Despite increased youth and adolescent participation in fast-pitch softball and the reporting of upper extremity injuries, there remains a relative paucity of research examining shoulder and elbow injuries in high school and collegiate softball athletes.
Objective:
To evaluate the reported incidence, setting, and positional factors associated with shoulder and elbow injuries in high school and collegiate fast-pitch softball players.
Data Sources:
PubMed, Ovid, Medline, EMBASE, Scopus, Cochrane Central, and Clinicaltrials.gov.
Study Selection:
English-language articles reporting the incidence of shoulder and/or elbow injuries occurring in high school or collegiate fast-pitch softball players were included. Biomechanical studies, review articles, abstract only texts, previous systematic reviews, and meta-analyses were excluded.
Study Design:
Systematic review.
Level of Evidence:
Level 4.
Data Extraction:
Two reviewers independently evaluated studies. Data related to the reported incidence of shoulder and elbow injuries, injury setting, position, and rate of return to play after injury were recorded.
Results:
A total of 22 studies were identified. In high school athletes, shoulder injury rates ranged from 0.88 to 1.14 per 10,000 athletic exposures (AE), with elbow injury rates ranging from 0.41 to 0.71 per 10,000 AE. In collegiate athletes, reported injury rates ranged from 3.76 to 5.93 per 10,000 AE for shoulder and 1.5 to 3.39 per 10,000 AE for elbow injuries. Shoulder and elbow injuries were reported more commonly during competition in high school athletes, and with greater frequency in the practice setting in collegiate athletes. No association between injury incidence and position was appreciated at either the high school or collegiate level. Most (81%-96%) athletes were able to return to sport within 3 weeks of injury.
Conclusion:
The incidence of shoulder and elbow injuries was greater in collegiate softball athletes than in high school athletes.
AdamsJE.Injury to the throwing arm. A study of traumatic changes in the elbow joints of boy baseball players. Calif Med. 1965;102(2):127-132.
2.
AragonVJOyamaSOliaroSMPaduaDAMyersJB.Trunk-rotation flexibility in collegiate softball players with or without a history of shoulder or elbow injury. J Athl Train. 2012;47(5):507-513.
3.
BakshiNKInclanPMKirschJMBediAAgrestaCFreehillMT.Current workload recommendations in baseball pitchers: a systematic review. Am J Sports Med. 2020;48(1):229-241.
4.
BarfieldJOliverG.What do we know about youth softball pitching and injury?Sports Med Open. 2018;4(1):50.
5.
BarrentineSWFleisigGSWhitesideJAEscamillaRFAndrewsJR. Biomechanics of windmill softball pitching with implications about injury mechanisms at the shoulder and elbow. J Orthop Sports Phys Ther. 1998;28(6):405-415.
BonzaJEFieldsSKYardEEComstockRD.Shoulder injuries among United States high school athletes during the 2005-2006 and 2006-2007 school years.J Athl Train. 2009;44(1):76-83.
8.
CampbellMMcKenzieJESowdenA, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020;368:l6890.
9.
Centres for Disease Control and Prevention. Sports-related injuries among high school athletes – United States, 2005-06 school year. MMWR Morb Mortal Wkly Rep. 2006;55(38):1037-1040.
10.
CrossKMMcMurrayMHertelJ, et al. Shoulder and elbow injury rates and characteristics among collegiate baseball student-athletes. Int J Sports Phys Ther. 2020;15(5):792-803.
11.
DarrowCJCollinsCLYardEEComstockRD.Epidemiology of severe injuries among United States high school athletes: 2005-2007. Am J Sports Med. 2009;37(9):1798-1805.
12.
DavisJTLimpisvastiOFluhmeD, et al. The effect of pitching biomechanics on the upper extremity in youth and adolescent baseball pitchers. Am J Sports Med. 2009;37(8):1484-1491.
13.
DoyleFM.Review of the windmill pitch: biomechanics and injuries. J Chiropr Med. 2004;3(2):53-62.
14.
EscamillaRFBarrentineSWFleisigGS, et al. Pitching biomechanics as a pitcher approaches muscular fatigue during a simulated baseball game. Am J Sports Med. 2007;35(1):23-33.
15.
FeeleyBTSchiselJAgelJ.Pitch counts in youth baseball and softball: a historical review. Clin J Sport Med. 2018;28(4):401-405.
16.
FleisigGSAndrewsJRCutterGR, et al. Risk of serious injury for young baseball pitchers: a 10-year prospective study. Am J Sports Med. 2011;39(2):253-257.
17.
FreehillMTArcherKRDiffenderferBWEbelBGCosgareaAJMcFarlandEG.Changes in collegiate starting pitchers’ range of motion after single game and season. Physician Sportsmed. 2014;42(1):69-74.
18.
GoochBLLambertBSGobleHMcCullochPCHedtC.Relationship between pitch volume and subjective report of injury in high school female fast-pitch softball pitchers. Sports Health. 2022;14(5):702-709.
19.
GranthamWJByramIRMeadowsMCAhmadCS.The impact of fatigue on the kinematics of collegiate baseball pitchers. Orthop J Sports Med. 2014;2(6):2325967114537032.
20.
HassebrockJDPatelKAMakovickaJL, et al. Elbow injuries in National Collegiate Athletic Association athletes: a 5-season epidemiological study. Orthop J Sports Med. 2019;7(8):2325967119861959.
HoltzKAO’ConnorRJ.Upper extremity functional status of female youth softball pitchers using the Kerlan-Jobe Orthopaedic Clinic questionnaire. Orthop J Sports Med. 2018;6(1):2325967117748599.
