The Rugby World Cup may be a year away, but some of the sport’s biggest stars are already out of the tournament. Ireland’s Garry Ringrose, New Zealand’s Nehe Milner-Skudder, South Africa’s Jaco Kriel and Australia’s Izack Rodda, have all been impacted by shoulder injury which sees them potentially missing out on World Cup glory.

Rugby is renowned for its increased risk of shoulder injuries, but the incidence rate appears to have increased in recent years. Not only are rugby-related shoulder injuries becoming more commonplace, but their severity is also increasing too. Here, we’ll explore the type of shoulder injuries common in rugby players and what could be done to prevent them.

Which types of shoulder injuries are rugby players commonly exposed to?

There are a lot of different types of shoulder injuries rugby players are exposed to. However, the most common appear to be:

Labral tears – Out of all of the different shoulder injuries rugby players face, labral tears are one of the most common. The Labrum is incredibly important for proper shoulder function. The cartilage basically provides additional support for the bones within the shoulder. If it tears, it can have a significant impact on the shoulder movement.

In rugby players, a labral tear can occur due to an awkward fall, dislocation, direct impact, or overuse of the shoulder. It’s a painful injury, with the pain worsening when the arm is lowered or raised. Some patients may also hear a popping sound alongside movement of the shoulder.

Rotator cuff injuries – Another common injury, the rotator cuff can become damaged during rugby tackles, or due to an awkward fall. It’s typically injured when the player lands with their arm extended, causing pressure to push the arm too far backwards or downwards.

There are different grades of rotator cuff injuries, with full tears of the tendon being the least common, but most severe a player could face. These types of injuries are also more difficult to treat.

Shoulder instability – Players can develop shoulder instability due to overuse or a sudden injury. With this condition, the upper arm bone is forced out of the shoulder’s socket at the head.

While shoulder instability is most commonly associated with overhead sports, it can occur gradually in rugby players; particularly if they have suffered previous dislocation of the shoulder.

What could be done to prevent shoulder injury in the rugby player?

There are a number of ways rugby players can reduce their chances of suffering shoulder-related injuries.

Firstly, building up strength and flexibility within the upper body will help protect the joints. The more flexible the shoulder joint is, the less likely it will become damaged during a bad fall or direct impact. To prevent injuries caused by overuse of the shoulder, it is important for players to adequately rest between training and matches.

Although it is possible to prevent some rugby-related shoulder injuries, in direct contact sports there is always an increased risk. If you do develop a shoulder injury, the best thing you can do is seek treatment as soon as possible. Problems arise and careers are ruined, when players do not seek immediate treatment. The longer a shoulder injury is left untreated, the worse it becomes and the higher the risk a player will have long-term shoulder issues.

A new French study has revealed the benefits of early surgical intervention in isolated rotator cuff tears. According to the study’s findings, if surgery is performed early enough for supraspinatus tears, it helps to improve function and strength, amongst numerous other benefits.

Here, we’ll look at the findings which have been published in The Journal of Bone & Joint Surgery and what it means for patients.

Can the findings be trusted?

The study was conducted by an Orthopaedic Surgery Research Group in France and it followed a total of 511 patients. However, only 288 patients went on to have a follow-up, leading some experts to question the results.

The 511 patients had undergone surgery to repair full thickness supraspinatus tears in 2003. Results of the study were written up at a 10-year follow-up appointment. Out of the 288 patients who did go back for a follow-up, 210 received a magnetic resonance imaging (MRI) scan. This revealed the majority of patients had experienced significant improvement.

The standard Constant score was used to assess shoulder strength, motion, pain and daily activity abilities. In the majority of patients, their score had risen from an average 52 to 78. The scans also revealed around 80% of the tendons had healed, but there was still a minor residual tear found in most cases.

The follow-up also revealed patients who were found to have a build-up of fat in the repaired muscle didn’t heal and recover as well as those who didn’t. Fat build-up within the muscle is a sign of muscle degeneration.

Although the researchers themselves do admit there are limitations of the study due to the fact so many patients didn’t return for a follow-up, they still feel it provides a reliable analysis of how surgery could help to improve the outcome of supraspinatus tears. It’s certainly the longest-term study carried out to assess the benefits of surgery in isolated rotator cuff tears.

What are supraspinatus tears?

There are four major tendons within the rotator cuff of the shoulder, and the supraspinatus is one of them. It is also the most common type of rotator cuff tear patients suffer with. A tear, either partial or full-thickness, can occur because of a trauma, or through repeated micro-traumas.

The majority of full-thickness supraspinatus tears, tend to start out as partial tears and they worsen over time. This backs up the results of the French study in the fact surgery should be carried out early to prevent the condition worsening.

What treatment options are available?

Treatment is decided based upon the severity of the tear. Surgery currently tends to be used as a last resort. Instead, specialists prefer to start out with a physical therapy treatment plan; especially if the tear is only minor. This is because in the past, surgery was known to come with long, often painful recovery times.

However, surgical techniques have advanced and as the French study shows, surgery could be the most effective treatment for early supraspinatus tears. One thing all experts can agree on is the earlier a patient seeks treatment for this type of rotator cuff tear, the better the outcome will be.

Overall, the study’s findings are promising and they do give a good indication of the long-term success rates of early surgery in supraspinatus tears. It also showed the success rate remains the same regardless of whether open or closed surgical techniques are used.

Shoulder problems are extremely common, yet they’re also often ignored. Although some find the issue resolves itself without intervention, the majority of shoulder injuries and conditions will worsen over time.

