man holding shoulder indicating an injury

Steven Corbett – Management and Treatment of Shoulder Injuries in Sport – Injury Rehab Network

The October Injury Rehab Network with BASRaT featured a presentation from Mr Steven Corbett, Consultant Orthopaedic Shoulder Surgeon, Fortius Clinic. The online event took place on the evening of Monday 13th October with 385 sports rehabilitation practitioners in attendance.

Steve shared insights into the management and treatment of shoulder injuries in sport. The recording is available to watch here.

Mr Steven Corbett, Consultant Orthopaedic Shoulder Surgeon, Fortius Clinic

Steve Corbett qualified from St Thomas’ Hospital, London, in 1990. He undertook surgical training in the UK and France, working, among others, with Roger Emery and Laurent Lafosse. In 2000, he was awarded a Doctor of Philosophy (PhD) for his research on fracture healing.

In 2003, he was appointed as Consultant Orthopaedic and Trauma Surgeon at Guy’s and St Thomas’ Hospitals, London, specialising in Upper Limb Surgery. Subsequently, he became one of the founder members of Fortius Clinic, London.

Corbett is a named reviewer for several medical journals and serves as editor and contributor to a number of leading textbooks. His research interests include clavicle fractures, acromioclavicular joint injuries, shoulder dislocation, and rotator cuff tears. He has been a member of the BESS Research Committee and contributed to developing several national guidelines. He has also held various managerial roles across the NHS and private medicine, focusing on clinical governance and quality improvement.

Once a keen sportsman himself, he now enjoys supporting amateur and professional athletes in successfully returning to their chosen activities.

Management and Treatment of Shoulder Injuries in Sport

shoulder injury getting medical physio therapy

Introduction

The presentation began with an overview of bone, joint, and soft tissue injuries.

Bone Injuries

Clavicle Fractures

Corbett outlined the three types of clavicle fracture:

Type 1: Middle third clavicle (80%)
Type 2: Distal end clavicle (15%)
Type 3: Medial third clavicle (5%)

Fractures may be aligned, displaced, angulated, or comminuted. Management varies, and the speaker discussed potential complications related to shortening. Around 80% of patients can be treated with a brace, though 30% report dissatisfaction, 15% experience nonunion, 29% neurological symptoms, and 25% residual pain.

When considering surgery, the consultant highlighted several indications for plating, including:

Completely displaced > 1.5cm shortening
Skin at risk
Open fractures
Neurovascular injury
Floating shoulder
Obvious clinical deformity
Multiple injuries

Patients treated with plates tend to experience faster union, reduced risk of nonunion, and fewer complications. More than 90% of athletes return to sport post-surgery in approximately 3.35 months.

Greater Tuberosity Fracture

Discussion then moved to greater tuberosity fractures, which account for around 2% of proximal humeral fractures. These are often associated with a fall onto the shoulder (sometimes with dislocation) or the elbow (nutcracker effect). Displaced fractures require fixation.

It was noted that some fractures may not be identified on X-ray, leading to confusion, anxiety and unrealistic expectations for recovery. Athletes who have not regained expected mobility or remain in pain 6–8 weeks post-injury should undergo an MRI to confirm the diagnosis. Such injuries are managed as combined bone and soft tissue trauma, with recovery taking up to 5–8 months.

Shoulder Joint Injuries

AC Joint

The surgeon discussed the anatomy of the acromioclavicular (AC) joint and the role of the AC and coracoclavicular (CC) ligaments in shoulder function. AC joint injuries are graded from 1 to 6 (sprain to complete rupture), with grade 3 being the most common.

Injury surveillance in rugby shows that 45% of players have sustained an ACJ injury, with the shoulder accounting for 43% of all injuries and ACJ injuries representing 16%.

Grades 1–2 are managed non-operatively using strapping, a sling, a brace, or a figure-of-eight support to immobilise the joint.

Rehabilitation includes:

Sling for 2 weeks
Movement for 2 weeks
Light strengthening

Full recovery is typically achieved within 8–10 weeks, with 98% of patients recovering fully. If progress is slow, a cortisone injection may be considered.

Operative management for grades 4–5 involves fixation using a combination of pins, plates, screws, or wires. Post-operative recovery includes:

Sling for 3–4 weeks
Mobilisation below shoulder height up to 6 weeks
Gradual return to unrestricted movement and strengthening

The consultant explained that not all grade 3 ACJ injuries are identical and may require differing approaches. Grade 3A injuries have a stable AC joint without overriding the clavicle on cross-body adduction and do not require surgery. Grade 3B injuries, which show overriding of the clavicle, do.

