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Current Reviews in Musculoskeletal Medicine

Erschienen in:

05.12.2022 | Gender and Racial Disparities (S Edwards, Section Editor)

Sports-Related Shoulder Injuries Among Female Athletes

verfasst von: Casey L. Wright, Jhillika Patel, Carolyn M. Hettrich

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 6/2022

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Abstract

Purpose of Review

The objectives of this review are to explore the recent literature evaluating sports-related shoulder injuries among female athletes.

Recent Findings

Recent literature has highlighted sex-related differences in injury trends and patterns among athletes. Increased participation of women in both recreational and professional sports has resulted in increased exposure to injury. While men experience greater rates of shoulder injury overall, women tend to experience more overuse-related injuries. Evidence also suggests women are more susceptible to shoulder laxity and rotator cuff tears. In comparison to their male counterparts, women note poorer function, increased pain, and decreased activity level following shoulder injuries. Women may also be more likely to experience worse outcomes following surgical intervention. Sex-related differences in injury patterns and outcomes results from a combination of molecular and environmental influences, including hormone pathways, shoulder morphology, and differing rates of participation in, and athletic regulations among, certain sports.

Summary

Sex-related differences occur in how athletes sustain, experience, and recover from sports-related injuries. A comprehensive understanding of sex-related injuries enhances clinical decision making, treatment, and recovery. Further research is needed to clarify sex as an independent variable when evaluating sports-related shoulder injuries.

Wizemann TM, Pardue ML. Institute of Medicine (US) Committee on understanding the biology of sex and gender. Exploring the biological contributions to human health: does sex matter? Washington (DC): National Academies Press (US); 2001; pp. 173–184. https://doi.org/10.17226/10028

Hettrich CM, Hammoud S, LaMont LE, Arendt EA, Hannafin JA. Sex-specific analysis of data in high-impact orthopaedic journals: how are we doing? Clin Orthop Relat Res. 2015;473:3700–4. https://doi.org/10.1007/s11999-015-4457-9.CrossRef

3.••

Gianakos AL, George N, Pinninti A, Kwan S, LaPorte D, Mulcahey MK. Sex- and gender-specific analysis in orthopaedic studies. Clin Orthop Relat Res. 2020;478(7):1482–8. https://doi.org/10.1097/CORR.0000000000001172. (Explores current landscape of orthopaedic publications evaluating sex-related differences and highlights need for further research to include sex as an independent variable.).CrossRef

Kaipel M, Reichetseder J, Schuetzenberger S, Hertz H, Majewski M. Sex-related outcome differences after arthroscopic shoulder stabilization. Orthopedics. 2010;33(3). https://doi.org/10.3928/01477447-20100129-18.

Largacha M, Parsons IM IV, Campbell B, Titelman RM, Smith KL, Matsen F. Deficits in shoulder function and general health associated with sixteen common shoulder diagnoses: a study of 2674 patients. J Shoulder Elb Surg. 2006;15(1):30–9. https://doi.org/10.1016/j.jse.2005.04.006.CrossRef

Owens BD, Agel J, Mountcastle SB, Cameron KL, Nelson BJ. Incidence of glenohumeral instability in collegiate athletics. Am J Sports Med. 2009;37:1750–4. https://doi.org/10.1177/0363546509334591.CrossRef

Morrissey PJ, Maier SP, Zhou JJ, Sedaghatpour D, Shah NV, Torre BB, et al. Epidemiology and trends of adult ice hockey injuries presenting to United States emergency departments: a ten-year analysis from 2007–2016. J Orthop. 2020;22:231–6. https://doi.org/10.1016/j.jor.2020.04.015.CrossRef

Irick E. Student-athlete participation 1981-82 - 2018-19. In: NCAA sports sponsorship and participation rates report. National Collegiate Athletic Association. 2019. https://ncaaorg.s3.amazonaws.com/research/sportpart/2018-19RES_SportsSponsorshipParticipationRatesReport.pdf. Accessed 18 December 2020.

USA Hockey, Inc. 2016-2017 season final registration reports. In: Membership statistics. 2017. https://www.usahockey.com/membershipstats. Accessed 23 December 2020.

10.

Wessel LE, Eliasberg CD, Bowen E, Sutton KM. Shoulder and elbow pathology in the female athlete: sex-specific considerations. J Shoulder Elbow Surg. 2020;S1058-2746(20)30892-2. https://doi.org/10.1016/j.jse.2020.10.020 Epub ahead of print.

11.

Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311–9.

12.

