Organizational risk profiling and education associated with reduction in professional pitching arm injuries: a natural experiment

Garrett S Bullock; Charles A Thigpen; Gary S Collins; Nigel K Arden; Thomas J Noonan; Michael J Kissenberth; Douglas J Wyland; Ellen Shanley

doi:10.1016/j.xrrt.2023.03.005

Organizational risk profiling and education associated with reduction in professional pitching arm injuries: a natural experiment

JSES Rev Rep Tech. 2023 Apr 18;3(3):295-302. doi: 10.1016/j.xrrt.2023.03.005. eCollection 2023 Aug.

Authors

Garrett S Bullock^{1

2

3}, Charles A Thigpen^{4

5}, Gary S Collins^{6

7}, Nigel K Arden^{2

3}, Thomas J Noonan^{8

9}, Michael J Kissenberth¹⁰, Douglas J Wyland¹⁰, Ellen Shanley^{4

5}

Affiliations

¹ Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
² Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, UK.
³ Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
⁴ University of South Carolina Center for Rehabilitation and Reconstruction Sciences, Greenville, SC, USA.
⁵ ATI Physical Therapy, Greenville, SC, USA.
⁶ Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK.
⁷ Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁸ Department of Orthopaedic Surgery, University of Colorado School of Medicine, Boulder, CO, USA.
⁹ University of Colorado Health, Steadman Hawkins Clinic, Englewood, CO, USA.
¹⁰ Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.

Abstract

Background: Risk profiling and education are strategies implemented to help reduce injury risk; however, currently. there is little evidence on the effect of these interventions on injury incidence. The purpose of this study was to evaluate the influence of risk profiling and education on upper extremity injury incidence in minor league (MiLB) pitchers and to stratify by injury severity.

Methods: A prospective natural experiment study was conducted from 2013 to 2019 on MiLB pitchers. Beginning in the 2015 season, pitchers were examined and risk profiled for upper extremity injury. Shoulder external, internal, total range of motion, horizontal adduction, and humeral torsion were measured. Organizational risk profiling and education was implemented starting in 2015, based on preseason assessments. Chi-squared test was performed to investigate potential differences between shoulder range of motion risk categories between 2013-2014 (pre) and 2015-2019 (post) seasons. Interrupted time series analyses were performed to assess the association between organizational risk profiling and education on arm injury in MiLB pitchers and were repeated for 7-27 and 28+ day injury severity.

Results: 297 pitchers were included (pre: 119, post: 178). Upper extremity injury incidence was 1.5 injuries per 1000 athletic exposures. Pitchers in the 2015-2019 seasons demonstrated increased preseason shoulder injury risk for internal (P = .003) and external (P = .007), while the 2013-2014 seasons demonstrated greater horizontal adduction risk (P = .04). There were no differences between seasons for total range of motion risk (P =.76). Risk profiling and education resulted in an adjusted time loss upper extremity injury reduction for the 2015-2019 seasons (0.68 (95% CI: 0.47, 0.99)), which impacted 7-27 days (0.62 (95% CI: 0.42, 0.93)) but not for 28+ days (0.71 (95% CI: 0.47, 1.06)) time loss. There was no reduction in combined trunk and lower extremity injuries for the 2015-2019 seasons (1.55 (95% CI: 0.79, 3.01)).

Conclusions: Organizational risk profiling and education appear to reduce professional pitching overall and 7-27-day upper extremity injury risk by 33%-38%. There was no difference in trunk and lower extremity injuries over the period, strengthening the reduction in upper extremity injury risk results. This suggests that while injury risk increased over time, organizational risk profiling mitigated the expected increase in upper extremity injury rates. Risk profiling and education can be used as a clinical screening and intervention tool to help decrease upper extremity injuries in professional baseball populations.

Keywords: Baseball; Elbow; Humeral torsion; Minor league baseball; Risk mitigation; Shoulder.