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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2. 23/03/2013
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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4. 23/03/2013
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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5. 23/03/2013
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6. 23/03/2013
Direct'Impact'
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7. 23/03/2013
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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8. 23/03/2013
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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9. 23/03/2013
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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10. 23/03/2013
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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11. 23/03/2013
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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