All things exercise, injuries, treatment & rehab!
You will have struggled to miss the story about Mo Salah injuring his shoulder during Liverpool's Champions League Final defeat to Real Madrid. With some clamour to ban Sergio Ramos and an Egyptian lawyer threatening him with a €1bn lawsuit it is clear that this story has generated some interest. Egyptian football fans face a worrying wait to see if their star player will be fit for the World Cup in a couple of weeks time.
We have decided to look at the injury in more detail and the possible treatments Salah may receive in order to get him fit as quickly as possible.
What actually happened?
What are the likely injuries?
My initial thoughts were that Salah had either damaged his acromioclavicular joint (ACJ) or fractured his clavicle (collarbone), with the clavicular fracture obviously being an immediate problem, whereas an ACJ injury could have been managed allowing Salah to continue. However, it has been reported that Salah dislocated his shoulder, meaning that his humerus bone was separated from its socket within the scapula (shoulder blade). This is an extermely painful injury (from personal experience!) although I would be inclined to say that he subluxed the shoulder rather than dislocated it. The difference here being that with a subluxation the shoulder is partically dislocated and the humeral head pops back into the socket, whereas a dislocation results in the humerus staying out of the joint in the majority of cases.
Despite the Egyptian FA's assertion that the X-ray showed that Salah simply had a sprain of the shoulder ligaments, this is actually impossible to ascertain from this test. X-rays cannot show ligament damage, they simply show us whether there is any damage to the bone. Therefore it would be more accruate to assume that the X-ray showed no bony damage, which in itself is significant in this case. A bony Bankart lesion involves a fracture of part of the glenoid of the scapular and is relatively common in traumatic shoulder dislocations. An early repair of this type of injury via surgery is important to reduce the likelihood of recurrent issues. This would have been extremely difficult to manage for the World Cup and would likely have forced Salah out.
What is the likely treatment?
Working in rugby we see a significant number of injuries to all three of these structures, with very differing management and long-term prognosis. The initial treatment for each includes placing the arm in a sling to minimise any further damage to the injured tissue and those around it, whilst also trying to help manage the pain the individual is experiencing. We will generally manage minor ACJ injuries (grade 1 and some grade 2) ourselves with therapy, rehabilitation and appropriate taping.
Any more significant ACJ injuries (some grade 2 & grade 3), clavicular fractures and shoulder dislocations will be referred to specific shoulder specialists for further investigation and surgical management. There is strong evidence that surgery to help stabilise the shoulder joint following first time disclocation is key in reducing the likelihood of recurrent dislocations. This is now a common first line treatment in most athletes and involves around a 12 week period of rehabilitation prior to returning to full activity.
What are the implications for his club?
Not only did Liverpool lose their star player in the biggest game of the season, it is likely they will lose him for an early portion of next season too. With the 25th of June being the earliest date Egypt will finish their World Cup campaign, the earliest Salah should return is mid-September, therefore meaning he may miss the first month of the new season. Theo Walcott's rehabilitation from a similar injury lasted four months in total and he still felt the psychological effects many months later.
It will be interesting to see how this story develops and the long-term impact of the injury on Salah's career.