuff injury) (r = 0.337, P = .085). Correlations with the American Shoulder and Elbow Surgeons were also significant (r = 0.807, P < .001). The construct validity of the SST was acceptable, with all 8 hypotheses demonstrating significance (P < .05). The SST was responsive to change (effect size, 0.81; standardized response mean, 0.81). However, there were differences after stratification for age group and injury type. The SST demonstrated overall acceptable psychometric performance; however, differences were found when data were stratified by age and injury type.

Adolescent↗
PubMed1993

Sonography of the shoulder in patients with tears of the rotator cuff: accuracy and value for selecting surgical options.

OBJECTIVE: The management of patients with signs and symptoms referable to the rotator cuff depends on the presence of cuff injury and the size of the tear. Treatment options include conservative nonsurgical management for patients with an intact or partially torn cuff, arthroscopic decompression of the coracoacromial space for those not responding to nonsurgical management, and a range of surgical techniques to repair full-thickness tears. This study was designed to determine whether sonographic evaluation with classification of the extent of cuff injury is accurate for purposes of treatment planning. SUBJECTS AND METHODS: Preoperative sonography of the rotator cuff was performed on 225 patients, and findings were classified into intact, partial tear, small full-thickness tear, large full-thickness tear, and massive tear groups. Surgical correlation with the predicted sonographic classification was provided by arthroscopic inspection or open surgery. RESULTS: The sonographic findings were surgically confirmed for 206 (92%) of the 225 patients. More extensive cuff injury was encountered during surgery than had been predicted sonographically in 11 patients (5%); less extensive injury than predicted was found during surgery in eight patients (4%). CONCLUSION: Our results show a high correlation between the sonographic classification of rotator cuff injury and the surgical findings. The selection of appropriate treatment programs can be reliably based on the sonographic classification.

Adult↗
PubMed2000

Shoulder dislocations in patients older than 40 years of age.

Shoulder dislocations in patients over 40 years of age are common and are frequently associated with serious injuries to adjacent structures. Associated injuries such as brachial plexus injury, rotator cuff tear, axillary artery injury, fractures about the shoulder, and recurrent dislocation can make shoulder dislocations challenging problems for the clinician. Early diagnosis and treatment of associated injuries and treatment complications are the mainstays in prevention of morbidity and, even, mortality.

Adult↗
PubMed2004

Shoulder pathoanatomy in marathon kayakers.

OBJECTIVES: To determine the prevalence of soft and hard tissue abnormalities and their interrelations in the shoulders of marathon kayakers and to examine the pathoanatomical factors that predispose these athletes to injury. METHODS: Fifty two long distance kayakers completed a questionnaire. Their shoulders were examined for range of motion, pain, and stability using a standard set of 10 clinical tests. The shoulder was subsequently scanned by magnetic resonance imaging (MRI) in three planes and evaluated for evidence of injury or other abnormality. The relation of clinical symptoms and MRI findings was investigated with respect to kayaker's age, number of years kayaking, and number of marathon races completed. RESULTS: Thirty subjects were asymptomatic at the time of scanning, and twenty two showed symptoms of pain and/or instability. MRI showed acromioclavicular hypertrophy, acromial or clavicular spur, supraspinatus tendinitis, and partial tear of the supraspinatus as the most common abnormalities. Kayaker's age, number of years kayaking, and number of races completed did not relate significantly to symptoms or to the presence of an abnormality on MRI scan. Of all the pathoanatomical findings that are reported to predispose to rotator cuff injury, only acromial and clavicular spurs were found to correlate highly with supraspinatus muscle pathology. CONCLUSIONS: Rotator cuff injuries make up a large portion of the injuries seen in marathon kayakers, about twice the number reported for sprint kayakers. These injuries are the result of secondary impingement factors associated with overuse, possibly specific to kayakers, and not the result of bony restrictions around the shoulder joint. Acromioclavicular hypertrophy is a common finding in marathon kayakers, but is possibly the result of portaging or a previous injury.

