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Shoulder injuries in football
Football is considered the most popular sport in the world and is extremely popular in Portugal. Although lower limb injuries are definitely the most common in this sport, shoulder injuries are the most common in the upper limb and account for around 20-30% of all football injuries, with an increasing incidence.
Football can be considered a contact sport, with hand-to-hand ball disputes, sliding tackles and frequent falls, which increases the risk of traumatic injuries that can be serious and disabling.
What are the most common shoulder injuries in football players and how can they occur?
According to studies, the three most common injuries are clavicle fractures, acromioclavicular dislocations, and shoulder or glenohumeral dislocations. Overuse injuries, such as tendonitis or ruptures of the rotator cuff or biceps brachii tendon, are less common and are associated with specific gestures, such as throwing a ball with the hands.
Clavicle fractures occur due to direct trauma to the shoulder or a fall with support from the upper limb. The deformity is evident in adults, but may be discreet in children or fractures of the lateral third without displacement. There are three groups of clavicle fractures, according to their location. The most common are those of the intermediate third, followed by those of the lateral third. The latter may be associated with injuries to the ligaments that join the clavicle to the shoulder blade, behaving like acromioclavicular dislocations.
Acromioclavicular dislocations are caused by falls on the shoulder and are characterized by the stretching or rupture of the ligaments that connect the clavicle to the shoulder blade (acromioclavicular and coracoclavicular – the most important).
There are varying degrees of severity, from minor sprains to complete rupture of all ligaments. In these situations, a lateral deformity, with prominence of the clavicle and dropping of the shoulder, is evident and results in pain and functional limitation.
Shoulder dislocations occur when the head of the humerus (the upper bone of the arm) moves away from the articular surface of the shoulder blade, most commonly forward (anterior dislocation).
Although the first episode is traumatic in most cases, there may be a genetic predisposition and excessive elasticity of the tissues that increases the risk of its occurrence. After a first dislocation, the risk of it occurring again increases exponentially, especially in those who practice contact sports.
Do shoulder injuries vary depending on the level of competition? Does position on the field influence the risk of injury?
Current scientific evidence focuses mainly on professional football players, due to their greater capacity for monitoring and data collection. Although traumatic shoulder injuries are also the most common in recreational or leisure players, their prevalence may be lower, not only due to the lower frequency of practice, which reduces the time of exposure to risk, but also due to the lower intensity during the game. However, the lower physical preparation of recreational athletes may affect their response time after injuries, which translates into a lower ability to cushion falls.
On the other hand, goalkeepers are players who require the use of their hands to defend and put the ball back into play. It is believed that these players have an almost five times higher risk of shoulder injuries and their downtime is significantly longer than outfield players when they suffer this type of injury.
What treatments are available for shoulder injuries in football?
The treatment of shoulder injuries in football players takes into account the characteristics of each specific injury and the athlete, their level of competition and position on the field, stage of the season or the rest of their professional life, among others.
Clavicle fractures can be treated with a brachial suspension that immobilizes the arm for a few weeks. However, when the deviation is excessive, there is an increased risk of a painful and less functional shoulder, so surgery to correct the deformity and fix the fracture may provide better results.
Milder acromioclavicular dislocations can also be treated conservatively, with good recovery after the affected ligaments have healed. In more severe cases, with complete rupture and joint instability, there are minimally invasive methods of fixation assisted by arthroscopy that stabilize the clavicle and allow a return to the previous sporting level.
Shoulder dislocations, or glenohumeral instability, are a controversial topic that generates much discussion about the best treatment. In general, after an initial episode, conservative treatment with immobilization for a few weeks can be attempted, followed by a specific rehabilitation period. Some cases may benefit from immediate surgical treatment, which can be performed using minimally invasive arthroscopic surgery (video-assisted surgery).
When the problem is recurrent, with multiple episodes of dislocation or a feeling of unstable shoulder, surgery allows the shoulder to be restored to stability and to be able to return to sports in the future.
