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Rugby shoulder injuries 2013

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Rugby shoulder injuries 2013

  1. 1. 23/03/2013 LennardFunk Wrigh/ngtonUpperLimbUnit SalfordUniversity Sharks SomeFacts•  Rugby>highestriskperplayer>hourofinjuryofallsports.•  Shoulder>20%ofallRugbyInjuries•  2ndmostcommon,aFerKnee•  35%ofinjuriesoftheshoulderarerecurrentinjuries•  Themaneuvermoststronglyassociatedwithinjurywasthe tackle,accoun/ngfor49%ofinjuryepisodesinmatches. 1
  2. 2. 23/03/2013Forces The new GPS system which we wore during the Four Nations - attached to aman bra under our shirts - consistently showed us that we were taking impacts of 10 gs and upwards during a match.! The gravity force of a car travelling at 100km/h that comes to a stop in 0.2 seconds is 14.2 gs. ! And we dont have airbags! ! Jon Wilkin, Feb 2010" RugbyInjuries •  LabralInjury–18(42%) •  ACJoint Sprain –12(28%) •  ACJointDisloca/on–3(7%) –  Acute>0 –  Chronic>3 •  RotatorCuffTear–2(4.5%) •  GlenohumeralArthri/s–1(2%) 2
  3. 3. 23/03/2013 RugbyAudit2007 Funk&Roney•  Professional 180 •  Amateur 52 •  Semi>professional 12 •  Academy 4 •  Unknown 2Rugby A Malone, L Funk, K Mohamed, C Ball; 2007Lesions 3
  4. 4. 23/03/2013SHOULDERINJURYPATTERNSINPROFESSIONALRUGBYLFunk,KRoney,CJSM,2007 VideoAnalysisStudy Crichton, Jones & Funk - BJSM 2012 •  Try>Scorer •  DirectImpact •  Tackler •  Flexedlanding Rotator Cuff Tear Bankart SLAP 4
  5. 5. 23/03/2013 5
  6. 6. 23/03/2013DirectImpact 6
  7. 7. 23/03/2013PlayerPosi/on LFunk,KRoney, CJSM,2007Inves/ga/ons•  NopreviousSurgery=MRArthrogram•  PreviousSurgery=CTArthrogram 7
  8. 8. 23/03/2013 MRArthrogramv.Scope N Karlson, J Geoghan, L Funk; 2008 Sensitivity) Specificity) Accuracy)SLAP)) 0.42) 0.92) 77%)Rotator)Cuff)Tear)) 0.50) 0.86) 83%)Hill)Sachs)) 0.91) 0.78) 90%)Bankart)) 0.85) 0.83) 86%) SLAPTestsPandya,)NK)et)al.)Arthroscopy.)24(3):311O7,)2008))Test) Sensitivit y)O Brien s) 90%)Mayo) 80%)Jobe s) 76%)MRA)–)Surgeon) 72%)MRA)O)Radiologist) 50%) •  AnexperiencedShoulderSurgeonbefer •  Cancorrelatewithclinicalcontext •  ExperienceofreviewingScopes&Scans 8
  9. 9. 23/03/2013LesionsMajor Minor • BonyBankart • UndisplacedLabralTear• ALPSA • Par/alCuffTear• RotatorCuffTear • ACJDisloca/on• HAGL Surgery •  EarlySurgery: –  Largestructurallesions –  LateinSeason –  UnabletoReturn •  Rehab&Return: –  Minorlesions –  EarlyseasonTypesofSurgery •  MostlyArthroscopicRepairs •  OpenrepairsforBonyreconstruc/ons 9
  10. 10. 23/03/2013RugbyRehabProtocolBen Macdonald, Mike Lancaster, Meiron Jones, Doug Jones,Christine Holmes, Kat Tatlow, Len Funk •  Player>specificandtailoredtosuittheplayer sage,posi/on, requirements,surgeonandtherapists. •  Itisnot accelerated or aggressive or /mespecific . •  Itisalsosurgeon>specificanddependentonthequalityandtype offixa/onachieved.Thereforetheprotocolisa guide andnota prescrip/on.Communica/onbetweentheplayer,therapists, trainingstaffandsurgeonareessen/al. •  Progressiontoeachphaseiswhenthepa/entisabletoperform alloftheexercisesinthepreviousphasewithoutanydiscomfort orapprehension.Eachphaseisintroducedprogressively. LFunk,KRoney, RugbyResults 03> 05 CJSM,2007 Pain Sa/sfac/on(%) Playingat previouslevel Pre>op 5 11% 0% 3months 10 87% 89% 6months 12 93% 94% 10
  11. 11. 23/03/2013Timetoreturntoplay LFunk,KRoney, CJSM,2007 LFunk,KRoney, ReturntoPlay CJSM,2007ArthroscopicStabilisa/ons Fourie & Funk, 2009 11
  12. 12. 23/03/2013Returntoplayby/meofsurgery Fourie & Funk, 2009Returntoplaybyage Fourie & Funk, 2009 Creighton et al. CJSM 2010 12
  13. 13. 23/03/2013 THANK YOU o.uk ho ulderdoc.clenfunk@s 13

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