Risk of shoulder/elbow injuries and imaging abnormalities in female collegiate baseball and softball players

Shoulder and elbow injuries are common in overhead-throwing players; however, limited data exist regarding injury prevalence and imaging abnormalities among female collegiate baseball and softball players, particularly in relation to early sport participation.

This cross-sectional observational study was conducted among national-level collegiate baseball and softball teams. A total of 67 female players participated, including 53 softball players and 14 baseball players. Players completed questionnaires assessing self-reported shoulder and elbow injuries or discomfort. Diagnostic ultrasound was used to evaluate structural abnormalities of the shoulder and elbow. Firth penalized logistic regression analyses were performed to identify factors associated with imaging abnormalities and self-reported symptoms.

Shoulder pain or discomfort was reported by 35.9% of softball players and 64.3% of baseball players, while elbow pain or discomfort was reported by 32.1% and 35.7%, respectively. Abnormal ultrasound findings of the shoulder were highly prevalent, affecting 79.3% of softball players and 100% of baseball players. Abnormal elbow ultrasound findings were observed in 56.6% of softball players and 50.0% of baseball players. Participation in baseball but not softball before high school was significantly associated with increased odds of abnormal elbow ultrasound findings (odds ratio = 9.26; P = .04) and shoulder pain or discomfort (odds ratio = 21.99; P = .02) compared with participation in other sports during that period. Softball participation before high school was not significantly associated with elbow imaging abnormalities, elbow symptoms, or shoulder imaging abnormalities.

Among female collegiate overhead players, abnormal shoulder and elbow ultrasound findings were highly prevalent. Pre-high school baseball participation was strongly associated with abnormal elbow imaging findings and shoulder symptoms, whereas softball participation was not. These findings suggest that early baseball exposure may contribute to an increased upper extremity injury risk in female players.