Kim Y, Lee JM, Wellsandt E, Rosen AB. Comparison of shoulder range of motion, strength, and upper quarter dynamic balance between NCAA division I overhead athletes with and without a history of shoulder injury. Phys Ther Sport. 2020;42:53–60. https://doi.org/10.1016/j.ptsp.2019.12.007.CrossRef

13.

Okholm Kryger K, Dor F, Guillaume M, Haida A, Noirez P, Montalvan B, Toussaint JF. Medical reasons behind player departures from male and female professional tennis competitions. Am J Sports Med. 2015;43:34–40. https://doi.org/10.1177/0363546514552996.CrossRef

14.

Gescheit DT, Cormack SJ, Duffield R, Kovalchik S, Wood TO, Omizzolo M, et al. Injury epidemiology of tennis players at the 2011-2016 Australian Open Grand Slam. Br J Sports Med. 2017;51(17):1289–94. https://doi.org/10.1136/bjsports-2016-097283.CrossRef

15.

Gil JA, Goodman AD, DeFroda SF, Owens BD. Characteristics of operative shoulder injuries in the National Collegiate Athletic Association, 2009-2010through 2013-2014. Orthop J Sports Med. 2018;6(8):2325967118790764. https://doi.org/10.1177/2325967118790764.CrossRef

16.

Kerr ZY, Hayden R, Barr M, Klossner DA, Dompier TP. Epidemiology of national collegiate athletic association women’s gymnastics injuries, 2009-2010 through 2013-2014. J Athl Train. 2015;50:870–8. https://doi.org/10.4085/1062-6050-50.7.02.CrossRef

17.

Frank RM, Romeo AA, Bush-Joseph CA, Bach BR. Injuries to the female athlete in 2017: Part I: General considerations, concussions, stress fractures, and the female athlete triad. JBJS Rev. 2017;5(10):e4. https://doi.org/10.2106/JBJS.RVW.17.00017.CrossRef

18.

Schroeder AN, Dawn Comstock R, Collins CL, Everhart J, Flanigan D, Best TM. Epidemiology of overuse injuries among high-school athletes in the United States. J Pediatr. 2015;166:600–6. https://doi.org/10.1016/j.jpeds.2014.09.037.CrossRef

19.

Asker M, Holm LW, Källberg H, Waldén M, Skillgate E. Female adolescent elite handball players are more susceptible to shoulder problems than their male counterparts. Knee Surg Sports Traumatol Arthrosc. 2018 Jul;26(7):1892–900. https://doi.org/10.1007/s00167-018-4857-y.CrossRef

20.

Roos KG, Marshall SW, Kerr ZY, Golightly YM, Kucera KL, Myers JB, Rosamond WD, Comstock RD. Epidemiology of overuse injuries in collegiate and high school athletics in the United States. Am J Sports Med. 2015;43(7):1790–7. https://doi.org/10.1177/0363546515580790.CrossRef

21.••

Post EG, Trigsted SM, Riekena JW, Hetzel S, McGuine TA, Brooks MA, et al. The association of sport specialization and training volume with injury history in youth athletes. Am J Sports Med. 2017;45(6):1405–12. https://doi.org/10.1177/0363546517690848. Large case-control study characterizing the increased risk of overuse injuries with increased athletic specialization in adolescence.CrossRef

22.

Frisch KE, Clark J, Hanson C, Fagerness C, Conway A, Hoogendoorn L. High prevalence of nontraumatic shoulder pain in a regional sample of female high school volleyball athletes. Orthop J Sports Med. 2017;5(6):2325967117712236. https://doi.org/10.1177/2325967117712236.CrossRef

23.

Melugin HP, Leafblad ND, Camp CL, Conte S. Injury prevention in baseball: from youth to the pros. Curr Rev Musculoskelet Med. 2018;11(1):26–34. https://doi.org/10.1007/s12178-018-9456-5.CrossRef

24.

Giroto N, Hespanhol Junior LC, Gomes MRC, Lopes AD. Incidence and risk factors of injuries in Brazilian elite handball players: a prospective cohort study. Scand J Med Sci Sports. 2017;27(2):195–202. https://doi.org/10.1111/sms.12636.CrossRef

25.

Sauers EL, Dykstra DL, Bay RC, Bliven KH, Snyder AR. Upper extremity injury history, current pain rating, and health-related quality of life in female softball pitchers. J Sport Rehabil. 2011;20(1):100–14. https://doi.org/10.1123/jsr.20.1.100.CrossRef

26.

Lear A, Patel N. Softball pitching and injury. Curr Sports Med Rep. 2016;15:336–41. https://doi.org/10.1249/JSR.0000000000000293.CrossRef

27.

