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Incidence of shoulder dislocations in the UK, 1995-2015: a population-based cohort study

Anjali Shah¹, Andrew Judge^1,2,3, Antonella Delmestri¹

¹Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

|November 16, 2017

Insights

Primary shoulder dislocations are most common in young men. However, incidence unexpectedly rises in women over 50, a trend not seen in men, warranting further investigation into this demographic pattern.

Area of Science:

Orthopedics
Epidemiology
Public Health

Background:

The incidence of primary shoulder dislocations, particularly age- and gender-specific rates in the UK, remains largely uncharacterized.
Understanding these epidemiological patterns is crucial for public health initiatives and clinical management.

Purpose of the Study:

To evaluate the age-specific and gender-specific incidence of primary shoulder dislocations in the United Kingdom.
To provide the first national-level data on shoulder dislocation incidence using primary care records.

Main Methods:

A cohort study utilizing UK primary care data from the Clinical Practice Research Datalink (CPRD) between 1995 and 2015.
Inclusion criteria: patients aged 16-70 years with a shoulder dislocation. Coding accuracy for primary dislocations was validated.
Incidence rates were calculated per 100,000 person-years with 95% confidence intervals.

Main Results:

The coding accuracy for shoulder dislocations in the CPRD was 89%, with 76% confirmed as primary dislocations.
Overall incidence was higher in men (40.4/100,000 person-years) than women (15.5/100,000 person-years).
The highest incidence occurred in men aged 16-20 years (80.5/100,000 person-years), while incidence in women increased with age, peaking at 28.6/100,000 person-years in those aged 61-70.

Conclusions:

This study provides the first UK-based incidence data for primary shoulder dislocations using national primary care records.
A key finding is the increased incidence in women over 50, contrasting with men in the same age group.
Further research is needed to understand the unknown reasons behind this age-related incidence increase in women and to explore treatments and predictors for recurrent dislocations.

Read full analysis

Abstract

Objective:

This cohort study evaluates the unknown age-specific and gender-specific incidence of primary shoulder dislocations in the UK.

Setting:

UK primary care data from the Clinical Practice Research Datalink (CPRD) were used to identify patients aged 16-70 years with a shoulder dislocation during 1995-2015. Coding of primary shoulder dislocations was validated using the CPRD general practitioner questionnaire service.

Participants:

A cohort of 16 763 patients with shoulder dislocation aged 16-70 years during 1995-2015 were identified.

Primary Outcome Measure:

Incidence rates per 100 000 person-years and 95% CIs were calculated.

Results:

Correct coding of shoulder dislocation within CPRD was 89% (95% CI 83% to 95%), and confirmation that the dislocation was a 'primary' was 76% (95% CI 67% to 85%). Seventy-two percent of shoulder dislocations occurred in men. The overall incidence rate in men was 40.4 per 100 000 person-years (95% CI 40.4 to 40.4), and in women was 15.5 per 100 000 person-years (95% CI 15.5 to 15.5). The highest incidence was observed in men aged 16-20 years (80.5 per 100 000 person-years; 95% CI 80.5 to 80.6). Incidence in women increased with age to a peak of 28.6 per 100 000 person-years among those aged 61-70 years.

Conclusions:

This is the first time the incidence of shoulder dislocations has been studied using primary care data from a national database, and the first time the results for the UK have been produced. While most primary dislocations occurred in young men, an unexpected finding was that the incidence increased in women aged over 50 years, but not in men. The reasons for this are unknown. Further work is commissioned by the National Institute for Health Research to examine treatments and predictors for recurrent shoulder dislocation.

Study Registration:

The design of this study was approved by the Independent Scientific Advisory Committee (15_260) for the Medicines & Healthcare products Regulatory Agency.

Keywords:

clinical practice research datalink cprd incidence shoulder dislocation

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