The shoulder is a ball and socket joint but the socket is very shallow – this allows a lot of movement (compare how much more movement you can get at the shoulder than another ball and socket joint, the hip) but it does make it quite inherently unstable. There are, therefore, a few stabilising structures to prevent it dislocating all the time. One of these structures is called the glenoid labrum, which is kind of like an octopus sucker between the ball and socket. A nice picture of this can be seen here. This can be injured in several ways such as when falling on the shoulder, falling on an outstretched hand or making a tackle. Treatment options can be both conservative (such as physiotherapy) or, where necessary, surgery. The labrum doesn’t repair particularly well on its own, but if it is only a minor tear then training the muscles to be strong and supportive can lead to a full relief of pain. For more information on this topic, refer to our blog on this topic.
Rotator cuff tear
As mentioned already, the shoulder is inherently an unstable joint so requires extra stabilising from other soft tissue structures. Apart from the labrum, a group of structures called the rotator cuff muscles have a big role in this stabilisation. The 4 rotator cuff muscles are: supraspinatus, infraspinatus, teres minor and subscapularis.
Rugby, being such a high impact sport, can lead to damage of these small muscles and they can become strained/torn. If it is a partial tear it will often recover on its own although as the symptoms start to settle it will be important to strengthen these muscles with exercises such as this, this and this. Just be aware that you don’t want to start these too soon as it could make things worse – your physio will be able to advise on when these are safe.
In some cases where there is a severe tear surgery may be required to repair the muscle. More information on surgical repair can be found here.
This could be either the glenohumeral joint (the ‘main’ shoulder joint i.e. the ball and socket part) or the the acromioclavicular joint (where the outer part of the collar bone meets with the acromion process of the shoulder blade – see diagram. For this we will focus on the dislocation at the ball and socket joint.
Shoulder dislocations are not uncommon in rugby with it being such a physical game. Essentially what happens is the ball is dislocated out of the socket. The shoulder is particularly susceptible to this as this socket is very shallow and, despite many stabilising structures including muscles, ligaments, joint capsule and the glenoid labrum (see above), if the force is great enough it may be forced out of the socket. The ball may be dislocated forwards, backwards or downwards known as anterior, posterior and inferior dislocations respectively.
There can be some associated bruising of either joint surface, which should settle with time, but there may also be damage to previously mentioned soft tissue structures around the joint so it is important to strengthen these to reduce the chance of future dislocations. Again, some basic strengthening exercises will be important for this, but exactly what these are will depend on the type and severity of dislocation and your physio will be able to advise on this.
In severe cases or when there have been multiple dislocations surgery may be necessary. Again, these will depend on the type of dislocation(s) but a common one is called a Bankart repair, an animation of which can be seen here. Just click shoulder >> Bankart repair.
If surgery is required the rehab will also be required afterwards. This tends to take around 3 months (if returning to contact sports like rugby) and will initially start as some gentle mobility exercises and mobilisations before progressing on to strengthening and working back to full ‘game strength’ from there.