Sporting Shoulder injuries

Humans have a unique ability to throw, which has offered us huge evolutionary advantages over other animals. Such an ability to throw has allowed humans to hunt and defend. The structure and function of the human shoulder are central to achieving this remarkable throwing ability. 

Additionally, the shoulder joint has an extensive range of motion which allows us to place the hand in a large functional hemisphere. Although these qualities have been central to human superiority in the food chain, the shoulder has to pay the price in the form of predisposition to certain injuries when it comes to sports.

In contact sports such as Rugby, the shoulder is particularly predisposed to dislocations. In fact, rugby is associated with the highest number of injuries per season per player as compared to all other sports. Dislocation of the shoulder, in simple terms, means the dislodgement of the ball and socket joint. The shoulder joint has a relatively small and shallow socket, to allow for a large range of motion, and is hence predisposed to such injuries. Keyhole surgery allows repair of most of these injuries and results in a high proportion of players returning to play.

Overhead sports, such as volleyball, Tennis, Cricket bowlers, swimming and baseball place the arm in an extreme position repetitively. As we have seen, such throwing position is one of the fundamental evolutionary advances in humans. However, repetitive loading of the shoulder in such an extreme position leads to “peel off” of the lining of the socket and the ball. Such internal damage may present with the player losing the power in their throw and may also be excessively painful. A thorough clinical examination and specialised investigations such as MRI scan are useful to make such a diagnosis. Management consists of specialist physiotherapy, technique modification and arthroscopic surgery. Although a return to a high level of play is usually possible, the extent of damage is an essential determinant of outcomes.

Horse riders and cyclists present commonly with fracture of their collarbone or disruption of the AC joint (joint between the collarbone and the shoulder blade). Such injuries are usually for a fall, and a vast majority of these need surgical fixation to achieve proper function and return to a high level of sports.

Combat sports such as wrestling and boxing also have a unique set of common injuries. Shoulder dislocations, AC joint injuries and tendon ruptures are often seen in this group. Early diagnosis and surgical treatment would usually return a high proportion of patients to play.\

We have seen that individual sports are associated with certain shoulder injuries, which are unique to them. The decision to proceed with surgery and its timing involves consideration of the type of injury, nature of sport, sporting season and player motivation. Finally, to achieve success a team approach to management is crucial with an orthopaedic surgeon working along with a specialist physiotherapist, coach, team doctor and sports psychologist.

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