Background Approximately 6 million youngsters play organized baseball yearly, and injuries are common. Defining of risk factors for injuries in the throwing shoulder has largely been confined to the ...professional thrower. Unfortunately, these risk factors apply to only 1% of pitchers at risk for injury. Risk factors for injury in youth pitchers have received far less attention than those in more mature professional pitchers. Development of such an understanding would help clarify injury prevention efforts for the other 99% of pitchers actively participating in competitive baseball. This study intended to determine the ability of range of motion (ROM) measures to predict arm injuries in baseball pitchers aged 8 to 18 years. Methods Supine passive shoulder ROM was assessed in 115 pitchers with a digital inclinometer. Two trials of ROM were measured before the season. Arm injuries were prospectively tracked. Receiver operating characteristic curves were used to identify athletes who were at high risk for injury. Statistical significance was set a priori (α = .05). Results There were 33 injured and 82 uninjured pitchers. Side-to-side differences of horizontal adduction >15° and internal rotation >13° may discriminate between those adolescent pitchers at 4 and 6 times greater risk of injury, respectively. Conclusion Preseason ROM differences were able to identify those adolescents at high risk for injury during the season. It appears that the risk profile for adolescent pitchers includes horizontal adduction differences that differ from the established prospective profile in adult pitchers.
Background: Range of motion deficits in shoulder external rotation (ER), internal rotation (IR), total rotation range of motion (ER + IR), and horizontal adduction (HA) have been retrospectively ...associated with overhand athletes’ arm injuries.
Hypothesis: The authors expected the incidence of upper extremity injury in high school softball and baseball players with side-to-side shoulder range of motion deficits to be greater than the incidence of upper extremity injury in players with normal shoulder range of motion.
Study Design: Cohort study (prognosis); Level of evidence, 2.
Methods: High school softball and baseball players (N = 246) participated. Before the start of the season, passive shoulder ER, IR, and HA were assessed at 90° of abduction with the scapula stabilized. Relative risk (RR) was calculated to examine range of motion measure, by categorical criteria, and risk of upper extremity injury.
Results: Twenty-seven shoulder and elbow injuries (9 softball, 18 baseball) were observed during the season. The dominant shoulder of all injured players and baseball players displayed a significant decrease in HA (P = .05) and IR (P = .04). The dominant shoulder total rotation of injured baseball players displayed a significant decrease (mean difference = 8.0° ± 0.1°; P = .05) as compared with the dominant shoulder of uninjured baseball players. Players who displayed a decrease of ≥25° of IR in the dominant shoulder were at 4 times greater risk of upper extremity injury compared with players with a <25° decrease in IR, especially for baseball players. While we observed a 1.5 to 2 times increased risk of injury for the 10° to 20° loss in rotational range of motion for the overall sample and baseball, the risk estimates were not statistically significant (P > .05).
Conclusion: There are large mean deficits in shoulder IR and HA between injured and noninjured players, but not in ER or total rotation. Passive shoulder IR loss ≥25° as compared bilaterally was predictive of arm injury. Shoulder range of motion deficits differed between sports and appeared more predictive of injury for baseball players.
To characterise whether preseason screening of shoulder range of motion (ROM) is associated with the risk of shoulder and elbow injuries in overhead athletes.
Systematic review and meta-analysis.
Six ...electronic databases up to 22 September 2018.
Inclusion criteria were (1) overhead athletes from Olympic or college sports, (2) preseason measures of shoulder ROM, (3) tracked in-season injuries at the shoulder and elbow, and (4) prospective cohort design. Exclusion criteria were (1) included contact injuries, (2) lower extremity, spine and hand injuries, and (3) full report not published in English.
Fifteen studies were identified, and they included 3314 overhead athletes (baseball (74.6%), softball (3.1%), handball (16.1%), tennis (2.0%), volleyball (2.0%) and swimming (2.2%)). Female athletes are unrepresented (12% of the overall sample). Study quality ranged from 11 to 18 points on a modified Downs and Black checklist (maximum score 21, better quality). In one study, swimmers with low (<93°) or high (>100°) shoulder external rotation were at higher risk of injuries. Using data pooled from three studies of professional baseball pitchers, we showed in the meta-analysis that shoulder external rotation insufficiency (throwing arm <5° greater than the non-throwing arm) was associated with injury (odds ratio=1.90, 95% confidence interval 1.24 to 2.92, p<0.01).
Preseason screening of shoulder external rotation ROM may identify professional baseball pitchers and swimmers at risk of injury. Shoulder ROM screening may not be effective to identify handball, softball, volleyball and tennis players at risk of injuries. The results of this systematic review and meta-analysis should be interpreted with caution due to the limited number of studies and their high degree of heterogeneity.
CRD42017072895.
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