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090 Joint hypermobility in athletes is associated with shoulder injury and shoulder pain: a systematic review and meta-analysis
  1. Behnam Liaghat1,
  2. Julie Rønne Pedersen1,
  3. J Young James1,2,
  4. Jonas Bloch Thorlund1,3,
  5. Birgit Juul-Kristensen1,
  6. Carsten Bogh Juhl1,4
  1. 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  2. 2Department of Research, Canadian Memorial Chiropractic College, Toronto, Canada
  3. 3Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
  4. 4Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark


Background Joint hypermobility in athletes is associated with increased risk of knee injuries, but currently it is unclear if joint hypermobility is associated with increased risk of shoulder injuries.

Objective To assess the association between joint hypermobility and shoulder injuries in athletes.

Design Systematic review and meta-analysis. Odds ratios (OR) for having shoulder injuries in exposed (joint hypermobility) athletes compared with non-exposed (without joint hypermobility) athletes were estimated using a random effects meta-analysis. We performed subgroup analyses to explore the effect of sex, type of sport, sports level, study type, risk of bias, and exposure definition (generalised joint hypermobility (GJH) or shoulder joint hypermobility). Risk of bias was assessed using Newcastle-Ottawa Scale, and overall quality of evidence using Grading of Recommendations Assessment, Development and Evaluation.

Setting Recreational and elite sports settings or military settings.

Patients (or Participants) Athletes (all sports) and military personnel above 16 years of age.

Interventions (or Assessment of Risk Factors) Exposure: GJH or shoulder joint hypermobility.

Main Outcome Measurements Acute shoulder injury or activity-related shoulder pain.

Results In total, 2,496 participants (31.9% females, mean age 19.9 years) from seven studies were included. Athletes with joint hypermobility were more likely to have shoulder injuries (OR = 3.41, 95% CI 1.88, 6.21, I2 = 71.5%) than athletes without joint hypermobility. Exposure definition had large impact on estimates (GJH, OR = 1.97, 95% CI 1.32, 2.94; shoulder joint hypermobility, OR = 6.79, 95% CI 3.91, 11.80; p=0.002), while remaining subgroup analyses showed no differences. The overall quality of evidence was low.

Conclusions We found 3-fold higher odds of shoulder injuries among athletes with joint hypermobility compared with non-exposed athletes. Due to low quality of evidence, future research may change the effect estimate. These findings highlight the need for prevention of shoulder injuries in athletes with joint hypermobility.

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