SHOULDER DISLOCATION INJURY

Rehabilitation of a Professional Rugby Player



Rehabilitation of a Professional Rugby Player

Patient

Simon is a 20 year old professional rugby player who dislocated his right shoulder in a tackle last week. An MR scan has indicated significant internal damage to the gleno-humeral joint, including a SLAP lesion of the labrum, and he is due to have an arthroscopic reconstruction in two weeks' time. Following this he is keen to return to play as soon as possible.

As a physiotherapist and a member of the rehabilitation team I have designed a program based on scientific literature in order to help Simon in his rehabilitation and to help him to return to sport. First, I will provide a short introduction about the patient's condition and about the surgical procedure and their relation to the patient's rehabilitation. I will describe a rehabilitation program which consists of two phases: a pre-operative phase and a post-operative phase. Finally, I will provide criteria for return to play.

Clinical Scenario

Shoulder (glenohumeral joint) dislocation is a common injury among athletes at a rate of 11.2 per 100,000 per year, which is usually accompanied with detachment of the labrum from the antero-inferior rim of the glenoid - which is called a SLAP (Superior Labrum Anterior Posterior) lesion - especially with the first episode. The labrum is a fibro cartilaginous ring which attaches to the bony rim of the glenoid fossa and provides stability to the shoulder joint by increasing the depth of the glenoid fossa, and by providing a point of attachment for the capsule, the glen humeral ligaments, and the biceps. The challenge with this condition is the high rate of recurrence, particularly among younger athletes.

Non-surgical treatment is associated with a higher rate of recurrence than surgical treatment. The retrospective studies that exist have shown recurrence rates as high as 90% in patients between 21 - 30 years of age who have a first time dislocation and are treated non-operatively (www.tsaog.com). Studies have shown that rates of recurrent instability after a first-time shoulder dislocation are reduced by surgical intervention compared to non-operative treatment at 2 years of follow-up (7% v 46%) (Robert et al, 2009). Arthroscopic stabilization has become the preferred method of surgical intervention due to its many advantages over other operations including reduced pain, greater effectiveness in regaining full range of motion, improved cosmetics, reduced operation hours and blood loss, and no risk of developing sub scapular related complications (www.goortho.net).

Issues of Interest

Pre-operative rehabilitation

The physiotherapist should meet the patient and the rehabilitation team before surgery to establish reasonable goals whilst accepting differences in expectations between the patient, physician and physiotherapist. Establishing a positive relationship with the patient will ensure cooperation throughout the sometimes stressful rehabilitation process. It is important to provide accurate information about the surgical and rehabilitation processes to give the patient realistic idea of what to expect (David, Magee et al, 2009). The goals for the pre-operative stage are restoring ROM, reducing pain and swelling, and restoring pain-free functional ...