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