Rotator Cuff Injuries in Tennis Players

Tennis Injuries Among German League Players: Investigating Patterns and Epidemiology of Acute and Chronic Injuries

Purpose

While injuries among elite tennis athletes are extensively documented, a notable research gap exists regarding tennis injuries among club-level players. This study examines tennis injuries in German league players, with a particular emphasis on the impact of racquet properties and court surfaces, distinguishing between chronic and acute injuries.

Patients and Methods

Retrospectively analyzing data from 600 tennis players over a 1.5-year period, a standardized questionnaire covered anthropometrics, injury characteristics, equipment usage, and court surface conditions.

Results

The study identified 1012 tennis-related injuries, averaging 1.7 per player. Acute injuries predominantly affected the lower extremity (56%), with ankle injuries being the most prevalent, and ligaments were the most commonly affected structures (36.4%). Chronic complaints (reported by 364 athletes) focused on the upper extremity (63.2%), primarily tendon injuries (56.8%). Racket properties exhibited no significant impact on chronic upper extremity injuries.

Conclusion

This study highlights a high incidence of acute lower extremity injuries, especially ankle ligament injuries, among German league tennis players. It offers crucial insights for devising targeted injury prevention strategies applicable to amateur, semi-professional, and professional tennis players, despite finding no significant link between racquet material and chronic upper extremity injuries.

Shoulder pathologies in CrossFit: a magnetic resonance imaging study of 51 cases

BACKGROUND

Recent scientific work shows that the most common injuries in CrossFit© occur in the shoulder joint. This paper aims to provide a review of shoulder pathologies in a young CrossFit© cohort via MRI and clinical examination.

METHODS

A survey was conducted in 13 CrossFit "boxes" in Germany, in which athletes with recurrent shoulder pain could report for a clinical examination and MRI diagnostic. Fifty-one CrossFit athletes with chronic shoulder pain agreed to participate in the study and were then examined physically and by MRI.

RESULTS

Fifty-one active CrossFit athletes aged 21-45 years (mean 33.7 years, 35 male and 16 female) were recruited. The most frequently detected pathologies were partial lesions of the supraspinatus tendon (N.=25; 49%) and labral lesions (N.=11; 21.6%). The findings also identified partial lesions of the subscapularis tendon (N.=9; 17.6%), pulley lesions (N.=9; 17.6%), and partial lesions of the infraspinatus muscle (N.=2; 3.9%).

CONCLUSIONS

These data demonstrate the need for a specific focus on particular shoulder injuries in CrossFit. Knowledge about the type of shoulder pathologies caused by CrossFit training allows for training-specific adaptations with regard to prevention, as well as a more targeted, sport-specific therapy. This study is the first in the literature to present on structural changes in the shoulders of active CrossFit athletes.

Return to Play in the Professional Athlete

The management of any injury in elite athletes poses unique challenges distinct from the general population because the goal is rapid recovery and return to play (RTP) while simultaneously managing residual symptoms and minimizing risk of reinjury. The time required for treatment, recovery, and return to peak performance can have consequences for both the athlete and his or her team: financial implications, psychological stressors, team dynamics, and future performance. RTP after an injury in the professional athlete requires a complex decision-making process with many stakeholders. Several factors influence this decision, not the least of which is the type and mechanism of injury. This article provides an overview of the RTP process including nonmedical factors that may influence this decision, common injuries seen in professional athletes, injury patterns particular to certain popular sports, and imaging guidelines for such injuries.

Criteria, Timing, and Factors Associated With Return to Competitive Sport After Rotator Cuff Surgery

Rotator cuff pathology in competitive athletes is common and may produce chronic symptoms and joint disability, impairing sports participation and leading to premature retirement. Athletes are a high-functioning patient population with unique characteristics. Decision-making for return to sport is a complex and multifactorial process. Literature is sparse and does not provide precise guidelines to assist physicians to make the right decision. This review aimed to highlight factors affecting outcome, timing, and criteria for return to competitive sport after rotator cuff surgery to help physicians to clearly counsel athletes and make high-quality decisions for return to sport.

