Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I've been coaching high school sports (football, basketball, baseball) for 25 years. I've never seen an athlete tear his rotator cuff until this year. One of our receivers got tackled in the end zone (made the touch down!) but he got hit in the shoulder from behind by three other guys. Took the medical staff quite a while to figure out what it was because they assumed his symptoms were from a stinger. Just wanted to let other coaches and docs know to look for more than the obvious. Thanks.

Answer:

There's an old saying in the medical world, When you hear hoofbeats, think horses, not zebras. The idea is to look for the obvious, not the unusual. In the case of young athletes, a rotator cuff tear would be unusual -- most athletes experience this type of injury only after prolonged, repetitive overuse. But with the type of injury you describe, the history alone should tip off the examiner that there may be more going on than a simple burner or stinger. Injuries to the neck and upper arm can stun the nerve plexus in that area causing what you referred to as burners or stingers. Numbness and even what looks like sudden paralysis develops but goes away fairly quickly (often by the end of the game). The idea to look deeper would be supported by the lack of improvement in symptoms. An athlete who is still in pain and can't lift the arm or move it in all directions should be re-evaluated quickly. An early diagnosis and treatment can save the athlete's arm and career. A delayed diagnosis and waiting too long to repair the damage could result in further damage to the soft tissues. Worst case scenario is that too long of a delay in treatment could mean the soft tissues can't be repaired. A loss of motion, strength, and function could leave the athlete out of the game. The excellent tendon quality in young (adolescent) athletes is what makes a complete recovery possible. Before inflammation and excessive swelling fill the area, the surgeon can clean up the damage, repair the tear(s), and send the athlete along to rehab. Your point is well taken. Although rupture of the rotator cuff in young athletes is rare, it can happen. The case of your player demonstrates the need for careful examination in any athlete who suffers a direct blow to the shoulder. Imaging studies can be followed by arthroscopic exam whenever athletes present with shoulder pain, weakness, and loss of motion that doesn't go away quickly after the injury. With early intervention, young athletes have an excellent chance of recovery and return to sports. Thanks for taking the time to write in and share your experience with others who might see something similar and help athletes get the prompt evaluation, diagnosis, and treatment they need. Kimberly A. Turman, MD, et al. Massive Rotator Cuff Tear in an Adolescent Athlete: A Case Report. In Sports Health. January/February 2010. Vol. 2. No. 1. Pp. 51-55.

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