Acromioclavicular Joint Sprains Research Articles

Concussion increases within-player injury risk in male professional rugby union

ObjectivesTo assess within-player change in injury risk and between-player subsequent injury risk associated with concussive and common non-concussive injuries in professional rugby union.MethodsThis prospective cohort study in Welsh professional male...

Shoulder Pain - Dodgeball

HISTORY: 39-year-old right-handed man presented to clinic for right shoulder pain. Symptoms were present for 4-5 months prior and began several days after playing in a dodgeball tournament. There was no trauma or clear inciting event. Pain was localized to the top of the right shoulder and worse with reaching across the body and with overhead activities. The 3-4 weeks prior to presenting to clinic he noticed a lump and swelling over the top of the shoulder and clavicular region that was not painful to touch. His pain was rated overall 3/10 intensity. PHYSICAL EXAM: Full range of motion of the shoulder in abduction, flexion without pain. Negative empty can test, Hawkins and Neers tests on the right. Speeds test negative on the right. Fullness and bony prominence noted at the distal clavicle on the right shoulder. No focal tenderness at the AC joint. Mild discomfort with scarf test on the right. DIFFERENTIAL DIAGNOSIS: 1. Acromioclavicular joint sprain 2. Acromioclavicular joint arthralgia 3. Distal clavicle osteolysis 4. Osteoid osteoma. TESTS AND RESULTS: Ultrasound right shoulder: Cortical irregularity of the distal right clavicle. XR right shoulder: Distal clavicular ill-defined lytic lesion with apparent cortical breakthrough superiorly and possibly inferiorly. MRI right shoulder: Indeterminate 3.6 cm expansile enhancing lesion with fluid. Biopsy right clavicle with USP6 genotype testing: consistent with an aneurysmal bone cyst FINAL/WORKING DIAGNOSIS: Aneurysmal bone cyst in the distal clavicle TREATMENT AND OUTCOMES: 1. Patient referred to orthopedic oncology and underwent biopsy 2. Underwent aspiration of aneurysmal bone cyst with injection of doxycycline 3. 2 months post-operatively continued to have pain and tightness in the shoulder 4. 5 months post-operatively reported resolution in shoulder pain and improved mobility, interval sclerosis noted of aneurysmal bone cyst on imaging

Epidemiology of Shoulder Injuries in Schoolboy Rugby Union in Ireland.

Background:The shoulder has been reported as a frequent location of injury in adult professional and amateur rugby, with match injury incidence rates ranging from 1.8 to 3 per 1000 player-hours (h). An increased understanding of the incidence and mechanism of shoulder injuries in school rugby players is vital to establish effective injury preventive strategies and advise on appropriate rehabilitation.Purpose:To describe the incidence, nature, and severity of shoulder injuries in schoolboy rugby in Ireland.Study Design:Descriptive epidemiology study.Methods:Injury surveillance was carried out for Senior Cup teams across two seasons (N = 665 players aged 17-19 years) in Ireland from 2018 to 2020. Match and training injury data were recorded using an online system by trained nominated injury recorders. Match exposure was also recorded.Results:Shoulder match injury incidence was 12.2 per 1000 h (95% CI, 9.1-16.2), with a mean severity of 47 days’ time loss and an overall burden of 573 days per 1000 h. In total, 47 match and 5 training shoulder injuries were recorded. The most common injuries were shoulder dislocations/subluxations (34%), followed by acromioclavicular joint sprains (30%). Shoulder dislocations/subluxations represented the most burdensome injury (280 days per 1000 h). The tackle accounted for the majority (81%) of shoulder injuries. Forwards sustained a significantly higher incidence of shoulder injuries (8.3/1000 h) in comparison with backs (3.9/1000 h), with a rate ratio of 2.13 (95% CI, 1.15-3.94; P = .015).Conclusion:We found a notably higher injury incidence rate in schoolboy rugby as compared with the adult amateur and professional game. Shoulder injuries were responsible for more days lost than any other injury, and shoulder dislocations were the most severe. This is of particular concern so early in a player’s career and warrants further investigation into potential risk factors and mechanisms associated with shoulder injuries in school-age players.