Oliver GD, Gilmer GG, Anz AW, Friesen KB, Brittain AR, Goodlett MD, Dugas JR, Andrews JR. Upper extremity pain and pitching mechanics in National Collegiate Athletic Association (NCAA) Division I softball. Int J Sports Med. 2018;39(12):929–35. https://doi.org/10.1055/a-0658-1546.CrossRef

28.

Neer CS, Foster CR, Neer CS 2nd, Foster CR. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone Joint Surg Am. 1980;62(6):897–908.CrossRef

29.

Longo UG, Rizzello G, Loppini M, Locher J, Buchmann S, Maffulli N, Denaro V. Multidirectional instability of the shoulder: a systematic review. Arthroscopy. 2015;31(12):2431–43. https://doi.org/10.1016/j.arthro.2015.06.006.CrossRef

30.

Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J Rheumatol. 2007;34(4):804–9.

31.

Cameron KL, Duffey ML, Deberardino TM, Stoneman PD, Jones CJ, Owens BD. Association of generalized joint hypermobility with a history of glenohumeral joint instability. J Athl Train. 2010;45:253–8. https://doi.org/10.4085/1062-6050-45.3.253.CrossRef

32.••

Magnuson JA, Wolf BR, Cronin KJ, Jacobs CA, Ortiz SF, Bishop JY, et al. Sex-related differences in patients undergoing surgery for shoulder instability: a multicenter orthopaedic outcomes network (MOON) shoulder instability cohort study. J Shoulder Elbow Surg. 2019;28(6):1013–21. https://doi.org/10.1016/j.jse.2019.02.020. National, multicenter cohort demonstrating sex-related differences in etiology, associated pathology, and outcomes among individuals undergoing shoulder instability surgery.CrossRef

33.

Beighton P, Horan F. Orthopaedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg Br. 1969;51(3):444–53.CrossRef

34.

Dragoo JL, Castillo TN, Braun HJ, Ridley BA, Kennedy AC, Golish SR. Prospective correlation between serum relaxin concentration and anterior cruciate ligament tears among elite collegiate female athletes. Am J Sports Med. 2011;39(10):2175–80. https://doi.org/10.1177/0363546511413378.CrossRef

35.

Dragoo JL, Lee RS, Benhaim P, Finerman GAM, Hame SL. Relaxin receptors in the human female anterior cruciate ligament. Am J Sports Med. 2003;31(4):577–84. https://doi.org/10.1177/03635465030310041701.CrossRef

36.

Palejwala S, Tseng L, Wojtczuk A, Weiss G, Goldsmith LT. Relaxin gene and protein expression and its regulation of procollagenase and vascular endothelial growth factor in human endometrial cells. Biol Reprod. 2002;66(6):1743–8. https://doi.org/10.1095/biolreprod66.6.1743.CrossRef

37.

Owens BD, Cameron KL, Clifton KB, Svoboda SJ, Wolf JM. Association between serum relaxin and subsequent shoulder instability. Owens BD, Cameron KL, Clifton KB, Svoboda SJ, Wolf JM. Association between serum relaxin and subsequent shoulder instability. Orthopedics. 2016;39(4):e724–8. https://doi.org/10.3928/01477447-20160421-01.CrossRef

38.

Churchill RS, Brems JJ, Kotschi H. Glenoid size, inclination, and version: an anatomic study. J Shoulder Elb Surg. 2001;10:327–32. https://doi.org/10.1067/mse.2001.115269.CrossRef

39.

Merrill A, Guzman K, Miller SL. Gender differences in glenoid anatomy: an anatomic study. Surg Radiol Anat. 2009;31:183–9. https://doi.org/10.1007/s00276-008-0425-3.CrossRef

40.

Owens BD, Campbell SE, Cameron KL. Risk factors for anterior glenohumeral instability. Am J Sports Med. 2014;42(11):2591–6. https://doi.org/10.1177/0363546514551149.CrossRef

41.

Hansen M, Couppe C, Hansen CSE, Skovgaard D, Kovanen V, Larsen JO, Aagaard P, Magnusson SP, Kjaer M. Impact of oral contraceptive use and menstrual phases on patellar tendon morphology, biochemical composition, and biomechanical properties in female athletes. J Appl Physiol. 2013;114:998–1008. https://doi.org/10.1152/japplphysiol.01255.2012.CrossRef

42.

Shultz SJ, Levine BJ, Nguyen AD, Kim H, Montgomery MM, Perrin DH. A comparison of cyclic variations in anterior knee laxity, genu recurvatum, and general joint laxity across the menstrual cycle. J Orthop Res. 2010;28:1411–7. https://doi.org/10.1002/jor.21145.CrossRef

43.

