#AFL Round 15 Swans v Suns Sat 29-Jun at SCG #AFLSwansSuns @sydneyswans

[wolftone57]

I'll start my reply with a disclaimer in that I am an anaesthetist who works with upper limb surgeons who deal with these issues.
The shoulder is inherently unstable given its required functions. The shoulder joint unlike say the knee joint, is pretty loose and is held together by the muscles (rotator cuff), ligaments and capsule.
Treatment will depend on the injury but also the desired end result. So for an 80yo with a degenerative rotator cuff, pain relief with a reasonable level of function is ok. An AFL ruckman, who is constantly at full extension / abduction will need a strong joint ie intact and strong muscles / ligaments / capsule to withstand the rigours of professional, contact sport.
It doesn't take much to make a shoulder joint unstable so it may be, Cal only has a small soft tissue tear that can either be rehabed non surgically or require minor arthroscopic surgery. However, if he is rushed back, I would worry that he could really damage the shoulder (if it isn't already). But this is all speculation and obviously more will be revealed once he has his scans.

Just a few questions on the dislocation. Doesn't a dislocation stretch, if not tear, the ligaments, muscles and tendons? Isn't it even more likely that tears will be a likely scenario after a second straight dislocation? Even without a rotator cuff injury, with tears etc, isn't more the case that he will miss several matches at the very least?

Some tears can require an op if extreme enough. Although, having had torn ligaments and tendons in my shoulder and living with Frozen Shoulder, on most occasions an op would not be performed but the shoulder let to heal by itself. This takes up to 18 months. In the case of a sports person I suppose they would operate?

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[Ralph Dawg]

The Swans medical doctor, Dr Tom Cross, should know a thing or two about shoulder injuries - he had four shoulder reconstructions himself before age 22 as a rugby player.

Coffee with Cynthia: Dr Tom Cross - sydneyswans.com.au

And for the technically minded, he’s written a paper on rotator cuff problems in sport (see an attachment at the weblink below).

Dr Tom Cross | Sports Physician Sydney | Sports Medicine Sydney

(Note also a paper about hip pointer injury which he’s called the ‘Franklin-Naismith Lesion’ [emoji3]).

Incidentally, in Sinclair’s ‘Conversations with Cal’ podcast with Dan Menzel, Cal and Dan joked about how thorough Tom Cross is, with Cal saying the doctor is much loved by the players.

So I think Sinclair is in good hands. Unfortunately though he might be out for some weeks, if not the season if he has to have surgery.

Thanks for the link Meg - agree that he's in good hands. Dr Cross has a very impressive CV.

[barry]

The Swans medical doctor, Dr Tom Cross, should know a thing or two about shoulder injuries - he had four shoulder reconstructions himself before age 22 as a rugby player.

Coffee with Cynthia: Dr Tom Cross - sydneyswans.com.au

And for the technically minded, he’s written a paper on rotator cuff problems in sport (see an attachment at the weblink below).

Dr Tom Cross | Sports Physician Sydney | Sports Medicine Sydney

(Note also a paper about hip pointer injury which he’s called the ‘Franklin-Naismith Lesion’ [emoji3]).

Incidentally, in Sinclair’s ‘Conversations with Cal’ podcast with Dan Menzel, Cal and Dan joked about how thorough Tom Cross is, with Cal saying the doctor is much loved by the players.

So I think Sinclair is in good hands. Unfortunately though he might be out for some weeks, if not the season if he has to have surgery.

You cant judge this on reputation only. Yes he is a doctor, yes he has personal experience with shoulders.

But he can still make poor decisions and it is obvious that he made, or was pressured to make, a poor one in putting Sinclair out there again which resulted in another dislocation.

In normal dislocations the tendons and ligaments are stretched (and some are torn). So for a few weeks rest allows them to repair. Once there is some repair, you can strap the joint to minimize the chance of further damage.
In Sinclairs case, his first dislocation would have damaged those tendons so they would be very loose and not much holding the shoulder in place. Another dislocation will do further damage = longer reabilitation.

[liz]

Kennelly's shoulder used to pop out all the time. Sometimes more than once during a game. They'd stick it back in and he'd carry on.

Doesn't that suggest that no two shoulders (or shoulder injuries) are the same, and that it's impossible to diagnose cause or prognosis sitting in the stand or on the couch?

[dejavoodoo44]

Kennelly's shoulder used to pop out all the time. Sometimes more than once during a game. They'd stick it back in and he'd carry on.

Doesn't that suggest that no two shoulders (or shoulder injuries) are the same, and that it's impossible to diagnose cause or prognosis sitting in the stand or on the couch?

The first thing that pops into my mind, when Kennelly's shoulder is mentioned, is Leo Barry having a go at putting it back in, and then realising, that putting a shoulder back in was harder than it looked.
And ages ago, I read Tadhg's brief memoir. In it he discussed his shoulder. If I remember rightly, it used to pop out in a range of domestic situations: like doing the ironing and getting into a bath.

