What Are the Risk Factors for Shoulder and Elbow Injuries in Professional Baseball Pitchers?

    Increasing numbers of elbow-related injuries in professional baseball pitchers has led to research studying risk factors, especially those that can be modified and adjusted to help prevent lost playing time.

    Decreased shoulder flexion and external rotation were identified as key predictors of injuries to pitchers during the season in a study presented at the American Orthopaedic Society for Sports Medicine’s Annual Meeting in Toronto, Ontario, Canada.

    “Our research showed that in the pitchers studied, the most significant factors associated with elbow injury rates included the presence of shoulder external rotation deficit and shoulder flexion deficit greater than 5 degrees during spring training,” noted lead author Christopher L. Camp, MD, from Hospital for Special Surgery in New York.

    “Internal rotation deficits did not demonstrate a similar risk for injury during the season.”

    The study examined pitchers of 1 Major League Baseball (MLB) team over the course of 6 seasons (2010 through 2015), beginning with a preseason assessment of range of motion (ROM).

    Throughout 132 pitcher seasons, 53 shoulder and 28 elbow injuries occurred, with the most common elbow injury being tears of the ulnar collateral ligament (UCL).

    The risk of elbow injury increased 1.09 times for every 1-degree decrease in shoulder flexion, 1.07 times for every 1-degree increase in external rotation deficit, and 2.83 times with a greater than 5-degree flexion deficit compared with the non-dominant side.

    “Identifying these predictors of injury can hopefully help medical staff work with pitchers,” Dr. Camp said, “and ultimately help prevent lost playing time in the future.”

    The group’s research adds to previous studies that have shown glenohumeral internal rotation deficits are a risk factor for shoulder and elbow injuries.


    Camp CL, Sinatro A, Spiker A, Werner BC, Altchek DW, Coleman SH, Dines JS. Decreased Shoulder External Rotation and Flexion are Greater Predictors of Injury than Internal Rotation Deficits: Analysis of 132 Pitcher-Seasons in Professional Baseball (paper 113). Presented at the Annual Meeting of the American Orthopaedic Society for Sports Medicine, July 20-23, 2017, Toronto, Ontario, Canada. All abstracts from the meeting can be found here.