Mechanisms of Shoulder Injury in Elite Rugby Players
Authors: J Crichton, D Jones, L Funk
References: British Journal of Sports Medicine. 2012
Background: Shoulder injuries in rugby players are common, but the mechanisms of injury are less well understood.
Purpose: This study aims to elucidate common mechanisms of injury and identify the patterns of injury they produce.
Study Design: Descriptive epidemiological study
Methods: Videos of twenty-four elite rugby players sustaining shoulder injuries were reviewed by rugby-medical experts independently to describe the mechanism of injury. The mechanisms reported by each reviewer were collated and analysed to determine the level of agreement between reviewers and conclude an overall description of injury mechanisms.
Results: We identified three main mechanisms of shoulder injury from the video analysis. These are the ‘Try-Scorer’, characterised by hyperflexion of the outstretched arm such as when scoring a try; the ‘Tackler’, characterised by extension of the abducted arm behind the player whilst attempting to tackle an opponent; and the ‘Direct Impact’, characterised by a direct blow to the arm or shoulder when held by the side in neutral or slight adduction. The Try Scorer and Tackler mechanisms both involve a levering force on the glenohumeral joint (GHJ) due to movement of the outstretched arm. These mechanisms predominantly cause GHJ dislocation, with Bankart, reverse Bankart and Superior Labrum Anterior-Posterior (SLAP) tears. The Try-Scorer Mechanism also caused the majority (83%) of rotator cuff tears. The Direct Hit mechanism resulted in GHJ dislocation and labral injury in 37.5% of players and was most likely to cause Acromioclavicular Joint (ACJ) dislocation and scapula fractures, injuries that were not seen with the other mechanisms.
Conclusion: This study describes the three common injury mechanisms in rugby resulting in serious shoulder injuries – ‘Try Scorer’, ‘Direct Impact’ and ‘Tackler’. Greater understanding of the mechanisms involved in rugby shoulder injury is useful in understanding the pathological injuries, guiding treatment and rehabilitation and aiding the development of injury prevention methods.
Key Terms: Shoulder injury, rugby, mechanism