Shoulder Injuries In Rugby Players

Shoulder injuries are very common in rugby players due to the frequent amount of forceful physical contact and collisions with other players and the playing surface (Pallis, Cameron, Svoboda and Owens 2012). English professional Rugby Football Union clubs were surveyed in the 2002-2003 and 2003-2004 seasons and the results showed that acromioclavicular joint injuries accounted for 32% of all shoulder injuries assessed (Headey, Brooks and Kemp, 2007). The acromioclavicular joint is extremely susceptible to trauma because of its small, incongruent articulating surfaces (Levangie and Norkin, 2006). An injury to this joint is often a result of force on the superior shoulder or a fall onto an outstretched arm. Injuries can range from minor ligament

The acromion is a bony process that extends laterally from the spine of the scapula (Drake, Vogl and Mitchell, 2015). This acromioclavicular joint is described as a diarthrodial synovial joint encased by a thin joint capsule lined with synovium (Alice, Jonelle, Petscavage-Thomas and Gino, 2014). The joint is stabilised by three ligaments. Ligaments are strong bands of inelastic fibrous tissue that connect bone to bone and enhance the stability of a joint (Dudley, 2006).The outer third of the clavicle is joined to the scapula by the conoid and trapezoid ligaments of the coracoclavicular ligament and superiorly the acromioclavicular ligament passes between adjacent regions of the clavicle and acromion [1] (Drake, Vogl and Mitchell, 2015). As well as this the joint is also reinforced by the fascial attachments of the overlying deltoid and trapezius muscles (Greene and Karas, 2010). The function of the acromioclavicular joint is the ability to raise the arm above the head and across the body. It also helps with movement of the scapula resulting in a greater degree of arm rotation by providing a pivot for the scapula and thoracic vertebrae. As well as this it transmits forces from the upper limb to the rest of the body (Edell,

Sprains refer to when a ligament attaching two bones together is forced beyond its normal range (Dudley 2006). A grade 2 sprain will involve the complete disruption of the acromioclavicular ligament and partial disruption of the coracoclavicular ligaments, however these remain intact (Manaster, May and Disler, 2013). This injury can cause the acromion to depress and produce a ‘step’ which may be visible on initial observation of the joint, an X-Ray or on initial palpation. A sprain of the acromioclavicular joint can also be called a shoulder separation which is not to be confused with a shoulder dislocation which involves the glenohumeral joint (Martini, Nath and Bartholomew, 2015). The initial treatment of this injury would be to follow the PRICE guidelines (protection, rest, ice, compression, elevation). These guidelines aim to reduce undue stress on the injury, prevent further injury and promote the healing process (Kerr, Daley, Booth and Stark,