Shoulder Instability

Shoulder Instability 364 200 Dr Paul Annett

It was disappointing to hear that Kurt Gidley had succumbed to an unstable shoulder, sustaining a second dislocation of his shoulder this season. His shoulder had been unstable last season with at least one dislocation against Melbourne around 12 months ago.

Shoulder instability is one of the major injury concerns of an NRL level rugby league player. The extreme levels of force in the tackle leave the shoulder regularly prone to injury.

It is generally considered that an unstable shoulder, especially in the form of a true dislocation, will have a very high rate of recurrence in the younger athlete. This is certainly well above the 90% mark. In a first grade rugby league player this would be basically a 100% chance, given the nature of the game.

If the instability occurs during the season then an attempt will usually be made to keep the player playing. This may take a period of up to 6 weeks with physio, shoulder strengthening and a rehabilitation program. When the shoulder shows normal movement, power and better stability (as defined by a negative apprehension test) then a return to contact training may be resumed. The shoulder will be stabilised with taping and a brace for all tackling and football activity after this. Once full training is achieved the player will be passed fit to play, but there will always be the possibility of further instability. Even if the player makes it through the rest of the season, strong consideration should be made for a shoulder reconstruction in the off season to prevent further problems the next year.

Apprehension test for shoulder instability

Investigations may play a part in this decision. Most players will obtain an MRI scan of the shoulder. If there is a tear to the glenoid labrum (a thickened ligament on the edge of the shoulder socket) , then this must be repaired surgically as it will not repair on its own. Only surgical repair will confidently allow the player to resume their normal level of training and game play.

Glenoid labrum tear

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