Summary

Overhead and non-overhead athletes have similar clinical presentations with no difference in injury characteristics or postoperative outcomes. Given comparable injury characteristics, a tendency to bias instances of first-time shoulder dislocation in overhead athletes as “less severe” in comparison to non-overhead athletes, should be reconsidered.

Abstract

Introduction

Little is known about differences in pathology between overhead and non-overhead athletes after first-time anterior shoulder dislocations. The aim of this study was to characterize epidemiology and outcomes of overhead and non-overhead (contact or collision) athletes after shoulder stabilization surgery following a first-time anterior instability event. We hypothesized that overhead athletes would have a milder clinical presentation, more benign imaging, fewer intraoperative anchors placed, and superior postoperative outcomes compared to non-overhead athletes.

Methods

Patients with first-time anterior shoulder instability events undergoing operative management between 2013-2020 were included. Exclusion criteria included multiple dislocations and multidirectional shoulder instability. Baseline demographics, imaging, intraoperative findings, and postoperative outcomes including range of motion and revision rate were retrospectively collected. Overhead sports were defined as those that require lifting above one’s head and those that utilize a throwing arc of motion. Labral tear location was determined using the clock method.

Results

A total of 256 patients (83 overhead athletes, 126 non-overhead athletes) were available for analysis. There were no significant differences in demographics. More non-overhead athletes had first-time shoulder dislocations of their dominant shoulders compared to overhead athletes (73.9% vs. 42.7%, p = 0.026). Table 1. Percentage of bony Bankart and Hill-Sachs lesions were equivalent. There was no difference in preoperative and postoperative ROM or strength. No difference was observed with regard to total labral tear size, incidence of concomitant posterior or superior labrum tear, or total anchors used. There were no differences in revision rate between cohorts.

Conclusions

Overhead and non-overhead athletes have similar clinical presentations with no difference in injury characteristics or postoperative outcomes. Given comparable injury characteristics, a tendency to bias instances of first-time shoulder dislocation in overhead athletes as “less severe” in comparison to non-overhead athletes, should be reconsidered. Future studies evaluating predictive risk factors that influence outcomes between these two athletic populations are warranted.