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SHOULDER INSTABILITY IN THE COLLISION ATHLETE –THE ‘COLLISION SHOULDER’
A.A. Malone, L. Funk, K. Mohammed and C.M. Ball
Abstract
We document intra-articular pathology in collision athletes with shoulder instability and describe the ‘collision shoulder’ - a direct impact without dislocation, with unusual labral injury, significant intra-articular pathology and neurology.
183 collision athletes were treated for labral injuries in 3 centres. Details of injury mechanism and intra-articular pathology at surgery were recorded.
Premier league and International (Elite) comprised 72 players. A tackle was implicated in 52% of injuries and 65% had a dislocation. The mechanism of injury was ABduction External Rotation (ABER) in 45%, direct impact 36%, abduction only 8% and axial load 6%. Dislocation occurred in 51% of shoulders with ABER mechanism. A Bankart lesion was found in 79% of these shoulders; Hill-Sachs in 58% and Bony Bankart in 26%. Inferoposterior involvement of labral tears was present in only 11%, superior labral Antero-posterior (SLAP) lesions in 32% and partial injury to the rotator cuff in 32%. In those sustaining a direct impact to the shoulder, 61% did not document dislocation, had a high incidence of inferoposterior labral involvement (50%), neurological symptoms (32%), and a low incidence of Bankart (33%), Hill-Sachs (22%) and Bony Bankart (11%) lesions. The mechanism did not affect incidence of superior labral / SLAP tears (18%), or capsular tears (including Humeral Avulsion of Glenohumeral Ligaments - HAGL) – 15%. Elite athletes had less dislocations (43% vs 74%) irrespective of mechanism, but were 40% more likely to have neurology, posteroinferior labral, cartilaginous or capsular injuries. They had twice the incidence of Bony Bankart and rotator cuff lesions and 5 times more SLAP / superior labral tears.
Collision athletes with shoulder instability have a wide spectrum of pathoanatomy of the labrum and frequent associated intra-articular lesions. Significant injury often occurs in the Elite athlete and those sustaining a direct hit without dislocation (the ‘Collision Shoulder’).
A Bankart lesion is an injury to the anterior glenoid labrum associated with anterior shoulder dislocations. It usually requires surgical repair. It is named after Arthur Sydney Blundell Bankart, an English orthopaedic surgeon, who lived from 1879-1951. at the botom; towards the feet The labrum is a firm, white structure that forms a ring around the glenoid cavity (the cup of the ball and socket shoulder joint). It deepens the socket, providing stability to the joint. A firm, white structure that forms a ring around the glenoid cavity (the cup of the ball and socket shoulder joint).
It deepens the socket, providing stability to the joint.
at the back; behind Superior Labral Antero-Posterior lesion - Abbreviated term for an injury to the superior labrum of the glenoid. at the top; towards the head References
BESS 2007, Telford UK
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