Single-row or Double-row Rotator Cuff Repair

Rotator cuff tears are potentially a career-ending injury for athletes. The surgeon must identify which patients will benefit from surgical repair. The factors to consider are age, type of sport, time since injury, athlete's level, and the patient's expectations. An essential and independent fact determining the surgical treatment is whether the damage is due to overuse or from a traumatic/collision injury. Some sports are more demanding than others resulting in different return-to-participation (RTP) rates. This RTP return rate can present a real challenge and more so by a desire to reach the pre-injury level of play. The incidence of rotator cuff tearing varies from one sport to another. In football players this can be 12% whereas for tennis players this incidence is 4% to 17%. The RTP rate must be considered when making treatment decisions and is influenced by the level of the athlete: for professional athletes, the rate is 61%, and for recreational 73%. When the surgeon and the patient decide on the surgical treatment, the surgeon must consider whether to perform a double-row or a single-row rotator cuff tendon repair. The decision-making and the surgical technique will be addressed.

Effects of Yoga Training Applied with Telerehabilitation on Core Stabilization and Physical Fitness in Junior Tennis Players: A Randomized Controlled Trial

INTRODUCTION

This study aimed to investigate the effects of yoga training applied with telerehabilitation on core stability, and strength, balance, flexibility, upper extremity stability, body awareness, and quality of life in tennis players aged 6-18 years.

METHODS

Forty tennis players were randomly divided into two groups to participate in this study. The control group (n = 20) continued tennis training and was informed about the importance of the core region. The yoga group (n = 20) received yoga training with telerehabilitation 2 days a week for 8 weeks. Athletes were evaluated with sport-specific core muscle strength and stability tests, the back scratch test, the sit and reach test, the flamingo balance test, the y-balance test (lower quarter), the upper extremity closed kinetic chain stability test, the SF-36, and body awareness questionnaires. Measurements have been done in the tennis club before and after the 8 weeks of training.

RESULTS

A significant increase was determined in core strength and stability, sit and reach, back scratch test, upper extremity stability, and body awareness questionnaire in the yoga group (p < 0.001). Flamingo and Y balance test results were significant (p < 0.002). Positive improvements were found in SF-36s energy-fatigue level, mental well-being, social function (p < 0.042), pain (p < 0.005), and general health (p < 0.001). A significant increase was observed in the core strength measurement mean score in the control group (p < 0.018). Sit and reach test, flamingo test, and body awareness questionnaire were found to be significant after the intervention (p < 0.001). Significant improvements were found in the pain (p < 0.042), and mental well-being (p < 0.001) sub-parameters of the SF-36.

CONCLUSION

In the study, it was concluded that yoga training applied with telerehabilitation in tennis players aged 6-18 has a positive effect on core strength, and stabilization, physical fitness parameters, quality of life, and body awareness.

Einleitung

Mit dieser Studie sollten die Auswirkungen von Yogatraining in Verbindung mit Telerehabilitation auf Rumpfstabilität, Kraft, Gleichgewicht, Flexibilität, Stabilität der oberen Extremität, Körperwahrnehmung und Lebensqualität bei Tennisspielern im Alter von 6 bis 18 Jahren untersucht werden.

Methoden

Vierzig Tennisspieler wurden randomisiert in zwei Gruppen aufgeteilt und nahmen an der Studie teil. Die Kontrollgruppe (n = 20) führte das Tennistraining fort und wurde über die Bedeutung der Rumpfregion aufgeklärt. Die Yoga-Gruppe (n = 20) erhielt an 2 Tagen pro Woche über 8 Wochen ein Yogatraining mittels Telerehabilitation. Die Sportler wurden mittels sportartspezifischer Tests zur Kraft und Stabilität der Rumpfmuskulatur, dem Back-Scratch-Test, dem Sit-and-Reach-Test, dem Flamingo-Balance-Test, dem Y-Balance-Test (unteres Viertel), dem Closed Kinetic Chain Upper Extremity Stability Test sowie dem SF-36 und dem Fragebogen zur Körperwahrnehmung beurteilt. Die Messungen wurden im Tennisclub vor und nach dem 8-wöchigen Training durchgeführt.

Ergebnisse

In der Yoga-Gruppe wurde ein signifikanter Anstieg der Rumpfkraft und -stabilität sowie im Sit-and-Reach-Test, Back-Scratch-Test, der Stabilität der oberen Extremität und beim Fragebogen zur Körperwahrnehmung festgestellt (p < 0,001). Die Ergebnisse des Flamingo-Balance-Tests und des Y-Balance-Tests fielen signifikant aus (p < 0,002). Verbesserungen zeigten sich beim SF-36-Score für Energieverlust und Erschöpfung, psychisches Wohlbefinden, soziale Funktion (p < 0,042), Schmerzen (p < 0,005) und allgemeine Gesundheit (p < 0,001). In der Kontrollgruppe war ein signifikanter Anstieg des mittleren Scores der Rumpfkraftmessung zu beobachten (p < 0,018). Der Sit-and-Reach-Test, der Flamingo-Test und der Fragebogen zur Körperwahrnehmung fielen nach der Intervention signifikant aus (p < 0,001). Bei den Unterparametern Schmerz und psychisches Wohlbefinden des SF-36 wurden signifikante Verbesserungen festgestellt (p < 0,042 bzw. p < 0,001).

