Soccer Shoulder - Lennard Funk

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Lennard Funk

Shoulder injuries in Soccer - our experience and research.

Health & Medicine Travel

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
Lennard Funk
1

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
INCIDENCE
• 2-4% of all injuries
!
• BUT:
– Longest period of time away from
play
3

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
EKSTRAND ET AL. BR J SPORTS MED 2009
4
Original article
Table 3 Injury pattern by severity of injuries
Total 1–3 Days 4–7 Days 8–28 Days >28 days
Injury location
Head and neck 77 (2) 19 (2) 23 (2) 29 (2) 6
Neck/cervical spine 23 11 (1) 8 3 1
Shoulder/clavicula 80 (2) 12 (1) 16 (1) 30 (2) 22 (3)
Upper arm 3 1 2 0 0
Elbow 24 3 10 8 3
Forearm 5 1 0 2 2
Wrist 8 1 1 4 2
Hand/ﬁnger/thumb 38 8 6 16 8
Sternum/ribs/upper back 47 (1) 9 16 (1) 19 (1) 3
Abdomen 31 3 7 17 (1) 4
Lower back/pelvis 237 (5) 74 (8) 78 (7) 66 (4) 19 (3)
Hip/groin 616 (14) 119 (12) 169 (15) 256 (16) 72 (10)
Thigh 1064 (23) 184 (19) 272 (23) 469 (28) 139 (20)
Knee 818 (18) 183 (19) 155 (13) 268 (16) 212 (30)
Lower leg/Achilles tendon 511 (11) 116 (12) 132 (11) 178 (11) 85 (12)
Ankle 625 (14) 150 (15) 185 (16) 220 (13) 70 (10)
Foot/toe 268 (6) 75 (8) 81 (7) 63 (4) 49 (7)
Unknown 8 2 3 3 0
Injury type
Fracture 160 (4) 7 9 59 (4) 85 (12)
Other bone injury 26 5 1 6 14 (2)
Dislocation/subluxation 50 (1) 5 4 24 (1) 17 (2)
Sprain/ligament injury 828 (18) 123 (13) 197 (17) 334 (20) 174 (25)
group.bmj.comon June 21, 2010 - Published bybjsm.bmj.comDownloaded from

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
PREMIERSHIP SHOULDER INJURIES
• Data courtesy of Health Partners
Europe
• Anonymous
!
!
• Jan 2007 - Jan 2010
• 35,000 claimed injuries
• 3.3% Shoulders
5
Mills, Pritchard, Funk, Batty. BJSM. 2011

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
INCIDENCE
6
0
10
20
30
40
50
60
70
80
90
100
2006-2007 2007-2008 2008-2009 2009-2010
Right Left
Mills, Pritchard, Funk, Batty. BJSM. 2011

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
SURGERY
7
!
Mills, Pritchard, Funk, Batty. BJSM. 2011

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
TYPES OF SURGERY
8
!
Mills, Pritchard, Funk, Batty. BJSM. 2011

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
• 25 Professional Footballers
– 15 Field players
– 10 Goalkeepers
9
GOALKEEPERS  
VS. OUTFIELD PLAYERS Hart & Funk, KSSTA. 2013

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
INJURY PATTERNS
10
Hart & Funk, KSSTA. 2013

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
FIELD
11
Goalie

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
FINDINGS IN GOALKEEPERS
SHOULDERS
• Poor postural control and position
• Abdominal
• Pelvis
• Scapula thoracic
• Poor recruitment of posterior cuff
• Problems with thoracic and
costo-vertebral joints
12
Tatlow & Funk, 2008

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
Common Injuries
13
6%
81%
16%
12% (outfield)
50% (goalies)
12%
18%
Mills, Pritchard, Funk 
ISSM, 2011

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
CLASSIFICATION OF LESIONS
14
Major ‘Minor’
• Bony Bankart!
• ALPSA!
• Rotator Cuff Tear!
• HAGL!
• Undisplaced Labral Tear!
• Partial Cuff Tear!

