Posttraumatische Schulterinstabilität im Wachstumsalter

BACKGROUND: Post-traumatic shoulder instability in adolescence represents a very rare condition. However, most of these patients develop recurrent shoulder dislocations over time. METHODS: We report about a retrospective study, which included 32 patients younger than 16 years of age. The mean follow-up was 5 years. Our evaluation focussed on patients' age at the time of first shoulder dislocation, type of injury, and the results after conservative and operative treatment. RESULTS: After the first dislocation, all shoulders were immobilized for 3 weeks and were treated with physiotherapy afterwards. Of these 32 patients, 30 (94%) developed recurrent shoulder dislocations. Eight patients remained in a conservative regimen (age <15 years) and 21 patients were operated for persistent shoulder instability (age >15 years). The recurrence rate was 8 of 21 patients (36.5%) in the operative group and 4 of 8 patients in the conservative group. At the time of follow-up, 4 of 8 conservatively treated patients had returned to their former sports activities and 15 of 21 (71%) in the operated group. CONCLUSIONS: Our results on post-traumatic shoulder instability in adolescence show high recurrence rates in both conservative and operative groups. After adolescence, including ossification of the glenoid, operative treatment is able to decrease the recurrence rate and to increase the sports ability of these young patients.     

Anterior shoulder dislocation in adolescents

Of 780 patients treated for primary anterior shoulder dislocations, 33 (4.2%) were aged 12 to 17 years at the time of the dislocation. We clinically evaluated 28 of these patients a mean of 7.1 years after the initial dislocation. All patients were radiographed, and 15 underwent magnetic resonance imaging or computed arthrotomography of the shoulder. The primary dislocation had been traumatic in 21 patients (75%) and atraumatic in 7 patients (25%). Recurrent dislocations had occurred in 24 cases (86%), the number of recurrences ranging from 1 to 30. In the group with traumatic primary dislocations, the rate of recurrences was 92% and the mean number of redislocations was 7 in the patients who had been 14 to 17 years of age at the time of the initial injury, whereas the corresponding figures were 33% and 0.3 in the patients who had been 13 years of age or less at the time of the initial injury. Imaging studies showed a Bankart lesion in 80% of cases; each of these patients had had a traumatic primary dislocation and was 14 to 17 years old at the time of injury. During the follow-up period, operative stabilizing procedures had been performed in 7 cases. At follow-up evaluations, all nonoperated patients showed clinical evidence of anterior or multidirectional instability of the involved shoulder; of the operated patients, each of those with traumatic primary dislocations reported no recurrences and had a satisfactory result, whereas both of the patients with atraumatic primary dislocations continued to have subluxation and/or dislocations of the operated shoulder. In the 14- to 17-year-old adolescents with traumatic primary dislocations in whom imaging studies show Bankart lesions, there is an indication for prophylactic stabilizing surgery at the time of the initial injury.     

Correlation between Bankart and Hill-Sachs lesions in anterior shoulder dislocation

Background: Bankart lesions and Hill‐Sachs lesions are commonly associated with anterior shoulder dislocations. The presence of Bankart lesion indicates the need for surgical repair. Magnetic resonance imaging (MRI) has been shown to be sensitive in detecting these two lesions. The aim of this study is to investigate the correlation between Bankart lesions and Hill‐Sachs lesions on MRI for patients with traumatic anterior shoulder dislocations. Methods: Between 2003 and 2005, 61 patients from Alfred and Sandringham Hospitals had an MRI as part of the investigation for traumatic anterior shoulder dislocations. The MRI scans were reviewed and subsequently confirmed by a radiologist to show the presence or absence of Bankart and Hill‐Sachs lesions. The data were then analysed by a statistician. Results: Although patients with one of these lesions were more than two‐and‐a‐half times as likely to have the other, small study numbers precluded this result from achieving statistical significance. (odds ratio, 2.67 (0.83–8.61), P = 0.10). Younger age was a strong predictor of a recurrence of shoulder dislocation (odds ratio, 0.93 (0.89–0.98), P = 0.005). The presence of Bankart or Hill‐Sachs lesions on MRI for the primary shoulder dislocation group was similar to the recurrent group (73% vs. 72% for Bankart lesion and 67% vs. 70% for Hill‐Sachs lesion). Conclusion: There is a strong correlation between both lesions. This apparent trend can be useful in predicting the presence of a Bankart lesion when a Hill‐Sachs lesion is identified on a plain radiograph. This study suggests the consideration of surgical repair after identification of a Hill‐Sachs lesion on plain radiographs, especially for younger patients where the rate of re‐dislocation is high.     

