Throwing Shoulder Adaptations Are Not Related to Shoulder Injury or Pain: A Preliminary Report

Background: Overhead throwing in baseball and softball athletes induces shoulder adaptations theorized to increase risk of shoulder musculoskeletal injury (MSI) and/or pain due to range of motion (ROM) deficits. Hypothesis: Shoulder ROM adaptations are associated with a higher risk for developing shoulder MSI and pain. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: A total of 60 National Collegiate Athletic Association Division I athletes cleared for full athletic participation and free from upper extremity MSI in the last 4 weeks (age, 19.0 +/- 1.2 years; weight, 82.1 +/- 13.7 kg; height, 178.6 +/- 11.2 cm; softball, n = 23; baseball, n = 37). Passive glenohumeral internal rotation (IR), external rotation (ER), and horizontal adduction (HA) ROM were measured with the scapula stabilized and used to categorize participants with/without external rotation gain (ERG), external rotation insufficiency (ERI), glenohumeral internal rotation deficit (GIRD), pathological GIRD, and posterior shoulder tightness (PST) before the competitive season. Groups were then compared to assess the incidence of shoulder MSI prospectively and prevalence of shoulder pain at the initial evaluation. Results: Baseball and softball athletes demonstrated significantly less IR ROM in the dominant shoulder (50.6 degrees +/- 9.4 degrees) compared with the nondominant shoulder (59.1 degrees +/- 8.6 degrees; P < 0.01) and significantly more ER ROM (dominant, 104.6 degrees +/- 12.1 degrees; nondominant, 97.7 degrees +/- 12.0 degrees; P < 0.01). Incidence of shoulder MSI was 15% but was not significantly related to any shoulder adaptations. No significant relationship was found between prevalence of pain and any shoulder adaptations in the 27% of athletes with pain. Conclusion: Increased ER and decreased IR ROM adaptations in intercollegiate overhead throwing athletes do not appear to be correlated to risk of shoulder MSI or pain. Clinical Relevance: The findings of this level 3 prospective study provide clinicians working with overhead athletes information regarding shoulder MSI risk and pain. It is recommended that clinicians should not use ROM adaptations exclusively to determine increased risk of shoulder MSI.

Automated summary

This prospective study found that increased external rotation range of motion (ROM) and decreased internal rotation ROM in intercollegiate overhead throwing athletes do not appear to be correlated to risk of shoulder musculoskeletal injury (MSI) or pain.