Preventing shoulder injuries in adolescent rugby players

As young athletes grow and develop, their bodies undergo changes that can make them more susceptible to shoulder injuries, especially during high-impact sports like rugby. Understanding these injuries, their treatment options, and prevention strategies is crucial for ensuring the health and long-term performance of young athletes. Mr Eyiyemi (Yemi) Pearse, renowned consultant orthopaedic surgeon, provides an expert insight.

What are the most common shoulder injuries in adolescent rugby players?

Among the various shoulder injuries encountered in adolescent rugby players, five stand out:

Shoulder dislocations

Shoulder dislocations occur when the ball at the top of the upper arm bone (the humeral head) pops out of the shoulder socket (the glenoid). Dislocations are common in rugby players due to the high-impact nature of the sport. They occur more commonly in adolescent players for several reasons. Firstly, the structures that keep the shoulder in joint are more elastic and stretchier than in adult shoulders. Secondly, the muscles that keep the shoulder in joint and stop dislocations are more prone to fatigue, resulting in slower reaction times. Thirdly, there can be significant variations in the size of adolescent players and therefore the forces to which the shoulder is subjected during collisions and impacts can be huge.

Most players know when they have dislocated their shoulder even though they may have never experienced a dislocation before. There is usually a visible deformity accompanied by intense pain and the inability to move the arm.

Shoulder subluxations / partial dislocations

Partial dislocations of the shoulder joint (also known as subluxations) can result in damage to two key stabilising structures in the shoulder, the joint capsule and the labrum. Unlike a first shoulder dislocation which players remember clearly and have to come off the pitch, a subluxation can be caused by what seems to be a relatively minor and inconsequential injury and players are often able to finish the game. However, players have persisting and recurring pain deep within their shoulders and a sense of weakness in the shoulder that can persist for months.

Acromioclavicular (AC) joint injuries

The shoulder blade (scapula) is held in place by muscles at the back and by the collar bone (clavicle) in front. The joint between the tip of the shoulder blade (the acromion) and the clavicle (the acromioclavicular joint) is very important for maintaining the position and stability of the scapula. A fall on the upper part of the shoulder can cause the acromion (and therefore the whole scapula) to separate from the clavicle at the acromioclavicular joint. This causes immediate pain and visible swelling at the end of the clavicle. The degree of separation correlates with the severity of the injury and this will determine how unstable the scapula becomes. An unstable scapula causes pain and weakness and surgical repair may be required to avoid chronic symptoms associated with more severe injuries.

Clavicle fractures

Clavicle fractures can result from direct impacts but more commonly are caused by falls on the shoulder during tackles. The injured payer experiences acute severe shoulder pain, some swelling, and difficulty moving the arm. A visible deformity and bruising are usually present.

Rotator cuff injuries

The rotator cuff comprises a group of muscles and tendons that stabilise the shoulder joint. It is unusual for adolescents to injure their rotator cuff tendons badly enough to detach them from the bone, and most rotator cuff injuries in adolescent rugby players are minor and cause local inflammation which rarely persists beyond a few days.

How can shoulder injuries in adolescent rugby players be prevented?

Pre-season training progressing from non-contact to semi-contact and then full contact play, as well as the use of pads and tackle bags, helps develop muscle memory and improve anticipation and reaction times of shoulder stabilising muscles.

Attention to technique is important as is the development of “game sense”. Coaches should emphasise safe tackling and falling techniques, as these can significantly reduce the risk of injury. Teaching players how to safely absorb impacts and avoid awkward falls can protect their shoulders from excessive strain.

Much of the modern rugby game demands strength and speed. Strength training has become integral to rugby training at adolescent and adult levels of the sport. However, aerobic conditioning is essential to avoid fatigue-related injury, and fitness training should not be sacrificed for strength training. Young rugby players need both.

Adequate recovery from major injuries is a given, but recovery from minor injuries is also important. Injuries in one body segment transfer effort “up the kinetic chain” and a gluteal and lower back strain will result in greater stress on the shoulder which will make it more prone to fatigue and injury.

Proper rest and recovery are vital for avoiding overuse injuries. Young athletes should not train or compete too frequently and should allow enough time for their bodies to recover. Ensuring players are pushed to, but not beyond, their physical limits can help prevent injuries.

How are shoulder injuries in adolescent rugby players treated?

Prevention is by far the best “treatment”.

Acute shoulder dislocations should be reduced (the ball put back into the socket) as soon as possible and this is best done under sedation in the Accident and Emergency Department or in a Minor Injuries Unit. The injured player should then be reviewed by a shoulder expert (either a specialist physiotherapist or a shoulder specialist consultant), as dislocations associated with fractures may need emergency surgery. Most though are treated initially with physiotherapy but unfortunately, in spite of physiotherapy, many adolescent rugby players experience a persisting sense of distrust of their shoulders and the majority have further dislocations or subluxation of their shoulders. They should see a surgeon for a discussion about stabilisation surgery.

Some clavicle fractures and the more severe AC joint injuries should be managed with urgent/acute surgery and it is best to consult a shoulder surgeon for an opinion early. However, the first line of treatment for most other shoulder injuries is non-operative.

Other injuries are initially treated using the R.I.C.E (rest, ice, compression, elevation) method, which can help reduce pain and swelling, though compression and elevation are difficult to achieve in the shoulder. Additionally, non-steroidal anti-inflammatory drugs (NSAIDs) may also be prescribed to alleviate pain and control inflammation.

Physiotherapy is a critical component of recovery, and a physiotherapist can design a rehabilitation programme tailored to the player's specific injury that focuses on restoring range of motion, aerobic capacity, strength and reaction times of the shoulder muscles. A good physiotherapist will supervise and monitor a graduated return to sports. Rugby is a game where external energy (an opponent) can be applied to the shoulder at random and requires fast muscle reaction times and good anticipation (game sense). It might be possible to return to sports where external energy is applied to the shoulder predictably before a return to rugby where external energy can be applied very suddenly and unexpectedly.

If conservative treatment is ineffective, reconstruction surgery may be required, and this can include arthroscopic (keyhole) and open (requiring a surgical incision) procedures. Above all, it’s essential to consult with an orthopaedic surgeon to discuss the most appropriate surgical options based on the specific injury and the athlete’s goals.

If you would like to book an appointment with Mr Eyiyemi (Yemi) Pearse, head on over to his Top Doctors profile today.