Immobilization After Primary Dislocation of the Shoulder

A total of 226 patients with primary shoulder dislocation were followed up for 1 year, the primary object being to observe the effect of immobilization on the incidence of redislocation. the shoulders were immobilized in a mitella for 1 week in all the 127 patients older than 50 years of age, and in 53 of the patients under 50 years of age. the shoulders of the remaining 46 patients (under 50 years) were completely immobilized with a stockinette—Gilchrist bandage for a period of 3 weeks.

Thirteen per cent (30/226) suffered from one to four redislocations each during the follow-up period. Because most recurrences occurred in the patients under 30 years of age, these patients were compared with the older ones in the analysis. the frequency of redislocation was higher in the group of 53 patients under 30 years than in the older subgroup (P< 0.001). Twenty-six of these 53 patients (under 30 years), who had been immobilized for 1 week, presented a higher frequency of redislocation than the remaining 27 patients subjected to 3 weeks' immobilization (P<0.05). Manual labourers experienced more numerous redislocations than office workers (P<0.01). the greater the initial trauma to the shoulder, the lower was the incidence of recurrence. There were only two among the 57 patients with early complications of the primary shoulder dislocation who had a redislocation (P< 0.001). Residual stiffness was encountered more often in the patients over 30 years than in the younger ones (P< 0.001).

Following primary shoulder dislocation, 1 week's immobilization in a sling is sufficient in patients over 30 years, while in the case of most of the younger patients 3 weeks' complete immobilization of the shoulder is recommended.     

Longer immobilization extends the "symptom-free" period following primary shoulder dislocation in young rugby players

The purpose of this study was to evaluate the effect of longer immobilization following primary shoulder dislocation in young rugby players for the prevention of recurrence. We sent a questionnaire regarding shoulder dislocation to all senior high school and college rugby teams in the southwest region of Japan. We received replies from 5476 players in 196 teams (i.e., answers were received from 76% of the teams). Based on the answers from the 79 rugby players who had undergone shoulder dislocations and who were eligible for the study, we divided them into two groups; group I: immobilization for 0–3 weeks at the time of the initial dislocation (n = 61), and group II: immobilization for 4–7 weeks (n = 18). We compared the time-course from primary dislocation to recurrence between the two groups, using the Kaplan-Meier method. The age range at the time of the primary dislocation was 14–23 years (average, 16.7 years). The probability of recurrence in groups I and II, respectively, was 78% and 44% after 1 year; and 85% and 69% after 2 years. The median period from return to rugby to recurrence was 4 months in group I and 14 months in group II. The symptom-free period was extended when immobilization was carried out for 4 weeks or more, in comparison with the symptom-free period in those who had immobilization for 3 weeks or less. Received: December 13, 2000/Accepted: September 26, 2001     

Recurrences after initial dislocation of the shoulder. Results of a prospective study of treatment

During the years 1978 and 1979, the results in 257 patients with a primary anterior dislocation of the shoulder were prospectively studied. The patients were less than forty years old and had been treated at twenty-seven Swedish hospitals. Thirty-two patients had a fracture of the greater tuberosity, but none of them reported having any further dislocations within two years after treatment, while 32 per cent of the patients without this fracture had a redislocation during the same period. The incidence of fractures of the greater tuberosity varied with the age of the patient; the highest rates were in the age groups of twelve to thirteen years and thirty-four to forty years (43 and 30 per cent, respectively), while in the age group of twenty to twenty-two years this injury was found in only 3 per cent of the patients. Chip fractures of the glenoid rim were found in 8 per cent of the patients, most of whom were in the older age groups. Impression fractures in the posterior part of the humeral head were demonstrated in 55 per cent of the patients and were not associated with a significantly higher rate of recurrence of dislocation. One hundred and twelve patients used an immobilization device for three to four weeks, while 104 patients began to use the shoulder as early and as freely as possible. At the two-year follow-up the groups showed an equal rate of recurrence of dislocation. In the age group of twenty-two years or younger nearly 50 per cent of the patients had one or more recurrences, regardless of treatment. In the two older age groups (twenty-three to twenty-nine and thirty to forty years old), the incidence of recurrence was 25 per cent or less.     

