Rugby

Rugby is one of the highest-risk sports for shoulder injuries.  20% of rugby injuries affect the shoulder. Recurrent injury is affects over a third of players, and an injury on one side are increases the risk of injuring the other side. The tackle is responsible for the majority of all shoulder injuries in rugby, but direct impact onto the shoulder (fall onto it with arm at side, or collision) and overreaching injuries (try scoring and diving tackles) can also cause injury. 

Labral Tears and Instability

Those injured in a tackle are more likely to have anterior labral tears and bony Bankart lesions.  Players injured from a direct impact on their shoulder are prone to complex labral tears (posterior and superior labral tears).  Try scoring or diving caused anterior labral tears, rotator cuff injury and capsular injuries. 

Shoulder dislocations in rugby players often involve considerable force and the anatomical damage from even a single dislocation can be very severe.  Dislocations from rugby are more likely to involve bony socket (glenoid) fractures and have more extensive labral and capsular tears than dislocations outside of collision sport.  Recurrent instability in rugby players is a big problem.  Even after arthroscopic stabilisation, some players will suffer repeated dislocation if they continue to play.  Factors such as your age, your level of play and whether or not you have bone damage affect your risk of re-dislocation after keyhole surgery. For some players requiring surgery to stabilise their shoulder, a bony (Latarjet) procedure will provide a more reliable result, although this is a more invasive operation and does not restore normal anatomy in the same way that keyhole surgery does. 

The labrum is a cartilage rim that lines your shoulder socket (glenoid).  It normally requires a dislocation, a traction injury or an impact, to rip this from the bone of your socket.  Rugby players with shoulder pain may well have a labral tear, even though their shoulder has never fully come out of joint.  Posterior labral tears, which are generally uncommon, may exist in up to half of elite rugby players with shoulder instability, and especially in those with a history of a direct impact to their shoulder.   Labral tears may require surgical repair to allow you to return to full function. This is done by keyhole surgery.  

Acromioclavicular Joint Problems

A direct blow to the top of your shoulder is the most common mechanism of injury to the acromio-clavicular joint (AC joint).  These are very common in rugby players because of the collision nature of the sport.  Not every AC joint dislocation requires surgery, but some injuries are more likely to do poorly without stabilisation. 

Rugby players are also prone to more chronic AC joint pain.  They are lifting heavy weights and sustain repeated shoulder impacts.  Over time this can cause damage to the cartilage inside the AC joint or it can cause the bone of the lateral end of the clavicle to resorb (osteolysis).  Patients with AC joint pain will have pain at the end of range that is exacerbated by play.  Normally players with a painful, but stable AC joint can continue to play, but it is painful.  These patients do well with arthroscopic excision of the distal clavicle and can expect to retun to play within 6-8 weeks. 

Rotator Cuff Injury

Your rotator cuff is subjected to large forces as you perform ripping and forward-play manoeuvres.  Partial tears to an otherwise healthy rotator cuff are not uncommon and may occur at the same time as dislocation or labral injury in your shoulder.  Sometimes they require surgical repair as part of your keyhole surgery. 

Can I prevent shoulder injuries from rugby?

Of course, most injuries occur during a tackle or after a direct impact.  Correct tackling technique aims to prevent your shoulders from entering vulnerable positions at impact, but as a dynamic sport, of course, misjudgements and the tendency of your opposition to try to avoid your tackle conspire to make injury common despite this!

As with many sports, your core stability, shoulder girdle strength and endurance will reduce your chances of injury and, if you do get out of position, they will improve your chances of compensating without getting injured.  Before your season begins it is recommended that you undertake rugby-specific training to optimise your condition.  Physiotherapists, rugby coaches and personal trainers will be able to help you with this. 

If you already have an injury or an unstable shoulder and wish to play, then you may wish to wear a shoulder brace. Commercially available braces and tapes (KT tape) aim to achieve a reduced risk of dislocation by:
  - Improving your shoulder position awareness and muscle control - people with shoulder instability often have poor joint position awareness whcih hinders corrective muscle actions that prevent dislocation.  A neoprene brace will improve the feedback from your skin and help tell your brain where your shoulder is. Studies have shown improved joint position sense with bracing and taping.

- Limiting access to the ‘vulnerable shoulder position’ for dislocation - 90% of shoulder dislocations come out forwards: the vulnerable position for anterior dislocation is with you arm raised up away from the body and with your forearm pointing skywards. These braces restrict the forearm rotation and therefore claim to reduce the likelihood of a dislocation. Two example braces are shown below, but several companies offer similar products

 

If you have injured your shoulder whilst playing rugby, or if you have concerns about returning to play, do get in touch via the contact section, or book an appointment. 

 What is my sports recovery after surgery?

The return to sport rate after shoulder surgery is high.  The time taken for competitive return varies between studies, but generally ranges between 4 - 7 months.  Some injuries tend to take longer to rehabilitate from and these are often the more complex injury patterns.