Anderson Matthew J J, Confino Jamie E, Mack Christina D, Herzog Mackenzie M, Levine William N
Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA.
IQVIA, Durham, North Carolina, USA.
Orthop J Sports Med. 2023 Oct 11;11(10):23259671231198025. doi: 10.1177/23259671231198025. eCollection 2023 Oct.
Shoulder instability encompasses a spectrum of glenohumeral pathology ranging from subluxation to dislocation. While dislocation frequently leads to removal from play, athletes are often able to play through subluxation. Previous research on glenohumeral instability among athletes has largely focused on missed-time injuries, which has likely disproportionately excluded subluxation injuries and underestimated the overall incidence of shoulder instability.
To describe the epidemiology of shoulder instability injuries resulting in no missed time beyond the date of injury (non-missed time injuries) among athletes in the National Football League (NFL).
Descriptive epidemiology study.
The NFL's electronic medical record was retrospectively reviewed to identify non-missed time shoulder instability injuries during the 2015 through 2019 seasons. For each injury, player age, player position, shoulder laterality, instability type, instability direction, injury timing, injury setting, and injury mechanism were recorded. For injuries that occurred during games, incidence rates were calculated based on time during the season as well as player position. The influence of player position on instability direction was also investigated.
Of the 546 shoulder instability injuries documented during the study period, 162 were non-missed time injuries. The majority of non-missed time injuries were subluxations (97.4%), occurred during games (70.7%), and resulted from a contact mechanism (91.2%). The overall incidence rate of game-related instability was 1.6 injuries per 100,000 player-plays and was highest during the postseason (3.5 per 100,000 player-plays). The greatest proportion of non-missed time injuries occurred in defensive secondary players (28.4%) and offensive linemen (19.8%), while kickers/punters and defensive secondary players had the highest game incidence rates (5.5 and 2.1 per 100,000 player-plays, respectively). In terms of direction, 54.3% of instability events were posterior, 31.9% anterior, 8.5% multidirectional, and 5.3% inferior. Instability events were most often anterior among linebackers and wide receivers (50% and 100%, respectively), while posterior instability was most common in defensive linemen (66.7%), defensive secondary players (58.6%), quarterbacks (100.0%), running backs (55.6%), and tight ends (75.0%).
The majority of non-missed time shoulder instability injuries (97.4%) were subluxations, which were likely excluded from or underreported in previous shoulder instability studies due to the inherent difficulty of detecting and diagnosing shoulder subluxation.
肩关节不稳定涵盖了一系列从半脱位到脱位的盂肱关节病变。虽然脱位常常导致运动员无法继续比赛，但运动员往往能够带着半脱位继续比赛。以往关于运动员盂肱关节不稳定的研究主要集中在导致缺赛的损伤，这可能不成比例地排除了半脱位损伤，并低估了肩关节不稳定的总体发生率。
描述美国国家橄榄球联盟（NFL）运动员中伤后无缺赛情况（非缺赛损伤）的肩关节不稳定损伤的流行病学特征。
描述性流行病学研究。
对NFL的电子病历进行回顾性分析，以确定2015年至2019赛季期间非缺赛的肩关节不稳定损伤。对于每例损伤，记录运动员年龄、运动员位置、患侧肩部、不稳定类型、不稳定方向、损伤时间、损伤场景和损伤机制。对于比赛期间发生的损伤，根据赛季中的时间以及运动员位置计算发病率。还研究了运动员位置对不稳定方向的影响。
在研究期间记录的546例肩关节不稳定损伤中，162例为非缺赛损伤。大多数非缺赛损伤为半脱位（97.4%），发生在比赛期间（70.7%），且由接触机制导致（91.2%）。与比赛相关的不稳定的总体发病率为每100,000运动员参赛次数中有1.6例损伤，在季后赛期间最高（每100,000运动员参赛次数中有3.5例）。非缺赛损伤比例最高的是防守二线队员（28.4%）和进攻线卫（19.8%），而踢球手/弃踢手和防守二线队员的比赛发病率最高（分别为每100,000运动员参赛次数中有5.5例和2.1例）。在不稳定方向方面，54.3%的不稳定事件为后向，31.9%为前向，8.5%为多方向，5.3%为下向。不稳定事件在前卫和外接手中最常见的是前向（分别为50%和100%），而后向不稳定在防守线卫（66.7%）、防守二线队员（58.6%）、四分卫（100.0%）、跑卫（55.6%）和近端锋（75.0%）中最常见。
大多数非缺赛的肩关节不稳定损伤（97.4%）为半脱位，由于检测和诊断肩关节半脱位存在固有困难，这些损伤可能在以往的肩关节不稳定研究中被排除或报告不足。