Adult↗
PubMed2005

Prevalence and variance of shoulder injuries in elite collegiate football players.

BACKGROUND: Shoulder injuries are the fourth most common musculoskeletal injury encountered in American football players. There is little information in the literature on the role of playing position in the type of shoulder injuries seen. HYPOTHESIS: There is a high prevalence of shoulder injuries in elite collegiate American football players, with type of injury varying by playing position. STUDY DESIGN: Cohort study (prevalence); Level of evidence, 3. METHODS: A total of 336 elite collegiate American football players were invited to the National Football League Combine for physical testing and medical evaluation. Current and historical data were evaluated for the purpose of this study, and all players underwent radiographic examinations, including plain radiographs and/or magnetic resonance imaging when necessary. All shoulder pathological conditions and shoulder surgical procedures were recorded. Players were categorized by position for the analysis of position-specific trends. RESULTS: Of the players, 50% had a history of shoulder injuries, with a total of 226 shoulder injuries (1.3 injuries per player injured); 56 players (34%) had a total of 73 surgeries. The most common injuries were acromioclavicular separation (41%), anterior instability (20%), rotator cuff injury (12%), clavicle fracture (4%), and posterior instability (4%). The most common surgeries performed were anterior instability reconstruction (48%), Mumford/Weaver-Dunn surgery (15%), posterior instability surgery (10%), and rotator cuff surgery (10%). Shoulder injuries were more common in quarterbacks and defensive backs. Surgery was more common in linebackers or linemen. A history of anterior instability was more common in defensive players, with surgery required 76% of the time. Linemen had more rotator cuff injuries and posterior instability than players in other positions. CONCLUSION: Shoulder injuries are common injuries in elite collegiate football players, with one-third undergoing surgical procedures. There are definitive trends in the types of injuries per player position.

Acromioclavicular Joint↗
PubMed2005

Arthroscopic rotator cuff debridement without decompression for the treatment of tendinosis.

PURPOSE: The treatment of rotator cuff injury in the absence of a full-thickness tear has traditionally consisted of acromioplasty. However, this disorder may also be treated by arthroscopic rotator cuff debridement without acromioplasty. Our previous study of 79 shoulders so treated reported 87% good or excellent results at an average 53-month follow-up. The purpose of this article is to report the long-term, average 9.5-year follow-up of this cohort. TYPE OF STUDY: Long-term follow-up of case series. METHODS: We retrospectively reviewed the records of 62 shoulders in 60 patients who had undergone arthroscopic rotator cuff debridement for partial-thickness rotator cuff tears. Demographic criteria, residual pain, and the ability to return to recreational athletics were noted. The UCLA Shoulder Score and the Simple Shoulder Test scores were determined and statistical analysis performed. RESULTS: Using the UCLA Shoulder Score, there were 79% excellent or good results at an average 114 months of follow-up. Patients with Workers' Compensation claims had significantly worse results, with only 40% rated good or excellent. Of the 60 patients, 77% had no or only minimal pain, 57% were still able to perform recreational athletics without difficulty, and 20% could participate at a lower level of intensity. CONCLUSIONS: Arthroscopic debridement of rotator cuff injury in the absence of a full-thickness tear has good long-term results and minimizes additional surgical trauma. LEVEL OF EVIDENCE: Level IV, case series.

Adolescent↗
PubMedDate not supplied

Correlation of radiographic and arthroscopic findings with rotator cuff tears and degenerative joint disease.

The purpose of this study was to identify early signs of rotator cuff tear and glenohumeral articular cartilage degeneration by using conventional radiography. A non-weighted anteroposterior oblique and a weighted active abduction view were evaluated for superior humeral migration and matching degenerative changes at the inferolateral acromion and superior aspect of the greater tuberosity in 40 patients who underwent shoulder arthroscopy. Measurements of the glenohumeral distance were performed. Surgical reports were reviewed to determine rotator cuff and glenohumeral articular cartilage status. Matching degenerative changes correlate with complete rotator cuff tear (P =.04); superior migration does not. Severe glenohumeral cartilage loss correlates with narrowing of the superior joint space on the anteroposterior oblique radiograph (P =.02) and with narrowing of the mid joint space on the active abduction view (P =.05). Both glenohumeral articular cartilage degenerative change and rotator cuff injury, before formation of typical sequelae of chronic rotator cuff tear, can be detected with the use of conventional radiography.

