Cooper and that scapula fracture
That fractured scapula!
The scapula is the shoulder blade, it is a triangular shaped bone located in the upper back that is protected by a complex system of muscles. The scapula provides the primary connection between the chest and the arm. Research indicates scapula fractures make up less that 1% of all broken bones. These fractures usually occur during high energy, trauma injuries. Therefore significant force is needed for a fracture to occur as the scapula is protected by the chest and shoulder muscles.
In Cooper’s case the likely mechanism of injury was during contact against Souths the week before. Fuelled by adrenaline the Roosters half managed to get back to his feet and play one of the most incredible roles to deliver the Roosters a grand final victory. Here’s some background to the injury, please keep in mind I’m not privy to fine details and am addressing this in very general terms.
Symptoms
- Extreme pain when you move the arm – This is why Cooper had his arm limp by his side most of the game and why all photos in the media during the grand final lead up had him with his arm by his side.
- Pain localised to the upper back, across the shoulder blade and/or at the top of the shoulder aggravated during deep breathes as chest wall movement may cause the fractured scapula to move. Thus for Cooper not only was impact painful but spare a thought for him playing 77minutes in the game’s most elite environment.
- Swelling at the back of the shoulder
- A grinding sensation during shoulder movement
- Inability to lift the affected arm and the desire to hold both the arm and the shoulder immobile.
Additional injuries
Shoulder expert Greiwe, RM. 2015, estimated that 80-95% of people with scapula fractures have additional injuries such as:
- Rib fractures
- Collapsed lung
- Bruised lung
- Injury to the brachial plexus
- Clavicle fracture
- Head or spine injury
The Roosters medical team would have thoroughly assessed Cooper’s condition and his decision to play would not have been taken lightly.
Treatment
Non surgical – Usually the arm is placed in a sling while the fracture heals, during which time a physiotherapist will prescribe rehab exercises. This process usually takes 6months to a year.
Surgery – This isn’t my specialty, but in a recent discussion with a shoulder specialist he advised that some scapular fractures need surgery;
- Fractures of the glenoid surface, when the bone has been displaced
- Fractures of the neck of the scapula
- Fractures of the acromion process
During the operation, bone fragments are positioned in normal alignment and then held together by plates and screws. Following surgery, a period of immobilisation will commence and then rehab. This process can also take up to a year.
My take
As we know Cooper only had a week to get ‘fit’. Personally, I can’t explain how he did it.
This is one of those cases when the only explanation is mental toughness, mind over matter. From a medical point of view even with the best care and pain relief, it was incredible to watch how he was able to run, let alone tackle 100kg+ forwards running at full pace.
Despite pain relief it is still about the players ability to handle the pain of the injury. It’s going to hurt, there is no way around it. The best way I can explain Coopers 77minutes is ‘fight or flight’, and the endorphins that help us achieve tremendous things in pain.
Part of what makes an elite athlete an elite athlete is their ability to play through pain.
While many medical officers and health professionals won’t agree with Coopers decision to play, one thing must be considered – after countless hours of training and practice, no matter how big or small an injury, this won’t stop a player such as Cooper who has made hurdling obstacles a routine.
Andrew Ilieff is a physiotherapy based in Double Bay, Sydney. Andrew successfully treats sports injuries suffered during all sports such as rugby league, rugby, football, cricket, tennis and many more.
