Rugby Union on-field position and its relationship to shoulder injury leading to anterior reconstruction for instability

doi:10.1016/j.jsams.2010.08.005

Journal of Science and Medicine in Sport

Volume 14, Issue 2, March 2011, Pages 111-114

https://doi.org/10.1016/j.jsams.2010.08.005 Get rights and content

Abstract

Due to the unique demands of each position on the Rugby Union field, the likelihood of an athlete sustaining a dislocation of their shoulder joint that requires surgical reconstruction may be affected by their position on the field. 166 patients with 184 involved shoulders requiring anterior reconstruction following an on-field Rugby Union injury between January 1996 and September 2008 were analysed. The mean age at time of injury was 18 years with the mean age at time of surgery being 20 years. The most prevalent mechanism of injury was a tackle in 66.3% of players. Players were more likely to suffer injury to their non-dominant shoulder than their dominant side (McNemar's Test, p < 0.001). Statistical analysis using chi-squared test of goodness of fit showed there was not a uniform risk of injury for all player positions. Positions with significantly different risk of injury were five-eighth (increased risk) and wing (reduced risk). Although we observed an increased risk in flankers and fullbacks, and a lower risk in second row, these results did not reach statistical significance after application of the Bonferroni correction. This information can be utilized by team staff to assist in pre-season conditioning as well as the development of improved muscle co-ordination programmes for the non-dominant shoulder, and planning a graduated return to sport by the player recovering from surgical reconstruction of the shoulder for instability.

Introduction

It is well documented that the high-collision nature of Rugby Union1, 2, 3 is conducive to injury. The incidence of injury for Rugby Union has been documented at 69–218 per 1000 player-hours4, 5, 6 for professional players, with an injury defined as “requiring a player to miss 24 h of activity”.

Shoulder dislocations have an incidence of 1.25 per 1000 player-hours6, 7 in Rugby Union and accounted for 1.5%² of all injuries (17th most common injury) in Argentinean Rugby between 1991 and 1997. Bathgate et al., 2002, highlighted the severity of shoulder instabilities, which is determined by the number of weeks absent from rugby-related activities, as shoulder dislocations accounted for 80% of severe shoulder injuries,⁴ while Brooks et al., showed that shoulder dislocations resulted in an average of 106 days absence from Rugby activities for English professional Rugby Union players.⁶

A number of studies have identified positions at risk of overall injury in Rugby Union1, 8, 9 with some contradictory findings; however, no study could be found with a focus on the risk factors for shoulder dislocations in Rugby Union. As each position on the field is subject to unique demands, the likelihood of an athlete engaging in a situation, which could compromise the stability of their glenohumeral joint, may be affected by their position on the field.

Section snippets

Methods

This study is a prospectively enrolled series of patients who required anterior shoulder reconstruction for instability acquired whilst playing Rugby Union between January 1996 and September 2008. The inclusion criteria were: male and a shoulder injury occurring on the rugby field leading to surgery for anterior instability (arthroscopic or open). Female rugby players requiring a reconstruction were excluded, as there were too few to consider for statistical analysis. Player demographics; the

Results

There were 269 patients who required anterior reconstruction following an on-field Rugby Union injury between January 1996 and September 2008. Of these patients only 166 patients with 184 involved shoulders were included. This is a series of young, geographically mobile individuals and 103 were not contactable because of changes in address including movement interstate and overseas. All patients contacted agreed to participate within the study. The mean age of the patients at time of injury was

Discussion

The incidence of shoulder injury has been previously documented for Rugby Union.2, 6, 7 Headey et al., in their study of English Premiership Rugby Union clubs over two seasons, noted that shoulder injuries had an incidence of 8.9/1000 player match hours with instability constituting about 14% of these cases.⁷ Others have also commented on the considerable severity of shoulder dislocations, rendering the injured player unable to take part in team training activities and matches for lengthy

Conclusion

Our study has demonstrated that there is a statistical difference in the likelihood of players sustaining shoulder injuries requiring surgical reconstruction for instability depending on their on-field position at the time of injury. The five-eight can be considered a high-risk position with a trend to increased risk in the flankers and fullback positions. Conversely, the wing can be considered as a significantly safer position with a trend to lesser risk in the second row. This information can

Practical implications

•
Different positions on the rugby field have a variably risk of injury leading to anterior shoulder reconstruction for instability.
•
The non-dominant shoulder is significantly more at risk for instability.
•
Allowances for these increased risks should be accommodated when players undergo pre-season conditioning and post-surgical rehabilitation.

