RESUMEN
Background: Youth around the globe place their shoulders at risk for injury when participating in sports. Shoulder injuries may vary in severity, produce the potential for time-loss from sport, and result in functional disability. We sought to explore sport-related shoulder injuries in youth by identifying injury rates, risk factors, injury mechanisms, and injury prevention strategies. Methods: All relevant full-text articles were identified by searching MEDLINE, EMBASE, CINAHL, Sport Discus, and the Cochrane Controlled Trials Registry. No date restrictions were used. All full-text studies reporting original research describing sport-related shoulder injury among female and/or male youth from 5 to 18 years old were included. Results: Of 3,889 studies screened, 97 described shoulder injury in youth sports. Shoulder injuries were identified in 24 unique sports. The median seasonal prevalence of shoulder injury was 10.9% (range 1.2-28.2%). The most common injury mechanisms identified were contacted with another player, contact with the playing environment, and falling to the ground. Risk factors for shoulder injury identified were side-to-side strength imbalances, weak external rotator muscles, and scapular dyskinesia. One study evaluated a successful training strategy to prevent shoulder injuries, but two other interventions demonstrated no effect. Conclusions: Sport-related shoulder injuries are prevalent among youth athletes. Injury risk factors identified included modifiable intrinsic factors such as strength, range of motion, and training load. The most common injury mechanism was direct contact with either another person or an object in the playing environment. Innovative shoulder-specific strategies are needed to reduce shoulder injuries in this population. Trial Registration: PROSPERO ID: CRD42020189142.
RESUMEN
BACKGROUND: Shoulder pain is a highly prevalent condition and a significant cause of morbidity and functional disability. Current data suggests that many patients presenting with shoulder pain at the primary care level are not receiving high quality care. Primary care decision-making is complex and has the potential to influence the quality of care provided and patient outcomes. The aim of this study was to develop a clinical decision-making tool that standardizes care and minimizes uncertainty in assessment, diagnosis, and management. METHODS: First a rapid review was conducted to identify existing tools and evidence that could support a comprehensive clinical decision-making tool for shoulder pain. Secondly, provincial consensus was established for the assessment, diagnosis, and management of patients presenting to primary care with shoulder pain in Alberta, Canada using a three-step modified Delphi approach. This project was a highly collaborative effort between Alberta Health Services' Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI). RESULTS: A clinical decision-making tool for shoulder pain was developed and reached consensus by a province-wide expert panel representing various health disciplines and geographical regions. This tool consists of a clinical examination algorithm for assessing, diagnosis, and managing shoulder pain; recommendations for history-taking and identification of red flags or additional concerns; recommendations for physical examination and neurological screening; recommendations for the differential diagnosis; and care pathways for managing patients presenting with rotator cuff disease, biceps pathology, superior labral tear, adhesive capsulitis, osteoarthritis, and instability. CONCLUSIONS: This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of shoulder pain, and assist in clinical decision-making for primary care providers in both public and private sectors.