Epidemiology of Upper Extremity Injuries in NCAA Men’s and Women’s Ice Hockey

Background: Ice hockey is a physically demanding sport where athletes are susceptible to a variety of injuries. Several studies reported the overall injury rates in ice hockey; however, there is a paucity of information on upper extremity (UE) injuries among collegiate ice hockey players. Purpose: To describe the epidemiology of UE injuries among collegiate male and female ice hockey players with NCAA (National Collegiate Athletic Association) injury surveillance data from 2004-2005 to 2013-2014. Study Design: Descriptive epidemiology study. Methods: Data were obtained from the NCAA Injury Surveillance Program for all UE injuries sustained during the academic years 2004-2005 to 2013-2014. Injury rates, rate ratios (RRs), and injury proportion ratios were reported with 95% CIs. Results: During the 10 years studied, the overall rate of UE injuries for men was higher than that for women (236 vs 125 injuries per 100,000 athlete-exposures [AEs]; RR, 1.89; 95% CI, 1.67-2.15). UE injuries sustained during either pre- or postseason were approximately 3 times higher for men than for women (preseason: 149 vs 53 per 100,000 AEs; RR, 2.83; 95% CI, 1.69-4.74; postseason: 143 vs 49 per 100,000 AEs; RR, 2.91; 95% CI, 1.33-6.38). The overall injury rate was highest during the regular season (men: 257 per 100,000 AEs; 95% CI, 242-272; women: 143 per 100,000 AEs; 95% CI, 126-160). Additionally, the injury rate for men and women was higher during competition than practice (men: 733 vs 83 per 100,000 AEs; 95% CI, 687-780 and 75-92; women: 303 vs 64 per 100,000 AEs; 95% CI, 259-348 and 52-76). The most common injury observed was acromioclavicular joint sprain (men, 29.1%; women, 13.8%). For both groups, acromioclavicular joint injuries accounted for most non–time loss, moderate time loss (2-13 days), and severe time loss (≥14 days) injuries. Conclusion: Men and women sustained a significant number of UE injuries playing collegiate ice hockey during the period studied, with acromioclavicular joint sprain being the most common UE injury and the one that most frequently led to significant time loss. These data may provide insight for future injury prevention and guide improvements in training.

Epidemiology of shoulder and elbow injuries in National Collegiate Athletic Association wrestlers, 2009-2010 through 2013-2014

ABSTRACTObjectives: Examination of the incidence of shoulder and elbow injuries in the collegiate wrestling population is limited. Therefore, we sought to determine the incidence of shoulder and elbow injuries in wrestlers competing in the National Collegiate Athletic Association (NCAA), and investigate the risk factors involved.Methods: All shoulder and elbow injuries in wrestlers from the 2009–2010 through 2013–2014 academic years in the NCAA Injury Surveillance Program database were extracted. The incidence of different injuries, sports, activity, time-in-game, competition status, and injury characteristics was recorded. Risk-ratios were calculated to determine risk factors for injury.Results: Collegiate wrestlers had an incidence of 21.59 shoulder and elbow injuries per 10,000 athletic exposures (AEs). The most frequent injury types included elbow ulnar collateral ligament tears, shoulder impingement, and acromioclavicular joint sprains, although there was significant variability. Freshman collegiate wrestlers suffered a significantly higher percentage of shoulder and elbow injuries than more senior athletes, signifying an association between experience and injury risk. There was a 4-fold higher incidence of injury during competition. Injuries were significantly more likely to occur later in the match, with a 2.5-fold increased risk compared with early. While 26.8% of wrestlers were out of play for at least 14 days, only 5.9% of all injuries required surgery. Lastly, Division I collegiate wrestlers had the highest overall injury rate.Conclusions: Collegiate wrestlers have a high incidence of shoulder and elbow injury, with specific risk factors identified here. This at-risk patient population should be monitored closely for signs of fatigue, which may leave them susceptible to injury. Further prospective investigation of wrestling injuries with a special attention to injury prevention in higher risk athletes are needed to further validate these findings.