[Ralph Dawg]

Just a few questions on the dislocation. Doesn't a dislocation stretch, if not tear, the ligaments, muscles and tendons? Isn't it even more likely that tears will be a likely scenario after a second straight dislocation? Even without a rotator cuff injury, with tears etc, isn't more the case that he will miss several matches at the very least?

Some tears can require an op if extreme enough. Although, having had torn ligaments and tendons in my shoulder and living with Frozen Shoulder, on most occasions an op would not be performed but the shoulder let to heal by itself. This takes up to 18 months. In the case of a sports person I suppose they would operate?

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This is always the issue with professional sports people. Us mere mortals can afford to wait, take a more conservative approach etc. Cal is an integral part of our team. The team's season literally could hang on his shoulder so this is where the advice of an experienced team Dr like Cross comes into play. A small tear to the capsule or rotator cuff can be managed conservatively but Cal would have significant occupational exposure to further trauma and damage to a joint that may not be 100% as opposed to us who may not be able to hang up the washing in the short term (not a bad thing although my wife would kill me!). So I guess what I am saying is that it's complicated but I would trust Dr Cross to make the right decision.

[barry]

Kennelly's shoulder used to pop out all the time. Sometimes more than once during a game. They'd stick it back in and he'd carry on.

Doesn't that suggest that no two shoulders (or shoulder injuries) are the same, and that it's impossible to diagnose cause or prognosis sitting in the stand or on the couch?

Yeah, it depends on how many dislocations the shoulder has had. Kennelly's shoulder has probably been dislocating many times, and so his ligaments are loose and not to much more damage occurs. (However every dislocation causes some damage).
It looked like it was a new injury to Sinclair with the obvious discomfort he was in.

Whatever the case, it was a mistake to put Sinclair back on after a dislocation, which is proven because they didnt send him back out after the 2nd.

[Markwebbos]

I imagine also that being a ruckman is about the worst position to play with a shoulder that's liable to dislocate as you keep having to put your arm up to try and tap the ball. I could see him missing the rest of the season getting it right. Didn't Fyfe or someone have an extra bit of bone stuck on to prevent dislocation?

[Markwebbos]

It was only a mistake sending him back out if the second dislocation did further damage. Which is possible but nobody actually knows.

I'm not for a second trying to suggest anyone should refrain from the wild speculation which is the lifeblood of RWO

[Jimitron5000]

One of ex-players, Gerard Bennett had problems with his shoulders dislocating easily. From memory it got to the point where it would dislocate, then be popped back in and away he would go.

[goswannies]

I imagine also that being a ruckman is about the worst position to play with a shoulder that's liable to dislocate as you keep having to put your arm up to try and tap the ball. I could see him missing the rest of the season getting it right. Didn't Fyfe or someone have an extra bit of bone stuck on to prevent dislocation?

Actually you are more likely to sustain an anterior dislocation (the most common) attempting to tackle - as you have the full weight of a player externally rotating your shoulder - or falling onto your arm and rolling.

I’d have thought “bone” would only likely to be “stuck on” if there was a fracture or avulsion or perhaps if there was need of a tenodesis requiring bone grafting. Ralph Dawg could likely shed light on that

[goswannies]

One of ex-players, Gerard Bennett had problems with his shoulders dislocating easily. From memory it got to the point where it would dislocate, then be popped back in and away he would go.

Therein lies the problem. It’s not just the dislocation at the time. Each dislocation and subsequent dislocation further weakens the joint capsule, predisposing the shoulder to easier risk of subsequent dislocation. There will also be increased risk of labral damage (giving pain, catching and less stability), damage to the chondral cartilage of the humeral head or glenoid (predisposing the shoulder to osteoarthritis later in life), tears to tendons (particularly the rotator cuff) because of gross instability and movement, and potential neural and vascular compromise.

Ralph Dawg rightly points out that elite athletes will have different objectives to the general population. It’s a matter of risk vs reward and and player’s preferences & priorities. Medicos are very aware of this.

[KTigers]

After his shoulder went out the second time, I was kind of hoping Sinkers would go all Mel Gibson in one of those
"Lethal Weapon" movies and slam his shoulder into one of goal posts (or Dane Rampe, whichever was nearest) and put it
back in.

[goswannies]

Yeah, it depends on how many dislocations the shoulder has had. Kennelly's shoulder has probably been dislocating many times, and so his ligaments are loose and not to much more damage occurs. (However every dislocation causes some damage).

Tadhg actually had arthroscopic shoulder stabilisation surgery in 2008

[Ralph Dawg]

Actually you are more likely to sustain an anterior dislocation (the most common) attempting to tackle - as you have the full weight of a player externally rotating your shoulder - or falling onto your arm and rolling.

I’d have thought “bone” would only likely to be “stuck on” if there was a fracture or avulsion or perhaps if there was need of a tenodesis requiring bone grafting. Ralph Dawg could likely shed light on that

As far as I know, you're correct. The injuries that we deal with either straight repairs that are sutured or the insertion of anchors into the humerus to which you can then attach tendon to. These procedures are done either arthroscopically or open. Let's hope Cal doesn't need any of this because if he does, could be out for a while.........