Skip to main content
SpringerLink
Log in

Prospective multifactorial analysis of preseason risk factors for shoulder and elbow injuries in high school baseball pitchers

  • Sports Medicine
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To prospectively identify preseason physical factors for shoulder and elbow injuries during the season in high school baseball pitchers.

Methods

The study included 105 high school baseball pitchers [median age 16 (15–17) years]. The range of motion of the shoulder (90° abducted external and internal rotation) and elbow (extension/flexion), shoulder muscle strength (abduction and prone internal and external rotation), shoulder and elbow laxity, horizontal flexion, and scapular dyskinesis were assessed. After the season, the participants completed questionnaires regarding shoulder and/or elbow injuries, with injury defined as an inability to play for ≥1 week due to elbow/shoulder problems. The results of two groups (injured and noninjured) were compared using t tests and Chi-square analyses. Stepwise forward logistic regression models were developed to identify risk factors.

Results

Twenty-one injuries were observed. In univariate analysis, 90° abducted internal rotation and total arc of the dominant shoulder and the ratio of prone external rotation in the dominant to nondominant sides in the injured group were significantly less than those in the noninjured group (P = 0.02, 0.04, and 0.01, respectively). In logistic regression analysis, 90° abducted internal rotation in the dominant shoulder and prone external rotation ratio were significantly associated with injuries (P = 0.02 and 0.03, respectively).

Conclusion

A low prone external rotation ratio and decreased 90° abducted internal rotation in the dominant shoulder in the preseason were significant risk factors for shoulder and elbow injuries in high school baseball pitchers. The results may contribute to reduce the incidence of these injuries.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Barrentine SW, Fleisig GS, Whiteside JA, Escamilla RF, Andrews JR (1998) Biomechanics of windmill softball pitching with implications about injury mechanisms at the shoulder and elbow. J Orthop Sports Phys Ther 28:405–415

    Article  CAS  PubMed  Google Scholar 

  2. Bigliani LU, Codd TP, Connor PM, Levine WN, Littlefield MA, Hershon SJ (1997) Shoulder motion and laxity in the professional baseball player. Am J Sports Med 25:609–613

    Article  CAS  PubMed  Google Scholar 

  3. Borsa PA, Dover GC, Wilk KE, Reinold MM (2006) Glenohumeral range of motion and stiffness in professional baseball pitchers. Med Sci Sports Exerc 38:21–26

    Article  PubMed  Google Scholar 

  4. Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy 19:404–420

    Article  PubMed  Google Scholar 

  5. Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy 19:641–661

    Article  PubMed  Google Scholar 

  6. Byl NN, Richards S, Asturias J (1988) Intrarater and interrater reliability of strength measurements of the biceps and deltoid using a hand held dynamometer. J Orthop Sports Phys Ther 9:395–398

    Article  CAS  PubMed  Google Scholar 

  7. Byram IR, Bushnell BD, Dugger K, Charron K, Harrell FE Jr, Noonan TJ (2010) Preseason shoulder strength measurements in professional baseball pitchers: identifying players at risk for injury. Am J Sports Med 38:1375–1382

    Article  PubMed  Google Scholar 

  8. Chen FS, Rokito AS, Jobe FW (2001) Medial elbow problems in the overhead-throwing athlete. J Am Acad Orthop Surg 9:99–113

    Article  CAS  PubMed  Google Scholar 

  9. Dick R, Sauers EL, Agel J, Keuter G, Marshall SW, McCarty K, McFarland E (2007) Descriptive epidemiology of collegiate men’s baseball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 through 2003–2004. J Athl Train 42:183–193

    PubMed  PubMed Central  Google Scholar 

  10. Dines JS, Frank JB, Akerman M, Yocum LA (2009) Glenohumeral internal rotation deficits in baseball players with ulnar collateral ligament insufficiency. Am J Sports Med 37:566–570

    Article  PubMed  Google Scholar 

  11. Donatelli R, Ellenbecker TS, Ekedahl SR, Wilkes JS, Kocher K, Adam J (2000) Assessment of shoulder strength in professional baseball pitchers. J Orthop Sports Phys Ther 30:544–551