Epidemiology of Acromioclavicular Joint Sprains in 25 National Collegiate Athletic Association Sports

Background: No previous studies have described the incidence of acromioclavicular (AC) joint injuries in a large sample of National Collegiate Athletic Association (NCAA) student-athletes. Such data are needed to understand the injury prevalence, mechanisms of injury, and recovery patterns in NCAA student-athletes. Purpose: To describe the epidemiology of AC joint sprain injuries in 25 NCAA championship sports. Study Design: Descriptive epidemiology study. Methods: AC joint sprains were analyzed from the NCAA Injury Surveillance Program during the 2009-2010 to 2014-2015 academic years. AC joint sprain injury rates, rate ratios, and injury proportion ratios (IPRs) were reported with 95% CIs. Results: In the 25 NCAA sports examined during the 2009-2010 to 2014-2015 academic years, a total of 844 AC joint sprains were reported, for a rate of 1.72 per 10,000 athlete-exposures (AEs). The majority of AC joint sprains were reported in football (50.4%, n = 425). Most AC joint sprains occurred in competitions (66.0%, n = 557), and the competition rate was 8.58 times the practice rate (95% CI, 7.44-9.89). In sex-comparable sports (ie, soccer, basketball, ice hockey, lacrosse, baseball/softball, indoor track, outdoor track, cross-country, tennis, and swimming and diving), the AC joint sprain rate in men was 4.67 times that of women (95% CI, 3.56-6.14). Most AC joint sprains were caused by player contact (54.7%, n = 462), followed by surface contact (29.0%, n = 245). Of all AC joint sprains, 47.5% resulted in a time loss of <24 hours, and 5.9% were severe. In addition, 9.7% were recurrent, and only 1.0% required surgery. In sex-comparable sports, male athletes had a larger proportion of injuries due to player contact than did female athletes (IPR, 1.50; 95% CI, 1.06-2.13); female athletes had a larger proportion of injuries due to surface contact than male athletes (IPR, 1.55; 95% CI, 1.01-2.38). Also, compared with women, men had a larger proportion of AC joint sprains that were recurrent (IPR, 10.29; 95% CI, 1.45-72.90). Conclusion: The highest rates of AC joint sprains occurred in men’s football, ice hockey, and wrestling as well as women’s ice hockey. Most AC joint sprains across all sports occurred because of a contact mechanism, particularly from player-player contact. Further research into the specific activities and exposures at the time of injury may lend a better understanding of the causation of these injuries and lead to appropriate interventions to decrease their incidence and severity.

The Epidemiology of Acromioclavicular (AC) Joint Sprain in 25 National Collegiate Athletic Association Sports

No previous studies have described the incidence of acromioclavicular (AC) joint injury in a large-sample of National Collegiate Athletic Association (NCAA) student-athletes. Such research is needed to understand the injury prevalence, injury mechanisms, and recovery patterns in NCAA student-athletes. PURPOSE: To describe the epidemiology of AC joint sprain injuries in 25 NCAA championship sports. METHODS: AC joint sprains from the NCAA Injury Surveillance Program were analyzed for the 2009/2010-2014/15 academic years. AC joint sprain injury rates, rate ratios (RR), and injury proportion ratios (IPR) were reported with 95% confidence intervals (CI). The RRs were also compared between sex-comparable sports (i.e., soccer, basketball, ice hockey, lacrosse, baseball/softball, indoor track, outdoor track, cross country, tennis, and swimming and diving). RESULTS: During the study period, a total of 844 AC joint sprains were reported, for a rate of 1.72/10000 athlete-exposures (AE). The highest rates of AC joint sprain occurred in Men’s Ice Hockey (6.40/10000AE) and Football (3.79/10000AE) and Women’s Ice Hockey (2.12/10000AE). The AC joint sprain rate was higher in competition than practice (6.15 vs. 0.72/10000AE; RR=8.58; 95%CI: 7.44, 9.89). Most AC joint sprains were due to player contact (54.7%, n=462), followed by surface contact (29.0%, n=245). Overall, 71.1% of AC joint sprains resulted in time loss of less than 1 week. In sex-comparable sports, the AC joint sprain rate was higher in men than women (1.85 vs. 0.40/10000AE; RR=4.67; 95%CI: 3.56, 6.14). In sex-comparable sports, males had a larger proportion of injuries due to player contact than females (54.1% vs. 36.1%; IPR=1.50; 95%CI: 1.06, 2.13); females had a larger proportion of injuries due to surface contact than males (31.1% vs. 20.1%; IPR=1.55; 95%CI: 1.01, 2.38). CONCLUSIONS: Overall, most AC joint sprains were due to contact, particularly with other players. Differences in mechanisms in sex-comparable sports highlight rule differences between men’s and women’s sports and is an area of future exploration. Further research into the specific activities and exposures at the time of injury may lend a better understanding of the causation of these injuries and lead to appropriate interventions to decrease their incidence and severity.

