7. Common Injury Groups
• Contact Athletes
– Rugby
– Football
• Overhead Athletes
– Swimming, Racquets, Climbing, Cricket, Track & Field
• Trauma
– Motorsports
– Cycling
– Canoeing
– Horseriding
• Strength Athletes
– Powerlifting, weightlifting, Bodybuilding
8. Sport Popularity in UK
SPORT TV
Viewing
Participati
on
Interest
Football
46% 10% 45%
Rugby
Union
21% 6% 27%
Tennis 18% 3% 23%
Cricket 18% 2% 19%
Athletics 18% 2% 21%
Snooker 17% 5% 24%
Motorsport 16% NA 20%
Rugby
League
12% 2% 15%
Boxing 11% NA 14%
Golf 11% 6% 16%
11. "In an instant I knew my tour was over
and I could feel the tears coming,"
“I felt like a drowning man, I wanted to shout for help
but nobody could hear me.”
12. How can we help him?
• Technical Skills
• Knowledge:
– Risk factors
– Mechanism of Injury
– Pathology
– Effects of our surgery
• Recurrence Rates
• Complications
15. “The new GPS system which we wore during the Four Nations - attached to a
man bra under our shirts - consistently showed us that we were taking impacts
of 10 gs and upwards during a match.!
The gravity force of a car travelling at 100km/h that comes to a stop in 0.2
seconds is 14.2 gs.
And we don't have airbags!”
!
Jon Wilkin, Feb 2010
19. Recurrent Instability
Rates in Contact Sports
• Non-operative = 80% [Arciero, 1994]
• Open Bankart repair = 12%
• Arthroscopic Stabilisation = 14%
[Larrain, 2006]
– First dislocation = 4%
– Recurrent dislocations = 24%
– Under 18yrs age = 30% [Nixon & Funk, 2013]
20. • RCT of Latarjet vs. Arthroscopic Bankart
• Recurrence rate at 5 years:
– Latarjet = 12%
– Arth. Bankart = 24%
• Return to sport the same!
• Complication Rates higher (20%)
Latarjet Procedure [Bessier et al. JOST. 2013]
21. Recurrence Summary
• Higher in contact/collision sport
• Higher in young
• Higher after surgery for recurrent
dislocations
!
• Arthroscopic = Open Bankart
• Lower after Latarjet procedure
24. • Tackling Fatique = Reduced JPS
• End of range only
Proprioception & Fatigue
Herrington et al. Phys Ther Sport. 2008
25. Laxity
• ‘Lax’ shoulders = higher risk of
dislocation in rugby
– Cheng et al. JBJSB 2007
• High Beighton Score = higher risk of
dislocation in sports (not just
contact)
– Akhtar & Robinson. BJSM 2010
26. Isokinetic Strength
Nathan, Jones & Funk. SECEC. 2011
1. Those players that had rehabilitation following injury and
surgery had better strength & stability than those without
any shoulder injury.
2. Poor Isokinetic strength may be a risk factor for injury
3.Current rehabilitation methods are effective
4. Suggests this should applied to those that have not yet
suffered injury.
31. Player Position
• 25 Professional Footballers
– 15 Field players
– 10 Goalkeepers
Hart & Funk, KSSTA 2013
32. Clinical Examination:
Instability in Athletes
• True Instability
– Dislocation
– Subluxation
– Apprehension
– Large lesions
• Subclinical
Instability
– Dead Arm in ABER
– Pain in ABER
– Clunking
– No Apprehension
– Smaller lesions
37. Timing of Surgery
• Early Surgery:
– ‘Major’ lesions
– Late in Season
– Unable to Return
• Rehab & Return:
– ‘Minor’ lesions
– Early season
38. Types of Surgery
• Mostly Arthroscopic Direct Repairs
• Latarjet for High-Risk/Revision
39. • Anterior Instability
– Revision surgery (even without bone loss)
– Chronic Bony Bankart (> 3months)
– Any Bony Glenoid Loss
– True dislocation in Front Row forward
(Rugby Union)
– Higher level of sports
Latarjet in Athletes
40. • Player-specific - tailored to suit the player’s age,
position, requirements, surgeon and therapists.
• Not ‘accelerated’ or ‘aggressive’ or ‘time specific’.
• Surgery-specific - dependent on the quality and
type of fixation achieved.
• Protocol is a ‘guide’ and not a prescription.
• Phase Progression - when the patient is able to
perform all of the exercises in the previous phase without
any discomfort or apprehension. Each phase is
introduced progressively.
Ben Macdonald, Mike Lancaster, Meiron Jones, Doug Jones,
Christine Holmes, Kathleen Tatlow, Lennard Funk - 2004
Sports Specific Rehab
lenfunk@shoulderdoc.co.uk
48. Return to play by time of
0"
1"
2"
3"
4"
5"
Begin" Mid" End" Out"
Time"(months)"
63% of all operations took place in the last three months or out of season
Fourie & Funk, 2009