Return to sport:

Grade 1: 2–4 weeks
Grade 2: 4–8 weeks
Grade 3: 6–8 weeks

Referral guidance:

Early:

Grade 3, 4 and 5 – acute
Grade 2/3 – if uncertain

Later:

Grade 1–2 if significant pain at >6 weeks
Grade 1–2 if still pain at >10 weeks

Glenohumeral Joint

The talk then addressed injuries to the glenohumeral joint, often linked to dislocation. These can involve capsulolabral pathology (100%), biceps (35%), and rotator cuff (2%). Bone injuries may affect the humeral head (70%) or glenoid (30%), and chondral injuries occur in about 25%. Redislocation is common, mostly within two years of the initial event.

Non-operative rehabilitation:

Weeks 1–3: Rest and light activity
Weeks 3–6: Strengthening and sport-specific rehab
Weeks 6–12: Gradual return to sport

Surgical aims include reducing redislocation rates, improving confidence, and restoring pre-injury activity levels. The choice of procedure depends on the injury pattern, with operative options including arthroscopic (soft tissue) and open (bone) procedures.

Average return to play:

5.9 months after arthroscopic Bankart
5.1 months after open Latarjet
7 months after arthroscopic Bankart with remplissage

Referral criteria:

Under 30 years old
Recurrent dislocation
Contact sport
Apprehension, instability or loss of confidence
Over 45 years with a suspected cuff tear

SLAP Lesions

Superior Labrum Anterior to Posterior (SLAP) lesions were also reviewed, describing detachment of the labrum from the superior glenoid neck (Snyder et al, 1990).

The long head of the biceps originates from the supraglenoid tubercle and provides dynamic stability to the shoulder. Detachment leads to superior instability. Four types of SLAP tear are recognised, though diagnostic tests are difficult to validate; MRI remains the preferred diagnostic tool.

The surgeon noted that SLAP lesions are relatively rare and often difficult to distinguish, particularly between type 2 and type 4, or from normal anatomy.

Soft Tissue Injuries

a man holding his arm with a red overlay indicating an injury

Long Head of Biceps Rupture

This injury is often associated with rotator cuff pathology or heavy lifting. Repair may be considered in younger athletes. Practitioners are advised to refer early and request urgent imaging.

Patients may experience a 10–25% loss of strength, with 27% reporting biceps cramping. Re-rupture occurs in around 8%.

Triceps Rupture

Both operative and non-operative management approaches were outlined.

Non-operative:

Splint immobilisation with the elbow in 30° flexion for 4 weeks
Suitable for partial tears that can extend against gravity

Operative:

Primary surgical repair using transosseous tunnels or suture anchors
Recommended for acute complete tears or partial tears (>50%) with significant weakness

Post-operative rehabilitation:

0–2 weeks: Sling or brace at around 45° flexion
2–6 weeks: Increase flexion weekly up to 100°
6–12 weeks: Restore full range and begin strengthening
12–20 weeks: Progress to weight training

Pectoralis Major Rupture

Pectoral injuries are typically caused by a fall with the arm abducted. Common mechanisms include skiing, rugby tackles, falls through hatches, or heavy bench pressing. Signs include significant bruising of the chest and upper arm, and an abnormal contour of the pectoral muscles.

Injury profile:

Bone–tendon junction 65%
Muscle–tendon junction 35%
Both sternal and clavicular heads 75%
Single head 25%

Surgical repair is preferable within the first two weeks (easier within the first two months) but may still be performed later. Approximately 97% of individuals return to sport successfully.

Rotator Cuff

The presentation concluded with a focus on rotator cuff function—rotating the humerus relative to the scapula, compressing the humeral head into the glenoid fossa, and maintaining muscular balance. Injuries may be related to tendinitis, impingement, or tears.

Partial cuff tears can result from dislocation (PASTA lesion), repetitive trauma, or degeneration. Around one in four people over 45 show partial tears on imaging, most asymptomatic. About 60–70% do not progress to symptoms.

Non-operative management: Physiotherapy, injection therapy, and shockwave therapy.

Operative options: Arthroscopic debridement, completion and repair (+/- subacromial decompression).

Post-surgical outcomes are highly positive, with 98% satisfaction and significant pain improvement.

Corbett also discussed platelet-rich plasma (PRP) therapy, which shows some functional improvement but remains inconclusive. More research is needed to determine the ideal concentration, injection frequency, and patient selection. In full-thickness tears, PRP may assist healing after surgery, but it is ineffective as a standalone treatment.

Complete tear management:

Non-operative:

Physiotherapy
Injection therapy

Operative:

Arthroscopic repair
Open repair
Mini-open repair
Tendon transfer
Reverse shoulder replacement

Post-surgery satisfaction is around 90%, and the average re-tear rate is 20%, depending on age and tear size.

Further information and follow Mr Steven Corbett

Visit the Fortius Clinic website to find out more about Steven Corbett and his practice.

Q&A

Steve kindly answered questions put forward by practitioners who attended the session. Please see the presentation recording for the insights from Steve to the questions.

Presentation Recording

The recording of Steve’s presentation is available to watch here.

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