Shoulder instability in children 18 years and under
Studies examining recurrent shoulder instability following a first-time anterior shoulder dislocation do not differentiate between children and adults. The aim of this systematic review was to identify risk factors associated with recurrent shoulder instability following first-time traumatic anterior shoulder dislocation in children aged 18 years and under. A recurrent shoulder instability event was defined as either a subluxation or dislocation.
The mechanisms of injury for first-time traumatic anterior shoulder dislocation are often divided into two groups: sporting and non-sporting related. Children experiencing injury during sporting activity were 2.85 times more likely to experience recurrence, compared to non-sporting activity.
Children aged 14–18 years are 24.14 times more likely to experience recurrent instability compared with those aged 13 years and under.
Male children were 3.44 times more likely to experience recurrent instability compared to female children.
61.1% of participants with an open proximal humeral physis at the time of the initial dislocation had a recurrent episode of shoulder instability compared with 94.1% of participants with a radiographically confirmed closed proximal humeral physis.
83.3% of participants whose initial dislocation was on their dominant shoulder experienced recurrent instability, compared with 50% on their non-dominant side.
There is an indication people aged under 18 years with Hill-Sachs lesions were 17.18 times more likely to experience recurrent instability.
There is a controversy concerning Bankart lesions and risk of recurrent instability in children.
Eight common risk factors for recurrent shoulder instability following a first-time traumatic anterior shoulder dislocation in children 18 years old or younger were identified. These included: age, sex, mechanism of initial injury, state of physis closure, shoulder dominance and side of the affected shoulder, Hill-Sachs lesion and Bankart lesion.
> From: Olds et al., Br J Sports Med (2016) (Epub ahead of print). All rights reserved to BMJ Publishing Group Ltd. Click here for the Pubmed summary.