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
TIMING OF SURGERY
• Early Surgery:
– ‘Major’ lesions
– Late in Season
– Unable to Return
• Rehab & Return:
– ‘Minor’ lesions
– Early season
15

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
RETURN TO PLAY
• Unrestricted play = 11.4 weeks (3.7 SD)
– Outfield = 11.6 wks (4.1 SD)
– Goalies = 11.1 wks (3.2 SD)
16
Hart & Funk, KSSTA. 2013

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
ROTATOR CUFF TREATMENT
17
Impingement & Bursitis Rehab & Subacromial Injection
Partial Cuff Tears Platelet Rich Plasma Injection /
Arthroscopic debridement or
repair
Full Thickness Tear Arthroscopic Repair

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
SUMMARY
• Not common, but serious
• Outfield players = Labral injuries
• Goalkeepers = cuff pathology
• MR Arthrogram investigation of choice
• Arthroscopic surgery
• Sports specific rehabilitation
18

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
19

AMSTERDAM / THE NETHERLANDS
www.esska-congress.org
20

More from Lennard Funk

the common questions patients will ask once they have had a scan and a tear has been reported, particularly if they have had no injury of trauma, they ask what caused my tear. If I have a tear what can you do to fix it, it’s got to be fixed. How can I get better if it is not fixed. I have already had physiotherapy and that didn’t fix it so how will more physiotherapy. Some patients who are not keen on surgery, do I really need to have an operation. I have not had an injury. there are multiple options thrown into the mix here which we need to consider for an individual patient. The below illustration shows a very rough decision making tool that I would use in determining surgical or treatment options for particular patients. A younger patient who has both pain and weakness with a massive cuff tear, if it is partially repairable a biological augment would be suitable.  If their predominant weakness is external rotation i.e. a positive Hornblower sign but good elevation, a lat dorsi tendon transfer. For an older patient who has a predominant weakness but no significant pain, deltoid rehabilitation programme is indicated. If they do have pain, a suprascapular nerve procedure such as an ablation would be beneficial. For those that have significant pain and weakness with failed non-operative options, a reverse shoulder replacement would be the best option. The balloon as we said, has a very limited place and this is for the older patient with slight loss of function and pain with higher demands. For those that have more significant pain and elevation weakness, a superior capsular reconstruction would be my preferred option.

Rotator Cuff Update 2022 for Medbelle Len Funk.pptx

Lennard Funk

Lennard Funk & Puneet Monga Prepared for Orthopaedic Product News, 2017 Rotator cuff disease is very common. There is as much enthusiastic discussion and debate on its management as there was 80 years ago when Codman (1937) first described the pathology and surgical management. There is great variation amongst surgeons as to the management of rotator cuff tears biased by experience and their understanding of the literature, skills levels and regional variations. There has been a lot of research done on the pathology, non-operative and operative treatments over the last two decades. Also, over the last decade there have been massive strides in the development of new surgical techniques and technologies. However, despite these advances there is as much discussion and debate!

Should We Repair Rotator Cuff Tears OPN 2017.pdf

Lennard Funk

Anterior shoulder instability st4-6

Lennard Funk

ACJ revision surgery for failed reconstructions and excisions

Lennard Funk

Pectoralis Major Injuries for BESS 2020

Lennard Funk

Anterior shoulder Instability in the young athlete 2020 bostaa

Lennard Funk

Hariharan Mohan, Jagwant Singh, Michael Walton, Lennard Funk, Puneet Monga Cautious optimism following SCR may be offered to this challenging subset of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery. Further studies with longer term followup are recommended.

Superior Capsular Reconstruction Outcomes Wrightington 2020

Lennard Funk

Shoulder Instability Sports - Decision Making

Lennard Funk

Scapula Pain

Lennard Funk

Presentation at ISAKOS, 2019 There were 442 primary arthroscopic labral repair procedures performed over the three-year period. The total cohort had a mean age of 25.91±9.09 years (range, 14-67 years) and consisted of 89.6% males. There was no significant difference in mean age or gender between the isolated anterior, posterior or combined groups (p=0.383 and p=0.541, respectively). • Of the 442 patients who underwent a shoulder labral repair, isolated anterior labral pathology occurred in 52.9% (n=234), with posterior and combined labral tears accounting for 16.3% (n=72) and 30.8%, respectively (n=136) (Table 3). • Patients were stratified as either sporting or non-sporting; 74.9% of patients were categorised as sporting (n=331) and had a mean age of 24.91±5.69 years, which was significantly lower than the mean age of 35.40±11.94 years in the non-sporting population (p<0.001). In the non-sporting population 68.5% (n=76) of patients had isolated anterior labral tears with 12.6% (n=14) posterior and 18.9% (n=21) combined. In the sporting population isolated anterior labral tears accounted for 47.7% (n=158), posterior 17.5% (n=58) and combined labral tears 34.7% (n=115). The sporting population had a significantly greater proportion of posterior and combined labral tears with the non-sporting population a significantly greater proportion of anterior labral tears (p=0.013). • Rugby players had the greatest incidence of shoulder instability within the sporting cohort accounting for 231 cases. Of the 231 cases, 47.2% were isolated anterior labral tears, 12.6% isolated posterior and 40.3% combined lesions. Posterior and combined shoulder labral tears are more prevalent than previously reported in the civilian population. The rates are higher in young, sporting populations and especially in contact sports such as rugby.