THE IMPACT OF THE TACKLE: SHOULDER INJURIES IN A RUGBY UNION TEAM

BackgroundRugby Union (rugby) is the third most popular contact sport in the world and has one of the highest reported incidences of injuries amongst all sports. Thoroughly characterising these injuries...

Acromioclavicular Joint Injuries in the National Football League

Background: Previous studies investigating acromioclavicular (AC) joint injuries in professional American football players have only been reported on quarterbacks during the 1980s and 1990s. These injuries have not been evaluated across all position players in the National Football League (NFL). Purpose: The purpose of this study was 4-fold: (1) to determine the incidence of AC joint injuries among all NFL position players; (2) to investigate whether player position, competition setting, type of play, and playing surface put an athlete at an increased risk for this type of injury; (3) to determine the incidence of operative and nonoperative management of these injuries; and (4) to compare the time missed for injuries treated nonoperatively to the time missed for injuries requiring surgical intervention. Study Design: Descriptive epidemiological study. Methods: All documented injuries of the AC joint were retrospectively analyzed using the NFL Injury Surveillance System (NFLISS) over a 12-season period from 2000 through 2011. The data were analyzed by the anatomic location, player position, field conditions, type of play, requirement of surgical management, days missed per injury, and injury incidence. Results: Over 12 NFL seasons, there were a total of 2486 shoulder injuries, with 727 (29.2%) of these injuries involving the AC joint. The overall rate of AC joint injuries in these athletes was 26.1 injuries per 10,000 athlete exposures, with the majority of these injuries occurring during game activity on natural grass surfaces (incidence density ratio, 0.79) and most often during passing plays. These injuries occurred most frequently in defensive backs, wide receivers, and special teams players; however, the incidence of these injuries was greatest in quarterbacks (20.9 injuries per 100 players), followed by special teams players (20.7/100) and wide receivers (16.5/100). Overall, these athletes lost a mean of 9.8 days per injury, with quarterbacks losing the most time to injury (mean, 17.3 days). The majority of these injuries were low-grade AC joint sprains that were treated with nonoperative measures; only 13 (1.7%) required surgical management. Players who underwent surgical management lost a mean of 56.2 days. Conclusion: Shoulder injuries, particularly those of the AC joint, occur frequently in the NFL. These injuries can result in time lost but rarely require operative management. Quarterbacks had the highest incidence of injury; however, this incidence is lower than in previous investigations that evaluated these injuries during the 1980s and 1990s.

An Abnormal Bone Lesion of the Scapula in a Collegiate Basketball Player: A Case Report

To present the case of a bone lesion of the scapula in a collegiate basketball player. A 19-year-old National Collegiate Athletic Association Division I male basketball player presented with pain in the posterior region of the right shoulder. During practice, he was performing a layup when his arm was forced into hyperflexion by a defender. Evaluation revealed a bone lesion involving the scapular spine and base of the acromion. Acromioclavicular joint sprain, subacromial bursitis, subscapular bursitis, humeral head contusion, acromial fracture. The patient was treated for 2 months with therapeutic modalities and rehabilitation exercises. Because of persistent pain and the risk of a pathologic fracture, open surgical biopsy and bone grafting were then undertaken. Most simple bone cysts affect the proximal humerus and femur, whereas our patient's lesion was in the acromial complex. Athletic trainers should be alert to the unusual possibility of bone cysts, which are usually identified incidentally when radiographs are obtained for other reasons. Most simple bone cysts are asymptomatic, but a pathologic fracture can occur with trauma.

