Shoulder & Elbow

Rugby is a high-intensity contact sport, frequently causing shoulder injuries. Between the ages of 12 years to 18 years, academy and county level players are being selected for professional contracts, making this is a critical stage of their career. The present study aimed to describe the patterns of injury in adolescent rugby players with shoulder injuries.

Academy and county level rugby players in the target age group, over a 7-year period, were included in the present study. Data collected included the mechanism of injury, position and level of play, radiology and surgical findings, and recurrence rate at a minimum of 2 years post-surgery.

One hundred and sixty-nine cases adhered to the inclusion criteria, with most cases involving two or more pathologies in the shoulder (54%). Forwards sustained more shoulder injuries than backs, incurring more labral injuries. By contrast, backs had a higher incidence of bony pathology. The mechanism of injury frequently correlated with player positions. There was a 21% injury recurrence rate, with forwards (7%) and higher level academy players (11%) most likely to suffer a recurrence.

Shoulder injury patterns in this important group of adolescent contact athletes are complex, with recurrence rates being higher than those in older rugby players.

Lateral epicondylitis (LE) occurs in almost half of all tennis players. Racket-string tension is considered to be an important factor influencing the development of LE. No literature yet exists that substantiates how string-tension affects force transmission to the elbow, as implicated in LE development. We establish a quantitative relationship between string-tension and elbow loading, analyzing tennis strokes using rackets with varying string-tensions.

Twenty recreational tennis players simulated backhand tennis strokes using three rackets strung at tensions of 200 N, 222 N and 245 N. Accelerometers recorded accelerations at the elbow, wrist and racket handle. Average peak acceleration was determined to correlate string-tension with elbow loading.

Statistically significant differences (p < 0.05) were observed when average peak acceleration at the elbow at 200 N string-tension (acceleration of 5.58 m/s²) was compared with that at 222 N tension (acceleration of 6.83 m/s²) and 245 N tension (acceleration of 7.45 m/s²). The 200 N racket induced the least acceleration at the elbow.

Although parameters determining force transmission to the elbow during a tennis stroke are complex, the present study was able to control these parameters, isolating the effect of string-tension. Lower string-tensions transmit less force to the elbow in backhand strokes. Reducing string-tension should be considered favourably with respect to reducing the risk of developing LE.

We describe the clinical, radiological and surgical findings of failed distal biceps repair by gapping and report the functional outcomes following revision repair.

A retrospective review of five consecutive patients was conducted. Patients presented with radial-sided forearm pain after their distal biceps fixation. All patients had less than 5 cm of retraction of the biceps muscle belly, a palpable tendon although the manoeuvre was painful with weakness on resisted supination. Flexed abducted supinated magnetic resonance imaging (FABS MRI) showed a gap between the distal end of the tendon and the footprint on the radial tuberosity.

Mean FEA score at presentation was 44/100 (35 to 49). Mean time to re-operation was 18 months (range 4 months to 36 months). At revision, the distal end of the tendon was retracted and not making contact with the bone. All cases were revised to an in-bone endobutton repair. Mean postoperative Functional Elbow Assessment (FEA) scores undertaken at a mean of 14 months (range 5 months to 22 months) after revision improved to 95/100 (90 to 100).

Patients presenting with persistent radial sided forearm pain and weakness on provocative testing after distal biceps repair with a seemingly intact repair should be investigated with FABS MRI to look for evidence of failure of repair by gapping. Revision repair with an anatomic in-bone technique can lead to good results.