The epidemiology of shoulder dislocations

Summary In an urban population of a quarter of a million, all shoulder dislocations that occurred in a 5-year period were recorded. A total of 216 shoulder dislocations were seen, 53.3% in men. The overall incidence rate was 17/100000 per year. Incidence peaks were found in the age-group 21–30 years among men and in the age-group 61–80 years among women. Significantly more patients in the older age groups, and especially women, dislocated at home by falling on an outstretched arm, whereas the younger age-groups most frequently dislocated outside the home, e.g., on sports fields. A considerable number of patients (18.6%) were hospitalized, and 85.5% of the patients required outpatient follow-up. Prophylactic measures should be taken especially to increase the safety of the elderly in their homes.     

Die Therapie der traumatischen vorderen Schulterluxation: Aktueller Stand der Therapie in Deutschland Gibt es wissenschaftlich gesicherte Therapiekonzepte?

There are no generally accepted concepts for the treatment of traumatic anterior shoulder dislocation. The objective of this study was to ascertain the current treatment for traumatic shoulder dislocations in German hospitals and to compare this with the data reported in the literature. A total of 210 orthopedic surgery departments were asked for their treatment strategy in an anonymous country-wide survey; 103 questionnaires (49%) were returned for evaluation. Additional imaging (ultrasound, CT, MRI) beyond the routine X-rays is performed in 82% of clinics for primary shoulder dislocation (94% in recurrent dislocation). A young, athletic patient (< 30 years old) would be operated on for a primary traumatic shoulder dislocation in 73% of hospitals (98% in recurrent dislocation). In contrast, a patient of the same age, with a moderate level of sporting activity would be treated conservatively in 67% of cases (14% in recurrent dislocation). Similarly, for an active, middle-aged patient with a demanding job, 74% of responses favored conservative treatment after a primary dislocation and 6% after a recurrent dislocation. Older patients (> 65 years old) are usually treated conservatively after a primary or recurrent shoulder dislocation (99%, 69%). For a primary shoulder dislocation the most popular surgical reconstruction is a Bankart repair (75%). For recurrent shoulder dislocation several different operative techniques are seen (Bankart 29%, T-shift 26%, Putti-Platt 8%, Eden-Lange-Hybbinette 22%, Weber osteotomy 13%). Based on our literature review, we found: (1) The clinical examination of both shoulders is important to diagnose hyperlaxity; (2) Routine CT or MRI is not necessary for primary traumatic shoulder dislocations; (3) A young, athletic patient should undergo surgical reconstruction after a primary shoulder dislocation; (4) The operation of choice for primary and recurrent dislocation is the Bankart repair; (5) There is no sufficient evidence that an arthroscopic Bankart repair is as good as an open procedure; (6) There are limited indications for other operative techniques, as they are associated with a higher recurrence and arthrosis rate.     

A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study

This preliminary prospective study was conducted to determine whether immobilization with the arm in external rotation would decrease the rate of recurrence after initial traumatic anterior dislocation of the shoulder. Forty patients with initial shoulder dislocations were assigned to (1) conventional immobilization in internal rotation (IR group, n = 20) or (2) a new method of immobilization in external rotation (ER group, n = 20). The recurrence rate was 30% in the IR group and 0% in the ER group at a mean 15.5 months. The difference in recurrence rate was even greater among those who were aged less than 30 years (45% in the IR group and 0% in the ER group). Immobilization with the arm in external rotation is effective in reducing the rate of recurrence after initial dislocation of the shoulder.     

Papillary Microcarcinoma

Background Papillary microcarcinoma (PMC) is increasing in incidence because of diagnosis by ultrasound-guided fine-needle aspiration cytology. Methods Between January 1966 and December 1995, we treated 6019 patients with papillary cancer; among them, 2070 patients with PMC were studied. Results PMC is essentially very similar to papillary cancer that is 11 mm or larger and has a very good prognosis. Smaller tumors and younger patients have a better prognosis. Among PMC, larger tumors (6–10 mm) recur in 14% at 35 years compared with 3.3% in patients with smaller tumors. Patients older than 55 years have recurrence in 40% at 30 years, with a worse prognosis than younger patients who have a recurrence rate of less than 10%. Extracapsular invasion by the primary tumor also has a higher recurrence rate. The majority of recurrences are in the neck. Therefore, annual ultrasound of the neck is effective for recurrence surveillance. Conclusion Papillary microcarcinoma is similar to larger papillary carcinomas with tumor characteristics and age-based recurrence rate that extends for many years, justifying long surveillance after surgery.     

