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Cited by 42Shoulder Injury and TreatmentSports injuries and preventionConnective tissue disorders research

Joint hypermobility in athletes is associated with shoulder injuries: a systematic review and meta-analysis

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Liaghat, Behnam, Pedersen, Julie Rønne, Young, James J., Thorlund, Jonas Bloch, Juul-Kristensen, Birgit, Juhl, Carsten Bogh·2021·BMC Musculoskeletal Disorders
DOI 10.1186/s12891-021-04249-xPMC PMC8077913
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Abstract

Background: Joint hypermobility in athletes is associated with increased risk of knee injuries, but its role in relation to shoulder injuries has not been scrutinized. Therefore, our aim was to synthesize the evidence on the association between joint hypermobility and shoulder injuries in athletes. Methods: Data sources were MEDLINE, CINAHL, EMBASE, and SPORTDiscus from inception to 27th February 2021. Eligibility criteria were observational studies of athletes (including military personnel), mean age ≥ 16 years, and with a transparent grouping of those with and without joint hypermobility. A broad definition of joint hypermobility as the exposure was accepted (i.e., generalised joint hypermobility (GJH), shoulder joint hypermobility including joint instability). Shoulder injuries included acute and overuse injuries, and self-reported pain was accepted as a proxy for shoulder injuries. The Odds Ratios (OR) for having shoulder injuries in exposed compared with non-exposed athletes were estimated using a random effects meta-analysis. Subgroup analyses were performed to explore the effect of sex, activity type, sports level, study type, risk of bias, and exposure definition. Risk of bias and the overall quality of evidence were assessed using, respectively, the Newcastle–Ottawa Scale and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Among 6207 records, six studies were included with 2335 (range 118–718) participants (34.1% females; athlete mean age 19.9 years). Athletes with joint hypermobility were more likely to have shoulder injuries compared with athletes without joint hypermobility (OR = 3.25, 95% CI 1.64, 6.43, I 2 = 75.3%; p = 0.001). Exposure definition (GJH, OR = 1.97, 95% CI 1.32, 2.94; shoulder joint hypermobility, OR = 8.23, 95% CI 3.63, 18.66; p = 0.002) and risk of bias (low, OR = 5.25, 95% CI 2.56, 10.8; high, OR = 1.6, 95% CI 0.78, 3.29; p = 0.024) had large impacts on estimates, while the remaining subgroup analyses showed no differences. The overall quality of evidence was low. Conclusion: Joint hypermobility in athletes is associated with a threefold higher odds of having shoulder injuries, highlighting the need for prevention strategies in this population. However, due to low quality of evidence, future research will likely change the estimated strength of the association. Protocol registration: Open Science Framework registration osf.io/3wrn9.

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  • Research on adolescents and young adults with GJH remains predominantly focused on the biological and physical consequences of the condition.

    “While anxiety in adults with HSD and hEDS has been frequently studied, research on adolescents and young adults with GJH remains predominantly focused on the biological and physical consequences of the condition.69,70”

    From Role of Anxiety in Individuals with Generalized Joint Hypermobility: A Systematic Review (2025) · cites this paper as [70]

    The Results (Study characteristics) describe studies of mostly young adult athletes with joint hypermobility that measured shoulder injuries or pain, providing an example of research focused on physical consequences. The paper does not establish that research on adolescents and young adults with GJH is predominantly focused on biological and physical consequences; the adolescent swimmer study mentioned in the Discussion was excluded from the review. (LLM, conf=0.82)

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  • Young athletes with joint hypermobility were three times more likely to have shoulder injuries (e.g., dislocation) compared with athletes without joint hypermobility (OR = 3.25, p = 0.001).

    “A recent systematic review also found that young athletes with joint hypermobility were three times more likely to have shoulder injuries e.g., dislocation, compared with athletes without joint hypermobility (OR = 3.25, p = 0.001) [25].”

    From Pediatric joint hypermobility: a diagnostic framework and narrative review (2023) · cites this paper as [25]

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Cited by

Sorted by citations

Authors
Liaghat, B., Pedersen, J. R., Young, J. J., Thorlund, J. B., Juul-Kristensen, B., & Juhl, C. B.
Affiliations
University of Southern Denmark (DK)
Corresponding author
Liaghat, Behnam
ORCID
Venue
BMC Musculoskeletal Disorders
Publisher
Springer Science and Business Media LLC
Published
2021-04-26
Volume
22
Issue
1
Pages
389-389
ISSN
1471-2474 (ISSN-L)
DOI
10.1186/s12891-021-04249-x
PMC
PMC8077913
OpenAlex
W3158354111
Cited by
42
References
5
Citations by year
2026: 7 · 2025: 14 · 2024: 10 · 2023: 8 · 2022: 2 · 2020: 1
FWCI
1.20
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Musculoskeletal Disorders (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Surgery › Shoulder Injury and Treatment
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
Keywords
shoulder injuries, athletes, generalized joint hypermobility, overuse injuries, acute shoulder injury, shoulder pain, sports injuries, injury risk
MeSH terms
Shoulder Injuries, Adolescent, Adult, Athletic Injuries, Female, Humans, Joint Instability, Knee Injuries, Male, Shoulder Joint, Odds Ratio, Young Adult, Athletes

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