Surprising Data on Shoulder Instability in Female Athletes

While shoulder instability in male athletes is well-documented, there is still little known about the pathoanatomy and range of injuries in female athletes with shoulder instability.

To this end, a new study, “Pathoanatomy of Shoulder Instability in Collegiate Female Athletes,” published in a recent issue of The American Journal of Sports Medicine, shows that anterior and posterior labral tears are more common in female athletes than previously thought.

The researchers conducted a retrospective analysis of a consecutive series of female students at a National Collegiate Athletic Association Division I military service academy who underwent surgery for shoulder instability. The surgeries were all performed by the same surgeon between September 2008 and September 2014.

The lead researcher collected data on the mechanism of injury, number and frequency of dislocations, and direction of instability. The primary outcomes selected by the researchers for their study included recurrent instability after surgery and the need for revision.

In total, 36 student-athletes participated in the study. Sixty-nine percent of the instability events were caused by trauma and 61% of the total events were subluxations. In addition, 89% of the female athletes reported having more than one instability event. The direction of instability in most of them was anterior (26) with 7 of the athletes having combined anterior and posterior and 3 having multidirectional instability.

Overall, 26 patients (72%) had a Bankart tear, 9 (25%) had a posterior labral tear and 5 (14%) had superior labrum anterior to posterior tears. Nine patients had humeral avulsion of the glenohumeral ligament (HAGL) lesions and 16 patients had Hill-Sachs lesions. After the surgery, 9 of the student-athletes still experienced some instability and 6 of them underwent revision surgery to fix it.

According to the researchers, “shoulder instability in female athletes presents commonly as multiple subluxation events. While soft tissue Bankart lesions were found in numbers equal to those in previous studies includ[ing] both sexes, bony Bankart lesions were less common in women. Finally, the presence of combined anterior and posterior labral tears and HAGLs in women was more common than previously reported.”