Diskussion/Schlussfolgerung

Die Studie kam zu der Schlussfolgerung, dass Yoga-Training bei Anwendung mittels Telerehabilitation bei Tennisspielern im Alter von 6 bis 18 Jahren einen positiven Effekt auf die Rumpfkraft und -stabilisierung, die Parameter der körperlichen Fitness, die Lebensqualität und die Körperwahrnehmung hat.

Case report: Self-performed orthopedic exams in telehealth treatment of a youth athlete with acute rotator cuff strain

Background

Sports-related rotator cuff muscle injury is one of the most prevalent pathologies affecting overhead sports athletes. Since the COVID-19 pandemic and its subsequent stay-at-home protocols, physical therapy has transited into a new realm of telehealth. Current evidence regarding examining and managing RTC strain in telehealth physical therapy is minimal.

Case presentation

A self-referred 14-year-old female Chinese semi-professional tennis player presented with an acute right RTC strain. The mechanism of injury involved forehand strokes with left trunk rotation. No ligamentous or labral damage was observed on Magnetic Resonance Imagining. The individualized care plan included virtual partner-assisted assessment, online instructions on therapeutic exercises, and education with psychosocial considerations.

Outcome and follow-up

After a 6-week intervention, the patient demonstrated complete shoulder range of motion, full muscle strength, complete return-to-practice, 0% Quick DASH disability index, and 6/68 on the Tampa Scale for kinesiophobia.

Discussion

This case report demonstrated that telehealth is an accessible and cost-effective option for youth tennis athletes with RTC strain. This unique case showed a detailed roadmap from examination to discharge of this plan of care. There are also barriers including test and measure validity, and communication difficulties to be considered. Despite the challenges, this case was a good example of telehealth being an effective, repeatable, and cost-efficient option for patients with poor healthcare access.

Professional tennis players suffer high prevalence of shoulder alterations during the season: a possible tennis shoulder syndrome

PURPOSE

To analyze the shoulder alterations of professional tennis players during the competition season and to compare the differences between their dominant vs. non-dominant shoulders, as well as gender and age differences.

METHODS

Two-hundred and seventy shoulders of (78 men and 57 women) professional active tennis players were assessed during 3 ATP and WTA tournaments.

MAIN VARIABLES STUDIED

long head of biceps (LHB) tenderness and synovitis; glenohumeral internal rotation deficit (GIRD), total range of motion (TRM), external rotation (ER) and scapular dyskinesis (DK). Secondary variables: shoulder dominance, gender, age, training hours, ranking, type of backhand. LHB tenderness and synovitis were assessed by clinical and ultrasound examination, TRM with goniometer and DK by dynamic observation.

RESULTS

LHB tenderness of the dominant shoulder was present in 35% of all players, being more prevalent in women (47.4%) than men (26.9%) p = 0.023. LHB synovitis of the dominant shoulder was present in 20.2% of all players without difference between genders (n.s). High prevalence of GIRD was found in both dominant (87.4%) and non-dominant (56.3%) shoulders, being more prevalent in the dominant shoulder p = 0.00005. TRM was decreased in both dominant (144.5° ± 20.2°) and non-dominant shoulders (161.2° ± 18.9°) p = 0.00005. ER was normal in dominant (93.8° + /9.3°) and non-dominant shoulders (93.4° + /8.4°) (n.s). DK was present in 57.7% of dominant and 45.9% of non-dominant shoulders (n.s). The combination of LHB alterations, GIRD and DK in the dominant shoulder was present in 13.3% of the participants. There were no significant differences between younger (< 22 years) vs older players (≥ 22 years).

CONCLUSION

Professional tennis players actively playing suffer a high prevalence of LHB inflammation, GIRD, scapular dyskinesis and decreased TRM in their dominant and non-dominant shoulders. The LHB is a significant cause for anterior shoulder pain in this population. Women suffer more LHB tenderness than men. Young players are as affected as older players.

LEVEL OF EVIDENCE

Level IV.

