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  • Tim Bushnell

Did I Have a Stinger or a Shoulder Subluxation?"

TBS Physio makes the content of this blog available for general information only. The information in this blog is not a substitute for appropriate clinical advice from your health professional. You should speak to your health professional for personalised clinical advice.


You have probably heard (or even used) the word “stinger” circulating around Joeys over the past few weeks. While a stinger is the term most people use to describe the injury, it's important to understand that what you're more likely experiencing is a shoulder subluxation. Let's briefly differentiate between stingers and shoulder subluxations, and then delve into the details of shoulder subluxations and how we recommend you manage them.

 

Subluxation or Stinger Injury?

Shoulder subluxation injuries involve the partial or complete dislocation of the shoulder joint, leading to instability and recurrent dislocations. The shoulder joint, or glenohumeral joint, is an inherently unstable ball-and-socket joint. It can be described as a golf ball sitting on a golf tee, allowing for maximum mobility but limited stability. The primary stabilisers of the shoulder joint include the bony aspects of the joint, ligaments, and labrum. The secondary stabilisers include deep muscles like the rotator cuff, which help to hold the ball (humeral head) against the socket (glenoid). Unlike shoulder stingers, subluxations involve injury to the structures inside and surrounding the shoulder joint, such as bones, cartilage, labrum, ligaments, tendons, and muscles.


Stingers primarily involve traction or compression of the upper trunk of the brachial plexus. These injuries may involve transient sensation loss and muscle weakness of the shoulder and arm. In some cases, they can cause prolonged sensation change as well as weakness through any muscles that the brachial plexus nerves innervate, most commonly the deltoid and rotator cuff respectively.


Rugby Injury

Symptoms

  • Feeling of the shoulder "slipping" or moving out of place

  • Pain or sensation change down the arm and sometimes into the fingers

  • Pain or discomfort in the shoulder joint, especially during overhead movements

  • Swelling deep in the shoulder joint

  • Limited range of motion in the shoulder

  • The sensation of weakness or instability in the shoulder

 

Common Causes

TRAUMA:

  • Direct impact or force to the shoulder or arm, usually when it is in the position of abduction and external rotation (throwing position)


ANATOMICAL VARIATIONS:

  • Certain individuals may have naturally lax ligaments or shallow shoulder sockets, increasing their susceptibility to shoulder instability (sometimes termed hypermobility)


PREVIOUS INJURIES:

  • A history of shoulder dislocations or instability can weaken the integrity of the shoulder joint, making future subluxations more likely


POOR TACKLE TECHNIQUE:

  • If the arm is lifted too far away from the body when tackling, this places the shoulder in its weakest position

  • When the shoulder is in the throwing position, both the active (muscles/tendons) and passive (ligaments, joints, labrum) structures are in their weakest position


REPETITIVE OVERUSE:

  • Repeated overhead motions, such as throwing or lifting, can strain the shoulder joint and lead to instability over time


Poor tackle technique

Management Strategies

ASSESSMENT AND ACCURATE DIAGNOSIS:

  • See your Physio or Sports Doctor immediately for an assessment and accurate diagnosis. If you are injured while playing at Joeys on the weekend, we have Physios at all fields as well as a Sports Doctor.


REST:

  • Resting the shoulder and sometimes use of a sling can keep the shoulder in a safe position and promote healing.


IMAGING:

  • MRI is the gold standard assessment for all shoulder subluxations as it allows assessment of the soft and hard tissues of the shoulder joint. X-ray can help initially to rule out fracture and assess for any evidence of larger bony instability (hill-sachs lesion or bony bankart lesion).


PHYSIOTHERAPY REHABILITATION:

  • A structured Physiotherapy-guided rehabilitation program can improve mobility, enhance stability, and strengthen the muscles around the shoulder joint. This should progress from range of motion exercises, to scapular stabilisation and rotator cuff strengthening, to strengthening the larger compound muscles through resistance training.

  • Follow @tbsphysio on Instagram to see our favourite exercises for Shoulder Subluxations.


BRACING / STRAPPING:

  • Wearing a shoulder brace or strapping the shoulder joint (with rigid tape) during training and games can reduce the risk of recurrent subluxations.


SURGERY:

  • In more significant cases or recurrent instability, surgery may be necessary to repair damaged structures (arthroscopic stabilisation) or reinforce the shoulder joint with a bone block (laterjet procedure).

 

Prevention Strategies

TACKLE TECHNIQUE:

  • Keep the shoulder blade back and arm close to your body when tackling. This ensures both the active and passive structures in your shoulder are in a strong position. Focus on tackling with your body and not your arm or shoulder.


PREHAB:

  • Incorporate preventative ("prehab") proprioceptive and strengthening exercises into your gym program. Also, add prehab exercises into your warm-up before contact training.

  • Follow @tbsphysio on Instagram to see our top exercises for preventing subluxations.


SCREENING:

  • Speak with your Physio about identifying any underlying risk factors including any anatomical variants you may have that predispose you to shoulder instability injuries.

  • This may include clinical tests, strength tests and performance testing and analysis with our VALD ForceDecks.

  • The Athletic Shoulder Test can be used to evaluate the neuromuscular activity of the shoulder girdle in contact sports. It helps your Physio understand if the shoulder girdle is ready for contact and overhead throwing activities. These tests can be performed with force plates like our VALD ForceDecks.


GRADUALLY INCREASE EXPOSURE TO CONTACT:

  • In the off-season, work on tackle technique and gradually increase exposure to controlled contact activity in the pre-season. Gradually increase the volume and intensity before moving into uncontrolled live contact scenarios.

 

Shoulder subluxations can be frustrating, especially when they are not accurately diagnosed. With accurate diagnosis and appropriate early management, you can minimise their impact on your sport and prevent recurrence. If you can’t seem to get on top of your shoulder injuries, feel free to reach out to us.

 

Follow us on Instagram @tbsphysio to see our top exercises to help you stay on the field this season.

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