This clinical commentary presents a classification of rotator cuff disease in overhand athletes based on the mechanism of tendon failure. It separates compressive (impingement) from tensile (eccentric overload) injury, and primary from instability-driven secondary disease. A matching treatment algorithm favors conservative management first, with arthroscopic techniques for refractory cases.
The clinical rule this paper drives home: in a thrower with cuff symptoms, ask whether the impingement is primary or secondary to instability before you plan treatment. The thrower trades static stability for the motion needed to throw, so the cuff carries the dynamic-stability burden. When the capsule stretches, the humeral head translates anteriorly and secondarily impinges the cuff.
That mental model changes management. Decompressing a secondary impingement without addressing the underlying laxity will fail, which is why the classification separates primary from secondary disease. Understand the mechanism of tensile disease too: the deceleration phase generates violent eccentric loads that tear the undersurface of the supraspinatus, unlike top-surface impingement wear.
This is a 1993 clinical commentary, not comparative outcome data, so weight it as an expert framework rather than validated evidence. Its lasting value is the vocabulary of primary vs secondary and compressive vs tensile failure that still shapes how the throwing shoulder is evaluated.
This clinical commentary presents a classification of rotator cuff disease in overhand athletes based on the mechanism of tendon failure. It separates compressive (impingement) from tensile (eccentric overload) injury, and primary from instability-driven secondary disease. A matching treatment algorithm favors conservative management first, with arthroscopic techniques for refractory cases.
The clinical rule this paper drives home: in a thrower with cuff symptoms, ask whether the impingement is primary or secondary to instability before you plan treatment. The thrower trades static stability for the motion needed to throw, so the cuff carries the dynamic-stability burden. When the capsule stretches, the humeral head translates anteriorly and secondarily impinges the cuff.
That mental model changes management. Decompressing a secondary impingement without addressing the underlying laxity will fail, which is why the classification separates primary from secondary disease. Understand the mechanism of tensile disease too: the deceleration phase generates violent eccentric loads that tear the undersurface of the supraspinatus, unlike top-surface impingement wear.
This is a 1993 clinical commentary, not comparative outcome data, so weight it as an expert framework rather than validated evidence. Its lasting value is the vocabulary of primary vs secondary and compressive vs tensile failure that still shapes how the throwing shoulder is evaluated.