    Article  CAS  PubMed  Google Scholar 

  12. Grantham WJ, Iyengar JJ, Byram IR, Ahmad CS (2015) The curveball as a risk factor for injury: a systematic review. Sports Health 7:19–26

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hang DW, Chao CM, Hang YS (2004) A clinical and roentgenographic study of Little League elbow. Am J Sports Med 32:79–84

    Article  PubMed  Google Scholar 

  14. Kibler WB (1998) The role of the scapula in athletic shoulder function. Am J Sports Med 26:325–337

    Article  CAS  PubMed  Google Scholar 

  15. Kibler WB, McMullen J (2003) Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg 11:142–151

    Article  PubMed  Google Scholar 

  16. Lintner D, Mayol M, Uzodinma O, Jones R, Labossiere D (2007) Glenohumeral internal rotation deficits in professional pitchers enrolled in an internal rotation stretching program. Am J Sports Med 35:617–621

    Article  PubMed  Google Scholar 

  17. Lyman S, Fleisig GS, Waterbor JW, Funkhouser EM, Pulley L, Andrews JR, Osinski ED, Roseman JM (2001) Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc 33:1803–1810

    Article  CAS  PubMed  Google Scholar 

  18. Magnusson SP, Gleim GW, Nicholas JA (1990) Subject variability of shoulder abduction strength testing. Am J Sports Med 18:349–353

    Article  CAS  PubMed  Google Scholar 

  19. Morse CI (2011) Gender differences in the passive stiffness of the human gastrocnemius muscle during stretch. Eur J Appl Physiol 111:2149–2154

    Article  PubMed  Google Scholar 

  20. Mullaney MJ, McHugh MP, Donofrio TM, Nicholas SJ (2005) Upper and lower extremity muscle fatigue after a baseball pitching performance. Am J Sports Med 33:108–113

    Article  PubMed  Google Scholar 

  21. Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM (2006) Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med 34:385–391

    Article  PubMed  Google Scholar 

  22. Myers JB, Oyama S, Hibberd EE (2013) Scapular dysfunction in high school baseball players sustaining throwing-related upper extremity injury: a prospective study. J Shoulder Elbow Surg 22:1154–1159

    Article  PubMed  Google Scholar 

  23. Neer CS 2nd, Foster CR (1980) Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone Joint Surg Am 62:897–908

    Article  PubMed  Google Scholar 

  24. Pappas AM, Zawacki RM, McCarthy CF (1985) Rehabilitation of the pitching shoulder. Am J Sports Med 13:223–235

    Article  CAS  PubMed  Google Scholar 

  25. Rauh MJ, Macera CA, Ji M, Wiksten DL (2007) Subsequent injury patterns in girls’ high school sports. J Athl Train 42:486–494

    PubMed  PubMed Central  Google Scholar 

  26. Robinson TW, Corlette J, Collins CL, Comstock RD (2014) Shoulder injuries among US high school athletes, 2005/2006-2011/2012. Pediatrics 133:272–279

    Article  PubMed  Google Scholar 

  27. Rojas IL, Provencher MT, Bhatia S, Foucher KC, Bach BR Jr, Romeo AA, Wimmer MA, Verma NN (2009) Biceps activity during windmill softball pitching: injury implications and comparison with overhand throwing. Am J Sports Med 37:558–565

    Article  PubMed  Google Scholar 

  28. Ruotolo C, Price E, Panchal A (2006) Loss of total arc of motion in collegiate baseball players. J Shoulder Elbow Surg 15:67–71

    Article  PubMed  Google Scholar 

  29. Scher S, Anderson K, Weber N, Bajorek J, Rand K, Bey MJ (2010) Associations among hip and shoulder range of motion and shoulder injury in professional baseball players. J Athl Train 45:191–197

    Article  PubMed  PubMed Central  Google Scholar 

  30. Shanley E, Rauh MJ, Michener LA, Ellenbecker TS, Garrison JC, Thigpen CA (2011) Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players. Am J Sports Med 39:1997–2006

