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Off The Rotator Cuff Remarks

Saturday’s boxing super-fight between Manny Pacquiao and Floyd Mayweather was the richest fight in boxing history, and so understandably people were pretty excited to see what would happen. Due to the Vegas-England time difference, some people got up especially to watch the fight which began just before 5am last Sunday morning and ironically, the fight was nearly enough to put people back to sleep. The fight was a long time in the making with months of hype surrounding it and unfortunately, as with many events that are hyped up too much, the fight failed to deliver and many were left disappointed. Pacquiao was expected to pressure Mayweather in the first few rounds of the fight, but from the first bell, it was clear that Pacquiao wasn’t his usual scrappy self and pushing the action. It has now transpired Pacquiao was carrying a shoulder injury and is this week set to undergo surgery for a rotator cuff tear which could put him out of action for 9-12 months and possibly end his career as he is already considering retirement. So here’s the lowdown on rotator cuff injuries, how they occur and what the treatment plans can involve. Rotator cuff injuries are a common cause of shoulder pain and three main common rotator cuff conditions exist: Rotator cuff tendonitis Rotator cuff impingement syndrome Rotator cuff tear The rotator cuff is a group of four muscles around the shoulder joint which work as a unit to both stabilize the shoulder and help with overall movement. Rotator Cuff Tendonitis Rotator Cuff Tendonitis is the most common cause of shoulder pain and is caused by the inflammation and irritation of tendons around the rotator cuff muscles. The onset is usually sudden and acute with overuse being the main contributing factor in rotator cuff tendonitis such as athletes who repeatedly throw or jobs that involve repeated lifting. Usual symptoms include pain in the shoulder with the pain getting worse when your arm goes above shoulder level and it can be diagnosed by seeing your doctor who will give you a history and examination of the shoulder. The best test for rotator cuff tendonitis is the `painful arc test` where the arm is held by your side then lifted sideways and out in an arc with pain occurring at between 70° and 120°. Normal treatment involves the standard care of rest, painkillers and in some cases steroid injections and physiotherapy to improve mobility and reduce inflammation. Prognosis is generally good for this condition and people can make a full recovery if treatment is started early. If delayed, the shoulder can stiffen up and adhesive capsulitis (frozen shoulder) can occur.   Rotator Cuff Impingement Syndrome The rotator cuff tendon passes through the space underneath the shoulder blade called the subacromial space and in impingement syndrome, the tendon gets trapped in this space. Occurrence of this is generally due to wear and tear or conditions such as arthritis and the pain is generally more chronic than in the case of rotator cuff tendonitis with the pain increasing with activities that involve raising the arm above the head. Diagnosis is similar to rotator cuff tendonitis as well as the `Neel’s Impingement Test` where the arm is straightened and raised with the palm pointing away from the body, if pain occurs, impingement is likely. Treatment ranges from rest from movements involving repetitive shoulder motion to painkillers and sometimes surgery to widen the subacromial space is what is called a `decompression operation`. In some cases, this syndrome can lead to wear on the tendon, weakening it and causing a tear. Rotator Cuff Tear Rotator cuff tears are most common in the over 40s and usually are the result of injury in those that are younger, or rotator cuff syndrome in older people. Tears can be minor, partial or complete/full and treatment differs depending on the severity of the tear. Pain occurs on the front and outer part of the shoulder with reduced movement and weakness and diagnosis is made through history, examination and the `drop arm test` where the arm is lifted outwards and sideways towards the head, then back down again. Those with a tear will be able to lower the arm to 90°, but then below 90°, the arm will drop due to the tear. Depending on the extent of the tear, recovery and treatment can range from rest and physiotherapy to surgery in the case of full tears. In the case of Pacquiao, he is expected to have suffered a complete tear and Dr Neil ElAttache will be operating to repair the tear later this week saying to “Once you know he has a tear that’s not going to heal on its own, then the decision for an active person is you want to try to fix this before it gets bigger”. The injury and subsequent surgery could keep Pacquiao out of the ring for up to 12 months, as well as the possibility that he will be bought up on disciplinary charges by Nevada Boxing Officials for not disclosing the injury sooner. The injury was disclosed to the US Anti-Doping Agency which approved the use of anti-inflammatory shots in the run up to the fight but the real question is why Pacquiao’s corner checked `no` to shoulder injuries on the disclosure form when only a couple of hours before the fight Pacquiao’s corner asked for a shot of Toradol, an anti-inflammatory for him which was refused. In a statement made by Pacquiao’s camp they said “As Manny has said multiple times, he makes no excuses. Manny gave it his best” but his shoulder injury may well have affected his performance in the fight last Sunday morning and with up to 12 months out of the ring, Pacquiao’s future in professional boxing is uncertain to say the least.