RISK FACTORS FOR, AND PREVENTION OF, SHOULDER INJURIES IN OVERHEAD SPORTS: A SYTEMATIC REVIEW WITH BEST-EVIDENCES SYNTHESIS

Review written by Dr Teddy Willsey info

BACKGROUND & OBJECTIVE:

Shoulder injury and shoulder pain are substantial problems with incidence reported as high as 36% in specific cohorts of overhead throwing athletes. The burden of shoulder injury highlights the need for a greater understanding of risk factors and prevention strategies. The primary objective of this systematic review was to better understand the modifiable and non-modifiable factors that contribute to shoulder injury in order to synthesize best practice and prevention guidelines. While the authors recognized that the risk factors for injury may vary amongst different overhead sports, their goal was to assess overhead athletes as one group, assuming mechanisms linked to non-traumatic injury may not differ greatly due to the commonality of repetitive use and chronic exposure.

METHODS (WHAT THEY DID):

The authors conducted a reporting of this systematic review following the PRISMA design. PRISMA is an acronym standing for preferred reporting items for systematic reviews and meta-analyses. Eligibility criteria was broadly based for this systematic review. The authors chose to use randomized controlled trials, cohort studies, and case-control studies, reflecting the low overall quality of evidence on the topic. Studies were required to include at least 20 participants, report risk, odds, or incidence rate ratios, and pass the authors’ standards for internal validity and statistical rigor.

It was concluded that the studies were too heterogenous in nature to conduct a meta-analysis. Instead, the authors constructed a best evidence synthesis to report the magnitude of each risk factor. The direction and strength of evidence for each potential risk factor was assessed using an adapted version of previously defined criteria. 17 studies were included in total. Baseball was the most represented sport, with volleyball, lacrosse, softball, handball, tennis, and water polo included as well, listed in descending order of representation.

RESULTS / WHAT THEY FOUND:

Every potential risk factor investigated for shoulder injury amongst overhead athletes had limited evidence, with many of the risk factors being non-modifiable. Non-modifiable risk factors include male versus female, injury setting (competition vs training), and age or playing experience. Substantial

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