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The Incidence of Posterior Shoulder Instability and Labral Reconstruction: An 18-Year Population Based Study
ESSKA Academy. Woodmass J. May 11, 2018; 218032
Jarret Woodmass
Jarret Woodmass
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Abstract
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Objectives: Posterior shoulder instability (PSI) is estimated to represent <10% of patients with glenohumeral instability. PSI often occurs in the absence of posterior glenohumeral dislocation. The purpose of this project is to define the population-based incidence of PSI, describe trends over time, and evaluate changes in the rate of surgical management.

Methods: The study population included 115 patients (14 females, 101 males) who were diagnosed with new-onset PSI between 1996-2014. Complete medical records were reviewed to extract patient demographics and treatment details. Age and gender specific incidence rates were calculated and adjusted to the 2010 US population. Poisson regression using the crude incidence rates analysis was performed to examine trends by calendar timeline, gender, and age.

Results: The overall age- and sex- adjusted annual incidence of PSI is 4.2 per 100,000 person-years and posterior shoulder dislocation is 1.0 per 100,000 person-years. The peak incidence for PSI occurred at 30-39years for both males and females (15.7 and 2.1 per 100,000 person-years, respectively). PSI incidence is higher in males than females (7.3 vs 1.1 per 100,000 person-years, p<0.001). The 5-year cumulative risk of surgical intervention in 1996-2002, 2003-2008, and 2009-2014 was 50.0%, 64.2%, and 85.0%, respectively. Patients first seen between 2009-2014 had a significantly increased risk for surgery (p=0.009, HR=2.2, 95% CI 1.2-4.0) compared to patients seen in 1996-2002.

Conclusions: The incidence of posterior shoulder instability is 4 times greater than the incidence of posterior shoulder dislocation. There is a significantly greater incidence of PSI in males than females with a peak incidence in both genders in the 30-39 years range. The increased rate of surgical intervention observed during the study period may reflect evolving indications and surgical techniques.

Keywords:
posterior shoulder instability, shoulder dislocation, shoulder instability, shoulder epidemiology
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