Spectrum of operative childhood intra-articular shoulder pathology.

Eric W Edmonds,Shital N Parikh,Joanna H Roocroft

doi:10.1007/s11832-014-0598-8

Abstract

PurposeWith increased sports participation and medical community awareness, there appears to be an increase in pediatric musculoskeletal injuries. Our purpose was to identify the intra-articular injury pattern seen within the pediatric shoulder.MethodsA retrospective review was performed at two tertiary-care children’s hospitals between 2008 and 2011 on all patients who underwent magnetic resonance imaging (MRI) and subsequent shoulder arthroscopy. Exclusion criteria included: girls >14 years old and boys >16 years old. Demographics, MRI and arthroscopic findings were recorded. Labral pathology was grouped: Zone I (Bankart lesions, 3–6 o’clock for right shoulder), Zone II (posterior labral lesions, 6–11 o’clock), Zone III (SLAP lesions, 11–1 o’clock), and Zone IV (anatomic variants, 1–3 o’clock).ResultsOne hundred and fifteen children met criteria, mean age 14.4 years (range 8–16). There were 24 girls and 91 boys, with 70 right shoulders. Of 108 children, labral pathology involved: 72 Zone I (16 isolated anterior), 56 Zone II (15 isolated posterior), 38 Zone III (four isolated superior), and three had an isolated Buford complex. Seventy had more than one labral zone injured, and 31 (30 %) had more than two zones injured. Non-labral pathology included partial rotator cuff tears and humeral avulsions of the glenohumeral ligament.ConclusionWith 94 % of intra-articular pathology being labral tears, the distribution of proportion in children differs from adults; moreover, 23 % involved only the posterior or posterosuperior labrum. Treating surgeons should be prepared to find anterior tears extending beyond the zone of a classic Bankart lesion and an association with C rotator cuff tears.

Highlights

Child and adolescent participation in organized athletics has become exceedingly popular, with evidence of high intensity play and minimal periods of rest [1]
Labral pathologies identified at surgery were grouped into zones based on a clock-face system that we developed, and noted as if appearing at a right shoulder (Fig. 1): Zone I (Bankart lesions) were 3–6 o’clock, Zone II were 6–11 o’clock, Zone III were 11–1 o’clock, and Zone IV were 1–3 o’clock
Intra-articular pathology seen in the adult shoulder includes, but is not limited to: rotator cuff disease, biceps tendon pathology, labral pathology, osteoarthritis and instability; and, according to our results, the spectrum of pathology in children appears to differ from adults, with the primary intra-articular pathology (93 %) being labral pathology

Summary

Introduction

Child and adolescent participation in organized athletics has become exceedingly popular, with evidence of high intensity play and minimal periods of rest [1]. An estimated 7 million high school students are participating in sports annually, and the knee is most commonly injured, nearly 11 % of all injuries occurred at the shoulder [2]. There have been reports of shoulder injuries in the pre-teenage population, related to instability, labral pathology and shoulder impingement [3,4,5]. Most children sustain an injury to the developing bone and growth plate rather than the soft-tissues of the glenohumeral joint as in the skeletally mature population [6]. To the best of our knowledge, no epidemiologic studies exist focusing on operative intra-articular shoulder pathology in children. Most shoulder studies that discuss children are confounded by wide age ranges, including late adulthood [7]

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