Iycee Charles de Gaulle Summary dmorning repeated micro-trauma, meaning damage over time

dmorning repeated micro-trauma, meaning damage over time


Today, I am going to talk to you about Billy Slater’s shoulder injury also known as a rotator cuff tear. This rotator cuff tear is classified as a direct, soft tissue injury.

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Within your shoulder lies the Rotator cuff, which is a very important group of four small shoulder muscles which come together as tendons attaching at the top of the humerus to support the shoulder during movement.

A rotator cuff tear is quite simply a tear of your shoulder’s rotator cuff tendons. The tear can be a partial or full thickness tear.

The most obvious sign of a tear is the overall reduction in your shoulders functioning and movement, making daily activities more difficult. Examples of this include pain when elevating the arm, stiffness, swelling or disturbed sleep if you lie on the injured shoulder.

The cause of a tear can be

–          Direct trauma to the shoulder, or repeated micro-trauma, meaning damage over time due to wear and tear.

In Billy Slater’s case the tear to his rotator cuff was a result off direct trauma to his shoulder when tackled by Manu Vatevei on the opposing team during a game. He was tackled around his arms providing no force to shield his landing and in turn landing on his shoulder funnily. This caused a tear in Billy’s rotator cuff. At this stage, he got up again and kept playing making the injury worse. Here is a viewing of the injury occurring on field:


The initial assessment procedure to use when someone is dealing with a rotator cuff tear is referred to as TOTAPS, which stands for Talk, Observe, Touch, Active and passive movement and performing a skill test. TOTAPS is used so the trainer is able to identify where the injury is and the severity of the injury.

For billy, a quick on field inspection was taken and the injury was identified. Later on, he took part in a full medical examination, which involved active and passive range of motion, strength tests and overall shoulder injury tests. For example, strength can be tested using a hand-held dynamometer. He failed his tests and this presented to the doctor that there was further damage to his shoulder muscles.

In this case, the doctor will use special technologies including x-rays, ultrasounds, MRI’s and arthroscopies which all help identify in detail the shoulder joint and the damage that is done.



Once the injury has been examined and diagnosed, it must be managed properly to ensure a smooth recovery. First step in management of a rotator cuff tear is RICER, which stands for rest, ice, compression, elevation and referral.

Further treatment of a rotator cuff is the rehabilitation process of this injury, which involves physiotherapy. The physio helps strengthen the tendons in the arm through guiding the patient in specific stretches; in addition graduated exercise is necessary and instructed to ease the patient back into sports. Rehabilitation most commonly runs for 6-8 weeks but ultimately depends on the patient and the severity of the tear.

In Billy’s case, rehabilitation started with rest to gain strength and he then took part in progressive mobilisation and graduated exercise leading to modified training sessions. The sessions where designed to suit his needs and his trainers made sure he did not push himself. His physiotherapist also equipped him with the knowledge of certain exercises in which he was to complete daily to ensure the strengthening and conditioning of his shoulder muscles.

An example of an exercise used by physiotherapists is called the shoulder extension, which is as seen on the screen here.



However, with rehabiitation if the tear is of full thickness and identified as extremely severe, arthroscopic surgery is taken into consideration. This is when the tear in the tendon is manually repaired. 


Preventative actions that can be put in place to stop this injury from reoccurring include taping of the shoulder area. Taping holds together gently and is extremely beneficial in providing the injured area with extra support.

Billy was suited with medical protective equipment aswell as taping to seed up his recovery and prevent any further damage.

Procedures to be utilised when ensuring an athlete’s return to play includes the displays of readiness, return to play policies, procedures, and physiological readiness.


In billy’s case, the NRL return to play policy is that a player cannot return to lay until medical clearance is obtained by a doctor and paperwork has been signed by the Club’s Co-ordinator and; indicators of readiness must be present. These include the player’s amount of mobility and if they are pain-free.

On the other hand, psychological readiness is another consideration that is to be monitored as an injury can be both emotionally and physically traumatic. Billy was a high level player and the pressure was a lot, so a well sort out break was necessary before going back onto the field.

It is to be taken into account that the expectations of others are not affect billy’s decision to return to play. The fact that this injury could have been the end of his career means that the stake was high for billy to return to play without fault.


Through following these steps in diagnosis through to rehabilitation and the return to play considerations, billy is able to play again.


Thank you.