The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...

Lennard Funk

Presentation at ISAKOS, 2019 We performed a total of 142 pectoralis major repairs over a ten year period, of which 19 required allograft reconstruction. Of these 19 patients, 11 were available for response. All 11 patients were male with a mean age of 38.3 years (21 to 48 years). The mean time between injury and surgery was 12.2 months (4 to 30 months). Ten patients (91%) were unable to perform their previous level of work pre-operatively, with all patients returning to pre-injury occupation levels post-operatively. The main complaint prior to surgery was pain on pushing and moving the affected arm across the body, which improved in nine patients (82%), with no improvement reported in two patients. Strength improved significantly post-operatively, with only three patients reporting no improvement (paired t-test p=0.01). Six patients reported an improvement in cosmesis (50%).

Pectoralis major allograft reconstruction

Lennard Funk

What the surgeon wants from radiologist

Lennard Funk

Rotator cuff tear management 2019

Lennard Funk

Perioperative pain management toni hundle the arm clinic 2019

Lennard Funk

Hydrodistention is a treatment for frozen shoulder (FS) that is gaining popularity again. However, no large, long-term outcome data has been published yet. Our aims were to evaluate hydrodistension for the treatment of primary frozen shoulder (FS) in a large cohort of patients with long follow-up period. We present a case series of eighty-nine patients (36 males and 53 females) with a mean age of 52 years (33-73). Eleven (12.4%) had disease associations. We excluded post-operative secondary stiff shoulders. The mean volume injected was 33.7ml (16-66). 36/89 (40%) had capsular rupture. Six (6.7%) had adverse effects. The mean follow-up was 104.5 weeks (8-238). Mean improvement in forward flexion was 165.4, abduction 111.6, external rotation was hand above head with elbow back (and internal rotation in extension to T12. Mean improvement in quickDASH score was 17.1 (p<0.001) and Constant Score was 70.0 (p<0.001). Mean improvement in VAS was 7.3 (p<0.001). No patients had night pain (p<0.001). Eighty-eight (99%) returned to their previous occupation. Seventy-six (85%) returned to their previous level of sport. Gender, previous intra-articular steroid injection, volume of the injectate, type of steroid used, capsular rupture and underlying aetiology had no impact on outcome.

Hydrodistension outcomes 2017

Lennard Funk

Clinical predictors hydrodilatation in idiopathic fs 2017

Lennard Funk

Hydrodilation technique - Does it matter 2018

Lennard Funk

Adolescents are neither children, nor adults. The ages 12 to 18 years are a time of rapid growth and body changes. These vary significantly between individuals. At the same time the the intensity and pressures of competitive sport are increasing in this age group. This is the time when athletes are competing for school, clubs and national level. It is also the time when they are being scouted and signed for professional contracts. In my practice of 15 years so far, I have seen large changes in the pattern, frequency, intensity and complexity of shoulder injuries in adolescent contact athletes. We have studied this over the years and in this lecture I will present our data showing the increasing frequency and complexity over the years, as well as the difficult diagnosis and decision-making processes. I will also present our published outcomes of surgical management and question the future of managing this key group of athletes.

Adolescent contact athlete 2018

Lennard Funk

Bone Response to Suture Anchor Classification Training Document

Lennard Funk

Suture anchors are routinely used for shoulder labral reconstruction procedures. There is paucity of literature on how the response of bone to suture anchor should be measured following labral reconstruction. A new system, based on the use of magnetic resonance (MR) imaging, has been developed by Professor Bhatti and his trainee which grades bone signal changes around suture anchors using a five-point scale. This system, however, has not yet been tested on a clinical dataset. We tested the reliability of the grading system in an independent dataset. This validation study demonstrates that the grading system is feasible and has generally moderate reliability. And, although results could be improved if a training document is added at the beginning of the study, this grading system should undergo further validation testing for use in clinical trials.

Suture anchor Bone Response Validation Study

Lennard Funk

More from Lennard Funk (20)

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Anterior shoulder instability st4-6

ACJ revision surgery for failed reconstructions and excisions

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Anterior shoulder Instability in the young athlete 2020 bostaa

Superior Capsular Reconstruction Outcomes Wrightington 2020

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Scapula Pain

The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...

Pectoralis major allograft reconstruction

What the surgeon wants from radiologist

Rotator cuff tear management 2019

Perioperative pain management toni hundle the arm clinic 2019

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Clinical predictors hydrodilatation in idiopathic fs 2017

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Adolescent contact athlete 2018

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