A 3-month prospective study of injuries in amateur rugby and soccer

BACKGROUND: Studies of sports injury in Irish amateur sport are rare. RESEARCH QUESTION: To determine the injury incidence rates (IR) and severity in male amateur rugby and soccer. TYPE OF STUDY: A 3-month prospective observational study of collegiate rugby players (n = 54; M ± SD age 21 ± 2 yr, body mass 88.1 ± 10.7 kg, height 1.83 ± 0.52 m, body mass index 26 ± 2.6 kg.m−2) and soccer players (n = 21; M ± SD age 21 ± 2 yr, body mass 75.9 ± 8.0 kg, height 1.80 ± 0.57 m and body mass index 23 ± 1.9 Kg.m−2). METHODS: Fortnightly questionnaires detailing training and match exposure (hr) and injury status were completed under supervision, response rate was 92.7%. The study employed a time-loss injury definition. Injuries were examined by a physiotherapist, a mean ± SD time of 4.6 ± 4.3 days after onset. RESULTS: Subjects spent 2967.5 hr in training and 623.1 hr playing competitive matches. Sixty six injuries were recorded during the observation period (soccer, n = 15; rugby, n = 51). Match and training IR for soccer were 49.3 (95% CI 21.4 to 77.3) and 7.1 (95% CI 0 to 15.1) per 1000 hr and for rugby were 99.5 (95% CI 67.8 to 131.1) and 5.1 (95% CI 2.3 to 7.9) per 1000 hr, respectively. All injury types were more common in matches. In soccer, ankle sprains (ligament injury) had the highest IR, 16.5 per 1000 hr match-play (95% CI 0.3 to 32.6). In rugby acromioclavicular joint sprains had the highest IR (injury incidence rate), 15.7 per 1000 hr match-play (95% CI 3.1 to 28.3). CONCLUSION: The risk of injury in collegiate soccer and rugby is substantial, particularly in competitive matches. Rugby poses a greater risk of injury than soccer. Injury prevention strategies targeting ankle sprains in soccer, shoulder and knee sprains in rugby, and hamstring strains (muscle injury) in both sports are recommended.

Long-Term Safety of Using Local Anesthetic Injections in Professional Rugby League

Background Local anesthetic pain-killing injections are commonly used by some professional football teams to allow continued play for certain injuries; however, the long-term safety of this practice has not been studied. Hypothesis The majority of local anesthetic injections administered in professional football are helpful and safe, not leading to long-term sequelae. Study Design Case series; Level of evidence, 4. Methods A retrospective survey was conducted of 100 players over 10 seasons who had been injected with local anesthetic on 1023 occasions for 307 injuries (81% follow-up; average follow-up, 5 years; minimum, 1 year). A comparison of match performance statistics was made from 3 seasons between players using and not using local anesthetic. Results The majority (98%) of players would repeat the procedure if they had their injury again, although 32% felt that there were side effects associated with the procedure (including 22% who thought that the recovery of the primary injury was delayed and 6% who thought that the injury was worsened by playing with local anesthetic). On long-term follow-up, only 6% of players had significant residual pain in the body part injected. The satisfaction rates for acromioclavicular injuries, finger injuries, rib injuries, and iliac contusions were higher than for sternum injuries, wrist injuries, and ankle injuries. Player performance between those players injected and not injected with local anesthetic was not substantially different and mainly reflected a positional bias for the players who used local anesthetic. Conclusion The most commonly injected injuries—acromioclavicular joint sprains, finger and rib injuries, and iliac crest contusions—appear to be quite safe (in the context of professional sport) to inject at long-term follow-up. Conversely, ankle, wrist, and sternum injections appear to be less safe. A few injuries may have been substantially worsened by playing after an injection.