Management of shoulder dislocation--are we doing enough to reduce the risk of recurrence?

Young patients with shoulder dislocation are at high risk of recurrence. Traditionally, management has been conservative, but rehabilitative programmes are successful in fewer than 20% of patients. Recent studies suggest that early surgical intervention (arthroscopic lavage or stabilisation) can significantly reduce recurrence in young patients with primary traumatic anterior dislocation. This study demonstrated that in our region, 21% of all patients presenting with shoulder dislocation had already suffered recurrence at 1 year; in the 15-22 years age group this figure was 43%. We propose to offer young patients presenting with primary traumatic anterior dislocations arthroscopic lavage within 10 days of injury. The extra surgical workload is manageable within our current trauma service arrangements, and we believe that this form of treatment would be acceptable to patients.     

Do Very Young Korean Breast Cancer Patients Have Worse Outcomes?

Background In general, Korean women with breast cancer are younger than white women. We have compared the clinicopathologic characteristics and prognosis in very young and less young premenopausal Korean women with breast cancer. Methods Of the breast cancer patients treated at the Asan Medical Center in Seoul, Korea, from 1989 to 2002, 381 (9.6%) were younger than 35 years of age (the “very young” group) and 2320 were 35 to 50 years of age (the “less young” group). We retrospectively compared the clinicopathologic factors and survival rates of these two groups. Results The very young group with lymph node metastases had poorer 5-year survival (69.9% vs. 82.7%, P = .0063) and disease-free survival (58.1% vs. 74.1%, P < .0001) rates than their older counterparts. In addition, the very young group had more advanced-stage disease (P = .001), higher T stage (P = .001), and more positive lymph nodes (P = .024) than did their older counterparts, as well as higher percentages of estrogen receptor–negative disease (48.2% vs. 42.1%, P = .047), progesterone receptor–negative disease (53.5% vs. 44.1%, P = .002), and grade 3 histology (52.1% vs. 43.5%, P = .011) tumors. Conclusions Compared with older premenopausal Korean women with breast cancer, those younger than 35 years old had a poorer prognosis as a result of a higher rate of recurrence, a later stage at diagnosis, and more aggressive disease. Thus, in Korean breast cancer patients, age younger than 35 years was an independent predictor of recurrence.     

The rate of recurrence of traumatic anterior dislocation of the shoulder

Summary We have reviewed the history of 154 primary, traumatic dislocations of the shoulder in order to determine the risk of recurrence. We found a recurrence rate of 68% in patients under the age of 20, after a follow-up period of 1–9 years (average 4.5 years). There was a highly significant difference (p<0.0001) in the recurrence rate of patients under, and above, 30 years of age. Twenty per cent of the patients had a concurrent minor fracture at the shoulder with 2 out of 39 of the recurrent cases (5%) and 29 of the 115 non-recurrent cases (25%); this is also a significant difference (p<0.01). Neither the need for general anaesthesia at primary injury nor the occupation of the patient was a relevant factor in the final outcome of the dislocation. Four nerve injuries were encountered (3%), with no severe sequelae at follow-up. The young patient with no concurrent fracture at the time of the primary shoulder dislocation has a high risk of recurrence.

---

Résumé Afin d'évaluer le risque de récidive, on a revu 154 observations de luxations traumatiques primitives. 68% des patients âgés de moins de 20 ans ont présenté une récidive après une période variant de 1 à 9 ans (4.5 ans en moyenne). Le pourcentage de récidive, au dessus ou au dessous de l'âge de 30 ans, diffère de façon hautement significative (p<0.001). Vingt pour cent des cas présentaient également une fracture mineure de l'épaule, parmi lesquels 2 sur les 39 cas de récidive (5%) et 29 sur les 115 cas de non-récidive (25%). Cette différence est également significative (p<0.01). Ni la nécessité d'une anesthésie générale à l'occasion de la première réduction, ni le métier du patient n'étaient des facteurs influant sur le résultat final. Quatre lésions nerveuses (3%) ont été observées, aucune n'a entraîné de séquelles. Chez les patients jeunes qui présentent une première luxation de l'épaule sans fracture, le risque de récidive est très élevé.

