A Clinician's Guide to Evaluating and Managing Shoulder Overuse Injury in Softball Pitchers

BACKGROUND: Approximately one third of softball pitchers sustain a pitching-related injury across a single season, with the throwing shoulder being the most frequently injured site. Overuse is a commonly proposed mechanism given the repetitive high stress placed on the biceps-labral complex. CLINICAL QUESTION: How can clinicians evaluate and manage shoulder overuse injury in softball pitchers? KEY RESULTS: Clinical evaluation of softball pitchers should include a comprehensive patient history, physical examination, and appropriate imaging. Understanding injury mechanisms and risks will help clinicians assess and treat injuries effectively. Management should include a rehabilitation program that extends beyond the pitching shoulder to address the whole kinetic chain, with a focus on the lumbopelvic-hip complex. CLINICAL APPLICATION: Our model was designed by an interdisciplinary team for clinicians seeking to evaluate softball pitchers with shoulder overuse injury and develop rehabilitation programs that support return to play. This model can be used to implement evidence-based evaluation and management methods to improve athlete care. JOSPT Open 2026;4(4):385-394. Epub 11 September 2026. doi:10.2519/josptopen.2026.0227.