Shoulder Injuries in Contact Athletes

  • Sungjoon Lim
  • Lennard Funk


Contact athletes are prone to musculoskeletal injuries due to the high-impact nature of their sports. Shoulder injuries are extremely common and one of the leading causes of play-time loss. Acromioclavicular joint injury, anterior instability, rotator cuff injury, clavicle fracture, and posterior instability represent most of the injuries about the shoulder. This chapter describes the epidemiology, mechanism of injury, pathoanatomy, clinical evaluation of the major shoulder injuries as well as management guidelines with various treatment options.


Contact athletes Acromioclavicular joint injury Anterior shoulder instability Rotator cuff injury Clavicle fracture Posterior instability Epidemiology Mechanism of injury Pathoanatomy Clinical evaluation Guideline Non-operative treatment Surgery Guideline 


  1. 1.
    Rice SG, American Academy of Pediatrics Council on Sports M, Fitness. Medical conditions affecting sports participation. Pediatrics. 2008;121(4):841–8.CrossRefGoogle Scholar
  2. 2.
    Headey J, Brooks JH, Kemp SP. The epidemiology of shoulder injuries in English professional rugby union. Am J Sports Med. 2007;35(9):1537–43.CrossRefGoogle Scholar
  3. 3.
    Kaplan LD, Flanigan DC, Norwig J, Jost P, Bradley J. Prevalence and variance of shoulder injuries in elite collegiate football players. Am J Sports Med. 2005;33(8):1142–6.CrossRefGoogle Scholar
  4. 4.
    Crichton J, Jones DR, Funk L. Mechanisms of traumatic shoulder injury in elite rugby players. Br J Sports Med. 2012;46(7):538–42.CrossRefGoogle Scholar
  5. 5.
    Owens BD, Campbell SE, Cameron KL. Risk factors for posterior shoulder instability in young athletes. Am J Sports Med. 2013;41(11):2645–9.CrossRefGoogle Scholar
  6. 6.
    Provencher MT, LeClere LE, King S, McDonald LS, Frank RM, Mologne TS, et al. Posterior instability of the shoulder: diagnosis and management. Am J Sports Med. 2011;39(4):874–86.CrossRefGoogle Scholar
  7. 7.
    Tischer T, Salzmann GM, El-Azab H, Vogt S, Imhoff AB. Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med. 2009;37(1):136–9.CrossRefGoogle Scholar
  8. 8.
    Lanzi JT Jr, Chandler PJ, Cameron KL, Bader JM, Owens BD. Epidemiology of posterior glenohumeral instability in a young athletic population. Am J Sports Med. 2017;45(14):3315–21.CrossRefGoogle Scholar
  9. 9.
    Cameron KL, Duffey ML, DeBerardino TM, Stoneman PD, Jones CJ, Owens BD. Association of generalized joint hypermobility with a history of glenohumeral joint instability. J Athl Train. 2010;45(3):253–8.CrossRefGoogle Scholar
  10. 10.
    Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32(5):413–8.CrossRefGoogle Scholar
  11. 11.
    Nguyen V, Williams G, Rockwood C. Radiography of acromioclavicular dislocation and associated injuries. Crit Rev Diagn Imaging. 1991;32(3):191–228.PubMedGoogle Scholar
  12. 12.
    Dragoo JL, Braun HJ, Bartlinski SE, Harris AH. Acromioclavicular joint injuries in National Collegiate Athletic Association football: data from the 2004-2005 through 2008-2009 National Collegiate Athletic Association Injury Surveillance System. Am J Sports Med. 2012;40(9):2066–71.CrossRefGoogle Scholar
  13. 13.
    Lynch TS, Saltzman MD, Ghodasra JH, Bilimoria KY, Bowen MK, Nuber GW. Acromioclavicular joint injuries in the National Football League: epidemiology and management. Am J Sports Med. 2013;41(12):2904–8.CrossRefGoogle Scholar
  14. 14.
    Marcheggiani Muccioli GM, Manning C, Wright P, Grassi A, Zaffagnini S, Funk L. Acromioclavicular joint reconstruction with the LARS ligament in professional versus non-professional athletes. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1961–7.CrossRefGoogle Scholar
  15. 15.
    Mouhsine E, Garofalo R, Crevoisier X, Farron A. Grade I and II acromioclavicular dislocations: results of conservative treatment. J Shoulder Elb Surg. 2003;12(6):599–602.CrossRefGoogle Scholar
  16. 16.
    Cohen SB, Towers JD, Bradley JP. Rotator cuff contusions of the shoulder in professional football players: epidemiology and magnetic resonance imaging findings. Am J Sports Med. 2007;35(3):442–7.CrossRefGoogle Scholar
  17. 17.
    Goldberg JA, Chan KY, Best JP, Bruce WJ, Walsh W, Parry W. Surgical management of large rotator cuff tears combined with instability in elite rugby football players. Br J Sports Med. 2003;37(2):179–81.CrossRefGoogle Scholar