Shoulder Injury-football

HISTORY: A college football tailback with a known Bankart lesion sustained a shoulder injury after being tackled. During a game he received a posterolateral blow to the left shoulder by a helmet from an opposing player. He described immediate generalized left shoulder pain with transient numbness and tingling in the upper arm which resolved spontaneously. He reported weakness to abduction, forward flexion and elbow flexion associated with significant pain during these movements. He did not return to the game. PHYSICAL EXAM: Examination on the sidelines revealed no gross bony deformity or immediate swelling. There was diffuse tenderness to palpation over the anterior and superior aspect of the shoulder. His active range of motion was significantly reduced in forward flexion, abduction and external rotation of the shoulder. He also had weakness with resisted shoulder abduction, forward flexion, and external rotation, as well as with elbow flexion. There was decreased sensation to light touch over the shoulder and upper arm as compared to the right. Instability and apprehension signs were difficult to assess secondary to significant pain and inability to abduct and externally rotate the shoulder. The weakness and decreased sensation resolved spontaneously within 30 minutes. DIFFERENTIAL DIAGNOSIS: Anterior shoulder subluxation Distal clavicle fracture Scapular fracture Acromioclavicular joint sprain Contusion TEST AND RESULTS: Plain films (obtained the next morning): 3 views of the left shoulder -Fracture of the glenoid fossa extending into the neck of the glenoid and into the body of the scapula CT with 3 dimensional reconstructions (2 days after injury): -Mildly comminuted minimally displaced fracture of the scapula including the base of the glenoid and the glenoid fossa. FINAL DIAGNOSIS: Comminuted minimally displaced fracture of the glenoid and body of the scapula TREATMENT/OUTCOMES: 1. Immediate treatment consisted of placement in a sling and oral pain medications. Surgery was scheduled on the third day after the injury for internal fixation and repair of the old Bankart lesion. Return to play guidelines will follow recovery from surgery and will be driven more by Bankart repair than by internal fixation of the fracture.

Acromioclavicular joint injury: Enhanced technique of examination with dynamic maneuver

Acromioclavicular (AC) sprains can be graded in 3 to 6 different types according to Tossy or Rockwell, respectively. In mild sprains (Tossy and Rockwell I), movements in the AC joint are minimal, because the coraco-clavicular ligaments are intact. In these patients, stress radiography is usually normal, and sonographic examination at rest can be normal as well, showing minimal or no displacement between the 2 extremities of the bones. We present a simple dynamic maneuver to enhance the diagnosis of these mild sprains known as the cross-arm maneuver, in which the hand is placed on the opposite shoulder. The dynamic sonographic examination during this maneuver clearly shows abnormal movements in the clavicle's extremity, which "falls down" to the acromion in the cross-arm position and is raised and pulled from the acromion at rest. The maneuver is very easy to perform and may be useful when a mild AC joint sprain is suspected.

Shoulder Pain

Shoulder Pain

Return to Play Issues in Upper Extremity Injuries

The purpose of this paper is to outline general treatment and return to play (RTP) strategies as they pertain to athletes with various upper extremity injuries. It is not intended to be a comprehensive review of these injuries. A review of the literature plus expert opinion served as the basis for recommendations made regarding management strategies for returning the athlete to play after upper extremity injury. A Medline search was performed using the following key words: upper extremity injury, return to play, glenohumeral dislocation, acromioclavicular joint sprains, elbow dislocation, scaphoid fracture, metacarpal fracture, finger dislocation, tendon injury, hand, mallet finger, and jersey finger. These and other related terms were crossed using the Medline database from 1966 to 2005. Review of book chapters, articles generated from the Medline search, and expert opinion led to the recommendations that are presented here. There is general agreement regarding the treatment of many of the injuries discussed, but controversies do exist. RTP guidelines are largely dependent on the severity of initial injury, rates of healing, and return of strength. Each athlete with a particular injury to the upper extremity needs to be approached as an individual as no single set of treatment or RTP guidelines applies to all injuries or all individuals. Factors such as age, injury severity, hand dominance, type of sport participation, method of treatment, and chronicity of injury are among the many issues that must be considered when developing a treatment and RTP strategy for a particular athlete.

Shoulder Injuries to Quarterbacks in the National Football League

Background Quarterbacks are at risk for shoulder injury secondary to both the throwing motion as well as from contact injury. Objective To delineate the incidence and etiology of shoulder injuries to quarterbacks in the National Football League (NFL). Methods Using the NFL Injury Surveillance System (NFLISS), all reported injuries to quarterbacks between 1980 and 2001 were identified. Results A total of 1534 quarterback injuries were identified with a mean of 18.8 and a median of 6.0 days of playing time lost. The majority of these injuries occurred during a game (83.8%). Passing plays were responsible for 77.4% of all quarterbackrelated injuries. Shoulder injuries were the second most common injury reported (233 or 15.2%), following closely behind head injuries (15.4%). Direct trauma was responsible for 82.3% of the injuries, with acromioclavicular joint sprains being the most common injury overall (40%). Overuse injuries were responsible for 14% of the injuries, the most common being rotator cuff tendinitis (6.1%) followed by biceps tendinitis (3.5%). Conclusion In this review, the vast majority of shoulder injuries in quarterbacks occurred as a result of direct trauma (82.3%), and less than 15% were overuse injuries resulting from the actual throwing motion.

