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      Incidence of shoulder dislocations in the UK, 1995–2015: a population-based cohort study

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          Abstract

          Objective

          This cohort study evaluates the unknown age-specific and gender-specific incidence of primary shoulder dislocations in the UK.

          Setting

          UK primary care data from the Clinical Practice Research Datalink (CPRD) were used to identify patients aged 16–70 years with a shoulder dislocation during 1995–2015. Coding of primary shoulder dislocations was validated using the CPRD general practitioner questionnaire service.

          Participants

          A cohort of 16 763 patients with shoulder dislocation aged 16–70 years during 1995–2015 were identified.

          Primary outcome measure

          Incidence rates per 100 000 person-years and 95% CIs were calculated.

          Results

          Correct coding of shoulder dislocation within CPRD was 89% (95% CI 83% to 95%), and confirmation that the dislocation was a ‘primary’ was 76% (95% CI 67% to 85%). Seventy-two percent of shoulder dislocations occurred in men. The overall incidence rate in men was 40.4 per 100 000 person-years (95% CI 40.4 to 40.4), and in women was 15.5 per 100 000 person-years (95% CI 15.5 to 15.5). The highest incidence was observed in men aged 16–20 years (80.5 per 100 000 person-years; 95% CI 80.5 to 80.6). Incidence in women increased with age to a peak of 28.6 per 100 000 person-years among those aged 61–70 years.

          Conclusions

          This is the first time the incidence of shoulder dislocations has been studied using primary care data from a national database, and the first time the results for the UK have been produced. While most primary dislocations occurred in young men, an unexpected finding was that the incidence increased in women aged over 50 years, but not in men. The reasons for this are unknown. Further work is commissioned by the National Institute for Health Research to examine treatments and predictors for recurrent shoulder dislocation.

          Study registration

          The design of this study was approved by the Independent Scientific Advisory Committee (15_260) for the Medicines & Healthcare products Regulatory Agency.

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          Most cited references22

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          The incidence and characteristics of shoulder instability at the United States Military Academy.

          Thomas DeBerardino, Michele Duffey, Deborah Nelson … (2007)
          The literature provides little information detailing the incidence of traumatic shoulder instability in young, healthy athletes. Shoulder instability is common in young athletes. Descriptive epidemiologic study. We prospectively captured all traumatic shoulder instability events at the United States Military Academy between September 1, 2004, and May 31, 2005. Throughout this period, all new traumatic shoulder instability events were evaluated with physical examination, plain radiographs, and magnetic resonance imaging. Instability events were classified according to direction, chronicity, and type (subluxation or dislocation). Subject demographics, mechanism of injury, and sport were evaluated. Among 4141 students, 117 experienced new traumatic shoulder instability events during the study period; 11 experienced multiple events. The mean age of these 117 subjects was 20.0 years; 101 students were men (86.3%), and 16 were women (13.7%). The 1-year incidence proportion was 2.8%. The male incidence proportion was 2.9% and the female incidence proportion was 2.5%. Eighteen events were dislocations (15.4%), and 99 were subluxations (84.6%). Of the 99 subluxations, 45 (45.5%) were primary events, while 54 (54.5%) were recurrent. Of the 18 dislocations, 12 (66.7%) were primary events, while 6 (33.3%) were recurrent. The majority of the 117 events were anterior in nature (80.3%), while 12 (10.3%) were posterior, and 11 (9.4%) were multidirectional. Forty-four percent (43.6%) of the instability events experienced were as a result of contact injuries, while 41.0% were a result of noncontact injuries, including 9 subluxations caused by missed punches during boxing; information was unavailable for the remaining 15%. Glenohumeral instability is a common injury in this population, with subluxations comprising 85% of instability events.
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            Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients.

