Double Trouble for Overhead Throwing AthletesAthletes engaged in high-level overhead throwing sports are at risk for shoulder injuries. The constant, repetitive arm motion with force can result in a variety of problems. In this case series, athletes with both a superior labrum anterior-posterior (SLAP) tear and a tear of the infraspinatus rotator cuff muscle are the main feature. Results of surgical treatment for patients with both injuries are compared against baseball players with just the SLAP injury and repair.
This study is important because the road back to recovery after a SLAP injury is hard enough. But with the added infraspinatus injury, return to a preinjury level of play can be even more challenging. Tracking with athletes who have these injuries can aid surgeons in finding the operative technique and rehab program that will provide the best results.
The study included 17 high-level baseball players under the age of 25 years old who had arthroscopic surgery to repair both kinds of shoulder injuries. Suture anchors were used to repair both types of tears (labrum and tendon). An alternate method used for the tendon repair in some of the patients was with a free polydioxanone (PDS) suture.
At the time of the procedure, it was determined that two-thirds of the group had a partial tear of the infraspinatus tendon. The remaining one-third of the players had a full-thickness tear. After surgery, everyone wore a sling with a special (abduction) pillow designed to hold the arm away from the body. Gradual, progressive rehab with a physical therapist was the next step with the goal of returning to their preinjury play.
They were followed for at least two years and results measured using a variety of different tools. The players answered questions from a formal survey about their current playing abilities, ability to return to play, and at what level of participation.
As it turned out, the rate of return to full play was less than hoped for. Although there were no complications after surgery and no one needed a second (revision) operation, only one-third of the group could return to their preinjury level of play. A similar number of players returned to the game but at a lower level or in a different position. They just didn't have the throwing speed they needed to remain competitive. The last one-third of the group couldn't get back into the game at all.
Further analysis of the group showed that no one had what was considered an "excellent" result using the Kerlan-Jobe Orthopaedic Clinic Overhead Athlete Shoulder and Elbow (KJOC) questionnaire. Only one player scored high enough to rate a "good" score. The remaining players received a poor to fair result. And a closer look at the data revealed better results for the players whose infraspinatus tendon was repaired using the free PDS suture (compared with those whose repair was done with suture anchors).
The authors review current thoughts and theories about the specific actions of the shoulder, contact points, torsional and shear forces, and joint laxity that might contribute to these injuries. There is an interest and a need to identify the chain of events and possible causes leading to these complex shoulder injuries. A primary goal of future studies should be to use this information to find ways to prevent shoulder problems among these athletes.
In conclusion, high-level overhead throwing athletes with both a rotator cuff tear and labral tear are not likely to regain the precise kinematics (motion) needed to return to their former level of sports participation. The results from this study show that players with both injuries fare much worse than players with only the labral tear.
Jonathan P. Van Kleunen, MD, et al. Return to High-Level Throwing After Combination Infraspinatus Repair, SLAP Repair, and Release of Glenohumeral Internal Rotation Deficit. In The American Journal of Sports Medicine. November 2012. Vol. 40. No. 11. Pp. 2536-2541.
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