Adult↗
PubMed2004

The tension required at repair to reappose the supraspinatus tendon to bone rapidly increases after injury.

Rotator cuff tears occur frequently and can cause significant pain and reduced shoulder function. A high percentage of patients are satisfied after surgical repair of rotator cuff tears, but a smaller percentage of patients with chronic tears continue to have pain and poor shoulder function. This may be partly attributable to an increase in the repair tension, the force required at repair to reappose the tendon to its original insertion site on the humerus. Increases in repair tension have been shown to occur for long-standing ruptures of the supraspinatus tendon, but the precise tension at various times after injury are unknown. Therefore, the objective of the current study was to determine the repair tension at various times after a rotator cuff tear. This was achieved by creating a full-thickness supraspinatus tendon tear in a rat model and measuring the mechanical characteristics of the musculotendinous unit at 0, 2, 4, 9, and 16 weeks after injury. The repair tension rapidly increased initially after injury followed by a progressive, but less dramatic, increase with additional time. These findings suggest that rotator cuff tears should be repaired early in the clinical setting. Future studies will investigate the effect of repair tension on tendon to bone healing after repair.

Animals↗
PubMedDate not supplied

[Arthrography in the diagnosis of injuries of the rotator cuff].

The author analyzes 132 arthrograms of patients operated on for involvement of the rotating cuff of the arm. The reliability of this technique for the detection of a complete rupture of the cuff of the arm and its inability to assess the size of the rupture and degree of retraction of the cuff of the arm are shown. Arthrographic patterns of the condition are presented.

Arthrography↗
PubMed1995

[Ultrasonography of the shoulder in subacromial syndromes with disorders and injuries of the rotator cuff].

Shoulder sonography was performed prospectively in 4172 patients with 4588 shoulders affected with pathology of the subacromial space, among them 1227 operated cases with 425 rotator cuff tears (292 total tears and 133 partial tears). A two-criterion model with formal as well as echogenic and dynamic criteria was used for the diagnosis of cuff tears. The overall sensitivity in diagnosing rotator cuff tears was 95.3% (97.3% in total tears and 91.0% in partial tears). False-negative results were found overall in 1.6% of cases. Overall accuracy for all defects was 94.9%. Involvement of the supraspinatus tendon was found in 95.8%, of the infraspinatus in 39.3% and of the subscapularis in 10.1%. In 33.6% of cases, involvement of the long head of biceps was found. It was clearly correlated with the size of the tears: 25.9% in isolated supraspinatus tears and 68.8% in three-tendon tears of subscapularis, supraspinatus and infraspinatus. Differentiation between fresh, traumatic tears and degenerative tears is possible by means of measuring retraction, determining the length of the distal cuff stump and by formal criteria of the stump configuration as well as by bursal criteria. Differentiation of old tears of suspected traumatic origin from those with degenerative causes is impossible.

Adolescent↗
PubMed1988

Chronic unreduced dislocations of the glenohumeral joint: imaging strategy and pathologic correlation.

