Lack of Shoulder Motion Increases Risk for Elbow Injuries

Orthopedic Sports Medicine

Dr. David GeierDr. Geier is an orthopaedic surgeon and sports medicine specialist in Charleston, South Carolina. He also serves as chairman of the Public Relations Committee for the American Orthopaedic Society for Sports Medicine.


Elbow injuries are among the most common injuries for professional baseball pitchers. They are also among the most debilitating injuries, often resulting in surgery and long periods on the disabled list. Predicting which pitchers are most at risk for suffering elbow injuries, and correcting those risk factors could prevent many of these problems.


A study presented at the 2013 American Orthopaedic Society for Sports Medicine Annual Meeting in Chicago showed that a pitcher’s shoulder might affect his elbow. Kevin Wilk, DPT and his team in Birmingham, Alabama performed 505 examinations of 296 professional pitchers on the first day of Spring Training over eight seasons. They correlated this data with elbow injuries reported by injury reports of the players’ teams.




Wilk and his team found that a pitcher’s total range of motion could play a role in his suffering an elbow injury. They measured a pitcher’s internal rotation and external rotation lying supine with the shoulder abducted 90 degrees. Pitchers with a total range of motion deficit greater than five degrees in their dominant shoulder had a risk of suffering an elbow injury that placed him on the DL 2.3 times higher than those with full shoulder rotation.


Likewise, pitchers with a shoulder flexion deficit of five degrees or more were 2.8 times more likely to suffer an elbow injury.


“Overhead throwing athletes like baseball pitchers are already prone to a unique set of elbow injuries," Wilk explained. "With this in mind, we wanted to explore whether specific elements of the throwing motion can contribute to a greater injury risk.”




By identifying deficits in total range of motion and flexion as risks for elbow injuries, the medical staffs of baseball teams can likely prevent some of them from ever happening. The team doctors, athletic trainers and physical therapists can measure shoulder range of motion in each of their pitchers in Spring Training. Any pitcher found to lack shoulder rotation or flexion can be placed on an aggressive rehab program to restore motion before the start of the season.


In this study, the elbow injuries caused pitchers to spend an average of 51 days on the disabled list. A little bit of early detection and a preseason program to correct underlying shoulder problems might keep some of these pitchers on the mound instead of the operating room or physical therapy clinic.

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