Do Dang-Huy, Arvesen John E, McGinley James J, Robinson Amareesa K, Lovrich Eliza E, Ellis Henry B, Wilson Philip L
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Scottish Rite for Children Orthopedic and Sports Medicine Center, Frisco, Texas, USA.
Am J Sports Med. 2025 Jun 23;53(9):3635465251346901. doi: 10.1177/03635465251346901.
Identifying and understanding socioeconomic disparities among adolescents with traumatic shoulder instability can help to optimize care for patients by improving differences in the disease burden, disease severity, and awareness of resource limitations. Current studies evaluating disparities among patients with shoulder instability are limited to the adult population or surgical patients.
To evaluate how educational, health/environmental, and social/economic disparities influence the timing of shoulder instability treatment and shoulder instability severity among adolescents.
Cohort study; Level of evidence, 3.
A retrospective review of patients aged 10 to 19 years diagnosed with shoulder instability from January 2022 to April 2024 at a single institution was conducted. The Child Opportunity Index (COI) was used to evaluate inequalities in educational, health/environmental, and social/economic opportunities. Disease severity was determined using magnetic resonance imaging (MRI), including glenoid bone loss, Hill-Sachs interval size, distance to dislocation, and presence of an off-track lesion. Continuous variables were analyzed with the Mann-Whitney test or the Spearman correlation coefficient, while categorical variables were analyzed using the chi-square test. Significance was set at < .05.
There were 181 patients who met the inclusion criteria. Patients with a lower overall COI had a longer time from injury to initial presentation ( = -0.15; = .048), injury to orthopaedic evaluation ( = -0.17; = .027), and injury to MRI ( = -0.16; = .033) but not from injury to surgery. A history of recurrent dislocations was associated with a lower overall COI (B = -3.27; = .041), lower educational COI (B = -3.01; = .009), and lower social/economic COI (B = -3.65; = .049). Patients with a distance to dislocation <10 mm were associated with a lower overall COI (B = -7.59; = .003), lower educational COI (B = -8.38; = .045), lower health/environmental COI (B = -7.88; = .006), and lower social/economic COI (B = -8.22; = .001).
Children living in neighborhoods with fewer educational and social/economic opportunities were associated with longer times from injury to orthopaedic evaluation and from injury to MRI for shoulder instability and were at a higher risk for recurrent shoulder dislocations.
识别并理解创伤性肩关节不稳定青少年中的社会经济差异，有助于通过改善疾病负担、疾病严重程度及资源限制意识方面的差异，优化患者护理。目前评估肩关节不稳定患者差异的研究仅限于成年人群或手术患者。
评估教育、健康/环境及社会/经济差异如何影响青少年肩关节不稳定治疗时机及肩关节不稳定严重程度。
队列研究；证据等级为3级。
对2022年1月至2024年4月在单一机构诊断为肩关节不稳定的10至19岁患者进行回顾性研究。儿童机会指数（COI）用于评估教育、健康/环境及社会/经济机会方面的不平等。使用磁共振成像（MRI）确定疾病严重程度，包括肩胛盂骨质流失、希尔-萨克斯间隙大小、脱位距离及脱轨病变的存在情况。连续变量采用曼-惠特尼检验或斯皮尔曼相关系数进行分析，分类变量采用卡方检验进行分析。显著性设定为P < 0.05。
有181例患者符合纳入标准。总体COI较低的患者从受伤到首次就诊的时间较长（r = -0.15；P = 0.048），从受伤到骨科评估的时间较长（r = -0.17；P = 0.027），从受伤到MRI检查的时间较长（r = -0.16；P = 0.033），但从受伤到手术的时间无差异。复发性脱位病史与总体COI较低（B = -3.27；P = 0.041）、教育COI较低（B = -3.01；P = 0.009）及社会/经济COI较低（B = -3.65；P = 0.049）相关。脱位距离<10 mm的患者与总体COI较低（B = -7.59；P = 0.003）、教育COI较低（B = -8.38；P = 0.045）、健康/环境COI较低（B = -7.88；P = 0.006）及社会/经济COI较低（B = -8.22；P = 0.001）相关。
生活在教育和社会/经济机会较少社区的儿童，肩关节不稳定从受伤到骨科评估及从受伤到MRI检查的时间较长，复发性肩关节脱位风险较高。
