Surgical repair and rehabilitation of a combined 330° capsulolabral lesion and partial-thickness rotator cuff tear in a professional quarterback: a case report

Rehabilitation of An Analgesic Bracelet Based on Wrist-Ankle Acupuncture in Patients with Rotator Cuff Injury: A Randomized Trial

Objective

To evaluate the effect of transcutaneous electrical nerve stimulation (C-TENS) in the rehabilitation of rotator cuff injury.

Methods

A total of 60 patients diagnosed with mild to moderate rotator cuff injury were randomly divided into the control group and test group. Both groups received conventional rehabilitation treatment including physical therapy, joint mobilization, interventional therapy, and family recovery training. The test group additionally received TENS treatment on the upper area 4 or 5 of the wrist, based on the wrist-ankle acupuncture (WAA) theory. The results of the visual analogue scale (VAS), shoulder range of motion (ROM), and Constant-Murley score (CMs) were collected before and after the 1^st treatment and after the 5^th treatment. The differences of those indicators between the two groups were analyzed statistically.

Results

The VAS scores of measurement points after treatment were all improved compared with those at baseline. There was a significant difference between the two groups after the 1^st and the 5^th treatment (p < 0.05), and the improvements in the test group were better than those in the control group. The ROM of flexion, extension, abduction, adduction, internal rotation, and external rotation after the 1^st treatment and 5^th treatment in both groups were all improved compared with those at baseline. There was no significant difference between two groups. The CMs of the two groups after the 5^th treatment were all improved compared with those at baseline. There was no significant difference between two groups. No adverse events occurred during the treatment.

Conclusion

Electrical stimulation on the wrist combined with conventional rehabilitation is more effective in relieving pain than the conventional rehabilitation alone. Electrical stimulation on the wrist combined with conventional rehabilitation has no obvious effect in improving shoulder joint mobility and shoulder function.

Recurrent Labral Tearing on Magnetic Resonance Imaging Is Not Predictive of Diminished Participation Among National Football League Athletes

PURPOSE

To investigate the prevalence of shoulder labral repair and utility of magnetic resonance imaging (MRI) in determining the risks of recurrent labral tearing and impact on future participation in the National Football League (NFL).

METHODS

Athletes invited to the NFL Combine between 2012 and 2015 were retrospectively reviewed. Athletes with a history of labral repair and MRI of the operative shoulder at the Combine were included in the study for further analysis, excluding athletes without a history of labral repair, labral repair without MRI at the Combine, additional procedure to the operative shoulder, or athletes still undergoing rehabilitation at the time of the Combine after labral repair. All MRIs were reviewed to determine initial labral repair location, the presence of recurrent tearing, and any concomitant shoulder pathology. Prospective information on future NFL participation in regard to draft status, games played, and games started in the athlete's first NFL season after the Combine was compared between athletes with a history of labral repair with and without recurrent tearing versus all other athletes participating in the Combine.

RESULTS

A total of 132 (10.1%) athletes underwent 146 shoulder labral repair procedures before the NFL Combine, of whom 32% (n = 39 athletes, n = 46 shoulders) had recurrent labral tears on MRI. Athletes with recurrent tears were more likely to have undergone bilateral labral repairs (P = .048) and possess concomitant shoulder pathology (P < .001). Recurrent labral tearing was significantly more common in the posterior labrum in athletes with a history of posterior labral repairs (P = .032). Prospective participation in the NFL in terms of games played (P = .38) or started (P = .98) was not significantly reduced in athletes with a history of labral repair compared with those without repair. Participation was not diminished in athletes with recurrent labral tears compared with those with intact repairs or those with evidence of degenerative joint disease.

CONCLUSIONS

Athletes invited to the NFL Scouting Combine with a history of bilateral repair, posterior labral repair, and concomitant shoulder pathology are at high risk of recurrent labral tearing on MRI. No significant reduction in NFL participation the year after the Combine was seen in athletes with a history of labral repair, recurrent labral tearing, or degenerative joint disease who were successfully drafted into the NFL. In athletes with a history of labral repair, assessment of labral integrity on MRI alone is not predictive of future short-term participation.

LEVEL OF EVIDENCE

Level IV, prognostic study-case series.

Management of In-Season Concurrent Rotator Cuff Tear With Shoulder Instability in Professional Contact Football Athletes; Respect the Career Goals!

Introduction

Professional sports injuries are usually all dealt with at one single operation to return the player to the sport after appropriate rehabilitation. We questioned the assumption that rotator cuff tears must be repaired concurrently with instability syndromes, and aimed to allow a professional rugby league player to achieve career goals by NOT correcting all pathology at one surgery.

Case Presentation

A professional rugby league player presented with acute shoulder instability on a setting of a chronic full thickness rotator cuff tear. We performed an “in season” arthroscopic stabilization on an elite rugby league player, leaving a previously diagnosed large full thickness rotator cuff tear untreated. This allowed aggressive rehabilitation and return to contact competition at 12 weeks post-surgery. The player achieved a long held career goal of winning a premiership ring before undertaking rotator cuff repair at the end of the season. Latest follow up at seven years (still at elite level) demonstrated an asymptomatic shoulder.

Conclusions

The assumption that all pathology found at surgical exploration requires correction to play at elite level is not universally correct. We postulate that whilst rotator cuff deficiency has severe long-term sequelae, it is shoulder instability alone that prevents high level contact sports participation. Career goal management is an important part of managing elite level athletes. We have demonstrated that by careful management of the specific pathology preventing participation can allow elite athletes to achieve career goals without compromising long-term health.

[Rehabilitation concepts and return to sport after interventions on the shoulder]

BACKGROUND

Rehabilitation of athletes following surgical interventions for shoulder injuries is of utmost importance for recovery and return to sport.

OBJECTIVES

The aim was to determine adequate concepts for rehabilitation following shoulder surgery in athletes.

METHODS

A selective literature search was carried out in PubMed and a review of the available concepts is given taking personal experiences as well as national and international recommendations into consideration.

RESULTS

This article presents the basic principles of functional rehabilitation, the kinetic chain and the different phases in rehabilitation. Specific rehabilitation concepts and return to sport strategies following traumatic dislocation, superior labrum anterior to posterior (SLAP) lesions and rotator cuff tears are presented. There is little high-level scientific evidence available for the treatment of these patients and most concepts are based on clinical experience and expert opinion.

CONCLUSION

Rehabilitation of athletes with shoulder injuries requires a broad consensus strategy with respect to the next steps. Individual concepts for rehabilitation should take surgical and patient-specific criteria into consideration. Further research is urgently required to develop evidence-based recommendations.

Humeral stress edema: an injury in overhead athletes quarterback with humeral "shin" splints-a case report

Stress injury to the distal humerus has been reported as a cause of chronic arm pain among competitive tennis players. As the serve is technically similar to an overhead throwing motion, it is conceivable that this injury could occur in other overhead athletes. Overuse injuries, including rotator cuff tears, ulnar collateral ligament injuries, and joint sprains have routinely been reported in quarterbacks, but there are few reported cases of upper extremity bony stress injuries in these athletes. Magnetic resonance imaging aids in the diagnostic evaluation of an upper extremity injury as it can identify numerous structural injuries and early stress changes within bone. Accurately diagnosing stress reactions helps prevent progression toward stress fracture, which is possible if conservative measures are initiated early in the rehabilitation period. In this article, we report the case of an elite college quarterback who presented with localized elbow pain while throwing.