Shoulder Injuries

Having a strong and mobile shoulder is not the only component of preventing injury or optimizing performance. As the saying goes the chain is only as strong as it’s weakest link and this is true of the human body. Important factors in injury prevention include whole body stability and strength. A number of the exercises included in this programme don’t just focus on the shoulder but integrate trunk stability and lower body loading; especially those exercises included in the later phases of the programme.

Shoulder injuries can be extremely serious for any athlete but as we have described in the introduction, the rugby shoulder has to endure huge forces during contact situations. This ebook has been written as an injury prevention guide, not a rehab programme. Rehab for each shoulder injury needs to be approached differently. Many of the exercises in this programme are suitable for rehab as well as injury prevention but if you are suffering from an injury then get in touch with us for a consultation and we can advise you on the most appropriate approach for your rehab.

We have provided a brief look at some of the most common shoulder injuries here but as previously stated, if you have an injury then be sure to get it checked.

Some of the most common shoulder injuries for rugby players are low level contusions and impact related injuries. These injuries generally resolve quickly with minimal input – the most valuable input is time. Some of the more significant injuries that you may have heard of before are the following;

Dislocation

Dislocation of the gleno-humeral joint is when the head of the humerus leaves the socket of the glenoid and does not relocate. Dislocations often lead to a long time out of the game and can sometimes require surgery. Some common complications following a dislocation are long term weakness, damage to the labrum that surrounds the socket of the shoulder and bony damage that can present as hill sachs lesions at the top of the humerus or bankart lesions to the socket of the shoulder on the scapula. Nerves that run closely to the glenohumeral joint can also be damaged through direct impacts, traction or compression. Any injury involving nerves has a significantly longer recovery time. Dislocations can spontaneously relocate but it is often the case that they have to be relocated by a trained medical professional. Unfortunately once you have dislocated your shoulder once there is a higher risk that you will do it again.

Subluxations

Subluxations are similar to dislocations but the head of the humerus (arm) leaves the margins of the glenoid and spontaneously relocates itself, usually instantly. These injuries can have a similar but less severe presentation to dislocations.

Acromio-clavicular Joint Injuries (ACJ)

Another joint commonly injured is the acromio-clavicular (AC) joint that is located on the top of the scapula where it is joined by the collar bone. The joints can become damaged during collisions, typically when the arm is by the side or across the chest. These injuries can remain sore for weeks but in many cases players are able to continue using a pad to protect the joint from subsequent impacts if the grade of the injury is low. High-grade injuries that involve all of the ligaments of the joint may need surgery to repair the joint.

Sterno-clavicular Joint Injuries (SCJ)

Sterno-clavicular joint injuries are less common than ACJ injuries but can have significant consequences. Any sign of instability around this joint needs to be investigated appropriately.

Impingements

Impingements are commonly described in the shoulder. They are often attributed to poor mechanics at the shoulder, especially the scapula but this hasn’t been confirmed in the current research. What has been established though is that allowing acute inflammation to settle and then strengthening the shoulder is an effective strategy for management.

Cartilage Tears

Cartilage tears are a reasonably common findings on MRI imaging. If you were to scan a full squad of professional rugby players a significant number of them would have signs of cartilage tears and cartilage damage, many of them would have no symptoms of injury. The cartilage most commonly injured in the shoulder is called the labrum. The labrum runs around the glenoid of the scapula and serves to deepen the socket and offer increased stability to the gleno-humeral joint. A common labral tear in rugby players is called a SLAP tear – (Superior Labral tear from Anterior to Posterior). If you imagine the socket of the shoulder is a clock face the long head of the biceps attaches at 12. SLAP tears often involve a pulling away of the long head of biceps along with the cartilage at or around the 12 o’clock position. As with most injuries there can be varying degrees and ranges of cartilage tears, some require surgery some do not and can be managed extremely well with rehab.

Soft Tissue Injuries

These can include muscle tears, ligament tears and tendon tears and ruptures. They can present on a very wide scale and often do not occur in isolation. You are very likely to get ligament damage with a dislocation for example. The severity of the injury will dictate the level of input required to recover.

Imaging and Shoulder Injuries

For any rugby player with a shoulder injury additional imaging as well as a comprehensive clinical assessment can be useful. A useful closing paragraph for the introduction to injuries is the following; findings on medical images only tell you a very small part of the puzzle. You can have signs of damage on a scan but functionally be capable of training and playing as normal. As the saying goes, Treat the man/woman (player), not the scan.