ORIGINAL ARTICLES 23 IMAJ • VOL 18 • JANUARY 2016 Background: The popularity of bicycle riding for recreation, exercise and transportation has grown enormously in recent years, which has led to an increased incidence of bicycle- related injuries. While these injuries involve mainly the mus- culoskeletal system, data on shoulder-specifc injuries incurred while bike riding are lacking. Classifying these shoulder injuries may provide insight and assistance in the creation and implementation of effective protective gear and measures. Objectives: To investigate the types and mechanisms of shoulder injuries among cyclists. Methods: This study retrospectively examined all cyclists who incurred shoulder injuries while riding and were admitted to the emergency department and shoulder clinic between January 2008 and November 2013. The study included 157 subjects with various bicycle-related shoulder injuries treated with either conservative or surgical measures. Results: Eighty-four percent of injuries were caused by a direct blow to the shoulder, 7% by falling on an outstretched hand, 6% were traction injuries, and 3% were due to hyper- abduction. Nine different clinical types of injury were observed; the most common injuries were clavicle fractures ( 32%), followed by acromioclavicular joint dislocations (22%), rotator cuff tears (22%), and humeral fractures (8%). Fifty-one percent of subjects were managed with conservative care and the remaining patients required surgical interventions. Conclusions: Shoulder injuries incurred while riding a bicycle span the entire spectrum of shoulder injuries and often result in debilitating conditions. Although the use of helmets is increasing, there is currently no effective protective gear or measures to prevent riders from suffering shoulder injuries. IMAJ 2016; 18: 23–26 bicycle, shoulder injuries, clavicle fractures, protective gear Bicycle-Related Shoulder Injuries: Etiology and the Need for Protective Gear Yariv Goldstein MD, Oleg Dolkart PhD, Ehud Kaufman MD, Eyal Amar MD, Zachary T. Sharfman MSc, Ehud Rath MD, Gavriel Mozes MD and Eran Maman MD Shoulder Unit, Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center affliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ABSTRACT: KEY WORDS: B icycles were introduced in the 19th century in Europe and in 2003 numbered more than one billion worldwide, which is twice the number of automobiles [1]. Te popularity of bicycle riding for recreation, transportation and exercise has risen immensely in recent years [1]. Te United States Department of Transportation estimated that 57,000,000 people (27% of the general U.S. population) rode their bicycles at least once in the summer of 2002 [1]. In the urban setting, many people opt for bicycle transportation due to the lower operative costs and added beneft of physical ftness. Of-road bicycling has become a leading recreational activity that spans all ages and has experienced a noticeable increase of cyclists in their ffh and sixth decades. Te increased popularity of bicycles for recreation and transportation has resulted in an increased incidence of bicycle-related injuries, involving primarily the musculoskel- etal system [2]. Tis is demonstrated clearly in South Korea where bike-related injuries increased by 44% between 2007 and 2009 [3]. It is unclear whether the presence or lack of transportation infrastructure protects riders from or contributes to bicycle accidents. Bicyclists are vulnerable because they must fre- quently share the same infrastructure with motorized vehicles, but bicycles ofer their users no physical protection in the event of a crash [4]. As such, bicycle-related accidents ofen super- sede motorcycle-related accidents in severity [5]. Bicycle-related injuries most commonly involve the upper and lower extremities followed by the head, face, abdomen, thorax and neck [6], with 86.7% of injuries above the waist- line [7]. Furthermore, it has been reported that the shoulder is the most common site of traumatic musculoskeletal injury among cyclists [5]. Head injuries account for the most devastating of all bicycle- related injuries and the nature of their sequelae are especially severe. As such, the development and implementation of special protective gear, namely the helmet, has been widely adopted and even mandated by law in some countries. Helmets have the potential to dramatically reduce the risk of serious head and face injuries by up to 88% [2,8-11]. However, no data are avail- able regarding the type of shoulder injuries incurred among cyclists and the availability or efectiveness of specifc shoulder protection gear. Te importance of shoulder protection is not neglected for motorcyclists, however, as many motorcycle jackets include shoulder armor, highlighting the importance of these protective measures. To the best of our knowledge, no study has analyzed bicy- cle-related shoulder injuries. Te purpose of this study was to