Ultrasound-based shoulder adaptations in elite female handball players

Female handball players represent an underrepresented yet potentially high-risk population for shoulder injuries. This study investigated shoulder adaptations in elite female handball players by assessing posterior capsule thickness (PCT), supraspinatus tendon thickness (STT), and acromiohumeral distance (AHD) using ultrasound, alongside range of motion (ROM) and isokinetic strength. Twenty athletes (18-32 years) were evaluated bilaterally. No side-to-side differences were observed in PCT or AHD. In contrast, STT and occupation ratio were greater in the throwing shoulder. The throwing shoulder demonstrated reduced internal and greater external rotation ROM, while total rotational ROM remained similar between sides. Internal rotation strength was higher in the throwing shoulder at both angular velocities. No associations were found between PCT and ROM or strength. AHD was positively correlated with external rotation ROM and the external-to-internal rotation strength ratio. These findings suggest sport-specific asymmetrical adaptations in elite female handball players without evidence of posterior capsular thickening.