4. 1 Sports Injuries
of the Shoulder
Lennard Funk
Mike Walton
Adam C. Watts
Mike Hayton
Chye Yew Ng
Editors
123
9 783030 230289
ISBN 978-3-030-23028-9
Sports
Injuries
of
the
Shoulder
This book provides a practical guide detailing the aetiology,
diagnosis, relevant pathology, management principles, and out-
comes of a variety of injuries to the shoulder including rotator
cuff disorders, glenoid bone loss, and pectoralis major ruptures
in both elite and non-elite athletes. Each chapter features clinical
pearls and a question and answer section to emphasize key points.
Sports Injuries of the Shoulder is an essential book for those
seeking an up-to-date resource. It is aimed at sports doctors and
musculoskeletal doctors; senior orthopedic trainees with an
interest in upper limb and those preparing for the FRCSOrth
exam and similar international exams, as well as surgeons with
a particular interest in shoulder conditions.
Lennard Funk · Mike Walton · Adam C. Watts · Mike Hayton
Chye Yew Ng Editors
Sports Injuries of the Shoulder
Funk
·
Walton
·
Watts
Hayton
·
Yew
Ng
Eds.
5. @theshoulderdoc
Plan
1. When to Fix in pro cyclists
- & Why.
2. Fixation methods
- pros & cons.
3. Return to cycling & competition
- When & Why.
4. Metalwork removal
- Why, When & Who!
12. @theshoulderdoc
Healing times &
➡ 28 year old male pro-cyclist
Prognostic index =
[-0.85 x (1 if displaced or 0 if undisplaced)]
+ [-0.36 x (1 if female or 0 if male)]
+ [-0.37 x (1 if comminuted or 0 if not)]
+ [-0.01 x (age of patient in years)]
X
X
X
15. @theshoulderdoc
Op vs Non-op?
Operative treatment leads to improved short-term functional outcomes, increased patient
satisfaction, an earlier return to sports and lower rates of non-union compared with conservative
treatment. In terms of cost-effectiveness, operative treatment also seems to be advantageous.
However, operative treatment is associated with an increased risk of complications and re-
operations, while long-term shoulder functional outcomes are similar.
17. @theshoulderdoc
Plate & Screws -
➡ Steel vs Titanium
➡ Low Profile
➡ Number of screws
➡ Locking vs non-locking
➡ Lag screws
➡ Working distance
Keys to success
21. @theshoulderdoc
When to Return to Sport?
➡ Is Fixation strong enough to protect fracture against forces
while it heals? (Load sharing)
➡ Time to radiographic union: Non-op 28.4wks vs Op 16.4 wks
(Canadian Orth Trauma Society, 2007)
➡ Benefits vs Risks
➡ MDT Decision - ultimately Patient’s decision! (document)
➡
22. @theshoulderdoc
Return to Cycling
Pro cyclists average 3.6 weeks
(range 2 to 6 weeks) std- 1.48
Pro motorcyclist average 7.6 weeks
(range 2 to 12 weeks) std- 4.56
Social riders average 12.86 weeks
(range 6 to 24 weeks) std- 6.72
Unpublished, Syed Shah & Len Funk, 2012
25. @theshoulderdoc
Summary
➡ Clavicle is unique - not long or flat bone
➡ Non-union = pain & dysfunction
➡ Union & RTS better with fixation
➡ Plate & screws standard
➡ Titanium precontoured, low profile
➡ RTS = when safe & MDT decision (patient-led)
➡ Removal should not be ‘routine’