     

Traumatic shoulder dislocation. Late functional results with reference to the frequency of redislocation

This study reports on the after-examination of 86 out of 107 patients with primary shoulder dislocation. Of greatest interest was the question which period of immobilisation would yield the best results. The most frequent type of dislocation was the subcoracoid position in 62% of all cases. In 44% the dislocations were associated with fractures especially of the greater tuberosity. The greatest number of dislocations occurred between 61 and 80 years of age (= 42%). The second highest number was found between 21 and 40 years of age (= 29%). In 47% of all cases the shoulder was immobilised for a week, in 40% between one and two weeks and in 13% for more than two weeks. The incidence of recurrence was 15% (13 patients). In 8 cases (= 9%) a recurrent dislocation of the shoulder resulted, whereas in 5 cases (= 6%) only one relapse occurred due to a repeated intense trauma. The function of the injured shoulder is most significantly impaired and rendered worse by the factors: higher age (greater than 41 years) and associated fractures. The duration of immobilisation itself has neither a significant influence on posttraumatic function of the shoulder nor on the incidence of recurrence. Therefore, an uncomplicated dislocation of the shoulder should be immobilised for a short period only. However, in cases of associated fractures, immobilisation will be necessary for a longer time.     

Incidence of anterior shoulder dislocation in Olmsted County, Minnesota

The records of all Olmsted County, Minnesota residents treated for an initial traumatic anterior shoulder dislocation during a ten-year period were reviewed to study the incidence and natural history of this condition. One hundred twenty-four patients had been treated during the study period, and in 116 patients (93.5%) complete follow-up evaluation was available. The overall adjusted incidence of initial traumatic shoulder dislocations was 8.2/100,000 person-years; of all traumatic shoulder dislocations, the rate was at least 11.2/100,000 person-years. Incidence rates were significantly greater for men than for women. There was no urban versus rural difference in incidence or recurrence rates. The authors concluded that shoulder dislocation occurs most frequently in younger male patients and occurs with similar frequency in urban and rural settings. Except for age-related differences in recurrence rates no significant referral bias was found among patients treated at a tertiary care facility as compared with patients from the local community.     

Treatment of aggressive fibromatosis (desmoid). Reducing the rate of recurrence by postoperative irradiation

Thirty-three patients with desmoid tumors were treated from 1 January 1970 through 31 December 1983 at the University Hospital in Basel. Twenty-nine patients were treated primarily by surgery in an attempt to cure. Sixty percent of these patients (17 of 29) suffered a subsequent recurrence. Of these 17 patients, 12 were treated with radiotherapy after a second operation. As a result, the recurrence rate was reduced to 25% (3 of 12). Following the initial tumor resection, 4 patients were treated by radiotherapy in an effort to cure. All 4 patients remain free of recurrence, with a median follow-up time of 56 months. The postoperative recurrence rate is dependent on age. No recurrences were observed in patients older than 40. In the younger patients, an increasing recurrence rate was observed the younger the patient. Radiotherapy can contribute to improved prognosis for desmoid tumors under the following circumstances: (1) when the tumor cannot be resected with histologically clear margins, or when resection margins are questionable; (2) when the patient is 30 years old or younger; (3) when the tumor is inoperable, or resectable only by means of a mutilating operation. For patients between 30 and 40 years of age, the question of postoperative radiotherapy should be discussed with the radiation oncologist, even following a microscopically complete resection.     

Functional outcomes of early arthroscopic bankart repair in adolescents aged 11 to 18 years

Recurrent shoulder instability can significantly affect a patient's quality of life and place them at risk for extensive soft tissue and bony injury with repeated dislocations. Literature on the operative management of recurrent instability in pediatric patients is limited, as most studies include pediatric patients within a larger sample group comprised primarily of adults. The purpose of this paper was to investigate the role of early arthroscopic Bankart repair (ABR) after anterior shoulder dislocation or subluxation in a pure pediatric population. We retrospectively reviewed 32 consecutive ABRs in 30 pediatric patients. Sixteen shoulders failed initial nonoperative therapy before ABR, whereas surgical stabilization was the primary treatment in 16 shoulders after initial evaluation at our institution. There were 17 males and 13 females with an average age of 15.4 years (age range, 11-18 years). The average follow-up was 25.2 months. Functional outcomes were measured using the single assessment numerical evaluation (SANE) score. In the initial nonoperative group, the average SANE score was 92.2. There were 3 shoulder redislocations in 2 patients (18.75%). In the 16 shoulders treated with ABR as initial therapy, the average SANE score was 91.8, and there were 2 shoulder redislocations in 2 patients (12.5%). We conclude that primary ABR is an effective treatment of traumatically induced shoulder instability in pediatric patients. Primary ABR limits multiple recurring shoulder dislocations that hinder a patient's quality of life and places them at risk for future negative sequelae.     

