Shoulder and elbow pathology in the female athlete: sex-specific considerations

Wessel, Lauren E.; Eliasberg, Claire D.; Bowen, Edward; Sutton, Karen M.

doi:10.1016/j.jse.2020.10.020

Cited by 10 publications

(7 citation statements)

References 71 publications

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“…These two parameters are then related to implant loosening. These parameters are probably also crucial to ensure glenoid screw fixation when dealing with a glenoid fracture or when performing a bone block procedure (e.g., Latarjet or Eden–Hybinette) in older (>40 years) female patients with shoulder instability 19,20 . Previous studies have measured the glenoid BMD using different methods and in different regions of interest, but only for pathological bone, mainly in glenohumeral osteoarthritis 5,21–23 .…”

Section: Introductionmentioning

confidence: 99%

“…These parameters are probably also crucial to ensure glenoid screw fixation when dealing with a glenoid fracture or when performing a bone block procedure (e.g., Latarjet or Eden–Hybinette) in older (>40 years) female patients with shoulder instability. 19 , 20 Previous studies have measured the glenoid BMD using different methods and in different regions of interest, but only for pathological bone, mainly in glenohumeral osteoarthritis. 5 , 21 , 22 , 23 Moreover, while most experimental studies are performed on synthetic bone to ensure comparable bone quality, reference BMD values are awaited to integrate BMD variation in implant evaluation and determine its implication in micro‐motion and implant loosening.…”

Section: Introductionmentioning

confidence: 99%

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Age‐ and sex‐specific normative values of bone mineral density in the adult glenoid

PezhmanEghbali

Becce

Goetti

et al. 2022

Journal Orthopaedic Research

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The objective of this study was to determine the normative bone mineral density (BMD) of cortical and trabecular bone regions in the adult glenoid and its dependence on the subject's age and sex. We analyzed computed tomography (CT) scans of 441 shoulders (310 males, 18–69 years) without any signs of glenohumeral joint pathology. Glenoid BMD was automatically quantified in six volumes of interest (VOIs): cortical bone (CO), subchondral cortical plate (SC), subchondral trabecular bone (ST), and three adjacent layers of trabecular bone (T1, T2, and T3). BMD was measured in Hounsfield unit (HU). We evaluated the association between glenoid BMD and sex and age with the Student's t test and Pearson's correlation coefficient (r), respectively. The lambda‐mu‐sigma method was used to determine age‐ and sex‐specific normative values of glenoid BMD in cortical (CO and SC) and trabecular (ST, T1, T2, and T3) bone. Glenoid BMD was higher in males than females, in most age groups and most VOIs. Before 40 years old, the effect of age on BMD was very weak in both males and females. After 40 years old, BMD declined over time in all VOIs. This BMD decline with age was greater in females (cortical: r = −0.45, trabecular: r = −0.41) than in males (cortical: r = −0.30; trabecular: r = −0.32). These normative glenoid BMD values could prove clinically relevant in the diagnosis and management of patients with various shoulder disorders, in particular glenohumeral osteoarthritis and shoulder arthroplasty or shoulder instability, as well as in related research.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Age‐ and sex‐specific normative values of bone mineral density in the adult glenoid

PezhmanEghbali

Becce

Goetti

et al. 2022

Journal Orthopaedic Research

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“…Sex-specific biological and biomechanical characteristics make women and men differently prone to certain injuries, not only among tennis players but also in other sportsmen and sportswomen [35,36]. Many reasons have been postulated to explain the increased risk, including anatomical, biomechanical, neuromuscular and hormonal differences; focusing on the upper limb, an increased propensity towards generalised joint laxity and a different molecular composition of the tendon tissue could lead to a higher frequency of instabilityrelated complaints and tendinopathies in female athletes; nevertheless, current literature evidence for elbow lesions is limited, inconclusive and presents controversial results [37,38].…”

Section: Discussionmentioning

confidence: 99%

A low carrying angle is measured in elite tennis players just before ball impact during the forehand, suggesting a dynamic varus instant accommodation moving towards full extension

