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. 2025 May-Jun;17(3):474-483.
doi: 10.1177/19417381241280643. Epub 2024 Oct 6.

The Incidence of Shoulder and Elbow Injuries in High School and Collegiate Softball Athletes: A Systematic Review

Nichelle M Enata  1 , Paul M Inclan  2 , Robert H Brophy  1 , Derrick Knapik  1 , Matthew V Smith  1
Affiliations

The Incidence of Shoulder and Elbow Injuries in High School and Collegiate Softball Athletes: A Systematic Review

Nichelle M Enata et al. Sports Health. 2025 May-Jun.

Abstract

Context: 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.

Keywords: elbow; epidemiology; injury; shoulder; softball.

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Figures

Figure 1.
Figure 1.
PRISMA flowchart demonstrating the inclusion/exclusion process. PRISMA, preferred reporting items for systematic reviews and meta-analyses.
See this image and copyright information in PMC

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