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FIRSTLY, let me thank all medics who attended last Saturday’s meeting in Mbabane. For those who could not attend, please try and get the minutes.Today we are looking at the shoulder joint injuries.
Common sporting injuries of the shoulder include dislocations and labral pathology, acromioclavicular joint (ACJ) injuries, rotator cuff injuries, biceps injuries, and fractures. In very general terms, dislocations and ACJ injuries are more common in contact sports such as rugby and wrestling, while rotator cuff tears and biceps lesions are common in sports involving explosive heavy weight-lifting. Fractures around the shoulder are seen in sports involving crashes and falls from heights. All of these injuries can, however, occur in football.
Shoulder injuries appear to be an increasing problem for football players. This is likely to be related to the increasing demands of modern football, which is characterised by high speeds, pressing, and marking. Goalkeepers appear to be the players who are at most risk of sustaining a shoulder injury. While shoulder injuries are not among the most common injuries sustained during football, they can be associated with a prolonged absence from play.
The mechanism of injury is a key consideration. For example, an ACJ sprain almost always occurs after a fall onto the ‘point’ of the shoulder, while shoulder instability almost always happens when the arm is in an abducted and externally rotated position. ACJ arthropathy typically comes on insidiously and is made worse by pressing activities.
There are a variety of common fractures that can occur in football players. These are associated with acute trauma and can present in a similar way to some of the soft-tissue injuries. The acromioclavicular joint (ACJ) is a common site of injury, particularly for athletes involved in contact and collision sports such as football.
Acute management: Immediately following an injury, it is important to offer adequate pain relief. A sling can be very effective and can be combined with simple analgesia, NSAIDs and cryotherapy. Passive range-of-motion exercises, including pendulum and active-assisted exercises, should be considered. The player should stay below 90 degrees of abduction. They can be encouraged to maintain fitness if comfortable using a stationary bike and may be able to maintain the strength of their proximal kinetic chain.
Early rehabilitation: When the player’s pain has settled, and their range of motion has improved to 60-70 per cent of the unaffected side, they can progress with their rehabilitation. This can be a good time to identify biomechanical factors that may have been predisposed to injury. Exercises that might be useful in this phase include: Stretch of the posterior capsule sleeper stretch. Stretching anterior structures open book and towel exercises.
Progressive ROM exercises with the goal of achieving full ROM.
Strengthening of the rotator cuff and scapular stabilisers.
Work in single plains.
Closed chain scapular stability exercises.
Scapular squeeze and clock.
Players can progress to this phase when they have a normal full and painless. ROM and 75 per cent strength of the unaffected side.
The types of exercises that might be useful in this phase include:
Progressive multi-planar exercises - The addition of further resistance exercises, including weights and the use of medicine balls and more functional activity. Plyometric exercises.
When the player has a normal range of motion and more than 90 per cent strength of the uninjured side, they can progress to a return to football. This should be done in a gradual manner. Till next week may the Lord bless you all.