Full-Thickness Rotator Cuff Tears in the Throwing Athlete

Throwing athletes offer a unique challenge as the line between adaptive and pathologic is often blurred and the presence of an abnormality on imaging may not directly indicate the reason for discomfort. Furthermore, as a thrower progresses through their career, there is a higher incidence of abnormalities on advanced imaging, including rotator cuff tears. As such, a detailed history and physical exam are paramount in this population. Factors such as size of tear, chronicity of tear or pain, degree of pain, patient age, level of play, and position should all be considered during management. The initial treatment is usually dictated by the rotator cuff pathology. Nonoperative management is the mainstay of treatment of rotator cuff tears but depends largely on degree of pathology and concomitant findings. Symptoms that remain recalcitrant or recur despite 3 months or more may be indicated for operative management. Careful arthroscopic debridement to remove nonviable, unstable tissue will facilitate an accurate assessment of tear size if a tear is encountered. Generally, tear size has been utilized by surgeons deciding between debridement alone and repair. Articular-sided partial tears with an intact bursal surface may be candidates for a transtendinous approach, whereas bursal-sided partial tears are often completed for repair. Full thickness rotator cuff tears are best treated with standard rotator cuff repair techniques. While results of arthroscopic repair of rotator cuff tears in the general population have been favorable, there is substantially less volume and consistency in the literature in the elite throwing population.