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Justin Thompson, Pitcher for the Texas Rangers

WHAT'S INVOLVED IN A TORN ROTATOR CUFF? continued...

One of the common ways for a rotator cuff to be injured is by repetitive overhand activity. The rotator cuff tendons can be torn by a fall on the outstretched arm, which causes the rotator cuff to be pinched between the arm bone (humerus) and a part of the shoulder blade (acromion). The rotator cuff can also be torn by chronic impingement of the tendon on a bony spur from the acromion. The spur progressively breaks down the rotator cuff and may finally lead to a full thickness tear.

Patients with a rotator cuff tear often have pain with overhead activity and at night. However, some patients with a rotator cuff tear often have significant weakness in their arm and may be completely unable to lift their arm away from their side.

A rotator cuff tear is best diagnosed during a physical examination by an orthopaedist. An MRI (magnetic resonance imaging) may be obtained to confirm a full thickness rotator cuff tear. A full thickness rotator cuff tear often results in significant disability in the arm.

DIAGNOSIS

During the August 27th procedure, Andrews cleaned up some frayed ends around the rotator cuff but decided not to actually stitch up the small tear there. After Thompson complained of soreness, a preliminary MRI was done on May 8.

It was discovered that the tear had widened since the August surgery. John Conway, MD, the Rangers' team physician, said the tear appeared larger than first thought and now encompasses "more than 50%" of the depth of the tendon.

TREATMENT

An arthroscope inserted into the shoulder joint is used to view the shoulder joint and document any injury to the surfaces of the shoulder bones and also to confirm the presence, size, and position of the rotator cuff tear. The arthroscope may also be used to remove any bone spurs that are present in the shoulder area. Current techniques for repair of a rotator cuff tear require approximately a two-inch incision over the outer aspect of the shoulder. Through this incision, the rotator cuff tear is identified and the torn edge is reattached to the humerus bone with stitches.

Conway said surgery was the best option for Thompson to have a chance to play in 2001. "We can continue to rehab and hope it gets better, but at this stage he will not be ready for this season anyway," said Conway in a statement to reporters.

PREVENTION

Trainers and team doctors said that it's not unusual for pitchers to have abnormality in the cuff. Tears are unpredictable.

RECOVERY

It requires approximately 4-6 weeks for the rotator cuff tendon to heal down into the bone. During that time, if active motion of the shoulder is carried out, the rotator cuff may be pulled away from its repair site. Patients begin a formal physical therapy program at approximately 10-14 days after surgery. For the first 4-6 weeks, patients are allowed to actively move their hand, wrist, and elbow. Shoulder motion, however, is purely passive during that initial period. This passive motion is carried out by the physical therapist or by the patient with the assistance of the opposite arm. At 4-6 weeks, the rotator cuff tendon has healed enough to the bone that active assisted and active range of motion may be started.

Strengthening of the rotator cuff muscles begins about 8 weeks after surgery and continues for 2-3 months. Because of the stress from pitching, full recovery often takes a year. According to Conway, the recovery time for Thompson will be 6-12 months. Thompson will miss the entire 2000 season.

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