The epidemiology of shoulder injuries in English professional rugby union

Background: Shoulder injuries constitute a considerable risk to professional rugby union players; however, there is a shortage of detailed epidemiologic information about injuries in this population. Purpose: To describe the incidence, severity, and risk factors associated with shoulder injuries in professional rugby union. Study Design: Descriptive epidemiology study. Method: Medical personnel prospectively reported time-loss injuries in professional rugby union in England, and the shoulder injuries were evaluated. Results: The incidence of shoulder injuries was significantly lower during training (0.10/1000 player-training hours) compared with matches (8.9/1000 player-match hours). The most common match injury was acrornioclavicular joint injury (32%); the most severe was shoulder dislocation and instability (mean severity, 81 days absent), which also caused the greatest proportion of absence (42%) and had the highest rate of recurrence (62%). The majority of match shoulder injuries were sustained in the tackle (65%), and outside backs were the most likely to sustain an injury from tackling (2.4/1000 player-tackles). Injuries sustained during training were significantly more severe (61 days) than were those sustained during match play (27 days), and defensive training sessions carried the highest risk of injury (0.45/1000 player-hours; mean severity, 67 days). A mean of 241 player-days per club per season were lost to shoulder injuries. Conclusion: Results suggest the potential to reduce this injury burden by modifying training activities and implementing "prehabilitation" strategies in an effort to minimize the risk of shoulder dislocation/instability.