Although the evaluation of acute or recurrent dislocations of the glenohumeral joint (GHJ) using routine radiography, specialized views, arthrography, and computed tomography (CT) has been extensively studied, methods of evaluation and osseous pathology of chronic unreduced GHJ dislocations are not well documented. In order to define such methods and pathology, we studied nine patients with chronic (greater than 6 months) unreduced anterior, posterior, superior, or central dislocations as well as one patient with a chronic rotator cuff injury; and seven scapular specimens, six with matching humeral specimens, with osseous abnormalities similar to those in the patients. We examined 15 additional scapular specimens with evidence of subluxation secondary to chronic rotator cuff injury. Standard, reformatted, and three-dimensional (3D) CT techniques were used to evaluate both the patients and the specimens. Our results indicate that characteristic alterations occur in the scapula and humeral head that are far more extensive than the classic Hill-Sachs, Bankart, and trough lesions. Such alterations occur at sites of osseous contact between the malpositioned humerus and scapula and are modified owing to prolonged adjustments made by the patients in an attempt to increase GHJ motion. Although routine radiography and specialized views are of some value, standard and 3D CT provide a more accurate analysis of the location and extent of the bone abnormalities and, as such, should be employed, particularly in the evaluation of patients in whom surgery is being considered.

Acute Disease↗
PubMedDate not supplied

Magnetic resonance imaging evaluation of the rotator cuff tendons in the asymptomatic shoulder.

Thirty shoulders in 20 volunteers (average age, 29 years; range, 17 to 49) with no shoulder symptoms or known abnormalities were scanned using magnetic resonance imaging. All scans were interpreted by one radiologist who was blinded to clinical data. Appearance of rotator cuff tendons on the images was graded. Grade 0 was normal, homogeneous low signal intensity structure. Grade 1 lesion was focal, linear, or diffuse intermediate signal through the tendon. Grade 2 lesion was high signal intensity within the tendon and less than full thickness. Grade 3 was high signal intensity through full thickness of the tendon. No supraspinatus or infraspinatus tendons were grade 0 (normal); all supraspinatus and infraspinatus tendons had grade 1 changes through the tendons; and 7 of 30 (23%) of the tendons had grade 2 changes. None of the 30 shoulders had grade 3 changes in the rotator cuff tendons. There is a wide array of abnormal magnetic resonance imaging signals in shoulders of young asymptomatic individuals, but they do not have full-thickness rotator cuff tears (grade 3 lesion). Nonenhanced magnetic resonance imaging may be of limited value in defining rotator cuff injury in a patient with shoulder pain unless a full-thickness rotator cuff tear is suspected clinically.

Adolescent↗
PubMed2000

Management of rotator cuff and impingement injuries in the athlete.

OBJECTIVE: To review current concepts of the pathophysiology, diagnosis, and treatment of rotator cuff and impingement injuries in the athlete. DATA SOURCES: The information we present was compiled from a review of classic and recently published material regarding rotator cuff and impingement injuries. These materials were identified through a search of a personal literature database compiled by the authors, as well as by selective searching of the MEDLINE. In addition, much of the information presented represents observations and opinions of the authors developed over 8 to 10 years of treating shoulder injuries in athletes. DATA SYNTHESIS: Biomechanics of the normal shoulder and pathophysiology of rotator cuff injuries in the athletic population are discussed, followed by a summary of the important diagnostic features of rotator cuff and impingement injuries. The principles of rehabilitation are extensively presented, along with indications and important technical aspects of selected surgical procedures. General principles and specific protocols of postoperative rehabilitation are also summarized. CONCLUSIONS/RECOMMENDATIONS: Rotator cuff and impingement injuries in the athletic population are multifactorial in etiology, exhibiting significant overlap with glenohumeral instability. Nonoperative treatment is successful in most athletic patients with rotator cuff and impingement injuries. When nonoperative treatment fails, arthroscopic surgical techniques such as rotator cuff repair and subacromial decompression may be successful in returning the athlete to competition.

Journal Article↗
PubMed1992

[Ultrasonic examination of soft tissue injuries in the shoulder region].

Authors call attention with the demonstration of pictures of a few cases of their own to the significance of the ultrasound examination in cases of shoulder injuries. They stress that beside the demonstration of rotator cuff injuries the examination of the surrounding muscles and the labrum glenoidale should not be forgotten either. The modernization of the ultrasound devices, the improvement of the methods of examination and the obtaining of the necessary practice ensure a more and more important place to echography in the diagnosis of traumas of the motion organs.

Humans↗