Evaluation and Management of the Contact Athlete's Shoulder

Abstract

Shoulder injuries are common in contact athletes and vary in severity because of the required complex interplay of shoulder stability and range of motion for proper function. Pathology varies based on sport but most commonly includes shoulder instability, acromioclavicular injuries, traumatic rotator cuff tears, and brachial plexus injuries. Acute management ranges from reduction of shoulder dislocations to physical examination to determine the severity of injury. Appropriate radiographs should be obtained to evaluate for alignment and fracture, with magnetic resonance imaging commonly being necessary for accurate diagnosis and management. Treatments range from surgical stabilization in shoulder instability to repeat examinations and physical therapy. Return-to-play decision making can be complex with avoidance of reinjury and player safety being of utmost concern. Appropriate evaluation and treatment are vital because repeat injury can lead to long-term effects due to the relatively high effectsometimes seen in contact sports. Contact athletes represent a unique athletic group who place particularly high stresses on their shoulders with the most common injuries, including shoulder instability, acromioclavicular (AC) injuries, traumatic rotator cuff tears, and brachial plexus injuries. With increases in sports participation and trends toward early sport specialization in adolescence, increased injury rates have been seen. 1,2 However, this has not yet been successfully quantified. 3 Acute management includes appropriate on-field and in locker room evaluation followed by immediate treatment and proper return-to-play decision making. Physical examination should then be done without spectators with particular attention to the commonly mentioned pathologies. Initial imaging includes radiographs while MRI can aid in the evaluation of soft-tissue injuries. Typical nonoperative measures include restoration of range of motion and periscapular and rotator cuff strengthening. If surgical treatment is required for successful and durable return to sport, special considerations regarding the particular sport and position are vital. In contact athletes, surgical techniques that give superior stability should be considered to allow for improved durability in return to play. Although these surgical repairs commonly see greater forces, if treated

Outcomes of Shoulder Instability Surgery in Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 5 Years’ Mean Follow-up

“…Shoulder stability is especially important for high-level athletes, including competitive wrestlers who require smooth, stable tracking throughout the full shoulder range of motion and strength when engaging in contact. 1,2,26 However, this young athletic cohort remains at risk for recurrence despite treatment. With respect to ASI, Ranalletta et al 27 followed a cohort of 56 athletes (22 contact and 34 collision) after arthroscopic shoulder stabilization and observed a 14.7% rate of recurrent shoulder instability in the collision sport group (eg, rugby, boxing, ice hockey, American football, and wrestling) compared with 0% in the contact sport cohort (eg, soccer and field hockey).…”

“…1,8,10,14 Subsequently, there are generally fewer studies evaluating the effect of SIS in wrestlers. 2,33 Furthermore, given the high rate of injuries and need for operative intervention, additional studies are needed to effectively counsel wrestlers who sustain shoulder instability. 34 Therefore, the purpose of this study was to assess reoperation rates, patient-reported outcomes, and return to wrestling (RTW) after SIS in a cohort of competitive wrestlers.…”

The Epidemiology of Shoulder Injuries in Water Polo Players: A Monocentric Descriptive Study on Clinical and Radiological Presentation

“…Fifty-three patients (57.6% of the total) experienced a previous instability episode. As previously described by Franić et al and Hams et al [2,4], water polo players defend their teams by keeping their arms above their heads in order to physically obstruct opposing players, exposing maximally abducted and externally rotated shoulders to external forces [13][14][15][16]. Furthermore, players are exposed to direct and indirect traumas, potentially resulting in shoulder instability episodes, such as shoulder dislocations and/or subluxations [4,[13][14][15][16].…”

“…As previously described by Franić et al and Hams et al [2,4], water polo players defend their teams by keeping their arms above their heads in order to physically obstruct opposing players, exposing maximally abducted and externally rotated shoulders to external forces [13][14][15][16]. Furthermore, players are exposed to direct and indirect traumas, potentially resulting in shoulder instability episodes, such as shoulder dislocations and/or subluxations [4,[13][14][15][16]. The mean age (24.5 years) at presentation was significantly lower than the mean age (32.5 years) of the patients who suffered from chronic overload injuries (p < 0.01).…”

“…Water polo players keep their arms above their heads in order to physically obstruct opposing players, exposing the shoulder joint to external forces [13,14]. Moreover, with water polo being a contact sport, players are exposed to direct and indirect traumatic impacts, potentially resulting in acute shoulder events, such as shoulder dislocations and/or subluxations [4,[13][14][15][16].…”