The prog­no­sis is gloomy with time the en­emy

The Sunday Telegraph (Sydney) - - WRAP - BRIEN SEENEY THE NRL PHYSIO Phys­io­ther­a­pist Brien Seeney runs the pop­u­lar Twit­ter ac­count @nrl­physio

THE in­ter­est in Cooper Cronk’s shoul­der in­jury this week has been in­cred­i­ble.

I’ve been in­un­dated with queries from fans on Twit­ter des­per­ate for any in­sight into the most an­a­lysed body part in Aus­tralia.

The of­fi­cial di­ag­no­sis pro­vided by the Roost­ers last Sun­day re­vealed Cronk has suf­fered a “se­vere ro­ta­tor cuff in­jury”. In the med­i­cal world this usu­ally in­di­cates a sig­nif­i­cant tear or com­plete rup­ture of the ro­ta­tor cuff mus­cles or ten­dons in the shoul­der.

But there is a slim chance it is be­ing used as an um­brella term to in­clude a se­vere ro­ta­tor cuff in­jury of a dif­fer­ent na­ture. The best case sce­nario for Cronk is he has a sig­nif­i­cant ro­ta­tor cuff con­tu­sion (bruise/cork), which can cause short-term loss of func­tion in the shoul­der.

The pain and weak­ness in these cases of­ten set­tles in three to five days, which would put Cronk in a very good po­si­tion to play tonight.

How­ever, if as sug­gested Cronk’s se­vere in­jury in­volves a tear, rup­ture or avul­sion frac­ture of the ro­ta­tor cuff or even a scapu­lar fac­ture, the like­li­hood of him prov­ing his fit­ness takes a con­sid­er­able hit.

There are some NRL play­ers who play with ro­ta­tor cuff tears through the sea­son but they of­ten re­quire up­ward of a month on the side­line. Many cases re­quire ro­ta­tor cuff re­pair surgery and a four to six-month re­cov­ery pe­riod.

For Cronk, try­ing to bal­ance the ben­e­fits of get­ting a good night’s sleep or wak­ing every few hours for treat­ment will have been put to the test this week. But around-the­clock physio, an­ti­in­flam­ma­to­ries, re­hab ex­er­cises and rest might not have been enough.

With the im­por­tance of the game and a race against the clock, any treat­ment modal­ity that can pos­si­bly give five per cent im­prove­ment will have been con­sid­ered. Var­i­ous com­bi­na­tions of elec­tri­cal mus­cle stim­u­la­tors, platelet rich plasma (PRP) or cor­ti­sone in­jec­tions, hot and cold com­pres­sion ma­chines, cryother­apy and trips to the hy­per­baric cham­ber are of­ten used; any­thing to gain an edge and ac­cel­er­ate Cronk’s re­cov­ery.

While the pain can be man­aged quite well in these cases, Cronk’s avail­abil­ity will ul­ti­mately come down to his func­tion. His abil­ity to pass, kick and tackle with likely deficits in his shoul­der move­ment and strength will have sig­nif­i­cant in­flu­ence.

The signs aren’t pos­i­tive with Cronk ap­pear­ing to be un­able to com­plete these tasks at the fi­nal train­ing run yes­ter­day.

The risk of fur­ther in­jury also has to be taken into ac­count, as the ro­ta­tor cuff plays such an im­por­tant role in shoul­der sta­bil­ity. In­jury to the ro­ta­tor cuff can leave a player more sus­cep­ti­ble to shoul­der dis­lo­ca­tion and dam­age to other struc­tures in the shoul­der, par­tic­u­larly the lig­a­ments and car­ti­lage.

The fi­nal call will likely be made as a joint de­ci­sion be­tween Trent Robin­son, the med­i­cal staff and Cronk him­self. All three par­ties have to agree. Any­one votes ‘no’ and he won’t be play­ing. If Cronk does defy the odds his tough­ness and courage to com­pete through in­jury must be ap­plauded.

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