Shoulder Girdle Injuries
Shoulder girdle injuries are among the most common snow-sport injuries and more frequently occur in snowboarders than in skiers. Kim et al[1] investigated snowboarding and skiing injuries that occurred at a resort in Vermont from 1988 through 2006 and found that shoulder injuries and clavicle fractures in adult snowboarders accounted for 11.7% and 4% of all reported injuries, respectively. The number of snowboarding-related clavicle fracture rates has increased greatly since the emergence of terrain parks. The prevalence of these injuries appears to be increasing as a result of the popularity of performing aerial stunts. Kim et al[1] reported that 43.8% of clavicle fractures were sustained while snowboarding in terrain parks, 33.7% were associated with jumping activities, and 92.6% resulted from impact with the snow's surface.
In a study of shoulder injuries associated with skiing and snowboarding, McCall and Safran[20] reported that shoulder injuries account for 4% to 11% of alpine skiing injuries, with rotator cuff strains being the most common shoulder injury. Shoulder injuries associated with skiing are the result of four mechanisms: direct impact, axial load on an extended arm, resisted forced abduction of the arm, and external rotation forces resulting from a firmly planted ski pole in the grasp of a skier during a fall.
Ogawa et al[21] retrospectively reviewed glenohumeral dislocations in snowboarders and skiers treated at a Japanese hospital over a 5-year period. In skiers, glenohumeral dislocations accounted for 5.5% of all injuries. Of all sites of dislocation, the glenohumeral joint was the most common at 49.3%, followed by the elbow at 23.4% and the acromioclavicular joint at 17.9%. The prevalence of fracture-dislocations was higher in skiers than in snowboarders (33.9% and 12.4%, respectively). One common mechanism is secondary engagement of the leading toe-side edge of the snowboard, resulting in a fall forward. A high incidence of recurrent dislocations has been documented in younger patients (especially those aged <25 years) with a prior dislocation.
As in the general population, rotator cuff pathology is of primary concern in skiers and snowboarders aged >40 years with a prior dislocation.[20] Pevny et al[22] found that the incidence of concomitant rotator cuff tear was 35% after first-time dislocations in patients aged >40 years; therefore, radiologic assessment with MRI should be considered in these patients.
J Am Acad Orthop Surg. 2018;26(1):e1-e10. © 2018 American Academy of Orthopaedic Surgeons
