soccer shoulder - lennard funk
DESCRIPTION
Shoulder injuries in Soccer - our experience and research.TRANSCRIPT
AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
Lennard Funk
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AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
INCIDENCE
• 2-4% of all injuries !
• BUT: – Longest period of time away from
play
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AMSTERDAM / THE NETHERLANDS
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EKSTRAND ET AL. BR J SPORTS MED 2009
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Original article
Ekstrand J , Hägglund M , Waldén M . Br J Sports Med (2009). doi:10.1136/bjsm.2009.0605824 of 6
elite team with 25 players in the squad can expect about 50 injuries each season, half of them minor and causing absences of less than a week, but as many as eight or nine severe and causing absences of >4 weeks. Hamstring strain was the most common diagnosis, which is in accordance
with fi ndings in other studies carried out at elite level using the consensus study design. A typical 25-player squad can thus expect about seven hamstring strains each season. It can be speculated that the high risk of hamstring strain refl ects the high intensity of modern professional football.
Figure 1 Distribution of traumatic injuries during a match (data from the 2006/07 and 2007/08 seasons).
Figure 2 Distribution of traumatic and overuse injuries over the football season.
Table 3 Injury pattern by severity of injuries Total 1–3 Days 4–7 Days 8–28 Days >28 days
Injury location Head and neck 77 (2) 19 (2) 23 (2) 29 (2) 6 Neck/cervical spine 23 11 (1) 8 3 1 Shoulder/clavicula 80 (2) 12 (1) 16 (1) 30 (2) 22 (3) Upper arm 3 1 2 0 0 Elbow 24 3 10 8 3 Forearm 5 1 0 2 2 Wrist 8 1 1 4 2 Hand/fi nger/thumb 38 8 6 16 8 Sternum/ribs/upper back 47 (1) 9 16 (1) 19 (1) 3 Abdomen 31 3 7 17 (1) 4 Lower back/pelvis 237 (5) 74 (8) 78 (7) 66 (4) 19 (3) Hip/groin 616 (14) 119 (12) 169 (15) 256 (16) 72 (10) Thigh 1064 (23) 184 (19) 272 (23) 469 (28) 139 (20) Knee 818 (18) 183 (19) 155 (13) 268 (16) 212 (30) Lower leg/Achilles tendon 511 (11) 116 (12) 132 (11) 178 (11) 85 (12) Ankle 625 (14) 150 (15) 185 (16) 220 (13) 70 (10) Foot/toe 268 (6) 75 (8) 81 (7) 63 (4) 49 (7) Unknown 8 2 3 3 0Injury type Fracture 160 (4) 7 9 59 (4) 85 (12) Other bone injury 26 5 1 6 14 (2) Dislocation/subluxation 50 (1) 5 4 24 (1) 17 (2) Sprain/ligament injury 828 (18) 123 (13) 197 (17) 334 (20) 174 (25) Meniscus/cartilage 124 (3) 3 7 41 (2) 73 (10) Muscle injury/strain 1581 (35) 212 (22) 397 (34) 765 (46) 207 (30) Tendon injury 327 (7) 95 (10) 71 (6) 101 (6) 60 (9) Haematoma/contusion 744 (17) 306 (32) 282 (24) 141 (9) 15 (2) Abrasion 7 3 3 1 0 Laceration 31 10 (1) 11 10 0 Concussion 34 5 14 (1) 14 1 Nerve injury 29 7 3 14 5 Synovitis/effusion 158 (4) 55 (6) 36 (3) 55 (3) 12 (2) Overuse complaints 285 (6) 110 (11) 99 (9) 59 (4) 17 (2) Other type 91 (2) 23 (2) 27 (2) 24 (1) 17 (2)Total injuries 4483 971 1164 1651 697
Values within brackets show percentage of total (values below 1% not shown).
bjsports60582.indd 4bjsports60582.indd 4 5/26/2010 11:48:03 AM5/26/2010 11:48:03 AM
group.bmj.com on June 21, 2010 - Published by bjsm.bmj.comDownloaded from
AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
PREMIERSHIP SHOULDER INJURIES
• Data courtesy of Health Partners Europe
• Anonymous !!
• Jan 2007 - Jan 2010 • 35,000 claimed injuries • 3.3% Shoulders
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Mills, Pritchard, Funk, Batty. BJSM. 2011
AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
INCIDENCE
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0
10
20
30
40
50
60
70
80
90
100
2006-2007 2007-2008 2008-2009 2009-2010
Right Left
Mills, Pritchard, Funk, Batty. BJSM. 2011
AMSTERDAM / THE NETHERLANDS
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SURGERY
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!
Mills, Pritchard, Funk, Batty. BJSM. 2011
AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
TYPES OF SURGERY
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!
Mills, Pritchard, Funk, Batty. BJSM. 2011
AMSTERDAM / THE NETHERLANDS
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• 25 Professional Footballers – 15 Field players – 10 Goalkeepers
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GOALKEEPERS VS. OUTFIELD PLAYERS Hart & Funk, KSSTA. 2013
AMSTERDAM / THE NETHERLANDS
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INJURY PATTERNS
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Hart & Funk, KSSTA. 2013
AMSTERDAM / THE NETHERLANDS
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FIELD
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Goalie
AMSTERDAM / THE NETHERLANDS
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FINDINGS IN GOALKEEPERS SHOULDERS
• Poor postural control and position
• Abdominal
• Pelvis
• Scapula thoracic
• Poor recruitment of posterior cuff
• Problems with thoracic and
costo-vertebral joints
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Tatlow & Funk, 2008
AMSTERDAM / THE NETHERLANDS
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Common Injuries
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6%
81%
16%
12% (outfield) 50% (goalies)
12%
18%
Mills, Pritchard, FunkISSM, 2011
AMSTERDAM / THE NETHERLANDS
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CLASSIFICATION OF LESIONS
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Major ‘Minor’
• Bony Bankart!
• ALPSA!
• Rotator Cuff Tear!
• HAGL!
• Undisplaced Labral Tear!
• Partial Cuff Tear!
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TIMING OF SURGERY
• Early Surgery:
– ‘Major’ lesions
– Late in Season
– Unable to Return
• Rehab & Return:
– ‘Minor’ lesions
– Early season
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AMSTERDAM / THE NETHERLANDS
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RETURN TO PLAY
• Unrestricted play = 11.4 weeks (3.7 SD) – Outfield = 11.6 wks (4.1 SD) – Goalies = 11.1 wks (3.2 SD)
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Hart & Funk, KSSTA. 2013
AMSTERDAM / THE NETHERLANDS
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ROTATOR CUFF TREATMENT
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Impingement & Bursitis Rehab & Subacromial Injection
Partial Cuff Tears Platelet Rich Plasma Injection / Arthroscopic debridement or repair
Full Thickness Tear Arthroscopic Repair
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SUMMARY
• Not common, but serious
• Outfield players = Labral injuries
• Goalkeepers = cuff pathology
• MR Arthrogram investigation of choice
• Arthroscopic surgery
• Sports specific rehabilitation
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AMSTERDAM / THE NETHERLANDS
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