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Shoulder Instability in Women Compared with Men

Epidemiology, Pathophysiology, and Special Considerations

DeFroda, Steven F. MD1; Donnelly, Joseph C. BA1; Mulcahey, Mary K. MD2; Perez, Lizbeth BA2; Owens, Brett D. MD1

doi: 10.2106/JBJS.RVW.19.00007
Review Articles

  • » Although shoulder instability is well described, there is a paucity of literature examining the differences between women and men with regard to epidemiology, pathophysiology, and treatment of shoulder instability.
  • » Variability in muscle mass, ligamentous laxity, and overall biomechanics of the glenohumeral joint may cause men and women to experience shoulder instability in different ways.
  • » Additionally, differences in circulating hormones such as relaxin may contribute to increased joint laxity in women compared with men; these differences affect the pathophysiology of instability.
  • » The presence of increased physiologic laxity, due to these hormone levels, in female patients makes the treatment considerations more complex in that many classification systems do not take sex into consideration (i.e., the Instability Severity Index Score).

1Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island

2Department of Orthopaedic Surgery (M.K.M.), Tulane University School of Medicine (L.P.), New Orleans, Louisiana

E-mail address for S.F. DeFroda:

Investigation performed at Brown University, Providence, Rhode Island

Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and “yes” to indicate that the author had other relationships or activities that could be perceived to influence, or have the potential to influence, what was written in this work (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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