2 min read • October 20, 2022
Posted in
By Nikhil Sinha
Cam Newton, is a football player who was diagnosed with a partially torn rotator cuff in his throwing shoulder while playing with the Panthers in the 2016 football season. While Newton was able to recover from the injury and continued to throw, his effectiveness as a thrower was not quite the same as before.
The shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The shoulder itself functions like a ball-and-socket joint with the humerus being the ball and the scapula being the socket.
Of note, there is a lubricating sac called a bursa, which is between the rotator cuff and the bone on top of the shoulder (acromion) as shown below.
Tendons attach muscles to bone. When one or more of the rotator cuff tendons are torn, the tendon becomes either partially or completely detached from the humerus. Most rotator cuff tears occur in the supraspinatus tendon but can occur in the other three tendons as well. There are two types of rotator cuff tears:
A partial tear does not completely detach the tendon from the bone. In a partial tear, the tendon becomes thinned.
A full thickness tear can be divided into a full-thickness incomplete tear and a full-thickness complete tear. In a full thickness incomplete tear, only a small part of the tendon is detached from the bone. In a full-thickness complete tear, the tendon is completely detached from the bone as shown below on the image on the right.
Rotator cuff tears can either be caused by an acute injury or by degeneration (ie wear and tear). Examples of acute injuries that can cause a rotator cuff tear include falling on an outstretched arm, getting tackled, or lifting a heavy object with a jerking motion. Tears caused by degeneration are the result of most tears. As we age, this degeneration naturally occurs and can cause shoulder pain and limit range of motion. Repetitive stress such as throwing a football, is an example of an overuse injury that can cause rotator cuff degeneration.
• A sudden “pop” or tearing sensation during physical activity.
• Pain along the upper arm between the shoulder and elbow.
• Pain that increases when reaching out and overhead, or when lifting objects.
• Aching pain at rest or at night while trying to sleep.
• Loss of strength.
• Limited motion of the shoulder, especially reaching behind.
• Crepitation (a cracking sound) when moving.
Rotator cuff tears are considered soft tissue injuries, and soft tissue injuries often heal by themselves over time with proper nonsurgical treatment. Nonsurgical treatment includes rest, avoiding activities involving the shoulder, nonsteroidal anti-inflammatory drugs to help reduce inflammation, strengthening exercises, and physical therapy. If these approaches fail, cortisone steroid injections can help with pain relief, but do not work for everyone. If nonsurgical treatment including physical therapy does not work, shoulder surgery may be an option to discuss with a sports medicine specialist or orthopedic surgeon. If you are very active in overhead work or sports, your symptoms have lasted from 6 to 12 months, you have a large (greater than 3 cm) tear, or your tear was caused by an acute injury, then surgery may be appropriate.
For many football players who have suffered rotator cuff tears, the greatest concern is whether or not they can be back playing on the football field. Having a physical therapy treatment plan including rest, technique modification, rest, flexibility and strengthening exercises, and range of motion improvement exercises is an essential part of recovering from this injury and being able to play. Often, the sports medicine team will recommend a plan centered around reduced activity, individualized rehabilitation, relief and restoration. Following surgery, the period of recovery is typically 2-4 months. Once back on the field, it is important to not dismiss warm ups, monitor your playing time, report any pain immediately to the sports medicine team, continue to collaborate with sports medicine specialists and continue to engage in improving shoulder range of motion and strength with home exercises.
Keep good posture. Leaning forward with your head and shoulder can cause a shoulder blade problem and may lead to shoulder impingement syndrome.
Avoid sleeping on your side with your arm stretched overhead. Try not to lie on your shoulder while you sleep.
Avoid smoking as it decreases blood flow to the rotator cuff.
Limit activities with repetitive overhead arm action. Speak to your physical therapist about alternate motions that might be less risky.
Practice low resistance exercise and introduce more repetitions to gradually strengthen the small muscles of the shoulder without the risk of injury. Keep movements slow and steady.
Include arm raises to the side with external rotation and rest the shoulder before a workout routine.
Frequent massage with hot and cold compresses will be able to help reduce inflammation.
The rotator cuff is a complex set of muscles giving the shoulder stability and may be prone to injury risk, especially for NFL quarterbacks who make repetitive overhead throwing motions. This article serves to detail the anatomy behind the rotator cuff, highlight what happens in a rotator cuff tear, and how these tears can be treated and prevented. Returning from such an injury requires a proactive mindset and an established plan including but not limited to physical therapy and consulting with sports medicine specialists.
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