Background The shoulder joint is a common site of injury in tennis players. It is therefore important that sports medicine physicians diagnose and treat shoulder injuries correctly, in order to prevent professional and junior athletes from being sidelined for long periods of time. This presentation discusses a number of key issues in the management of shoulder injuries in competitive tennis players. Common shoulder injuries in tennis players include the anterior and posterior impingement syndrome, instabilities, rotator cuff lesions (tendinosis and ruptures) and lesions of the labrum (SLAP lesions). Although most players indicate that serving leads to the onset of pain, all strokes in tennis may induce pain over the anterior, superior and posterior aspect of the shoulder. Shoulder biomechanics One issue requiring special attention is the analysis of shoulder mechanics. The serving motion is a conjoint movement that stresses the acromio-clavicular, gleno-humeral and scapulo-thoracic joints. It is imperative to ask the athlete during what stage of motion pain is elicited. Athletes that have SLAP and other labral lesions often feel pain at impact and during follow-through, while patients with instability refer to pain during the late cocking and impact phases. Clinical findings Pain and instability are the two main complaints that lead athletes to seek the help of a physician. Special tests are helpful to establish the correct diagnosis. The following tests are routinely used: the Supraspinatus test (rotator cuff injuries), the Neer test (impingement), the O`Brien test (labrum lesions), the Speed test (biceps lesions), the Hawkins` test (bursitis, rotator cuff tears and impingement), and Jobe`s relocation and anterior drawer test (instability). Additional diagnostic tests X-ray examination of the injured shoulder may demonstrate damage to the bone and signs of instability (Hill-Sachs and Bankart lesions). The lateral view can be used to define the acromion type (Bigliani types I, II or III). Ultrasound and magnetic resonance imaging (MRI) may also be used. If chondral or labral lesions are suspected, MRI should be used with an intra-articular injection of contrasting fluid. Treatment Depending on the pathology of the lesion, therapy can range from conservative treatment to surgical procedures. Patients with a type III acromion with rotator cuff symptoms that do not respond to conservative treatment are generally referred for shoulder arthroscopy. Instabilities may be treated conservatively or operatively, depending on many factors that will not be discussed in further detail here. Rehabilitation and return to competition Rehabilitation is an important issue in the treatment of competitive tennis players. The type of injury, the type of treatment (conservative or operative) and the demands of play must be taken into consideration. Rehabilitation procedures should be aimed at pain relief, restoration of full range of motion, strengthening exercises to prevent muscle atrophy, and stimulation of proprioception. Different types of lesions require different forms of treatment, but different treatment approaches may also be indicated for the same type of injury in two different athletes.
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