Background Shoulder injuries are common in Australian Rules football and often lead to considerable time out due to injury. There are no published studies regarding the mechanisms of shoulder injury in Australian Rules football which may influence medical management and rehabilitation.

Objective To identify from video analysis mechanisms of shoulder injury in Australian Rules football (ARF) and compare those to mechanisms sustained in other codes of football.

Design Retrospective, video analysis, two independent assessors.

Setting Elite Australian Rules football league.

Participants 26 elite males, age 18–28 years.

Assessment of Risk Factors Medical staff confirmed all injuries which was defined as an injury causing a player to miss a match. Digital footage of 26 shoulder injuries was obtained from the 2015 playing season.

Main Outcome Measurements Mechanism of shoulder injury, history of previous shoulder injury, time of injury, use of taping during the game and if the player required surgery. This data was then compared to previously published video analysis studies on rugby shoulder injuries.

Results Three common mechanisms of shoulder injury exist in ARF; 1) tackling, with forced hyperextension of the players arm, 2) direct impact with the ground or another player 3) overhead marking where the arm is in some degree of abduction & external rotation. The final mechanism differs to rugby where a try scorer, forced hyper-flexion mechanism is more common to the code. Almost half of the players injured in the 2015 season required surgery and a quarter had a history of previous shoulder pathology. A high number of injured players were taped at the time of the incident. There was no significant association between injury incidence and game quarter.

Conclusions Systematic video analysis of shoulder injuries can provide a greater understanding of the likely pathology sustained from each mechanism and then may aid the development of injury prevention methods. Crossover exists between football codes with common mechanisms found however elite ARF has a unique mechanism to the code.