    Article  PubMed  Google Scholar 

  31. Stratford PW, Balsor BE (1994) A comparison of make and break tests using a hand-held dynamometer and the Kin-Com. J Orthop Sports Phys Ther 19:28–32

    Article  CAS  PubMed  Google Scholar 

  32. Sullivan SJ, Chesley A, Hebert G, McFaull S, Scullion D (1988) The validity and reliability of hand-held dynamometry in assessing isometric external rotator performance. J Orthop Sports Phys Ther 10:213–217

    Article  CAS  PubMed  Google Scholar 

  33. Tajika T, Kobayashi T, Yamamoto A, Kaneko T, Shitara H, Shimoyama D, Iizuka Y, Okamura K, Yonemoto Y, Warita T, Ohsawa T, Nakajima I, Iizuka H, Takagishi T (2015) Clinical and sonographic study of elbow injuries among young baseball players. J Orthop Surg (Hong Kong) (in press)

  34. Thomas SJ, Swanik KA, Swanik C, Huxel KC (2009) Glenohumeral rotation and scapular position adaptations after a single high school female sports season. J Athl Train 44:230–237

    Article  PubMed  PubMed Central  Google Scholar 

  35. Thomas SJ, Swanik KA, Swanik C, Huxel KC, Kelly JD (2010) Change in glenohumeral rotation and scapular position after competitive high school baseball. J Sport Rehabil 19:125–135

    Article  PubMed  Google Scholar 

  36. Trakis JE, McHugh MP, Caracciolo PA, Busciacco L, Mullaney M, Nicholas SJ (2008) Muscle strength and range of motion in adolescent pitchers with throwing-related pain: implications for injury prevention. Am J Sports Med 36:2173–2178

    Article  PubMed  Google Scholar 

  37. Tyler TF, Mullaney MJ, Mirabella MR, Nicholas SJ, McHugh MP (2014) Risk factors for shoulder and elbow injuries in high school baseball pitchers: the role of preseason strength and range of motion. Am J Sports Med 42:1993–1999

    Article  PubMed  Google Scholar 

  38. Uhl TL, Kibler WB, Gecewich B, Tripp BL (2009) Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy 25:1240–1248

    Article  PubMed  Google Scholar 

  39. Wilk KE, Macrina LC, Fleisig GS, Aune KT, Porterfield RA, Harker P, Evans TJ, Andrews JR (2014) Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: a prospective study. Am J Sports Med 42:2075–2081

    Article  PubMed  Google Scholar 

  40. Wilk KE, Macrina LC, Fleisig GS, Porterfield R, Simpson CD 2nd, Harker P, Paparesta N, Andrews JR (2011) Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med 39:329–335

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the personnel, players, coaches, and staff of the Gunma Prefecture High School Baseball Federation for their assistance and cooperation in this study. We also thank Kureha Special Laboratory Co., Ltd. for assistance with statistical analysis. This research was partly supported by grants from the Japan Sports Medicine Foundation 2012 and Kozuki Foundation 2012 to H.S.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan

    Hitoshi Shitara, Atsushi Yamamoto, Daisuke Shimoyama, Tsuyoshi Ichinose, Tsuyoshi Tajika, Haku Iizuka & Kenji Takagishi

  2. Department of Physical Therapy, Takasaki University of Health and Welfare, 37-1 Nakaorui, Takasaki, Gunma, 370-0033, Japan

    Tsutomu Kobayashi

  3. Department of Orthopaedic Surgery, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu, Takasaki, Gunma, 370-0829, Japan

    Toshihisa Osawa

Authors
  1. Hitoshi Shitara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tsutomu Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atsushi Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daisuke Shimoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tsuyoshi Ichinose
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tsuyoshi Tajika
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Toshihisa Osawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Haku Iizuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kenji Takagishi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hitoshi Shitara.

Ethics declarations

Conflict of interest

None declared.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shitara, H., Kobayashi, T., Yamamoto, A. et al. Prospective multifactorial analysis of preseason risk factors for shoulder and elbow injuries in high school baseball pitchers. Knee Surg Sports Traumatol Arthrosc 25, 3303–3310 (2017). https://doi.org/10.1007/s00167-015-3731-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3731-4

Keywords

Search

Navigation