Is it safe to use local anaesthetic painkilling injections in professional football?

The use of local anaesthetic painkilling injections in professional football can counter the performance-reducing impact of injury and lower the rate of players missing matches through injury. In the majority of cases, these injections are probably safe, although scientific evidence in this area is scant, particularly regarding long-term follow-up. The known long-term injury sequelae of professional football, such as increased rates of osteoarthritis of the knee (in particular), hip, ankle and lumbar spine, do not generally relate to the injuries for which local anaesthetic is commonly used. The most commonly injected injuries (acromioclavicular joint sprains, finger and rib injuries and iliac crest haematomas) are probably the safest to inject. There are risks of worsening injuries and known specific complications when local anaesthetic is used, and players requesting injections should be made aware of these. Local anaesthetic injections as painkillers should only be used when both the doctor and player consider that the benefits clearly outweigh the anticipated possible risks. Intra-articular injections to the knee, ankle, wrist, joints of the foot, and to the pubic symphysis and major tendons of the lower limb are best avoided in most circumstances. To enable the benefit and risk profile of local anaesthetic injections to be better understood, it is recommended that professional football competitions make local anaesthetics legal only with compulsory notification.

Grade I and II acromioclavicular dislocations: results of conservative treatment

The purpose of this study was to assess the results of acute grade I and II acromioclavicular (AC) joint sprains treated by conservative measures. Between 1993 and 1997, 37 consecutive patients were treated conservatively for AC joint sprains, grade I and II in the Tossy classification. Of these patients, 4 were excluded (three lost to follow-up and one sustained a further AC injury), leaving a series of 33 patients. Among them, in 9 (27%), chronic AC joint pathology that required subsequent surgery developed at a mean of 26 months after injury. The remaining 24 were reviewed clinically and radiologically at a mean of 6.3 years (range, 4-8 years) after injury. At the latest follow-up, 17 of the 33 patients (52%) remained asymptomatic. Of the 24 patients reviewed, 7 complained of activity-related pain. Eight patients presented with residual anteroposterior instability. Tenderness at the AC joint as well as a positive cross-body test was observed in 12 patients. The mean Constant score at follow-up was 82 points. The x-ray films showed degenerative changes in 13 patients, ossification of the coracoclavicular ligaments in 2, an association of degenerative changes with ossification of the coracoclavicular ligaments in 3, and distal clavicular osteolysis in 3. Only 4 cases had no radiographic changes after this kind of AC injury. On the basis of these results, we conclude that the severity of the consequences after grade I and II AC sprains is underestimated.

Acromioclavicular joint sprains: the post-injury recovery interval

Acromioclavicular joint (ACJ) sprains occur after injuries to the shoulder girdle. Current practice is to treat such injuries conservatively. This study determines the recovery interval of ACJ sprains treated conservatively. Forty-seven patients with grades I or II ACJ sprains were evaluated in a shoulder clinic and treated conservatively. The average age was 37 years, with the injury being caused by a fall, contact sport or road-traffic accident. At an interval of 12 months or greater these patients were assessed by means of a questionnaire. Six months post-injury, pain was described as significant by 14 (40%) patients, decreasing to 5 patients (14%) at final follow-up. A restricted range of movement was reported by seven patients (20%) 6 months post-injury. There is a positive correlation between patients symptomatic at 6 months and those whose symptoms persist beyond 1 year ( r=0.6, 95% CI=0.28–0.76, P<0.01). Three patients (9%) found that symptoms affected their ability to perform activities of daily living and two patients (6%) had to change sporting activities. Patients may continue to experience adverse symptoms beyond 6 months and should be advised accordingly on appropriate treatment should symptoms persist.