The Athletes Shoulder – The Surgeons Perspective – Injury Rehab Network Event
The latest event of the Injury Rehab Network with BASRaT featured the Shoulder Doc, Professor Len Funk. The March edition of the Injury Rehab Network was one of the most popular events to date with Len’s presentation prompting several questions from a very engaged group.
Len Funk is a Consultant Orthopaedic Surgeon working as part of the large upper limb unit at Wrightington Hospital and has a private practice in Manchester with The Arm Clinic.
Len established and runs Shoulderdoc.co.uk and is passionate about patient information and education, as well as providing the best quality of care through a multidisciplinary team. He routinely treats elite and professional athletes.
His practice has evolved to specialise completely on sports and soft tissue injuries of the shoulder. Providing second opinions, treating complex cases and performing revision surgery makes up a large proportion of his work. He practices closely with similar colleagues who specialise in complex trauma and shoulder replacement surgeries, as well as therapists dedicated to complex shoulder rehabilitation.
Academically, he has written numerous books and contributed to the work of others on shoulder surgery and rehabilitation and is actively involved in research, with over 100 research publications. He teaches both undergraduate and postgraduate medical, sports therapy and sports medicine students.
Len’s talk, ‘The Athletes Shoulder – The Surgeons Perspective’ explored shoulder injuries in sport and their treatment.
The event was attended by over 250 sports rehabilitators and sports injury professionals from across the UK and included some of BASRaT’s members from around the world.
The Athletes Shoulder
Len’s presentation provided sports rehabilitators with a concise refresher of the shoulder anatomy and common shoulder injuries in sport. To learn more, please see Len’s book Sports Injuries of the Shoulder and Len’s website.
Len’s presentation included useful graphics showing how the shoulder is made up of large muscles known as the movers and deep muscles which are the stabilisers and controllers of the shoulder joint. In total, the shoulder comprises 13 interlinked muscles.
Len described the role of the shoulder to position the hand in space.
Shoulder Injuries in Sport
Len provided a summary of the most common injury groups in sport by type of sport. Contact sports (primarily rugby and football) are first with the most shoulder injuries, overhead sports (cricket and other sports involving throwing) are second and strength sports (weightlifting and bodybuilding) third.
Rugby Shoulder Injuries
Shoulder injuries in rugby are usually caused by a collision. As the size, strength and speed of rugby players has increased this has brought with it larger and more impactful collisions – sometimes equivalent to a car crash. There is good surveillance and research into rugby injuries and this research has helped to inform both injury prevention and treatment.
Injuries to the shoulder in rugby often happen to the try scorer, tackler, on direct impact (with the ground, posts, or other items) or in a flexed fall where stress is placed onto the shoulder.
In treating shoulder injuries in rugby, a number of tests can be undertaken which may provide subtle signs as to the type and extent of the injury. Building on tests, scans can be used to further investigate the injury.
Len warned that professionals should not rely on scans alone and to ‘treat the man, not the scan’. Injuries could be major or minor lesions and may require early surgery for the best outcomes.
Len works closely with sports rehabilitation/ physio colleagues to rehab and return players. The rehab protocol should be tailored to each player and not accelerated. Len recommends Creighton’s Decision Based Model for Return to Play in Sport.
Football Shoulder Injuries
Like rugby, there is good research and data into shoulder injuries in football. Injuries in football players vary considerably from the general population. The types and incidence of shoulder injuries also vary greatly between goalkeepers and outfield players.
Overhead Athlete Injuries
In sports involving throwing and overhead arm movements, injuries can occur in both static and dynamic movements. Len described how shoulder instability is often the result of injuries. Core stability is important in helping to prevent and reduce the risk of shoulder injuries.
Shoulder Injuries in Golf
Len discussed how golf is a unique sport in that the demands of the leading and non-leading shoulder are different with each shoulder doing a different job.
Len kindly answered several questions following his presentation.
Question 1 – Why are more shoulder injuries occurring in rugby?
Answer – Players are bigger, stronger and are required to train and play more frequently. In younger players, there can also be a large difference in size. Len recommended seeing Dr Ian Horsley’s work on proprioception.
Question 2 – How should Scapular Dyskinesis be treated?
Answer – This is a complex injury and needs a thorough investigation to identify suitable treatment options.
Question 3 – Do you have any tips for shoulder rehab in golf?
Answer – Injuries can be managed through modifications and rehab. Painful exercises should not be prescribed. Surgery is generally only recommended when patients are suffering pain at night and are unable to play.
Question 4 – What is the best way to prevent shoulder injuries?
Answer – See Ian Horsley’s and Lee Herrington’s research. Activity should be tailored to the individual.
Question 5 – When is a pec major allograft suitable?
Answer – The right patient needs to be carefully selected with those who need strength for their job as the most suitable for surgery.
Question 6 – How should swelling be managed in rugby players?
Answer – See a specialist.
Question 7 – What are your thoughts on eccentric training?
Answer – This is a current trend, particularly for throwers.
Question 8 – Should steroid injections be used for chronic pain?
Answer – Steroid injections are anti-inflammatory and should only be used where they can assist in reducing inflammation.
Question 9 – When should surgery be considered in young rugby players?
Answer – Consider the patient, pathology, and their participation.
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