Diffuse Sclerosing Variant of Papillary Carcinoma of the Thyroid: A 35-Year Comparative Study at a Single Institution

Background Diffuse sclerosing variant (DSV) is a rare variant of papillary thyroid carcinoma (PTC), and the features of this carcinoma have not been fully characterized. The aim of this study was to analyze the clinicopathologic features of a large cohort of patients with this disease. Methods We reclassified primary thyroid carcinomas treated in a 35-year study period and studied the clinicopathologic features and outcomes of DSV of PTC in comparison with classic PTC. Results Fifteen patients (2 men and 13 women) with DSV of PTC were identified who had surgical resection of the thyroid. Fine-needle aspiration biopsy diagnosed 83% (10 of 12) of the tumors. Compared with classic PTC, patients with DSV presented at a younger age (mean age, 29 vs. 46 years; P = .0001), had larger tumors (mean diameter, 3.6 vs. 2.2 cm; P = .002), and had a higher incidence of cervical nodal metastases (80% vs. 43%; P = .006). Ten patients had received postoperative iodine 131 ablation, and four had also received external-beam irradiation. Distant metastases were detected in two patients (one in lung and one in brain). One third (5 of 15) of the patients developed disease recurrence. Lymph node recurrence was detected in one patient 12 years after the initial operation. Over a median follow-up period of 10.7 years, one patient with an initial incomplete excision died of the carcinoma. The overall disease-specific survival rate was 93%. Conclusions DSV of PTC had distinctive clinicopathologic features and a high incidence of recurrence after operation but had a prognosis similar to that of classic PTC.     

Schulterluxation

High recurrence rates after non-surgical treatment of traumatic anterior shoulder dislocation, especially in young patients, seem inacceptable. General indications for surgical treatment cannot be tolerated due to a high percentage of spontaneous remission in elderly patients without concomitant lesions. The correct therapy must be evaluated individually on the basis of age-dependent prognosis for recurrence, concomitant lesions and level of physical activity. In patients aged 30 years or older with primary shoulder dislocation without further lesions non-surgical treatment can be recommended. Immobilization in external rotation reduces recurrence rates. Surgical shoulder stabilization is advantageous in physical active patients aged 25 years or younger. Arthroscopic treatment is generally accepted due to similar results to open procedures and the advantages of minimally invasive surgery.     

Shoulder injuries from birth to old age: A 1-year prospective study of 3031 shoulder injuries in an urban population

IntroductionShoulder injuries are commonly encountered in emergency departments. In spite of this, the epidemiology is only partly known, and soft tissue injuries in particular remain unclear. The aim of this study was to obtain an overview of shoulder injuries in a general population cohort, and to estimate the relative proportion of the main injury categories soft tissue injuries, fractures and dislocations, as well as their variation with age and gender.Patients and MethodsWe registered prospectively all patients admitted with a suspected shoulder injury at a combined casualty and primary health care facility during one year. The facility serves all hospitals and all citizens of Oslo. The patient-reported questionnaires, electronic patient records and radiology reports were examined.Results3031 shoulder injuries were registered from May 2013 through April 2014. The median age was 37 years (range 14 days–102 years), 51 years in women and 31 years in men (p < 0.001), 60% were male. The male/female shoulder injury incidence rate ratio in the 20–34 years age group was 3.6 (95%CI, 3.0 to 4.3; p < 0.001). Contrary, the female/male rate ratio above 75 years was 2.1 (95%CI, 1.6–2.8; p < 0.001). Almost half of the injuries were soft tissue injuries, 35% were fractures and 17% were dislocations. The age-stratified incidence rates differed substantially in men and women. Fractures dominated in children up to 10 years and in adults over 60 years, soft tissue injuries in the ages between. The highest dislocation incidence rates were found in young males. A rotator cuff tear was diagnosed in 4% of the injuries.ConclusionWhich shoulder structures that are affected by injury vary substantially with age and gender. The shoulder injury incidence rates of young men and the elderly are high. The findings are important for the understanding of the shoulder and the diagnostic process in A&Es.