Adolescent contact athlete 2018
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Traumatic shoulder instability is common in adolescent contact athletes. The document summarizes epidemiological data showing that shoulder instability accounts for around 10-20% of cases in those under age 20. Rugby is the most common cause of instability injuries in adolescents, accounting for around 85% of cases in some studies. Recurrence rates after surgery are high, especially in those under age 16 who have a 2.5 times higher risk of recurrence compared to those 16-18 years old. Surgical treatment can successfully treat instability in adolescents, but outcomes may be improved by considering physeal injuries in younger teens and the potential role of bone block procedures like Latarjet.
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Adolescent contact athlete 2018
- 1. Traumatic Shoulder Instability in Adolescent Contact Athletes Lennard Funk
- 2. Adolescent • “The period of physical and psychological development from the onset of puberty to complete growth and maturity.” • Ages 12 - 18 years (physeal closure) • = Young Adult
- 3. Development • Glenoid concavity formed by 10yrs age • Glenoid has two ossification centres: • Upper 2/3 • from coracoid base • closes by 16-18 years age • Lower 1/3 • closes by 25 years age
- 4. Epidemiology • Rowe’s study(1956) of 500 instability cases: • 19.8% < 20yrs age • Torrance & Funk et. al. (2018) of 873 cases: • 10% < 18yrs age
- 5. Causes • Lawton et al. JBJS 2002 • 107 shoulders; < 17yrs
- 6. 85%- rugby 8% - Football 2& - canoeists 1% - American Football 1% - Cricket 1% - BMX 2% - Martial Arts 1% - Horse Rider Causes • Funk et al. 2012 • 158 surgically treated • mean age 16.8yrs Rug by 85% Football 8% Canoeing 2% Martial Arts 2% Cricket 1% BMX 1% American FBall 1%
- 7. Recurrences • Sports injury = 82% • Non-Sports = 50% • Deitch et al.; AJSM, 2003
- 11. Lesions 47% 17 ALPSA 22% 20%4% 5% 3% Funk et al. 2012 143 Scopes
- 12. Stanmore Classification • Based on MOI & Lesions Less Muscle Patterning Less Trauma Polar Type III Muscle Patterning Non-Structural Polar Type I Traumatic Structural Polar Type II Atraumatic Structural
- 13. No True Lesions (Type II) • Posterior = 13 (45%) • Anterior only = 3 (10%) • Combined = 13 (45%) • Funk et al. 2012 • 158 surgically treated • mean age 16.8yrs
- 14. Gender • Polar Type 1 = 7% Female (9/129) • Polar Type II = 45% Female (13/29) • Funk et al. 2012 • 158 surgically treated • mean age 16.8yrs
- 15. Surger y • 143 - Arthroscopic Stabilisations • 15 - Latarjet Procedures • Funk et al. 2012 • 158 surgically treated • mean age 16.8yrs
- 16. Outcome s• 90% = “better” or “much better” • 57% returned to sport at the same/higher level • 80% stopped sport for unrelated reasons: • Leaving school • Change sport • Focus on academics • Nixon & Funk et al.; JPOB, 2014
- 17. Outcome s • 31% recurrence within 5 years • All Contact Sports Injuries • 18% revision surgery • 35% Arthoscopic • 65% Latarjet • Nixon & Funk et al.; JPOB, 2014
- 18. Outcomes • Rate of recurrence under 16 = 68% • Rate of recurrence over 16 = 27% • Relative risk 2.5x if under 16 compared to 16-18 years (p=0.0002) Torrance, Walton, Monga, Watts Funk; AJSM, 2018
- 19. Outcomes Torrance, Walton, Monga, Watts Funk; AJSM, 2018
- 20. Summary • Traumatic Instability in the adolescent contact athlete: • Larger, Faster, Stronger - Diff. Rates • Higher rates of recurrence • Under 16 • Physeal injury? • ? Latarjet
Notas do Editor
- Background: Recurrent instability is the most common complication after traumatic anterior shoulder dislocation in young patients. Hypothesis: The rate of recurrent instability in a homogeneous population of adolescents after initial traumatic anterior shoulder dislocation is significant and is associated with a guarded prognosis for full recovery. Study Design: Retrospective cohort study. Methods: We identified 32 patients 11 to 18 years of age treated at our institution for a radiographically documented traumatic anterior shoulder dislocation; we performed a functional outcome assessment on 30 patients with use of two standard scoring systems. Results: Overall, instability recurred in 24 of 32 patients, with 23 experiencing at least one recurrent dislocation. Persistent instability led 16 of 32 to undergo a shoulder stabilization procedure. There were no significant differences in the functional outcome of patients who had undergone surgical stabilization and those who were treated nonoperatively. Conclusions: The recurrence rate of shoulder instability was 75%. Outcome scores were similar for patients treated with a surgical procedure and those treated nonoperatively. Clinical Significance: Treatment efforts must be aimed at optimizing shoulder strength and stability. Prognosis for full recovery remains guarded. Available outcome instruments may not discriminate well between patients who do and do not choose surgery.
- Summary: There is no one large study on pediatric shoulder instability. The purposes of this study were to characterize patients with shoulder subluxation or dislocation, the treat- ments provided, outcomes, and the predictors of good out- comes. Seventy shoulders in 66 patients were retrospectively reviewed, all with follow-up >2 years. The authors defined characteristics, treatment, outcomes, and associations between patient and treatment variables and outcome measures. Insta- bility was associated with boys, adolescents, and trauma. Forty- two shoulders received physical therapy, and 28 required surgery. At follow-up, 54 of 70 described their shoulders as “better” or “much better,” and 90% were performing at the same or higher levels of sports and work. Surgically treated patients were less likely to have recurrent instability or to report limitations. The current study is a large study of pediatric shoulder instability. Surgery improved stability, but overall, stability improved over time, with few patients having limita- tions at moderate- to long-term follow-up.
- The average height of a back in 2014 is four inches taller than a back in 1974. In terms of weight, the modern day player is 14kg heavier than an All Black babe in 1974, which is a massive jump in size.
- This pattern is also shown at the annual Craven Week schools tournament, where the average mass of the players has increased by almost 10 kg (6.6%) since 1968.