BackgroundShoulder injuries in rugby players are common, but the mechanisms of injury are less well understood. This study aims to elucidate common mechanisms of injury and identify the patterns of injury they produce.Materials and methodsTwenty-four elite rugby players, referred to the senior author for diagnosis and management of shoulder injuries, were selected. Videos of the injuries were independently reviewed by rugby-medical experts to describe the mechanisms of injury. The mechanisms reported were collated and analysed to determine the level of agreement between reviewers and conclude an overall description of injury mechanisms.ResultsThe authors identified three mechanisms of shoulder injury from the video analysis. These are the ‘Try-Scorer’, characterised by hyperflexion of the outstretched arm such as when scoring a try; the ‘Tackler’, extension of the abducted arm behind the player while tackling; and the ‘Direct Impact’, a direct blow to the arm or shoulder when held by the side in neutral or slight adduction. The Try Scorer and Tackler mechanisms both involve a levering force on the glenohumeral joint (GHJ). These mechanisms predominantly cause GHJ dislocation, with Bankart, reverse Bankart and superior labrum anterior–posterior tears. The Try-Scorer Mechanism also caused the majority (83%) of rotator cuff tears. The Direct Hit mechanism resulted in GHJ dislocation and labral injury in 37.5% of players and was most likely to cause acromioclavicular joint dislocation and scapula fractures, injuries that were not seen with the other mechanisms.ConclusionGreater understanding of the mechanisms involved in rugby shoulder injury is useful in understanding the pathological injuries, guiding treatment and rehabilitation and aiding the development of injury-prevention methods.

Systematic review and meta-analysis, level III.

Systematic review, Level IV.

Background Sternoclavicular joint (SCJ) injuries are uncommon. A minority of patients with anterior dislocation progress to chronic instability associated with pain and a limitation of activities, and thus surgery should be considered. A retrospective case series of an all anterior reconstruction of the SCJ with autologous palmaris longus is presented. Methods Five consecutive patients underwent SCJ stabilization using a palmaris longus autograft tunnelled through the anterior cortices of the medial clavicle and the manubrium sterni, avoiding posterior dissection of the SCJ and its associated risks. Results Three patients reported a completely stable SCJ after surgery at a mean 28 months postoperatively. One other patient reported improved stability and one reported recurrent instability. All patients had returned to work. The median Oxford Shoulder Score was 42 [interquartile range (IQR) 32 to 42] and the median Rockwood Score was 13 out of 15 (IQR 5 to 14). The median overall subjective satisfaction was 90% and, compared to the contralateral side, median satisfaction was also 90% (IQR 50% to 90%). Discussion The technique is safe and effective for reconstructing chronic anterior SCJ dislocations. The all anterior approach for reconstruction of the SCJ reduces the risk to the structures posterior to the medial clavicle, manubrium sterni or first rib.