  18. 18.
    Tambe A, Badge R, Funk L. Arthroscopic rotator cuff repair in elite rugby players. Int J Shoulder Surg. 2009;3(1):8–12.CrossRefGoogle Scholar
  19. 19.
    Engelsma Y, Willems WJ. Arthroscopic stabilization of posterior shoulder instability. Knee Surg Sports Traumatol Arthrosc. 2010;18(12):1762–6.CrossRefGoogle Scholar
  20. 20.
    Dickens JF, Owens BD, Cameron KL, Kilcoyne K, Allred CD, Svoboda SJ, et al. Return to play and recurrent instability after in-season anterior shoulder instability: a prospective multicenter study. Am J Sports Med. 2014;42(12):2842–50.CrossRefGoogle Scholar
  21. 21.
    Owens BD, Dickens JF, Kilcoyne KG, Rue JP. Management of mid-season traumatic anterior shoulder instability in athletes. J Am Acad Orthop Surg. 2012;20(8):518–26.CrossRefGoogle Scholar
  22. 22.
    McCarty EC, Ritchie P, Gill HS, McFarland EG. Shoulder instability: return to play. Clin Sports Med. 2004;23(3):335–51.CrossRefGoogle Scholar
  23. 23.
    Buss DD, Lynch GP, Meyer CP, Huber SM, Freehill MQ. Nonoperative management for in-season athletes with anterior shoulder instability. Am J Sports Med. 2004;32(6):1430–3.CrossRefGoogle Scholar
  24. 24.
    Bottoni CR, Wilckens JH, DeBerardino TM, D'Alleyrand JC, Rooney RC, Harpstrite JK, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med. 2002;30(4):576–80.CrossRefGoogle Scholar
  25. 25.
    Kim SH, Ha KI, Kim SH. Bankart repair in traumatic anterior shoulder instability: open versus arthroscopic technique. Arthroscopy. 2002;18(7):755–63.CrossRefGoogle Scholar
  26. 26.
    Potzl W, Witt KA, Hackenberg L, Marquardt B, Steinbeck J. Results of suture anchor repair of anteroinferior shoulder instability: a prospective clinical study of 85 shoulders. J Shoulder Elb Surg. 2003;12(4):322–6.CrossRefGoogle Scholar
  27. 27.
    Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16(7):677–94.CrossRefGoogle Scholar
  28. 28.
    Piasecki DP, Verma NN, Romeo AA, Levine WN, Bach BR Jr, Provencher MT. Glenoid bone deficiency in recurrent anterior shoulder instability: diagnosis and management. J Am Acad Orthop Surg. 2009;17(8):482–93.CrossRefGoogle Scholar
  29. 29.
    Porcellini G, Campi F, Paladini P. Arthroscopic approach to acute bony Bankart lesion. Arthroscopy. 2002;18(7):764–9.CrossRefGoogle Scholar
  30. 30.
    Shaha JS, Cook JB, Song DJ, Rowles DJ, Bottoni CR, Shaha SH, et al. Redefining “critical” bone loss in shoulder instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med. 2015;43(7):1719–25.CrossRefGoogle Scholar
  31. 31.
    Yamamoto N, Muraki T, An KN, Sperling JW, Cofield RH, Itoi E, et al. The stabilizing mechanism of the Latarjet procedure: a cadaveric study. J Bone Joint Surg Am. 2013;95(15):1390–7.CrossRefGoogle Scholar
  32. 32.
    Gartsman GM, Waggenspack WN Jr, O'Connor DP, Elkousy HA, Edwards TB. Immediate and early complications of the open Latarjet procedure: a retrospective review of a large consecutive case series. J Shoulder Elb Surg. 2017;26(1):68–72.CrossRefGoogle Scholar
  33. 33.
    Griesser MJ, Harris JD, McCoy BW, Hussain WM, Jones MH, Bishop JY, et al. Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review. J Shoulder Elb Surg. 2013;22(2):286–92.CrossRefGoogle Scholar
  34. 34.
    Young AA, Maia R, Berhouet J, Walch G. Open Latarjet procedure for management of bone loss in anterior instability of the glenohumeral joint. J Shoulder Elb Surg. 2011;20(2 Suppl):S61–9.CrossRefGoogle Scholar
  35. 35.
    Hovelius L, Sandstrom B, Saebo M. One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: study II-the evolution of dislocation arthropathy. J Shoulder Elb Surg. 2006;15(3):279–89.CrossRefGoogle Scholar
  36. 36.
    Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y, et al. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elb Surg. 2007;16(5):649–56.CrossRefGoogle Scholar
  37. 37.
    Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy. 2014;30(1):90–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Sungjoon Lim
    • 1
  • Lennard Funk
    • 1
    • 2
  1. 1.Department of Orthopedic SurgeryAsan Medical Center, University of Ulsan, College of MedicineSeoulSouth Korea
  2. 2.Upper Limb UnitWrightington HospitalWiganUK

Personalised recommendations