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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 01-02-2016 | Shoulder

Treatment of glenohumeral instability in rugby players

Author: Lennard Funk

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2016

Abstract

Rugby is a high-impact collision sport, with impact forces. Shoulder injuries are common and result in the longest time off sport for any joint injury in rugby. The most common injuries are to the glenohumeral joint with varying degrees of instability. The degree of instability can guide management. The three main types of instability presentations are: (1) frank dislocation, (2) subluxations and (3) subclinical instability with pain and clicking. Understanding the exact mechanism of injury can guide diagnosis with classical patterns of structural injuries. The standard clinical examination in a large, muscular athlete may be normal, so specific tests and techniques are needed to unearth signs of pathology. Taking these factors into consideration, along with the imaging, allows a treatment strategy. However, patient and sport factors need to be also considered, particularly the time of the season and stage of sporting career. Surgery to repair the structural damage should include all lesions found. In chronic, recurrent dislocations with major structural lesions, reconstruction procedures such as the Latarjet procedure yields better outcomes. Rehabilitation should be safe, goal-driven and athlete-specific. Return to sport is dependent on a number of factors, driven by the healing process, sport requirements and extrinsic pressures.

Level of evidence V.

Arciero RA, Wheeler JH, Ryan JB, McBride JT (1994) Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med 22(5):589–594CrossRefPubMed

Badge R, Tambe A, Funk L (2009) Arthroscopic isolated posterior labral repair in rugby players. Int J Shoulder Surg 3(1):4PubMedCentralCrossRefPubMed

Balg F, Boileau P (2009) The instability severity index score (ISIS score): a rational approach for patient selection in arthroscopic Bankart repair. J Bone Joint Surg 91(SUPP II):242

Beighton PH, Solomon L, Soskilne CL (1973) Articular mobility in an African population. Ann Rheum Dis 32(5):413PubMedCentralCrossRefPubMed

Burkhart SS, De Beer JF (2000) Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill–Sachs lesion. Arthroscopy 16(7):677–694CrossRefPubMed

Burris MW, Johnson DL, Mair SD (2007) Management of in-season anterior shoulder dislocation in the amateur athlete. Orthop N J 30(5):362

Cheng SC, Sivardeen ZK, Wallace WA, Buchanan D, Hulse D, Fairbairn KJ, Kemp SP, Brooks JH (2012) Shoulder instability in professional rugby players—the significance of shoulder laxity. Clin J Sports Med 22(5):397–402CrossRef

Cho NS, Hwang JC, Rhee YG (2006) Arthroscopic stabilization in anterior shoulder instability: collision athletes versus noncollision athletes. Arthroscopy 22(9):947–953CrossRefPubMed

Creighton DW, Shrier I, Shultz R, Meeuwisse WH, Matheson GO (2010) Return-to-play in sport: a decision-based model. Clin J Sports Med 20(5):379–385CrossRef

10.

Crichton J, Doug RJ, Funk L (2012) Mechanisms of traumatic shoulder injury in elite rugby players. Br J Sports Med 46:7538–7542CrossRef

11.

de Beer J, Bhatia DN (1999) Shoulder injuries in rugby players. Int J Shoulder Surg 23(1):1–3

12.

Dickens JF, Owens BD, Cameron KL, Kilcoyne K, Allred CD, Svoboda SJ, Sullivan R, Tokish JM, Peck KY, Rue JP (2014) Return to play and recurrent instability after in-season anterior shoulder instability a prospective multicenter study. Am J Sports Med 42(12):2842–2850CrossRefPubMed

13.

Fuller CW, Brooks JH, Cancea RJ, Hall J, Kemp SP (2007) Contact events in rugby union and their propensity to cause injury. Br J Sports Med 41(12):862–867PubMedCentralCrossRefPubMed

14.

Funk L, Tatlow K, Leftley C, Gibson J (2008) Shoulderdoc: shoulder exercise book. Shoulderdoc Ltd., Manchester. ISBN 9780956139603

15.

Gagey OJ, Gagey N (2001) The hyperabduction test an assessment of the laxity of the inferior glenohumeral ligament. J Bone Joint Surg (Br) 83(1):69–74CrossRef

16.

Gissane C, Jennings DC, Standing P (1993) Incidence of injury in rugby league football. Physiotherapy 79(5):305–310CrossRef

17.

Haseler CM, Carmont MR, England M (2010) The epidemiology of injuries in english youth community rugby union. Br J Sports Med 44(15):1093–1099CrossRefPubMed

18.

Headey J, Brooks JHM, Kemp SP (2007) The epidemiology of shoulder injuries in english professional rugby union. Am J Sports Med 9:1537–1543CrossRef

19.

Kalson NS, Geoghegan JM, Funk L (2011) Magnetic resonance arthrogram and arthroscopy of the shoulder: a comparative retrospective study with emphasis on posterior labral lesions and radiologist locality. Shoulder Elbow 3(4):210–214CrossRef

20.

Kibler WB, Sciascia AD, Hester P, Dome D, Jacobs C (2009) Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med 37(9):1840–1847CrossRefPubMed

21.

Kim SH, Park JS, Jeong WK, Shin SK (2005) The Kim test a novel test for posteroinferior labral lesion of the shoulder—a comparison to the jerk test. Am J Sports Med 33(8):1188–1192CrossRefPubMed

22.