Acknowledgements

We acknowledge and thank the contributions of Professor Michael Morgan and Dr Sharon Flahive who offered their support and assisted with information utilised within this study. No financial assistance has been received by the authors for this study.

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Cited by (30)

Shoulder isokinetic profile in professional rugby players does not vary with their on-field position
2021, Journal de Traumatologie du Sport
Les blessures de l’épaule des rugbymen professionnels sont fréquentes, souvent liées à des traumatismes de haute intensité. Leur prévention par une évaluation isocinétique fait partie intégrante de la préparation physique des joueurs. Cependant, les profils isocinétiques des muscles rotateurs internes (RI) et externes (RE) d’épaule des joueurs de rugby, précédemment définis, ne prennent pas en compte leur poste de jeu. Le but de cette étude était de comparer le profil isocinétique des muscles RE et RI des joueurs de rugby en fonction de leur poste : avants et arrières.
Quarante-deux joueurs de rugby professionnels étaient évalués. Un dynamomètre Con–Trex était utilisé pour tester les muscles RI et RE des deux épaules. Les données étaient obtenues successivement en mode concentrique à 60°/s et 240°/s puis en mode excentrique à 60°/s. Le pic de couple (PC), le pic de couple rapporté au poids des RI et RE et le ratio RE/RI étaient mesurés à chaque vitesse angulaire.
Le pic de couple des RI et RE était plus élevé pour les avants par rapport aux arrières pour le côté dominant pour tous les modes de contraction (p < 0,05). Aucune différence n’était retrouvée entre les deux groupes sur les pics de couples rapportés au poids (p > 0,05), sur le ratio RE/RI (p > 0,05) et sur le ratio mixte (p = 0,54).
Les avants avaient une plus grande force musculaire des épaules que les arrières. En rapportant les résultats au poids, la force musculaire et le profil isocinétique étaient similaires.
Professional rugby player's shoulder injuries are common, often related to high-intensity trauma. Their prevention by an isokinetic evaluation is an integral part of the physical preparation of the players. Profiles of shoulder internal and external rotator (IR and ER) muscles are established, but do not consider the player's on-field position. Our goal was to establish an isokinetic profile for shoulder external and internal rotator muscles in rugby players depending on their on-field position: forwards or backs.
Forty-two professional rugby players were tested during a rugby season. We used an isokinetic Con–Trex® dynamometer to measure internal and external rotation of the shoulder. Data were obtained successively in concentric contraction mode at 60°/s and 240°/s, then in eccentric contraction mode at 60°/s. Peak torque (PT), peak torque normalized to body weight (PT/BW) of the IR and ER muscles and the ratio of ER PT/IR PT (ER/IR ratio) were measured for each angular velocity.
Significant differences of PT (Nm) between forwards and backs were found in the dominant side for all tested velocities (P < 0.05). There were no statistical differences between groups in PT/BW (P > 0.05), ER/IR ratio (p > 0.05) and mixed ratio (P = 0.54).
Despite significant differences in the absolute values of isokinetic strength, there are no significant differences in shoulder strength normalized to body weight between forwards and backs.
Magnetic Resonance Arthrography in Rugby Players Undergoing Shoulder Stabilization for Glenohumeral Instability: Professionals Have Higher Frequencies of More Pathologies
2021, Arthroscopy, Sports Medicine, and Rehabilitation
Citation Excerpt :
As professional rugby players often endure planned collision-protected training, the incidence of such shoulder injuries leading to absence from play in rugby players is 90 times more likely to occur during competitive matches compared with club training sessions.3 Due to the high tackle rates in their game play, back-row players have been reported to have the greatest incidence of shoulder injury of all rugby players, with one event reported per 37 hours of play.24 In addition, rugby players with glenohumeral dislocations proceed to experience further dislocations and subsequent instability in nearly two thirds of cases and often require surgical stabilization in up to 50% of cases,3 with professional rugby players subsequently continue to pursue playing rugby post-stabilization.25
