Professional Documents
Culture Documents
DOI 10.1007/s00776-011-0087-6
ORIGINAL ARTICLE
Received: 25 August 2010 / Accepted: 6 April 2011 / Published online: 13 May 2011
The Japanese Orthopaedic Association 2011
Abstract
Background Shoulder injuries are common in rugby, with
the most severe match injury being shoulder dislocation
and instability. A limitation of epidemiological studies is
that the injury information is based on player interviews
after the injury or reports from the medical staff. The
objective of this study is to describe the specific injury
mechanisms for shoulder dislocation using video recordings in a consecutive series of 4 elite male rugby players
who sustained an episode of shoulder dislocation during an
official match.
Methods Videotapes were reviewed to identify the
mechanism of the injury. The incidents, including the play
leading up to each incident, were analysed. A shoulder
dislocation mechanism score was developed to describe the
injury mechanism and the events leading up to the injury.
Results For all the athletes, player-to-player contact was
responsible for the shoulder dislocation. Three of the four
injuries resulted from trauma with the elbow in an extended
Introduction
U. G. Longo (&) V. Denaro
Department of Orthopaedic and Trauma Surgery,
Campus Bio-medico University, Via Alvaro del Portillo,
200, Trigoria, 00128 Rome, Italy
e-mail: g.longo@unicampus.it
P. E. Huijsmans
Department of Orthopedics, Haga Hospital, Sportlaan 600,
2566 MJ The Hague, The Netherlands
N. Maffulli
Centre for Sports and Exercise Medicine, Barts and The London
School of Medicine and Dentistry, Mile End Hospital,
275 Bancroft Road, London E1 4DG, UK
J. F. De Beer
Cape Shoulder Institute, PO Box 15741, Panorama 7506,
South Africa
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U. G. Longo et al.
3.
4.
1.
2.
Video analysis
Eligibility criteria
2.
3.
Shoulder
Dominant
side
First
episode
Direction of
dislocation
Withdrawn
from match
Surgical diagnosis
1 (Fig. 1)
Left
Right
Yes
Anterior
No
2 (Fig. 2)
Right
Right
Yes
Posterior
Yes
3 (Fig. 3)
Left
Right
Yes
Anterior
Yes
4 (Fig. 4)
Right
Right
Yes
Anterior
Yes
Bankart lesion
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4.
5.
No
Posterior
Anterior
Anterior
No
Posterior
No
No
7.
8.
Yes
6.
9.
Results
Active
Extension
In the air
In the air
4 (Fig. 4) In the air
Flexion
Extension
Passive
Active
Extension
On the ground
In the air
On the ground
In the air
On the ground
On the ground
Active
Patients demographics
Four patients (mean age 23.7 years; range 2226) met the
inclusion criteria. All patients had undergone primary surgery at our institution (Table 1). The dominant arm was
involved in 2 patients. In all four patients the dislocation had
been caused by trauma. The detailed shoulder dislocation
mechanism score is reported in Table 2 for every athlete.
Discussion
This study evaluated the mechanisms of shoulder dislocation in four South African professional elite rugby players
on the basis of analysis of video recordings of injuries from
official matches. For all the athletes, player-to-player
contact was responsible for the shoulder dislocation. Three
of the four injuries resulted from trauma with the elbow in
an extended position forcing the shoulder to exceed the
limits of the normal range of motion and causing an
anterior shoulder dislocation. One injury resulted from
trauma with the elbow in a flexed position and the direction
of the injuring force along the longitudinal axis of the
humerus, causing a posterior shoulder dislocation. Generally, it is assumed that anterior shoulder dislocations occur
with the arm in abduction and external rotation. However,
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injuries, providing more reliable information than retrospective player interviews; to the best our knowledge, no
studies reported in the literature have used this approach to
study the mechanism of shoulder dislocations in elite rugby
players [13, 16, 1820].
This study was conducted on elite male rugby players.
There may be differences in injury mechanisms between
rugby and other contact sports, and between these players
and other player populations (for example, younger players, female players, and amateur players) that warrant
attention in future studies [13].
Another limitation of this study is that we do not report
the position of the athlete in the field, the training
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Fig. 3 a Overview of the
playing situation, b close-up of
the injured player with the fully
extended left arm tackling the
opponent, c, d anterior impact
of the fully extended left arm of
the injured player with the
opponent, e, f the injured player
falls, g, h the moment just after
the shoulder injury
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