Shoulder Check: Investigating Shoulder Injury Rates, Types, Severity, Mechanisms, and Risk Factors in Canadian Youth Ice Hockey

Objective: To describe shoulder-related injury rates, types, severity, mechanisms, and risk factors in youth ice hockey players during games and practices. Study Design: Secondary analysis of data from a 5-year prospective cohort study Safeto-Play (2013-2018). Subjects: Overall, 4419 individual players (representing 6585 player-seasons; 3806 males: 613 females) participated. During this period, 118 primary shoulder-related game injuries and 12 practice injuries were reported. Outcome Measures: Injury surveillance data was collected from 2013-2018 (time-loss or medical attention injuries). Descriptive statistics were calculated, and injury rates with 95% CI were estimated using Poisson regression. An exploratory multivariable mixed-effects Poisson regression model (clustering by team and offset by exposure hours) examined risk factors. Results: The shoulder injury rate was 0.70 injuries/1000 game-hours (95% CI 0.371.33) and 0.07 injuries/1000 practice-hours (95% CI 0.04-0.12). Two-thirds of game injuries (n=79, 69%) resulted in >8 days of time-loss, and more than one-third (n=44, 39%) resulted in >28 days of time-loss. An 82% lower rate of shoulder injury was associated with policy prohibiting body checking compared to leagues allowing body checking [IRR=0.18 (95% CI 0.10-0.32)]. A higher shoulder injury rate was seen for those who reported any injury in the last 12-months compared to those with no history [IRR=2.32 (95% CI 1.57-3.41)]. Conclusions: Most shoulder injuries resulted in more than one week of time-loss. Risk factors for shoulder injury included participation in a body checking league and history of injury in the previous 12 months. Further study of prevention strategies specific to the shoulder may merit further consideration in ice hockey.