Shoulder Instability, Performance and Return to Play in National Hockey League Athletes

Abstract

Objectives:Hockey players are at risk for various injury due to the aggressive nature of gameplay with the rate of shoulder injuries ranges from 8.6% to 21.9%. Although performance and return to play outcomes following shoulder instability events have been analyzed in other contact sports, there is a paucity of information on the effects amongst professional hockey players. Our study investigates the incidence of shoulder instability events in the National Hockey League (NHL) and the subsequent effect on return-to-play (RTP) and player performance. We hypothesized that NHL players sustaining a shoulder instability event returned to play at a high rate without significant changes in player performance after injury.Methods:A total of 67 confirmed in-season shoulder instability events were identified in the NHL between 2003 - 2017. Demographic characteristics and performance statistics one year prior to injury and one year following injury were collected and analyzed. Overall RTP was determined and differences in performance following injury were compared to experience-matched, era-matched, position-matched and age-matched controls. A separate analysis was performed comparing differences in performance as a function of operative and nonoperative treatment.Results:An average of 4.19 shoulder dislocations occurred per season in the NHL with an overall incidence rate of 0.020 instability events per 1000 game exposures (CI 0.017-0.027) with no significant differences between forwards and defensemen (p = 0.871). Overall, 33.8% of players suffered season ending injuries but 98.5% of all players were able to return to play with an average of 26.3±20.8 regular season games missed. Compared to controls, players suffering a shoulder instability event experienced an increase in both average time on ice and shooting percentage upon returning to gameplay (p = 0.002, p <0.001, respectively) yet there were no significant differences in seasons played, goals, assists and points per game; offensive, defensive and overall point shares compared to controls. In terms of treatment, 47.8% of all players were treated operatively with half of these players treated with surgery after suffering season-ending injuries. Compared to operative treatment, conservatively managed players experienced a significant decrease in points per game after injury (p = 0.034), however there were no significant differences in number of seasons played, goals per game, assists per game, offensive, defensive and overall point shares between treatment groups.Conclusion:Regardless of treatment, professional hockey players experience a high rate of return to play with acceptable performance outcomes following in-game shoulder instability events. Surgical management can be beneficial as an increase in points per game was seen in those treated operatively compared to players managed nonoperatively.