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Lennard'Funk'Wrigh/ngton'Upper'Limb'Unit'Salford'University'

Sharks'

Some'Facts'

•  Rugby'>'highest'risk'per'player>hour'of'injury'of'all'sports.'

•  Shoulder'>'20%'of'all'Rugby'Injuries'

•  2nd'most'common,'aFer'Knee'

•  35%'of'injuries'of'the'shoulder'are'recurrent'injuries''

•  The'maneuver'most'strongly'associated'with'injury'was'the'tackle,'accoun/ng'for'49%'of'injury'episodes'in'matches.'

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Forces'

“The new GPS system which we wore during the Four Nations - attached to a man bra under our shirts - consistently showed us that we were taking impacts

of 10 gs and upwards during a match. !The gravity force of a car travelling at 100km/h that comes to a stop in 0.2

seconds is 14.2 gs. ! And we don't have airbags!”!

Jon Wilkin, Feb 2010"

Rugby'Injuries'•  Labral'Injury'–'18'(42%)'•  AC'Joint'‘Sprain’'–'12'(28%)'•  AC'Joint'Disloca/on'–'3'(7%)'

–  Acute'>'0'–  Chronic'>'3'

•  Rotator'Cuff'Tear'–'2'(4.5%)'•  Glenohumeral'Arthri/s'–'1'(2%)'

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Rugby'Audit'2007'''Funk'&'Roney'

•  Professional ' ' '180 '' ''•  Amateur ' ' '52 '' ''•  Semi>professional ' '12 '''•  Academy ' ' '4 ' ''•  Unknown ' ' '2'

Rugby''Lesions'

A Malone, L Funk, K Mohamed, C Ball; 2007

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SHOULDER'INJURY'PATTERNS'IN'PROFESSIONAL'RUGBY''L'Funk','K'Roney,''CJSM,'2007'

Video'Analysis'Study'

•  ‘Try>Scorer’'•  ‘Direct'Impact’'•  ‘Tackler’'•  ‘Flexed'landing’'

Crichton, Jones & Funk - BJSM 2012

Rotator Cuff Tear

Bankart

SLAP

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Direct'Impact'

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Player'Posi/on' L'Funk','K'Roney,''CJSM,'2007'

Inves/ga/ons'

•  No'previous'Surgery'='MR'Arthrogram'

•  Previous'Surgery'='CT'Arthrogram'

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MR'Arthrogram'v.'Scope'

Sensitivity) Specificity) Accuracy)

SLAP)) 0.42) 0.92) 77%)

Rotator)Cuff)Tear)) 0.50) 0.86) 83%)

Hill)Sachs)) 0.91) 0.78) 90%)

Bankart)) 0.85) 0.83) 86%)

N Karlson, J Geoghan, L Funk; 2008

SLAP'Tests'

Test) Sensitivit

y)

O’Brien’s) 90%)

Mayo) 80%)

Jobe’s) 76%)

MRA)–)Surgeon) 72%)

MRA)O)Radiologist) 50%)

Pandya,)NK)et)al.)Arthroscopy.)24(3):311O7,)2008))

•  An'experienced'Shoulder'Surgeon'befer'•  Can'correlate'with'clinical'context'•  Experience'of'reviewing'Scopes'&'Scans'

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Lesions'

Major' ‘Minor’'• 'Bony'Bankart'• 'ALPSA'• 'Rotator'Cuff'Tear'• 'HAGL''

• 'Undisplaced'Labral'Tear'• 'Par/al'Cuff'Tear'• 'ACJ'Disloca/on'

Surgery'•  Early'Surgery:'

–  Large'structural'lesions'

–  Late'in'Season'

–  Unable'to'Return'

•  Rehab'&'Return:'

– Minor'lesions'

–  Early'season'

Types'of'Surgery'•  Mostly'Arthroscopic'Repairs'•  Open'repairs'for'Bony'reconstruc/ons'

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Rugby'Rehab'Protocol'

•  Player>specific'and'tailored'to'suit'the'player’s'age,'posi/on,'requirements,'surgeon'and'therapists.''

•  It'is'not'‘accelerated’'or'‘aggressive’'or'‘/me'specific’.''•  It'is'also'surgeon>specific'and'dependent'on'the'quality'and'type'

of'fixa/on'achieved.'Therefore'the'protocol'is'a'‘guide’'and'not'a'prescrip/on.'Communica/on'between'the'player,'therapists,'training'staff'and'surgeon'are'essen/al.

•  Progression'to'each'phase'is'when'the'pa/ent'is'able'to'perform'all'of'the'exercises'in'the'previous'phase'without'any'discomfort'or'apprehension.'Each'phase'is'introduced'progressively.'

Ben Macdonald, Mike Lancaster, Meiron Jones, Doug Jones, Christine Holmes, Kat Tatlow, Len Funk

Rugby'Results'‘03>’05'Pain' Sa/sfac/on'(%)' Playing'at'

previous'level'

Pre>op' 5' 11%' 0%'

3'months' 10' 87%' 89%'

6'months' 12' 93%' 94%'

L'Funk','K'Roney,''CJSM,'2007'

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Time'to'return'to'play' L'Funk','K'Roney,''CJSM,'2007'

Return'to'Play'L'Funk','K'Roney,''CJSM,'2007'

Arthroscopic'Stabilisa/ons'Fourie & Funk, 2009

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Return'to'play'by'/me'of'surgery'Fourie & Funk, 2009

Return'to'play'by'age'Fourie & Funk, 2009

Creighton et al. CJSM 2010

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lenfunk@shoulderdoc.co.uk

THANK YOU