Many tennis players encounter shoulder problems throughout their career. Often this occurs due to improper strength training, flexibility training, and/or overuse. The following exercises can be used to strengthen/stretch the rotator cuff musculature:

1. Lateral Raises
2. Frontal Raises
3. Barbell Rotator Cuff Stretch

Background

The shoulder joint (glenohumeral joint) is a multiaxial, diarthrodial (ball & socket) joint that has the greatest movement capabilities of all joints in the body. Because of its superior movement capabilities it lacks stability – stability is sacrificed to enhance mobility. Even though it is a ball-and-socket joint, the glenoid fossa (socket) is relatively shallow and the ligaments are lax (within normal movement ranges). Therefore, other structures are needed to keep the humeral head (the shoulder) in place. Those structures that contribute to stabilize the humeral head are:

• Cartilage (glenoid labrum)
• Ligaments (glenohumeral ligaments)
• Muscles/Tendons (Rotator Cuff = SITS)

1. Subscapularis
2. Infraspinatus
3. Teres Minor
4. Subscapularis

The most common injuries are shoulder dislocations and tears/inflammation to the tendons of the rotator cuff muscles (rotator cuff injury). Shoulder pain is generally caused via impingement or tendinitis - scapula impingement (acromion) or rotator cuff tendon tears. The rotator cuff muscles are small compared to the deltoid or bicep and hence they require adequate strength and endurance to ensure proper functioning of the entire shoulder joint. Due to prolonged and repetitious activities, especially overhead movement like swimming, throwing, or pushing, the small rotator cuff muscles cannot maintain dynamic stability due to muscle fatigue and/or other factors such as muscular imbalances (agonist stronger than antagonist), poor technique, inadequate warm-up and conditioning. All these aforementioned factors can lead to rotator cuff (tendon) tears (tendinitis) or rotator cuff impingement.

Signs & Symptoms

Rotator cuff impingement (scapula impingement) occurs due to pressure caused by the acromion when the arm is lifted because the acromion rubs onto the surface of the rotator cuff, causing pain and limiting movement. Sometimes, the bursa just over the rotator cuff can be inflamed and hence causing pain as well.

Generally, an individual suffering from rotator cuff injury will experience one of the following:

1. Pain when shoulder is moving and/or at rest
2. Stabbing pain when lifting or moving objects
3. Pain center moving from the front to the side

Treatment

A variety of treatment options are available – from surgical to non-surgical.

Non-Surgical

Initially, patients are advised to stop any overhead activities and rest the shoulder for days or weeks - anti-inflammatory medication generally accompanies the rest period. If pain is more severe, cortisone shots (injections) can be applied to the affected area (e.g. bursa). Another option is a physical rehabilitation/strengthening program that would include resistance training exercises such as frontal – or lateral raises that do not exceed 90˚ of shoulder extension.

Surgical

When non-surgical treatments don’t relief the pain then surgery might be the last option to create more space for the rotator cuff, which removes any impingement of the rotator cuff caused by the acromion of the scapula. Two common surgical procedures used are subacromial decompression or anterior acromioplasty. During the surgery a piece of the acromion and/or parts of the bursa are being removed either via open incision or arthroscopic (small video camera) procedure.

After surgery, a sling is used to remove pressure from the shoulder, speeding up the recovery process. Once the pain subsides, the individual starts a physical rehabilitation program that aims at strengthening the rotator cuff muscles while ensuring proper functional range of motion. Recovery from surgery and return to full range of motion can take anywhere between 2 – 12 month.