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Jordan Fiedor

SER 425 01

Dr. Tuscan

23 November 2020

Injuries are inevitable and will happen eventually on any sports team, therefore when an

injury does occur there needs to be a professional on site at all times. The professional must be

able to provide care, treatment, and assistance whenever an athlete needs help. Even though all

injuries can differ from type, severity, and location, there will always be a protocol that will need

to be executed for each injury. Starting at the time of incident, all the way till the athlete is fully

recovered and able to step back onto the field or jump back into the water. To show how a

professional could administer and implement care for a patient, I am going to present how a

rotator cuff injury is diagnosed, treated, and fully recovered before the athlete returns to play.

During a conference game for a men’s baseball team, a junior pitcher had to be removed

from the game and stop pitching due to a shar, intense pain in his shoulder after throwing a pitch.

The pitcher has had issues with his throwing shoulder in the past but decided to work through the

pain and hope that the discomfort would eventually go away. The pain could be recreated with

lateral or abduction movements of the arm and after throwing for a long duration caused pain and

soreness to the lateral portion to the shoulder. He was unable to lift up his arm without creating a

lot pain to his shoulder that would radiate down his arm.

Following the time of injury, the pitcher would address any concerns about the symptoms

with the Athletic Trainer (AT) or team physician that would be on-site during the sporting event.

The medical professionals would follow up with some physical tests in order to get a better

understanding of the potential injury and get a firm diagnosis. Some of the injuries that could
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come from the symptoms could be a muscular strain, a rotator cuff injury, SLAP tear, or some

type of impingement in the shoulder. These injuries are split between developing in a younger

population and developing later in life. A rotator cuff injury can be caused by repetitive trauma

from deceleration forces during throwing motions, which could be in this specific scenario. The

AT or physician would begin to question the athlete if has had an previous complications or

injuries to that shoulder. There has been no other major injury or trauma other than pain to the

specific site of where the injury occurred while he was pitching. The medical professional then

would start to palpate the site of injury and ask where he feels the most pain and tenderness in

order to get a better understanding of what the injury could be.

Since this is a shoulder injury and we suspect it came from overhead throwing we should

look towards injuries that are commonly associated with this. Two tests that come to mind that

deal with the shoulder and the overall stability of it are, the crank test and the drop arm test. The

crank test is associated with a labrum tear (SLAP tear) and the athlete would be placed onto a

table and be laying in a supine position. The AT or physician would move his arm throw a range

of motion of about 160 degrees of elevation in the scapular plane and flex the elbow at 90

degrees while applying pressure of the arm into the shoulder joint and rotating the arm externally

and internally. The reason for this is to cause the labrum to pinch and notice any clicking with

movement with or without pain. The other test mentioned is not similarly conducted as the crank

test. The drop test has the athlete standing or seated with proper posture. The professional then

would take arm of the injured side and raise it laterally from his side until the arm is at the

position of 90 degrees or parallel to the floor with external rotation. Once the patient reaches the

90 degrees with the aid of the professional, the professional will then remove their hand and

observe if the athlete is able to support their arm. If the athlete is unable to support their arm and
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allows the arm to drop, then this indicates a positive test which would could indicate tearing to

muscles or tendons of the rotator cuff. When preforming both of these tests with the pitcher he

had no pain or pitching during the crank test, but when performing the drop arm test, he was

unable to support his arm and allowed for a sudden drop which indicates a positive test.

After evaluating the athlete’s current condition, the AT would call or email to schedule a

future appointment with the team’s physician or orthopedic surgeon for further testing. This

testing would include radiographs, ultrasound, MRI or MR arthrogram. Following assessment

from the surgeon, they would consider which type of test would be necessary for the athlete.

After completing all required tests, the orthopedic will examine and review all tests and give a

conclusion on what the results are to the athlete. The result in this case is a large tear since the

tear was three to four centimeters and there was a minimal retraction of the torn ends. This will

conclude to surgical treatment that is necessary for our athlete to return to play.

With news of knowing that surgery would be necessary, the athlete should communicate

with their athletic trainers, so everyone knows the current situation. After surgical treatment, the

patient would meet with the orthopedic surgeon to receive news of how the surgery went and

how the recovery plan or protocol will be unfolded. They will talk and discuss all the

expectations with each phase of recovery and the timeline of the whole recovery process. After

the meeting with the physician, the athlete should again inform the training staff of the result of

surgery and communicate how the recovery protocol will take place.

The protocol that the athlete will perform has four different phases. Phase I will be aimed

towards passive motions and protection of the rotator cuff. The second phase contains more

active motions than the first phase and continues to add stretching to the shoulder. The third

phase begins to initiate strength training with the use of TheraBand’s and focuses on
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strengthening the rotator cuff. The last phase transitions into advanced strength training where

the athlete is allowed to use dumbbells and starts anywhere from two to five pounds. After each

follow up with the physician, the physician will determine if there needs to be any modifications

to the recovery program. Each phase throughout the program should show gradual improvement

to the injured site where after phase IV, the athlete should be able to resistance train to the same

volume and intensity as they did prior to the injury.

Each phase is constructed by the orthopedic surgeon with each phase having certain

expectations and goals that need to be met before advancement to the next. The physician or AT

will develop a workout plan for each phase based on set and rep schemes for each exercise. How

fast the athlete can advance each phase determines on his progression from week to week. The

AT and athlete will keep communication daily with each to ensure the athlete is completing

physical therapy every day or the days he is assigned and completed every rep in order to ensure

the best outcome possible. Each of the four phases lasts from anywhere from two to six weeks.

The time frame for each phase heavily depends on how well the athlete is progressing.

With phase I, the athlete should begin to regain some ROM but the majority of phase I is

to focus on stiffness in the shoulder, cervical, and scapular regions. Some other regions can be

the lower arm and hand. The second phase focuses on increasing ROM and active motion

heavily focused during this phase to reach full ROM. Phase III is performed to gain

proprioception and minor strength in the shoulder predominately while the fourth phase is to gain

strength in the shoulder that would allow the athlete to play their sport again. Phase IV utilizes

more dumbbell orientated exercises with the use of TheraBand exercises as well.

For the athlete to return to play of their sport, they must be able to gain their full strength,

range of motion, stability, and shoulder function that the athlete had prior to the injury. The
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patient may be allowed to continue their sport after the fourth phase is completed and all

symptoms have been resolved. The decision to allow the player to begin participating in their

sport will have to be a dual decision from their physician and AT. The coach has some sort of

say but mostly deals with the full magnitude of work they will do at practice from the advice of

the training staff. Even though the trainers, doctors, physical therapists, and coaches’ have

control of the treatment and what the athlete is allowed to do, it is the athlete to decide if they are

ready and capable to play at the highest level possible.

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Bibliography

 Week 7 UE Injury PowerPoint

 https://www.ajronline.org/doi/10.2214/AJR.08.1241#:~:text=In%20summary%2C

%20MR%20arthrography%20is,tears%20and%20partial%2Dthickness%20tears

 https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-rotator-

cuff-tear

 https://www.health.harvard.edu/a_to_z/rotator-cuff-injury-a-to-z

 https://www.matthewboesmd.com/rotator-cuff-repair-rehabilitation/

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825345/

 https://stanfordmedicine25.stanford.edu/the25/shoulder.html

 https://www.upmc.com/services/sports-medicine/conditions/rotator-cuff?

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 https://www.yorkvillesportsmed.com/blog/top-rotator-cuff-exercises-for-stretches-

strengthening