To quantify the magnetic resonance arthrography (MRA) findings in rugby players during preoperative workup for anterior surgical stabilization for glenohumeral instability.
All patients who underwent glenohumeral instability surgery in our institution between 2008 and 2018 were considered for inclusion. Rugby players were identified using the patient’s medical notes, with subsequent identification of all professional players. All rugby player’s preoperative MRA findings were recorded and analyzed.
Overall, 267 rugby players were included, 261 of whom were male (97.8%), with a mean age of 22.7 years (range 13-55 years). There were 58 professional rugby players (21.7%). The mean number of pathologies in nonprofessional rugby players was 5.0 pathologies versus 6.2 pathologies in the professional rugby players, with a significant difference in nonprofessional rugby players with up to 3 pathologies versus professional rugby players (26.3% vs 10.3%, P = .01). Professional rugby players had a statistically significant increased incidence of bicipital tendon lesions (25.9% vs 13.9%, P = .009), acromioclavicular joint degeneration (60.3% vs 42.1%, P = .016), glenohumeral bone loss (87.9% vs 69.9%, P = .006), and degenerative changes (67.2% vs 44.0%, P = .002) on their MRAs.
Rugby players undergoing surgical stabilization for glenohumeral instability often have a significant number of pathologies identified on MRA at the time of surgery. Professional rugby players showed concerningly greater frequencies of early degenerative changes when compared with nonprofessional rugby players.
III; Retrospective Cohort Study
The effect of physical fatigue on tackling technique in Rugby Union
2020, Journal of Science and Medicine in Sport
To measure the change in tackling technique of rugby union players following an acute bout of physically fatiguing exercise.
Randomised cross-over study design with a physical fatigue condition and no-physical fatigue condition (control).
Nineteen male amateur club rugby union players (n = 19) and a total of 887 tackles were analysed. During each condition, each player performed four sets of six tackles (three dominant and three non-dominant shoulder) on a contact simulator. Between each set of tackles in the physical fatigue condition, players performed the prolonged high-intensity intermittent running ability test. Using video, player's tackling proficiency for each tackle was measured by awarding either one point or zero points depending on whether a particular technique was performed or not. The sum of these points represents player’s tackling proficiency (score out of 9, measured in arbitrary units).
In the non-dominant shoulder, a difference between fatigue and control was found at set two (Fatigue 7.3 [7.1–7.6] AU vs. Control 7.6 [7.4–7.9] AU, p = 0.06, ES = 0.3 small) and set three (Fatigue 7.3 [7.0–7.5] AU vs. Control 7.7 [7.5–7.9] AU, p = 0.006, ES = 0.5 small). During the control condition, tackling proficiency scores improved from baseline for non-dominant tackles (Baseline 7.4 [7.2–7.6] AU, vs Set two 7.6 [7.4–7.9] AU, p = 0.08 ES = 0.3 small; vs Set three 7.7 [7.5–7.9] AU, p = 0.05, ES = 0.4 small).
In conclusion, this study shows that physical fatigue can potentially affect rugby union players’ tackling technique. Therefore, players should develop technical capacity to resist the effects of physical fatigue during the tackle.
Hand dominance in traumatic shoulder dislocations
2018, JSES Open Access
Citation Excerpt :
The correlation between young men sustaining shoulder dislocations while playing sport has been previously highlighted.13 Sundaram et al17 evaluated shoulder injuries (not dislocation specifically) in rugby players, showing that 57.5% of the players injured their nondominant arm. The study mentioned that this was an unexpected finding and theorized that this may be due to differences between coordination and strength.17
Shoulder dislocations are common injuries among athletes. Patients with instability after their injury often require stabilization procedures for treatment. The primary outcome measure was to see whether there was any correlation between the side of traumatic shoulder dislocation and dominance of hand. Secondary outcomes were to look at subgroups of age and sporting discipline.
This study recruited all patients with a frank dislocation that required arthroscopic surgical stabilization who attended the same private orthopedic surgeon. Exclusion criteria included injury without frank dislocation, nonsport-related injuries, and ambidexterity. Data were collected for 325 of 365 patients (89.0% response rate)
