SHOULDER INSTABILITY IN THE COLLISION ATHLETE

Abstract

The spectrum of pathoanatomy in collision athletes with shoulder instability is wide, with a high incidence of extended labral lesions and associated intra-articular injuries. The ‘collision shoulder’ describes an injury sustained by direct impact to the shoulder without dislocation, but with extensive labral damage and a high incidence of other intra-articular pathology and neurological symptoms.

One hundred and eighty-three collision athletes (rugby and rugby league) were treated for labral injuries related to their sport in three different centres. Details of the mechanism of injury and findings at surgery were recorded. Only 60% of athletes in the series presented following a documented dislocation or subluxation episode of the shoulder. An additional pattern of injury was recognised in the remaining athletes involving a direct impact injury to the shoulder. In these athletes the clinical symptoms and signs were less specific but there was a high incidence of ‘dead arm’ at the time of injury (72%).

The spectrum of pathology in this series was wide with a high incidence of associated intra-articular lesions. In those athletes with an impact type of injury without dislocation there was more extensive labral pathology with a high incidence of posterior labral tears (50%). The incidence of associated chondral lesions was similarly very high but significant bony pathology was less common than in the dislocation group (11 % versus 26%). Elite athletes had less frank dislocations but were more likely to sustain neurological injury, posterior labral tears, SLAP lesions and cartilaginous and capsular injuries.

The incidence of all lesions in this series of collision athletes is higher than those previously published. These lesions often occurred in the absence of a frank dislocation (the ‘collision shoulder). It is important to anticipate additional pathology when planning definitive management in these patients, with surgery tailored to the specific lesions found. The athlete with an impact type of injury without dislocation can do well following surgery, with a high rate of return to contact sport, either at the same or a higher level.