Gendre Patrick, Boileau Pascal
Polyclinique Saint Jean, Cagnes-sur-Mer, France.
Institut de Chirurgie Réparatrice, Nice, France.
Orthop J Sports Med. 2021 Oct 4;9(10):23259671211043449. doi: 10.1177/23259671211043449. eCollection 2021 Oct.
Weightbearing and traction-suspension movements with the upper limbs put considerable demands upon the shoulder region of high-level gymnasts. The diagnosis of instability in these gymnasts may be difficult because voluntary inferior shoulder subluxation is part of their training and is needed to perform some acrobatic figures.
To (1) assess the epidemiology of shoulder lesions requiring surgery, (2) describe the types of injuries and assess which maneuvers and equipment put the gymnast most at risk, and (3) present a pathoanatomic classification of the injured shoulder in high-level male gymnasts.
Case series; Level of evidence, 4.
Over a 20-year period (1994-2014), 26 high-level male gymnasts (30 shoulders; mean age, 22 years; range, 16-33 years) were referred to our surgical center for shoulder pain or instability. Four gymnasts underwent surgery on both shoulders. All shoulders were evaluated clinically, radiologically, and arthroscopically. An independent observer evaluated the circumstances in which these lesions occurred, including the apparatus used and the maneuvers performed.
The mean duration of symptoms before surgery was 8 months (range, 6-24 months). Eighteen injured shoulders (60%) had chronic overuse injuries. In 27 shoulders (90%), the mechanism of injury was traction of the arm in forced flexion-rotation while using suspension equipment with locked hands on the bars or the rings. In the remaining 3 shoulders, the traumatic position was one of an isometric muscle contraction against gravity, sustained while performing strength-and-hold positions on the rings. Based on the main presenting symptoms (pain and/or instability) and main anatomic lesions found during arthroscopy, the injured gymnasts' shoulders were classified into 2 categories: painful shoulders (n = 13) with no clinical, radiological, or arthroscopic findings of instability (mainly superior cuff and biceps anchor lesions) and unstable shoulders (n = 17) with isolated inferior capsule labral tears or mixed lesions (tendinous and capsulolabral). Some gymnasts with inferior labral tears had no recall of having suffered a dislocation or subluxation.
The majority of injuries requiring surgery in this population occurred during traction in forced flexion-rotation using suspension equipment. Injured shoulders were classified as either painful or unstable shoulders.
高水平体操运动员上肢的负重及牵引悬吊动作对肩部区域提出了相当高的要求。这些体操运动员的肩部不稳定诊断可能较为困难，因为主动的肩关节下脱位是他们训练的一部分，且是完成一些杂技动作所必需的。
（1）评估需要手术治疗的肩部损伤的流行病学情况；（2）描述损伤类型，并评估哪些动作和器械使体操运动员面临的风险最大；（3）提出高水平男性体操运动员受伤肩部的病理解剖分类。
病例系列研究；证据等级，4级。
在20年期间（1994 - 2014年），26名高水平男性体操运动员（30个肩部；平均年龄22岁；范围16 - 33岁）因肩部疼痛或不稳定被转诊至我们的外科中心。4名体操运动员双肩均接受了手术。所有肩部均进行了临床、放射学和关节镜检查。一名独立观察者评估了这些损伤发生的情况，包括使用的器械和进行的动作。
手术前症状的平均持续时间为8个月（范围6 - 24个月）。18个受伤肩部（60%）为慢性过度使用损伤。在27个肩部（90%）中，损伤机制是在使用双手锁定在杠或吊环上的悬吊设备时，手臂在强制屈曲旋转中受到牵引。在其余3个肩部中，受伤姿势是在吊环上进行力量保持姿势时，对抗重力的等长肌肉收缩。根据主要表现症状（疼痛和/或不稳定）以及关节镜检查中发现的主要解剖损伤，将受伤体操运动员的肩部分为两类：疼痛性肩部（n = 13），无临床、放射学或关节镜检查发现的不稳定表现（主要为肩袖上部和肱二头肌附着点损伤）；不稳定肩部（n = 17），有孤立的下关节囊唇撕裂或混合损伤（肌腱和关节囊唇）。一些有下关节唇撕裂的体操运动员回忆不起曾发生过脱位或半脱位。
该人群中大多数需要手术治疗的损伤发生在使用悬吊设备进行强制屈曲旋转牵引期间。受伤肩部分为疼痛性或不稳定肩部。