Tinkle BT, Bird HA, Grahame R, Lavallee M, Levy HP, Sillence D. The lack of clinical distinction between the hypermobility type of Ehlers-Danlos syndrome and the joint hypermobility syndrome (a.k.a. hypermobility syndrome). Am J Med Genet A. 2009;149A(11):2368–70. https://doi.org/10.1002/ajmg.a.33070.CrossRef

44.

Larsson LG, Baum J, Mudholkar GS. Hypermobility: features and differential incidence between the sexes. Arthritis Rheum. 1987;30:1426–30. https://doi.org/10.1002/art.1780301216.CrossRef

45.

Myer GD, Ford KR, Paterno MV, Nick TG, Hewett TE. The effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes. Am J Sports Med. 2008;36:1073–80. https://doi.org/10.1177/0363546507313572.CrossRef

46.

Trojan JD, Meyer LE, Edgar CM, Brown SM, Mulcahey MK. Epidemiology of shoulder instability injuries in collision collegiate sports from 2009 to 2014. Arthroscopy. 2020;36(1):36–43. https://doi.org/10.1016/j.arthro.2019.07.008.CrossRef

47.

Goodman AD, DeFroda SF, Gil JA, Kleiner JE, Li NY, Owens BD. Season-ending shoulder injuries in the National Collegiate Athletic Association: data from the NCAA Injury Surveillance Program, 2009-2010 through 2013-2014. Am J Sports Med. 2018;46:1936–42. https://doi.org/10.1177/0363546518773062.CrossRef

48.

Peck KY, Johnston DA, Owens BD, Cameron KL. The incidence of injury among male and female intercollegiate rugby players. Sports Health. 2013;5:327–33. https://doi.org/10.1177/1941738113487165.CrossRef

49.

Patzkowski JC, Dickens JF, Cameron KL, Bokshan SL, Garcia ESJ, Owens BD. Pathoanatomy ofshoulder instability in collegiate female athletes. Am J Sports Med. 2019;47:1909–14. https://doi.org/10.1177/0363546519850810.CrossRef

50.

Reeser JC, Joy EA, Porucznik CA, Berg RL, Colliver EB, Willick SE. Risk factors for volleyball-related shoulder pain and dysfunction. PM R. 2010;2(1):27–36. https://doi.org/10.1016/j.pmrj.2009.11.010.CrossRef

51.

Vaswani R, Arner J, Freiman H, Bradley JP. Risk factors for revision posterior shoulder stabilization in throwing athletes. Orthop J Sports Med. 2020;8(12):2325967120967652. https://doi.org/10.1177/2325967120967652.CrossRef

52.••

Bradley JP, Arner JW, Jayakumar S, Vyas D. Risk factors and outcomes of revision arthroscopic posterior shoulder capsulolabral repair. Am J Sports Med. 2018;46(10):2457–65. https://doi.org/10.1177/0363546518785893. Identifies risk factors for, and outcomes among, revision posterior shoulder stabilization surgery among a cohort of nearly 300 individuals. Female sex, smaller glenoid width, concomitant rotator cuff tear, surgical technique (number of suture anchors used), and dominant shoulder were identified as signficant risk factors.CrossRef

53.

Young SW, Dakic J, Stroia K, Nguyen ML, Safran MR. Arthroscopic shoulder surgery in female professional tennis players: ability and timing to return to play. Clin J Sport Med. 2017;27(4):357–60. https://doi.org/10.1097/JSM.0000000000000361.CrossRef

54.

Lin TT, Lin CH, Chang CL, Chi CH, Chang ST, Sheu WH. The effect of diabetes, hyperlipidemia, and statins on the development of rotator cuff disease: a nationwide, 11-year, longitudinal, population-based follow-up study. Am J Sports Med. 2015;43(9):2126–32. https://doi.org/10.1177/0363546515588173.CrossRef

55.

da Rocha MG, Amaral MV, Rezende E, Pitta R, dos Santos Vieira TC, Duarte MEL, Vieira AR, Casado PL. Evidence of genetic variations associated with rotator cuff disease. J Shoulder Elbow Surg. 2014;23(2):227–35. https://doi.org/10.1016/j.jse.2013.07.053.CrossRef

56.••

Figueiredo EA, Loyola LC, Belangero PS, Campos Ribeiro-Dos-Santos K, Emanuel Batista Santos S, Cohen C, et al. Rotator cuff tear susceptibility is associated with variants in genes involved in tendon extracellular matrix homeostasis. J Orthop Res. 2020;38(1):192–201. https://doi.org/10.1002/jor.24455. Elucidates genetic and molecular factors contributing to rotator cuff disease, which may contribute to sex-related differences seen in incidence of rotator cuff tears.CrossRef

57.

