Elite Tennis Players with a Weak Rotator Cuff: The Paradox of Infraspinatus Atrophy - A Clinical Commentary and Practical Approach.
Yannick Lambrecht, Leon Philipp Knoche, Lukas Höller
PMID 40756798WHAT IT FOUND
Infraspinatus atrophy is common in overhead athletes, affecting about 60% of male and 52% of female tennis players.
It often causes no pain or perceived weakness, but leads to measurable strength and proprioception deficits. Screening and early management are recommended despite the lack of symptoms.
Key findings
01Infraspinatus atrophy is prevalent in elite tennis players, with studies reporting rates of 60.1% in males and 52% in females.
02The condition is frequently asymptomatic regarding pain or self-perceived function, yet presents with objective deficits in external rotation strength and proprioception.
03Visual inspection alone is subjective and may miss atrophy due to muscle bulk; objective methods like ultrasound or functional testing are recommended to confirm diagnosis.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a narrative commentary and does not present original data or a systematic review of evidence. Diagnostic accuracy of visual inspection is noted as subjective and potentially unreliable without imaging or functional testing. The commentary relies on cited studies with varying designs, including case reports and cross-sectional data, which limits the strength of recommendations. There is no established standardized cut-off for infraspinatus thickness via ultrasound, making objective diagnosis challenging.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not assume that the absence of pain or self-reported functional deficits means the shoulder is healthy. This commentary emphasizes that athletes with significant infraspinatus atrophy often compensate and feel normal, yet have measurable strength and proprioception losses that predispose them to injury.