Last Updated on Wednesday, 23 March 2016 16:27
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question: Question: Three days ago I was mid-shot when an opposing player took my feet out from under me and I landed with all my weight on my left arm with my feet in the air. I kept on playing with some pain but then the pain got way worse when I tried to lift my hockey bag after the game. I had an MRI which showed a partial rotator cuff tear. How long will this keep me out of hockey, and how long should my arm stay in the sling?
Answer: The rotator cuff of the shoulder is a tendon sheath that covers the top, front, and back of the shoulder joint and is formed by the fusion of tendons from four muscles that run from the scapula (shoulder blade) to near the head of the humerus (upper arm bone). Tears of one or more of these tendons can occur from acute injuries such as the one you described or from chronic overuse such as in overhead throwing athletes.
The most common symptom is pain with use of the shoulder, especially using ones arms in overhead activities, and at night when trying to sleep. Pain with trying to carry heavy items as you described is also a classic symptom. Rotator cuff tears can be partial or full, and in fact, partial thickness tears may be more painful than full tears, although they may still allow stronger function. Patients with a suspected rotator cuff tear should be evaluated with a thorough physical exam of the shoulder. If the physical exam corresponds to a possible rotator cuff tear, the injury can be confirmed with ultrasound and/or MRI. Depending on the location and extent of the rotator cuff tear, the symptoms being experienced, and the physical demands of the patient, different treatment approaches may be pursued.
For partial rotator cuff tears, an initial trial of non-operative treatment is often preferable. This involves resting the shoulder or at least limiting shoulder activities, nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control and to decrease inflammation, and physical therapy to maintain range of motion. For an acute injury like the one you described, we recommend resting the shoulder in a sling with only passive range of motion for 2-3 weeks, followed by active range of motion without resistance if it can be done without increased pain. If you appear to be healing well, strengthening can be started around 6 weeks after the injury and possibly return to play in about 3 months.
In general, surgery for partial thickness rotator cuff tears is reserved for patients who do not respond well to a trial of nonoperative treatment. Surgical repair may be performed with a small open incision or arthroscopically (even smaller incisions that allow narrow surgical instruments and a camera to enter the joint), both of which have similarly reported results. Surgery may also involve removing a small amount of bone to prevent the injured tendons from getting pinched in the ball and socket joint of the shoulder.
In summary, partial rotator cuff tears from an acute injury in a young hockey player can usually be treated successfully without surgery. You will likely benefit from wearing a sling for at least a few weeks and doing physical therapy for a few months in order to allow the tear to heal properly before returning to on-ice activities.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it toeditor@letsplayhockey.com.
