This document discusses shoulder injuries in rugby players. It provides statistics showing that rugby has a high risk of shoulder injuries, which are often recurrent. Common shoulder injuries in rugby players include labral injuries, AC joint sprains, rotator cuff tears, and glenohumeral arthritis. Video analysis has shown that tackles are a major cause of shoulder injuries in rugby. The document outlines the forces involved in rugby tackles and compares them to car crash forces. It then discusses approaches to diagnosing and treating shoulder injuries in rugby players, including rehabilitation protocols and return to play timeframes following arthroscopic stabilization surgery.

1. 23/03/2013
Lennard'Funk'
Wrigh/ngton'Upper'Limb'Unit'
Salford'University'
Sharks'
Some'Facts'
• Rugby'>'highest'risk'per'player>hour'of'injury'of'all'sports.'
• Shoulder'>'20%'of'all'Rugby'Injuries'
• 2nd'most'common,'aFer'Knee'
• 35%'of'injuries'of'the'shoulder'are'recurrent'injuries''
• The'maneuver'most'strongly'associated'with'injury'was'the'
tackle,'accoun/ng'for'49%'of'injury'episodes'in'matches.'
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Forces'
The new GPS system which we wore during the Four Nations - attached to a
man 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 don't have airbags! !
Jon Wilkin, Feb 2010"
Rugby'Injuries'
• Labral'Injury'–'18'(42%)'
• AC'Joint' Sprain '–'12'(28%)'
• AC'Joint'Disloca/on'–'3'(7%)'
– Acute'>'0'
– Chronic'>'3'
• Rotator'Cuff'Tear'–'2'(4.5%)'
• Glenohumeral'Arthri/s'–'1'(2%)'
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3. 23/03/2013
Rugby'Audit'2007'
''Funk'&'Roney'
• Professional ' ' '180 '' ''
• Amateur ' ' '52 '' ''
• Semi>professional ' '12 '''
• Academy ' ' '4 ' ''
• Unknown ' ' '2'
Rugby'' A Malone, L Funk, K Mohamed, C Ball; 2007
Lesions'
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SHOULDER'INJURY'PATTERNS'IN'PROFESSIONAL'RUGBY'
'L'Funk','K'Roney,''
CJSM,'2007'
Video'Analysis'Study'
Crichton, Jones & Funk - BJSM 2012
• Try>Scorer '
• Direct'Impact '
• Tackler '
• Flexed'landing '
Rotator Cuff Tear
Bankart
SLAP
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Direct'Impact'
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Player'Posi/on' L'Funk','K'Roney,''
CJSM,'2007'
Inves/ga/ons'
• No'previous'Surgery'='MR'Arthrogram'
• Previous'Surgery'='CT'Arthrogram'
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MR'Arthrogram'v.'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%)
SLAP'Tests'
Pandya,)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%)
• An'experienced'Shoulder'Surgeon'befer'
• Can'correlate'with'clinical'context'
• Experience'of'reviewing'Scopes'&'Scans'
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Lesions'
Major' Minor '
• 'Bony'Bankart' • 'Undisplaced'Labral'Tear'
• 'ALPSA' • 'Par/al'Cuff'Tear'
• 'Rotator'Cuff'Tear' • 'ACJ'Disloca/on'
• 'HAGL'
'
Surgery'
• Early'Surgery:'
– Large'structural'lesions'
– Late'in'Season'
– Unable'to'Return'
• Rehab'&'Return:'
– Minor'lesions'
– Early'season'
Types'of'Surgery'
• Mostly'Arthroscopic'Repairs'
• Open'repairs'for'Bony'reconstruc/ons'
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Rugby'Rehab'Protocol'
Ben Macdonald, Mike Lancaster, Meiron Jones, Doug Jones,
Christine Holmes, Kat Tatlow, Len Funk
• Player>specific'and'tailored'to'suit'the'player s'age,'posi/on,'
requirements,'surgeon'and'therapists.''
• It'is'not' accelerated 'or' aggressive 'or' /me'specific .''
• It'is'also'surgeon>specific'and'dependent'on'the'quality'and'type'
of'fixa/on'achieved.'Therefore'the'protocol'is'a' guide 'and'not'a'
prescrip/on.'Communica/on'between'the'player,'therapists,'
training'staff'and'surgeon'are'essen/al.
• Progression'to'each'phase'is'when'the'pa/ent'is'able'to'perform'
all'of'the'exercises'in'the'previous'phase'without'any'discomfort'
or'apprehension.'Each'phase'is'introduced'progressively.'
L'Funk','K'Roney,''
Rugby'Results' 03> 05' CJSM,'2007'
Pain' Sa/sfac/on'(%)' Playing'at'
previous'level'
Pre>op' 5' 11%' 0%'
3'months' 10' 87%' 89%'
6'months' 12' 93%' 94%'
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Time'to'return'to'play' L'Funk','K'Roney,''
CJSM,'2007'
L'Funk','K'Roney,''
Return'to'Play' CJSM,'2007'
Arthroscopic'Stabilisa/ons'
Fourie & Funk, 2009
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12. 23/03/2013
Return'to'play'by'/me'of'surgery'
Fourie & Funk, 2009
Return'to'play'by'age' Fourie & Funk, 2009
Creighton et al.
CJSM 2010
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13. 23/03/2013
THANK
YOU
o.uk
ho ulderdoc.c
lenfunk@s
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