The Incidence and Characteristics of Shoulder Instability at the United States Military Academy

Duke University, Durham, North Carolina, United States
The American Journal of Sports Medicine (Impact Factor: 4.36). 08/2007; 35(7):1168-73. DOI: 10.1177/0363546506295179
Source: PubMed


The literature provides little information detailing the incidence of traumatic shoulder instability in young, healthy athletes.
Shoulder instability is common in young athletes.
Descriptive epidemiologic study.
We prospectively captured all traumatic shoulder instability events at the United States Military Academy between September 1, 2004, and May 31, 2005. Throughout this period, all new traumatic shoulder instability events were evaluated with physical examination, plain radiographs, and magnetic resonance imaging. Instability events were classified according to direction, chronicity, and type (subluxation or dislocation). Subject demographics, mechanism of injury, and sport were evaluated.
Among 4141 students, 117 experienced new traumatic shoulder instability events during the study period; 11 experienced multiple events. The mean age of these 117 subjects was 20.0 years; 101 students were men (86.3%), and 16 were women (13.7%). The 1-year incidence proportion was 2.8%. The male incidence proportion was 2.9% and the female incidence proportion was 2.5%. Eighteen events were dislocations (15.4%), and 99 were subluxations (84.6%). Of the 99 subluxations, 45 (45.5%) were primary events, while 54 (54.5%) were recurrent. Of the 18 dislocations, 12 (66.7%) were primary events, while 6 (33.3%) were recurrent. The majority of the 117 events were anterior in nature (80.3%), while 12 (10.3%) were posterior, and 11 (9.4%) were multidirectional. Forty-four percent (43.6%) of the instability events experienced were as a result of contact injuries, while 41.0% were a result of noncontact injuries, including 9 subluxations caused by missed punches during boxing; information was unavailable for the remaining 15%.
Glenohumeral instability is a common injury in this population, with subluxations comprising 85% of instability events.

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    • "A study by Owens and colleagues evaluating shoulder instability at a military academy found that the 1-year incidence of instability was 2.8 % [9]. In this older population of college-aged students, they found a slightly higher proportion of anterior dislocation (80 %) and a lower proportion of posterior instability (10 %), compared to 67 and 20 %, respectively, found in our study. "
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    ABSTRACT: Purpose With increased sports participation and medical community awareness, there appears to be an increase in pediatric musculoskeletal injuries. Our purpose was to identify the intra-articular injury pattern seen within the pediatric shoulder. Methods A retrospective review was performed at two tertiary-care children’s hospitals between 2008 and 2011 on all patients who underwent magnetic resonance imaging (MRI) and subsequent shoulder arthroscopy. Exclusion criteria included: girls >14 years old and boys >16 years old. Demographics, MRI and arthroscopic findings were recorded. Labral pathology was grouped: Zone I (Bankart lesions, 3–6 o’clock for right shoulder), Zone II (posterior labral lesions, 6–11 o’clock), Zone III (SLAP lesions, 11–1 o’clock), and Zone IV (anatomic variants, 1–3 o’clock). Results One hundred and fifteen children met criteria, mean age 14.4 years (range 8–16). There were 24 girls and 91 boys, with 70 right shoulders. Of 108 children, labral pathology involved: 72 Zone I (16 isolated anterior), 56 Zone II (15 isolated posterior), 38 Zone III (four isolated superior), and three had an isolated Buford complex. Seventy had more than one labral zone injured, and 31 (30 %) had more than two zones injured. Non-labral pathology included partial rotator cuff tears and humeral avulsions of the glenohumeral ligament. Conclusion With 94 % of intra-articular pathology being labral tears, the distribution of proportion in children differs from adults; moreover, 23 % involved only the posterior or posterosuperior labrum. Treating surgeons should be prepared to find anterior tears extending beyond the zone of a classic Bankart lesion and an association with C rotator cuff tears.
    Full-text · Article · Jun 2014
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    • "Shoulder instability is a common problem, with an overall incidence of acute glenohumeral dislocation in the general population reported from 11 to 56 per 100 000 person-years in different countries (Liavaag et al., 2011). The peak incidence occurs during the third decade of life, with a male dominance (Zacchilli & Owens, 2010) and anterior instability as the predominant direction (Owens et al., 2007). Young age predicts a high risk of recurrence and 67% of the patients below 35 years of age develop chronic instability, with new dislocations within 5 years of the primary dislocation (Robinson, 2006). "
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    ABSTRACT: To achieve pain control after arthroscopic shoulder surgery, nonsteroidal anti-inflammatory drugs (NSAIDs) are a complement to other analgesics. However, experimental studies have raised concerns that these drugs may have a detrimental effect on soft tissue-to-bone healing and, thus, have a negative effect on the outcome. We wanted to investigate if there are any differences in the clinical outcome after the arthroscopic Bankart procedure for patients who received NSAIDs prescription compared with those who did not. 477 patients with a primary arthroscopic Bankart procedure were identified in the Norwegian shoulder instability register and included in the study. 32.5% received prescription of NSAIDs post-operatively. 370 (78%) of the patients answered a follow-up questionnaire containing the Western Ontario Shoulder Instability index (WOSI). Mean follow-up was 21 months. WOSI at follow-up were 75% in the NSAID group and 74% in the control group. 12% of the patients in the NSAID group and 14% in the control group reported recurrence of instability. The reoperation rate was 5% in both groups. There were no statistically significant differences between the groups. Prescription of short-term post-operative NSAID treatment in the post-operative period did not influence on the functional outcome after arthroscopic Bankart procedures.
    Full-text · Article · May 2014 · Scandinavian Journal of Medicine and Science in Sports

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