Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players

Am J Sports Med. 2011 Sep;39(9):1997-2006. doi: 10.1177/0363546511408876. Epub 2011 Jun 17.


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.

MeSH terms

  • Adolescent
  • Baseball / injuries*
  • Baseball / physiology
  • Cohort Studies
  • Elbow Injuries*
  • Female
  • Humans
  • Male
  • Range of Motion, Articular / physiology*
  • Risk Factors
  • Shoulder / physiology
  • Shoulder Injuries*