Advances in the Treatment of Rotator Cuff Tears: Management of Rotator Cuff Tears in the Athlete

Unique biomechanical factors in the overhead and throwing athlete lead to a spectrum of rotator cuff pathology, usually with progressive lateralization of the supraspinatus footprint. Initial comprehensive nonoperative management is indicated for all athletes. Progression to arthroscopic debridement, repair of concomitant injuries, and possible rotator cuff repair with a transosseous equivalent technique are the current management strategies for athletes when nonoperative management fails.

Harms-related data are poorly reported among randomized controlled trials underpinning the American Academy of Orthopaedic Surgeons clinical practice guideline recommendations for rotator cuff injuries

BACKGROUND

Results produced from randomized controlled trials (RCTs) help guide clinical decision making and health policy. Therefore, it is essential that RCT outcomes- including harms (eg, adverse events)-are adequately reported such that clinicians, patients, and policy makers are equipped with all necessary information to complete risk-benefit assessment of the RCT's intervention. Here, we evaluated the quality of reporting of harms (eg, adverse events) in RCTs cited as supporting evidence for recommendations in the American Academy of Orthopaedic Surgeons (AAOS) Management of Rotator Cuff Injuries clinical practice guidelines (CPGs) using the Consolidated Standards of Reporting Trials (CONSORT) Extension for Harms Checklist.

METHODS

To quantify adherence to CONSORT Extension for Harms items, each RCT was screened for pertinent information satisfying each checklist item. Screening of CPG reference sections for RCTs underpinning CPG recommendations, as well as data extraction from each of the included RCTs, was performed in a blind and duplicate manner. Descriptive statistics-including frequencies, percentages, and 95% confidence intervals-were used to summarize overall percent adherence to checklist items. A linear regression model assessed the relationship of CONSORT Harms reporting over time.

RESULTS

Ninety-nine RCTs were included in our final sample. Fifty-seven RCTs (of 99; 57.6%) were conducted at a single center. Common funding sources included private (nonindustry) (17/99; 17.2%), private (industry) (8/99; 8.1%), and public (7/99; 7.1%) sources. Sample size for each trial most often consisted of <50 participants (29/99; 29.3%) or 51-100 participants (50/99; 50.5%). The average number of CONSORT Extension for Harms items adequately reported across all included RCTs was 5.7 (of 18; 31.7%). None of the included trials reported all 18 items. Twenty-six RCTs (of 99; 26.3%) adequately reported ≥50% of eligible checklist items. Fifty-nine RCTs (of 99; 59.6%) adequately reported ≤33% of eligible checklist items. Items with ≥50% adherence included item 2, item 7a, and item 8a. Items with ≤20% adherence included item 3b, item 4d, and item 5. Results from our linear regression demonstrated a slight, yet nonsignificant, improvement in adherence to the Harms Extension over time (R² = 0.009; P = .407).

CONCLUSIONS

Our results illustrate the poor state of harms reporting within RCTs cited as supporting evidence for the AAOS Management of Rotator Cuff Injuries CPG. Efforts to address these gaps in reporting are warranted, as complete knowledge of potential harms is critical to patients, clinicians, and health policy makers when determining best practice decisions in orthopedic surgery.

A longitudinal analysis of injury characteristics among elite and amateur tennis players at different tournaments from electronic newspaper reports

The non-complexity of tennis, coupled with its health benefits, renders it appealing and encourages varying competitions at different levels of age, gender, and expertise. However, the rapid increase in the participation rates witnesses a surge in injury occurrences, prompting the need for in-depth analysis to facilitate immediate intervention. We employed a media content analysis technique in which tennis-associated articles published in the last 5 years were examined. A total of 207 news reports were gathered and screened for analysis. Subsequently, 71 articles were excluded from the study due to content duplications or summary updates of existing news articles, while 23 news articles were also excluded from the study due to inappropriateness. Finally, 113 news reports directly related to injury in tennis were coded and analyzed. We examined various types of injuries reported from the screened articles with respect to their status (fresh, recurrent, and recovery) across expertise levels i.e., elite, or amateur. Similarly, the incidence of injury occurrences based on the types of tournaments the players engage in was also investigated. A chi-square analysis was employed to achieve the objectives of the study. Occurrences of tennis-associated injuries are disseminated across expertise levels [χ ( 18 ) 2 = 16.542; p = 0.555], with knee, hip, elbow, and shoulder injuries being highly prevalent in both elite and amateur players. Nevertheless, it was noted that elite players suffered a staggering 72.60% of injury-related problems, while amateur players sustained 27.40% of injuries. Moreover, the status of injury spreads based on types of tournaments [χ ( 4 ) 2 = 3.374; p = 0.497], with higher occurrences of fresh and recurrent injuries, while low recovery rates were observed. The findings further demonstrated that injuries are sustained regardless of tournament types [χ ( 36 ) 2 = 39.393; p = 0.321]. However, most of the injuries occurred at international tournaments (85%). Whereas, only 5.30% of the injuries occurred at national/regional tournaments while 9.70% were unidentified. It could be deduced from the findings of this investigation that elite players are more prone to injuries compared with amateur players. Furthermore, the most common tennis-related injuries affect the lower, trunk, and upper regions of the body, respectively. A large number of the reported tennis injuries are fresh and recurrent, with a few recoveries. The international tennis tournaments are highly attributed to injury occurrences as opposed to the national/regional tournaments. The application of the media-based data mining technique is non-trivial in projecting injury-related problems that could be used to facilitate the development of an injury index peculiar to the tennis sport for prompt intervention.