Asker M, Waldén M, Källberg H, Holm LW, Skillgate E. Preseason clinical shoulder test results and shoulder injury rate in adolescent elite handball players: a prospective study. J Orthop Sports Phys Ther. 2020;50(2):67–74. https://doi.org/10.2519/jospt.2020.9044.CrossRef

58.

Rodeo SA, Nguyen JT, Cavanaugh JT, Patel Y, Adler RS. Clinical and ultrasonographic evaluations of the shoulders of elite swimmers. Am J Sports Med. 2016;44(12):3214–21. https://doi.org/10.1177/0363546516657823.CrossRef

59.

Dischler JD, Baumer TG, Finkelstein E, Siegal DS, Bey MJ. Association between years of competition and shoulder function in collegiate swimmers. Sports Health. 2018 Mar;10(2):113–8. https://doi.org/10.1177/1941738117726771.CrossRef

60.

Razmjou H, Davis AM, Jaglal SB, Holtby R, Richards RR. Cross-sectional analysis of baseline differences of candidates for rotator cuff surgery: a sex and gender perspective. BMC Musculoskelet Disord. 2009;10:26. https://doi.org/10.1186/1471-2474-10-26.CrossRef

61.••

Daniels SD, Stewart CM, Garvey KD, Brook EM, Higgins LD, Matzkin EG. Sex-based differences in patient-reported outcomes after arthroscopic rotator cuff repair. Orthop J Sports Med. 2019;7(11) 2325967119881959. https://doi.org/10.1177/2325967119881959. Evaluated outcomes among 283 indidivuals undergoing arthroscopic rotator cuff repair and found women report increased pain and worse function during the initial postopoerative period.

62.

Eisner EA, Roocroft JH, Moor MA, Edmonds EW. Partial rotator cuff tears in adolescents: factors affecting outcomes. J Pediatr Orthop. 2013;33(1):2–7. https://doi.org/10.1097/BPO.0b013e318279c2e0.CrossRef

63.

Tuominen M, Stuart MJ, Aubry M, Kannus P, Tokola K, Parkkari J. Injuries in women’s international ice hockey: an 8-year study of the World Championship tournaments and Olympic Winter Games. Br J Sports Med. 2016;50(22):1406–12. https://doi.org/10.1136/bjsports-2015-094647.CrossRef

64.

Hibberd EE, Kerr ZY, Roos KG, Djoko A, Dompier TP. Epidemiology of acromioclavicular joint sprains in 25 National Collegiate Athletic Association sports: 2009-2010 to 2014-2015 academic years. Am J Sports Med. 2016;44(10):2667–74. https://doi.org/10.1177/0363546516643721.CrossRef

65.

Melvin PR, Souza S, Mead RN, Smith C, Mulcahey MK. Epidemiology of upper extremity injuries in NCAA men’s and women’s ice hockey. Am J Sports Med. 2018;46(10):2521–9. https://doi.org/10.1177/0363546518781338.CrossRef

66.

Lynall RC, Mihalik JP, Pierpoint LA, Currie DW, Knowles SB, Wasserman EB, Dompier TP, Comstock RD, Marshall SW, Kerr ZY. The first decade of web-based sports injury surveillance: descriptive epidemiology of injuries in US high school boys' ice hockey (2008-2009 Through 2013-2014) and National Collegiate Athletic Association men's and women's ice hockey (2004-2005 through 2013-2014). J Athl Train. 2018;53(12):1129–42. https://doi.org/10.4085/1062-6050-176-17.CrossRef

67.

McCarthy MM, Bihl JH, Frank RM, Salem HS, McCarty EC, Comstock RD. Epidemiology of clavicle fractures among US high school athletes, 2008-2009 Through 2016-2017. Orthop J Sport Med. 2019;7(7):2325967119861812. https://doi.org/10.1177/2325967119861812.CrossRef

68.

Vautrin M, Kaminski G, Barimani B, Elmers J, Philippe V, Cherix S, Thein E, Borens O, Vauclair F. Does candidate for plate fixation selection improve the functional outcome after midshaft clavicle fracture? A systematic review of 1348 patients. Shoulder Elbow. 2019;11(1):9–16. https://doi.org/10.1177/1758573218777996.CrossRef

Titel: Sports-Related Shoulder Injuries Among Female Athletes
verfasst von: Casey L. Wright
Jhillika Patel
Carolyn M. Hettrich
Publikationsdatum: 05.12.2022
Verlag: Springer US
Erschienen in: Current Reviews in Musculoskeletal Medicine / Ausgabe 6/2022
Elektronische ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-022-09802-2

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