            C Michael Robinson, Jonathan Howes, Helen Murdoch … (2006)
            The prevalence and risk factors for recurrent instability and functional impairment following a primary glenohumeral dislocation remain poorly defined in younger patients. We performed a prospective cohort study to evaluate these outcomes. We also aimed to produce guidelines for the design of future clinical trials, assessing the efficacy of interventions designed to improve the outcome after a primary dislocation. We performed a prospective cohort study of 252 patients ranging from fifteen to thirty-five years old who sustained an anterior glenohumeral dislocation and were treated with sling immobilization, followed by a physical therapy program. Patients received regular clinical follow-up to assess whether recurrent instability had developed. Functional assessments were made and were compared for two subgroups: those who had not had instability develop and those who had received operative stabilization to treat recurrent instability. On survival analysis, instability developed in 55.7% of the shoulders within the first two years after the primary dislocation and increased to 66.8% by the fifth year. The younger male patients were most at risk of instability, and 86.7% of all of the patients known to have recurrent instability had this complication develop within the first two years. A small but measurable degree of functional impairment was present at two years after the initial dislocation in most patients. Sample-size calculations revealed that a relatively small number of patients with a primary dislocation would be required in future clinical trials examining the effects of interventions designed to reduce the prevalence of recurrent instability and improve the functional outcome. Recurrent instability and deficits of shoulder function are common after primary nonoperative treatment of an anterior shoulder dislocation. There is substantial variation in the risk of instability, with younger males having the highest risk and females having a much lower risk. Future clinical trials to evaluate primary interventions should evaluate the prevalence of recurrent instability and functional deficits, with use of an assessment tool specifically for shoulder instability, during the first two years after the initial dislocation.
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              Incidence of glenohumeral instability in collegiate athletics.

              Jesse B Owens, Sally B Mountcastle, Julie Agel … (2009)
              Glenohumeral instability is a common injury sustained by young athletes. Surprisingly, little is known regarding the incidence of glenohumeral instability in collegiate athletes or the relevant risk factors for injury. A better understanding of the populations most at risk may be used to develop preventive strategies. The incidence of glenohumeral instability in collegiate athletics is high, and it is affected by sex, sport, type of event, and mechanism of injury. Descriptive epidemiologic study. The National Collegiate Athletic Association injury database was queried for all glenohumeral instability events occurring between the years 1989 and 2004. An analysis of the injuries was performed by sport, activity (competition versus practice), sex, type of event (primary versus recurrent), mechanism of injury, and time loss from athletic performance. Incidence rates and incidence rate ratios were calculated. A total of 4080 glenohumeral instability events were documented for an incidence rate of 0.12 injuries per 1000 athlete exposures. The sport with the greatest injury rate was men's spring football, with 0.40 injuries per 1000 athlete exposures. Overall, athletes sustained more glenohumeral instability events during games than practices (incidence rate ratio [IRR], 3.50; 95% confidence interval [CI], 3.29-3.73). Male athletes sustained more injuries than did female athletes (IRR, 2.67; 95% CI, 2.43-2.93). Female athletes were more likely to sustain an instability event as the result of contact with an object (IRR, 2.43; 95% CI, 2.08-2.84), whereas male athletes were more likely to sustain an event from player contact (IRR, 2.74; 95% CI, 2.31-3.25). Time lost to sport (>10 days) occurred in 45% of glenohumeral instability events. Glenohumeral instability is a relatively common injury sustained by collegiate athletes. More injuries occurred during competition and among male athletes.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2017
                Publication date (Electronic): 14 November 2017
                Volume: 7
                Issue: 11
                Electronic Location Identifier: e016112
                Affiliations
                [1 ]departmentNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences , University of Oxford , Oxford, UK
                [2 ]departmentFaculty of Medicine , University of Southampton , Southampton, UK
                [3 ]departmentMusculoskeletal Research Unit , University of Bristol , Bristol, UK
                [4 ]departmentNuffield Department of Primary Care Health Sciences , University of Oxford , Oxford, UK
                [5 ]departmentOxford Clinical Trials Research Unit , University of Oxford , Oxford, UK
                [6 ]departmentOrthopaedic Surgery , The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust , Middlesbrough, UK
                [7 ]departmentDepartment of Health Sciences , University of York , York, UK
                Author notes
                [Correspondence to ] Dr Anjali Shah; anjali.shah@ 123456ndorms.ox.ac.uk
                Author information
                http://orcid.org/0000-0001-8379-6531
                Article
                Publisher ID: bmjopen-2017-016112
                DOI: 10.1136/bmjopen-2017-016112
                PMC ID: 5695490
                PubMed ID: 29138197
                SO-VID: 87f7ccd6-9159-4c38-a455-42493e9351df
                Copyright © © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
                License:

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                Date received : 30 January 2017
                Date revision received : 16 October 2017
                Date accepted : 18 October 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000664, Health Technology Assessment Programme;
                Categories
                Subject: Epidemiology
                Subject: Research
                Subject: 1506
                Subject: 1692
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: shoulder dislocation,incidence,clinical practice research datalink,cprd
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: shoulder dislocation, incidence, clinical practice research datalink, cprd

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