There were 278 right hand-dominant patients (85.5%), with 136 (48.9%) requiring arthroscopic stabilization of their dominant side for dislocation. Of the remaining 47 left hand-dominant patients, 17 (36.2%) required operations on their dominant arm. In total, 153 patients (47.1%) dislocated their dominant shoulder and 172 (52.9%) dislocated their nondominant shoulder, with an odds ratio of 1.692 (95% confidence interval, 0.893-3.205).
This study suggests that there is no statistical significance between the side of shoulder dislocation and hand dominance of patients with shoulder dislocation. Future research could investigate further the causal relationship between hand dominance and mechanisms of injury.
Arthroscopic and Open Stabilization Techniques for Anterior Instability in the Contact Athlete
2016, Operative Techniques in Sports Medicine
Shoulder dislocations are common injuries seen in contact athletes and can cause substantial time away from play, reduce career length, and result in serious long-term morbidity. Contact athletes may be at higher risk for failure of surgical repair of shoulder instability than other individuals. In light of these issues, the contact athlete with shoulder instability deserves special attention. A number of surgical techniques have been described for treatment of shoulder instability in contact athletes, ranging from arthroscopic to open Bankart repair to bone block procedures. In this article, we review the clinical evaluation of the contact athlete with shoulder instability, including history taking, physical examination, and imaging findings. We discuss decision making for repair in terms of both timing and choice of procedure. Finally, we discuss techniques of arthroscopic and open Bankart repair and outcomes.
Shoulder injuries in rugby players: Mechanisms, examination, and rehabilitation
2014, Physical Therapy in Sport
Citation Excerpt :
Usman & McIntosh, 2013) Players in back positions that require more frequent tackles and tackling of opponents who are running at top speed are at a greater risk of shoulder dislocations than players in forward positions. ( King, Hume, & Clark, 2011; Sundaram, Bokor, & Davidson, 2011) The rate of injuries for female rugby teams is generally considered to be significantly less than male teams with more injuries to the lower extremities, especially the knee joint. ( Taylor, Fuller, & Molloy, 2011)
The sport of rugby is growing in popularity for players at the high school and collegiate levels.
This article will provided the sports therapist with an introduction to the management of shoulder injuries in rugby players.
Rugby matches results in frequent impacts and leveraging forces to the shoulder region during the tackling, scrums, rucks and maul components of the game. Rugby players frequently sustain contusion and impact injuries to the shoulder region, including injuries to the sternoclavicular, acromioclavicular (AC), and glenohumeral (GH) joints. Players assessed during practices and matches should be screened for signs of fracture, cervical spine and brachial plexus injuries. A three phase program will be proposed to rehabilitate players with shoulder instabilities using rugby specific stabilization, proprioception, and strengthening exercises. A plan for return to play will be addressed including position-specific activities.

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Original ResearchRugby Union on-field position and its relationship to shoulder injury leading to anterior reconstruction for instability

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Practical implications

Acknowledgements

J Sci Med Sport

Phys Ther Sport

J Shoulder Elbow Surg

Phys Ther Sport

J Shoulder Elbow Surg

J Electromyogr Kinesiol

Rugby World Cup 2003 injury surveillance project

Br J Sports Med

Incidence and nature of the most common rugby injuries sustained in Argentina (1991–1997)

Br J Sports Med

Contact events in rugby union and their propensity to cause injury

Br J Sports Med

A prospective study of injuries to elite Australian rugby union players

Br J Sports Med

A prospective study of injuries and training amongst the England 2003 Rugby World Cup Squad

Br J Sports Med

Original Research
Rugby Union on-field position and its relationship to shoulder injury leading to anterior reconstruction for instability