Arrigoni,

Cucchi,

Beltrame

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe goal of this study was to use image analysis recordings to measure the carrying angle of elite male tennis players during the forehand stroke, with the hypothesis that elite tennis players overstress their elbow in valgus over the physiological degree in the frontal plane just before ball contact on forehand groundstrokes.MethodsThe carrying angle of male tennis players ranked in the top 25 positions in the ATP ranking was measured on selected video frames with the elbow as close as possible to full extension just before the ball‐racket contact in forehands. These frames were extracted from 306 videos professionally recorded for training purposes by a high‐profile video analyst. All measures were conducted by three independent observers.ResultsSixteen frames were finally included. The mean carrying angle was 11.5° ± 4.7°. The intraclass correlation coefficient value was 0.703, showing good reliability of the measurement technique. The measured carrying angle was lower than what has been observed in historical cohorts using comparable measurement methodology, suggesting a possible instant varus accommodation mechanism before hitting the ball.ConclusionsThe observed decrease in the carrying angle is a consequence of an increase in elbow flexion position dictated by the transition from a closed to open, semi‐open stances. As the elbow flexes during the preparation phase, it is less constrained by the olecranon and its fossa, increasing the strain on the medial collateral ligament and capsule structures. Moving towards full extension before the ball‐racket contact, the elbow is dynamically stabilised by a contraction of the flexor muscles. These observations could provide a new explanation for medial elbow injuries among elite tennis players and drive specific rehabilitation protocols.Study DesignDescriptive epidemiology study.Level of EvidenceLevel IV.

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“…The difference between the sexes associated with shoulder instability has been reported previously. 14 , 15 , 19 , 26 , 35 Female athletes participating in soccer, basketball, and rugby have been reported to have a higher risk of shoulder dislocation compared with their male counterparts. 23 , 27 The Multicenter Orthopaedic Outcomes Network study group reported that capsular laxity was higher in females, whereas labral pathology and bone defect were higher in males.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Assessment of Anterior Humeral Head Translation in Patients With Anterior Shoulder Instability: Correlation With Demographic, Radiographic, and Clinical Data

Inoue

Takenaga

Tsuchiya

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Ultrasonography can be used to quantitatively assess anterior humeral head translation (AHHT) at different degrees of shoulder abduction. Risk factors for recurrent shoulder instability have been identified. Hypothesis: It was hypothesized that the number of dislocations or glenoid or humeral bone loss would be associated with more AHHT as measured using ultrasound. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 39 patients who underwent surgery for anterior shoulder instability were prospectively studied. Ultrasound assessment of AHHT was performed immediately after general anesthesia was induced. The upper arm was placed at 0°, 45°, and 90° of abduction, and a 40-N anterior force was applied to the proximal third of the arm. The distance from the posterior edge of the glenoid to that of the humeral head was measured at each abduction angle using ultrasound with and without a 40-N anterior force, and the AHHT was calculated. The differences in translation at each shoulder angle were compared. Additionally, the authors investigated the association between AHHT and demographic, radiographic, and clinical data. Results: Compared with the AHHT at 0° of abduction (5.29 mm), translation was significantly larger at 45° of abduction (8.90 mm; P < .01) and 90° of abduction (9.46 mm; P < .01). The mean translation was significantly larger in female patients than in male patients at all degrees of abduction ( P ≤ .036 for all). There was no correlation between AHHT at any abduction angle and number of dislocations, clinical data, or radiographic data (including bone loss). Conclusion: Ultrasound assessment of AHHT showed larger amounts of laxity at 45° and 90° than at 0° of abduction. Anterior glenohumeral laxity was greater in female than male patients. Glenoid or humeral bone loss did not correlate with AHHT, thereby clarifying that bone loss has no direct effect on measurements of capsular laxity in neutral rotation.

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Shoulder and elbow pathology in the female athlete: sex-specific considerations

Cited by 10 publications

References 71 publications

Age‐ and sex‐specific normative values of bone mineral density in the adult glenoid

Age‐ and sex‐specific normative values of bone mineral density in the adult glenoid

A low carrying angle is measured in elite tennis players just before ball impact during the forehand, suggesting a dynamic varus instant accommodation moving towards full extension

Ultrasound Assessment of Anterior Humeral Head Translation in Patients With Anterior Shoulder Instability: Correlation With Demographic, Radiographic, and Clinical Data

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