The impact of musculoskeletal conditions on the economy cannot be underestimated MSKs are one of the primary causes of absenteeism and the UK has one of the highest rates in Europe. Statistics released from the Health and Safety Executive, found that in 2015/16 there were 3,138,000 working days lost due to Work Related Upper Limb Disorders, with workers in the construction industry and skilled trade occupations having significantly higher rates of upper limb disorders.

Here, we’ll look at some of the most common shoulder symptoms you shouldn’t ignore and why it’s important to seek a diagnosis as early as possible.

Common shoulder symptoms to watch out for

Many people underestimate the severity of shoulder symptoms and the effect it can have on their lives. The shoulder is the most mobile joint within the body, making it extremely vulnerable to injury. Symptoms which develop within the shoulder can pinpoint to a number of injuries which is why they need to be checked out as quickly as possible. The most common symptoms to watch out for include:

Pain: The most common shoulder symptom patients experience is pain. Unfortunately, it can link to a wide range of different injuries and conditions, making it difficult to diagnose a specific cause purely from this symptom alone. For example, it could be a sign of a rotator cuff tear, shoulder instability, arthritis or a dislocation.

It is common for patients to put shoulder pain down to overusing the arm, misalignment while sleeping or as a temporary symptom brought on by injury. However, pain in the shoulder should never be ignored, especially if it is severe or brought on due to injury.

Stiffness: Shoulder stiffness is another common symptom often ignored and, like pain, it can be a sign of a more serious issue. Frozen shoulder is a common cause of stiffness within the shoulder joint and it is often mistaken for arthritis. If the condition is behind the stiffness you’re experiencing, you will notice it becoming gradually stiffer and more painful over time.

Stiffness can also be a sign of a dislocated shoulder, a shoulder separation or rotator cuff calcific tendonitis, amongst others.

Swelling: You may notice swelling directly after an injury, or it may develop gradually over time. It can also present itself either on the top of the shoulder or all over. Again, this symptom will typically be accompanied by pain and though it may go down on its own, swelling could pinpoint a more serious injury.

Weakness: If you’re struggling to move the arm or carry out daily tasks due to weakness in the shoulder, this absolutely shouldn’t be ignored. It could be a sign of shoulder impingement, a rotator cuff injury, or shoulder instability.

Locking: This is another potential symptom of shoulder instability. If you notice the joint popping, clicking or locking as you move the arm, you should get it checked out as soon as possible.

The above are the main symptoms to watch out for, but any issues you have with the shoulder should always be looked at by a doctor or a shoulder specialist. If these symptoms relate to a shoulder injury, the earlier you seek treatment the more likely it is to respond to conservative management.

Overall, if you’ve been experiencing pain, stiffness or numbness in the shoulder, it’s important to get it looked at as soon as possible. Never ignore shoulder symptoms, especially if the pain is becoming increasingly worse.

Recently, we read with interest a news story featured in the Evening Standard about a “pioneering initiative” known as awake surgery.

Referred to as a groundbreaking treatment option, it highlighted the benefits of patients undergoing shoulder and elbow surgery under new ‘awake’ regional anaesthesia. The newspaper claimed that a shoulder and elbow surgeon at a London hospital was one of the first to offer this innovative technique on upper limb injuries, having carried out 50 of these cases over the last year.

While it’s true that awake surgery does deliver some benefits over surgery carried out under general anaesthetic, there were a couple of significant errors in this news story. This isn’t a new technique and it is used routinely in orthopaedic operations. Our shoulder specialists have been carrying out awake regional anaesthetic procedures for over 15 years, equating to approximately 3,000 cases.

And, for some patients, a general anaesthetic combined with regional anaesthetic techniques to ensure optimal pain relief and earlier mobilisation will always be the preferred option.

Below, you’ll discover everything you need to know about the awake surgery technique, its benefits and the importance of choosing a reliable, highly experienced surgeon.

What is awake shoulder surgery?

Awake shoulder surgery enables the patient to stay awake throughout the procedure. However, most patients choose to be sedated to some degree.

An anaesthetist will inject medication near the nerves surrounding the shoulder and the surrounding area. This will numb the area where the surgery will be performed. It takes approximately 30 minutes for the anaesthesia to be injected and take effect.

The types of awake surgical procedures vary and will be selected based upon the injury being treated.

Benefits of awake shoulder surgery procedures

So, why are awake regional anaesthetic procedures being described as a pioneering technique? Some patients can suffer from side effects from general anaesthesia, such as nausea and dizziness, and, if patients have suffered from these side effects in the past, then these can be mitigated with awake sedation techniques.

In general, though, a general anaesthetic is very safe and well-tolerated and for many patients, shoulder surgery performed under a general anaesthetic augmented with a regional block can be the best option, depending on the patient’s health and fitness and whether major surgery of a much longer duration is required. Both patient and surgical factors will be taken into account in the pre-operative planning stage.

The biggest benefit of awake surgery is a faster recovery time from the anaesthesia, however most shoulder operations are relatively short in duration, hence even with a general anaesthetic combined with a regional block, most patients are able to go home the same day. Whilst some people like to watch their own surgery, for others, this is not so desirable!

The importance of choosing an experienced surgeon

As you can see, there are plenty of excellent benefits that come from undergoing awake regional surgery. However, to enjoy these benefits it’s important to choose an experienced surgeon who has been performing this type of operation for many years and can advise on the best option for you.