Contact Sports and Shoulder Injuries



Anyone can suffer a shoulder injury, but athletes involved in contact sports such as rugby, football and hockey are particularly vulnerable to fractures, separations and dislocations caused by the parts of the shouldercombination of speed and contact force to the shoulder upon impact, according to ONS Sports Medicine Specialist, Dr. Marc Kowalsky.

“The three most common injuries I see in athletes playing contact sports are clavicle fractures, AC joint separations and shoulder dislocations,” Dr. Kowalsky said.


Clavicle, or collarbone, fractures can occur along the bone anywhere between its attachment to the shoulder and the sternum. Direct trauma, and falling on an outstretched arm, are both common causes of a collarbone fracture.

A shoulder separation is the result of trauma at the acromioclavicular joint (AC joint), where the collarbone and the highest point of the shoulder blade, known as the acromion, meet. With this injury, the ligaments that hold the the joint together become stretched or torn from the force of the impact to the area.

A shoulder dislocation occurs when the head of the arm bone (humerus), or the ball of the shoulder joint, is driven out of the glenoid socket.  The injury is considered a complete, or locked, dislocation when the ball remains out of socket and requires manipulation in order to be put back in place.  A partial dislocation, a condition known as subluxation, occurs when the ball is forced out of its natural position in the socket, but is able to slip back in place on its own.


Trauma is the common denominator in these injuries, and they all can produce significant pain. Along with pain, these injuries typically cause an obvious deformity, including squaring of the shoulder with a dislocation, or a prominent bump or prominence with AC separations.  Injured athletes will also notice difficulty raising the arm, as well as tenderness, swelling, and eventual bruising.  In the case of a shoulder dislocation, the pain usually improves significantly when a physician performs a closed reduction, during which he or she puts the shoulder back in place.


Diagnosis is made initially by physical examination of the shoulder and an X-ray.

Early conservative treatment for mild injuries usually includes sling immobilization to protect the shoulder and minimize pain, along with ice, rest and Nsaids.  X-rays are used to assess alignment and the presence of a fracture.  An MRI will be considered, particularly for shoulder dislocations, if a soft tissue injury such as a labrum tear or injury to the rotator cuff tendons, is suspected.

Depending on the severity of the injury and the complexity of the treatment, physical therapy is usually prescribed to help patients gradually regain strength and mobility.  Surgery is typically considered only for significant injury with wide displacement, or for certain athletes at high risk for recurrent injury.


Of course, some injuries are unavoidable, but having proper fitting upper body gear can go a long way to dissipate the impact.  Balanced strength and conditioning in the muscles that support the shoulder is also key to help prevent an injury, minimize the extent of the injury if one should occur. Additionally, studies have shown that pre-injury strength and conditioning is also your best shot at a fast return to play.

The shoulder has several muscles that attach the shoulder blade (scapula), humerus and clavicle.  While it is important to have balanced strength in all muscles in the shoulder, the muscles and connecting tendons that make up the rotator cuff are the front line for shoulder stabilization.


As with any new exercise, it’s important to consult with a professional therapist or trainer, particularly if you have a prior injury or limitation. Strength and conditioning programs are suitable even for our youngest athletes, but the program should be age-appropriate and supervised.  Start slowly, and gradually increase repetitions, sets and level of resistance. And it is particularly important to focus on proper form.  Exercises done improperly can put unintended stress on other parts of the shoulder or even elsewhere in the body.

Trainers and physical therapists can help develop a shoulder strengthening program that’s right for you.  Many exercises to strengthen the rotator cuff can be done using a resistance band, particularly for strengthening your internal and external shoulder rotation, and the muscles in your scapula. Your posture alignment and range of motion will also benefit.

Planks are good to strengthen the core, back and shoulders, as long you maintain proper alignment. You can challenge yourself with a variation on a push up, where you start at a low plank and push up to a high plank one arm at a time.