Kralinger FS, Golser K, Wischatta R, Wambacher M, Sperner G (2002) Predicting recurrence after primary anterior shoulder dislocation. Am J Sports Med 30(1):116–120PubMed

23.

Kropf EJ, Tjoumakaris FP, Sekiya JK (2007) Arthroscopic shoulder stabilization: Is there ever a need to open? Arthroscopy 23(7):779–784CrossRefPubMed

24.

Larrain MV, Montenegro HJ, Mauas DM, Collazo CC, Pavón F (2006) Arthroscopic management of traumatic anterior shoulder instability in collision athletes: analysis of 204 cases with a 4-to 9-year follow-up and results with the suture anchor technique. Arthroscopy 22(12):1283–1289CrossRefPubMed

25.

Lebus GF, Raynor MB, Nwosu SK, Wagstrom E, Jani SS, Carey JL, Hettrich CM, Cox CL, Kuhn JE, MOON Shoulder Group (2015) Predictors for surgery in shoulder instability a retrospective cohort study using the feds system. Orth J Sports Med 3(10):2325967115607434

26.

Mazzocca AD, Brown FM, Carreira DS, Hayden J, Romeo AA (2005) Arthroscopic anterior shoulder stabilization of collision and contact athletes. Am J Sports Med 33(1):52–60CrossRefPubMed

27.

Mcdonough A, Funk L (2011) Critical reflection of the advanced rehabilitation of an elite rugby league player sustaining a posterior Bankart lesion. Phys Ther Sport 14(1):60–67CrossRef

28.

Millett PJ, Braun S (2009) The “bony Bankart bridge” procedure: a new arthroscopic technique for reduction and internal fixation of a bony Bankart lesion. Arthroscopy 25(1):102–105CrossRefPubMed

29.

Neyton L, Young A, Dawidziak B, Visona E, Hager JP, Fournier Y, Walch G (2012) Surgical treatment of anterior instability in rugby union players: clinical and radiographic results of the Latarjet–Patte procedure with minimum 5-year follow-up. J Shoulder Elbow Surg 21(12):1721–1727CrossRefPubMed

30.

Olds M, Ellis R, Donaldson K, Parmar P, Kersten P (2015) Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. Br J Sports Med 21:bjsports-2014

31.

Owen JM, Boulter T, Walton M, Funk L, Mackenzie TA (2015) Reinterpretation of O’Brien test in posterior labral tears of the shoulder. Int J Shoulder Surg 9(1):6PubMedCentralCrossRefPubMed

32.

Owens BD, Agel J, Mountcastle SB, Cameron KL, Nelson BJ (2009) Incidence of glenohumeral instability in collegiate athletics. Am J Sports Med 37(9):1750–1754CrossRefPubMed

33.

Phadnis J, Arnold C, Elmorsy A, Flannery M (2015) Utility of the instability severity index score in predicting failure after arthroscopic anterior stabilization of the shoulder. Am J Sports Med 43(8):1983–1988CrossRefPubMed

34.

Porcellini G, Campi F, Paladini P (2002) Arthroscopic approach to acute bony Bankart lesion. Arthroscopy 18(7):764–769CrossRefPubMed

35.

Provencher MT, LeClere LE, King S, McDonald LS, Frank RM, Mologne TS, Ghodadra NS, Romeo AA (2011) Posterior Instability of the shoulder diagnosis and management. Am J Sports Med 39(4):874–886CrossRefPubMed

36.

Rouleau DM, Hébert-Davies J, Djahangiri A, Godbout V, Pelet S, Balg F (2013) Validation of the instability shoulder index score in a multicenter reliability study in 114 consecutive cases. Am J Sports Med 41(2):278–282CrossRefPubMed

37.

Salomonsson B, Von Heine A, Dahlborn M, Abbaszadegan H, Ahlström S, Dalén N, Lillkrona U (2010) Bony Bankart is a positive predictive factor after primary shoulder dislocation. Knee Surg Sports Traumatol Arthrosc 18(10):1425–1431CrossRefPubMed

38.

Shah N, Naderi N, Funk L (2009) Arthroscopic bony Bankart repair in contact athletes. In: Presented at the British elbow and Shoulder Society Conference

39.

Stewart DR, Burden SB (2004) Does generalised ligamentous laxity increase seasonal incidence of injuries in male first division club rugby players? Br J Sports Med 38(4):457–460PubMedCentralCrossRefPubMed

40.

Torrance E, Walton M, Monga P, Watts A, Funk L (2015) Posterior and combined shoulder instability in a sporting population. Shoulder Elbow 7:309–332CrossRef

41.

Tzannes A, Murrel GAC (2004) An assessment of the interexaminar reliability of tests for shoulder instability. J Shoulder Elbow Surg 13:18–23CrossRefPubMed

42.

Tzannes A, Paxinos A, Callanan M, Murrell GA (2004) An assessment of the interexaminer reliability of tests for shoulder instability. J Shoulder Elbow Surg 13(1):18–23CrossRefPubMed

Title: Treatment of glenohumeral instability in rugby players
Author: Lennard Funk
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-015-3979-8

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Treatment of glenohumeral instability in rugby players

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