KerrZYLynallRCRoosKGDaltonSLDjokoADompierTP.Descriptive epidemiology of non-time-loss injuries in collegiate and high school student-athletes. J Athl Train. 2017;52(5):446-456.
26.
KnapikDMContinenzaSMHoffmanKGilmoreA.Youth baseball coach awareness of pitch count guidelines and overuse throwing injuries remains deficient. J Pediatr Orthop. 2018;38(10):e623-e628.
27.
KrajnikSFogartyKJYardEEDawnCR.Shoulder injuries in US high school baseball and softball athletes, 2005-2008. Pediatrics. 2010;125(3):497-501.
28.
LiNYGoodmanADLemmeNJOwensBD.Epidemiology of elbow ulnar collateral ligament injuries in throwing versus contact athletes of the National Collegiate Athletic Association: analysis of the 2009-2010 to 2013-2014 seasons. Orthop J Sports Med. 2019;7(4):2325967119836428.
LoosliARRequaRKGarrickJGHanleyE.Injuries to pitchers in women’s collegiate fast-pitch softball. Am J Sports Med. 1992;20(1):35-37.
31.
LymanSFleisigGSAndrewsJROsinskiED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002;30(4):463-468.
32.
LymanSFleisigGSWaterborJW, et al. Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc. 2001;33(11):1803-1810.
33.
MarshallSWHamstra-WrightKLDickRGroveKAAgelJ.Descriptive epidemiology of collegiate women’s softball injuries: National Collegiate Athletic Association injury surveillance system, 1988-1989 through 2003-2004. J Athl Train. 2007;42(2):286-294.
34.
MoolaSMunnZTufanaruC, et al. Systematic reviews of etiology and risk. In: AromatarisEMunnZ (eds). Joanna Briggs Institute Reviewer’s Manual. Vol 5. Adelaide, Australia: The Joanna Briggs Institute; 2017:217-69. Accessed February 5, 2022.
OliverGDSaperMGDrogoszM, et al. Epidemiology of shoulder and elbow injuries among US high school softball players, 2005-2006 through 2016-2017. Orthop J Sports Med. 2019;7(9):2325967119867428.
37.
OlsenSJIIFleisigGSDunSLofticeJAndrewsJR.Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 2006;34(6):905-912.
38.
PageMJMcKenzieJEBossuytPM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Rev Esp Cardiol (Engl Ed). 2021;74(9):790-799.
39.
PaulJBrownSMMulcaheyMK.Injury prevention programs for throwing injuries in softball players: a systematic review. Sports Health. 2021;13(4):390-395.
40.
PowellJWBarber-FossKD.Sex-related injury patterns among selected high school sports. Am J Sports Med. 2000;28(3):385-391.
41.
RechelJACollinsCLComstockRD.Epidemiology of injuries requiring surgery among high school athletes in the United States, 2005 to 2010. J Trauma2011;71(4):982-989.
42.
RobinsonTWCorletteJCollinsCLComstockRD.Shoulder injuries among US high school athletes, 2005/2006-2011/2012. Pediatrics. 2014;133(2):272-279.
43.
SaperMGPierpointLALiuWComstockRDPolouskyJDAndrewsJR.Epidemiology of shoulder and elbow injuries among United States high school baseball players: school years 2005-2006 through 2014-2015. Am J Sports Med. 2018;46(1):37-43.
44.
SauersELDykstraDLBayRCHuxel BlivenKSnyderAR.Upper extremity injury history, current pain rating, and health-related quality of life in female softball pitchers. J Sport Rehabil. 2011;20(1):100-114.
45.
ShanleyEMichenerLAEllenbeckerTSRauhMJ.Shoulder range of motion, pitch count, and injuries among interscholastic female softball pitchers: a descriptive study. Int J Sports Phys Ther. 2012;7(5):548-557.
46.
ShanleyERauhMJMichenerLAEllenbeckerTS.Incidence of injuries in high school softball and baseball players. J Athl Train. 2011;46(6):648-654.
47.
SkillingtonSABrophyRHWrightRWSmithMV.Effect of pitching consecutive days in youth fast-pitch softball tournaments on objective shoulder strength and subjective shoulder symptoms. Am J Sports Med. 2017;45(6):1413-1419.
Snyder ValierARHuxel BlivenKCGibsonA, et al. Non-time-loss and time-loss softball injuries in secondary school athletes: a report from the National Athletic Treatment, Injury and Outcomes Network (NATION). J Athl Train. 2020;55(2):188-194.
VeillardKLBoltzAJRobisonHJMorrisSNCollinsCLChandranA.Epidemiology of injuries in National Collegiate Athletic Association women’s softball: 2014-2015 through 2018-2019. J Athl Train. 2021;56(7):734-741.
53.
WassermanEBRegister-MihalikJKSauersEL, et al. The first decade of web-based sports injury surveillance: descriptive epidemiology of injuries in US high school girls’ softball (2005-2006 through 2013-2014) and National Collegiate Athletic Association women’s softball (2004-2005 through 2013-2014). J Athl Train. 2019;54(2):212-225.
54.
WassermanEBSauersELRegister-MihalikJK, et al. The first decade of web-based sports injury surveillance: descriptive epidemiology of injuries in US high school boys’ baseball (2005-2006 through 2013-2014) and National Collegiate Athletic Association men’s baseball (2004-2005 through 2013-2014). J Athl Train. 2019;54(2):198-211.
55.
WernerSLGuidoJAMcNeiceRPRichardsonJLDeludeNAStewartGW.Biomechanics of youth windmill softball pitching. Am J Sports Med. 2005;33(4):552-560.
56.
WernerSLJonesDGGuidoJAJrBrunetME.Kinematics and kinetics of elite windmill softball pitching. Am J Sports Med. 2006;34(4):597-603.
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