Return to contact criteria and assessment methods following traumatic anterior glenohumeral joint dislocations in rugby union players: a Delphi consensus study.

Abstract

Traumatic anterior glenohumeral joint dislocations are associated with prolonged time loss and high rates of reinjury in rugby. This is particularly common during contact events. There is a lack of clear guidance to facilitate return to contact decisions following these injuries in rugby. The aim of the study was to identify and reach consensus (≥70% agreement) regarding return to contact criteria and assessment methods following traumatic anterior glenohumeral joint dislocations in rugby union players. A three-round Delphi consensus study was conducted. Thirty-three health and sport practitioners participated in Round 1. Round 2 and 3 were completed by 28 and 26 practitioners respectively. Thirty criteria reached consensus for inclusion. These criteria included time frames, subjective ratings (including pain, apprehension, and player readiness) and clinical criteria (including clinical stability). Functional criteria such as range of motion, muscle function and proprioception of the glenohumeral joint, and fitness were also recommended for inclusion. In addition, assessment of rugby specific skills were recommended. Modalities reaching consensus to evaluate subjective criteria such as pain included Visual Analogue Scale ratings, specific questions, and palpation. The anterior apprehension and relocation test was recommended for clinical stability, whereas observation of functional movements was recommended to evaluate shoulder function. A comprehensive range of clinical, functional, subjective, and sport specific criteria and assessment methods should be considered alongside time frames to guide return to contact decisions following traumatic anterior glenohumeral joint dislocations in rugby union players.