If the shoulder is obviously dislocated the player is removed and is managed by the medical practitioner on the side of the field or referred to a hospital for reduction of the dislocation.
Deformity over the AC joint
pain can be the determining factor. Should the player be able to continue he may do so without any serious effects. On the other hand, should his pain be of such a nature that he is not able to play competently, he will be removed. Trying to play on does not have any serious deleterious effect though, but the pain and associated loss of function may limit his/her rugby playing performance from a team perspective.
Deeper injuries of the rotator cuff and labrum
These may not be visible from the surface and a simple test would be to ask the player to lift his arm. If he can do this comfortably, there is no immediate indication to remove him off the field and he could be allowed to play if pain allows him to. If, however, he is unable to elevate the arm he should be removed from the field.
If severe pain and deformity is evident over the collar bone this may be a fracture and he should be removed for further medical attention.
Brachial plexus injuries
This is referred to as a “burner” or “stinger”. The neck and the shoulder are often forced away from each other during a fall – this results in a stretch of the nerves of the brachial plexus with immediate burning pain and inability to move the arm. Often this settles quite quickly, usually in a few minutes and the player can continue to play. Where pain and weakness persist as a result of this stretch the player should be removed from the field. The diagnosis is usually obvious.
Often the player points to a painful lump at the medial (inner) side of the collar bone at the upper part of the chest (sterno-clavicular joint). If pain is not severe the player often continues and it is noteworthy that many players only present with these injuries after the game. It is common for these joints sprains to be painful and rugby players find it difficult to continue playing the contact situations ie tackling and often remove themselves from the field or indicate that they are unable to continue playing. Some of these SC joint injuries may be more serious (the medical staff should check that the joint is not posteriorly dislocated – if they are posteriorly dislocated and impinging on the vital structures) and in general it is advised that the player with these injuries be removed for medical assessment- mostly to exclude the posterior dislocations.
Biceps tendon injury/rupture
Although further damage with continued play is unlikely to cause more damage, the pain following the injury will usually be too intense to allow continuation.
Pec major rupture
Pec major rupture often goes unnoticed as the pain may be brief when the tendon tears off its insertion. The player could continue as there is not an immediate indication for removal off the field, however the loss of arm function due to weakness impairs
further rugby playing ability and the player usually indicates that they are unable to continue but soon after the match he should be referred for an assessment.