Surveillance of Injury Types, Locations, and Intensities in Male and Female Tennis Players: A Content Analysis of Online Newspaper Reports

The popularity of modern tennis has contributed to the increasing number of participants at both recreational and competitive levels. The influx of numerous tennis participants has resulted in a wave of injury occurrences of different types and magnitudes across both male and female players. Since tennis injury harms both players' economic and career development, a better understanding of its epidemiology could potentially curtail its prevalence and occurrences. We used online-based tennis-related injury reports to study the prevalence, location types, and injury intensities in both male and female tennis players for the past five years. It is demonstrated from the chi-square analysis that injury occurrences are significantly associated with a specific gender (χ2(18) = 50.773; p = 0.001), with male players having a higher risk of injury manifestation (68.10%) as compared with female players (31.90%). Nonetheless, knee, hip, ankle, and shoulder injuries are highly prevalent in both male and female players. Moreover, the injury intensities are distributed across gender (χ2(2) = 0.398; p = 0.820), with major injuries being dominant, followed by minor injuries, whilst a few cases of career-threatening injuries were also reported. It was similarly observed that male players recorded a higher degree of both major, minor, and career-threatening injuries than female players. In addition, male players sustained more elbow, hip, knee, shoulder, and thigh injuries than female players. Whereas, female players mostly suffered from Achilles and back injuries, ankle and hamstring injuries affected both genders. The usage of online newspaper reports is pivotal in characterizing the epidemiology of tennis-related injuries based on locations and gender to better understand the pattern and localization of injuries, which could be used to address the problem of modern tennis-related injuries.

Association Between Spikes in External Training Load and Shoulder Injuries in Competitive Adolescent Tennis Players: The SMASH Cohort Study

Background:

Few studies have examined the association between the acute:chronic workload ratio (ACWR) and complaints/injuries in young tennis players. Primary aims of this study were to investigate if accumulated external workload “spikes” in ACWR of tennis training, match play, and fitness training, and to see if high or low workload/age ratio were associated with the rate of shoulder complaints/injuries in competitive adolescent tennis players. Additional aims were to report the incidence of complaints/injuries stratified by sex and level of play and to describe shoulder injury characteristics.

Hypothesis:

Rapid increases in external workload are associated with the incidence of shoulder complaints and injuries.

Study Design:

A cohort study.

Level of Evidence:

Level 3.

Methods:

At baseline, 301 adolescent competitive tennis players, 13 to 19 years, were screened and followed weekly for 52 weeks with questionnaires, in the years 2018 to 2019. Information about time-varying accumulated external workload spikes (uncoupled ACWR >1.3), and workload/age ratio, in 252 uninjured players were used in Cox regression analyses with the outcomes shoulder complaints (≥20) and injuries (≥40) (Oslo Sports Trauma Research Center Overuse Injury Questionnaire).

Results:

For each additional workload spike in tennis training/match play, the hazard rate ratio (HRR) was 1.26 (95% CI, 1.13-1.40) for a shoulder complaint and 1.26 (95% CI, 1.15-1.39) for a shoulder injury. The HRR for fitness training was 1.11 (95% CI, 1.02-1.20) for a shoulder complaint and 1.18 (95% CI, 1.09-1.27) for a shoulder injury. Workload/age ratio was not associated with the rate of shoulder complaints or injuries.

Conclusion:

Accumulated external workload spikes of tennis training, match play, and/or fitness training are associated with a higher rate of shoulder complaints and shoulder injuries in competitive adolescent tennis players.

Clinical Relevance:

Consistency in training load on a weekly basis is most likely more beneficial for adolescent tennis players regarding shoulder complaints/injuries than a training schedule comprising rapid increases (ie, spikes) in workload.