The management of anterior shoulder dislocation within professional rugby and football players: A Review

by



ACKNOWLEDGEMENT

I would take this opening to express gratitude my study supervisor, family and associates for their support and guidance without which this study would not have been possible.

DECLARATION

I, [type your full first titles and last name here], declare that the contents of this dissertation/thesis represent my own unaided work, and that the dissertation/thesis has not previously been submitted for learned examination in the direction of any qualification. Furthermore, it represents my own attitudes and not inevitably those of the University.

Signed __________________ Date _________________

ABSTRACT

The shoulder joint is finely controlled by muscular attachments and proprioceptors found within the joint capsule and musculotendinous unit. The coordinated function of this joint is essential for athletic function. It has been hypothesized that with the increased stress and injury to these structures kinaesthetic awareness of the shoulder is inhibited and the joint becomes dysfunctional. The ability to use proprioceptive information to control limb position may be decreased leading to slowed protective reflexes. The current research is associated with the management of anterior shoulder dislocation. A review is conducted to study the treatment and management of the dislocation of the shoulders that usually occurs in the professional rugby and football players. The qualitative study is undertaken and a comprehensive literature has been searched in order to reach a stable conclusion.

TABLE OF CONTENTS

ACKNOWLEDGEMENTII

ABSTRACTIV

CHAPTER 1: INTRODUCTION1

Background1

Problem Statement2

Aim of the Research3

Research Objectives3

Primary Objective3

Secondary Objective3

Personal rationale3

Research Question5

CHAPTER 2: LITERATURE REVIEW6

Shoulder Dislocation6

Classification7

Anterior (forward)7

Posterior (backward)7

Inferior (downward)7

Anatomy of the shoulder8

Proprioception in the shoulder9

Shoulder Injuries10

Treatment options12

Non-surgical rehabilitation14

Surgery15

Open surgery16

Arthroscopic repair16

Professional rationale16

Surgical versus non-surgical16

CHAPTER 3: METHODOLOGY18

Paradigm18

Research design18

Databases18

Time period of searches19

Inclusion and Exclusion criteria19

Inclusion criteria20

Exclusion criteria20

Data analysis20

Reliability and validity/ Trustworthiness21

Ethical consideration21

CHAPTER 4: RESULTS22

Results22

Assessment of relevance22

Quality assessment23

Themes24

Gender24

Management/ interventions24

Outcome measures25

CHAPTER 5: DISCUSSION27

Discussion27

Surgical management27

Non-surgical management34

Limitations of study38

CHAPTER 6: CONCLUSION39

REFERENCES40

APPENDIX46

Table 1 Department of Health (DOH) 1998 critical appraisal tool.46

Table 2 Hierachy of evidence table47

Table 4 Rowe score48

CHAPTER 1: INTRODUCTION

The current study deals with the issue of anterior shoulder dislocation and elaborates upon its treatment and management in the professional rugby and football players. A detailed review, in this context, has been conducted in this dissertation for the purpose of developing and meting the aims and objectives of the study.

Background

In recent years, the investigators have studied proprioception of the shoulder joint during movement. The shoulder movement is a complex motion that is dependent on four joints: glenohumeral, scapulothoracic, sternoclavicular, and acromioclavicular (Lucas, 1973; Bechtol, 1980). The glenohumeral joint (GID) sacrifices stability for mobility (Donatelli, 1994) and therefore is prone to dislocation. Cave et al. (1974) reported the incidence of Anterior Shoulder Dislocation (ASD) to be 84 percent (%) from 394 dislocations. Recurrent dislocation is the most common complication of ASD and is estimated to be 80% in young active people (Simonet & Cofield, 1983).

Factors contributing to the stability of the GHJ during movement are static (articular components, glenoid labrum, negative-intraarticular pressure. capsule, and ligaments) and dynamic (rotator cuff biceps tendon) constraints. Perhaps proprioceptive feedback from sensory receptors located in the joint and muscle complex contributes to stability ...