Preseason Shoulder Strength Measurements in Professional Baseball Pitchers Identifying Players at Risk for Injury

Background: The ability to identify pitchers at risk for injury could be valuable to a professional baseball organization. To our knowledge, there have been no prior studies examining the predictive value of preseason strength measurements. Hypothesis: Preseason weakness of shoulder external rotators is associated with increased risk of in-season throwing-related injury in professional baseball pitchers. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Preseason shoulder strength was measured for all pitchers in a professional baseball organization over a 5-year period (2001-2005). Prone internal rotation (IR), prone external rotation (PER), seated external rotation (SER), and supraspinatus (SS) strength were tested during spring training before each season. The players were then prospectively followed throughout the season for incidence of throwing-related injury. Injuries were categorized on an ordinal scale, with no injury, injury treated conservatively, and injury resulting in surgery delineated 0, 1, and 2, respectively. Subset analyses of shoulder injuries and of players with prior surgery were also performed. The association between strength measurements and injury was analyzed using Spearman rank correlation. Results: A statistically significant association was observed for PER strength (P=.003), SEA strength (P=.048), and SS strength (P=.006) with throwing-related injury requiring surgical intervention. Supraspinatus strength was also significantly associated with incidence of any shoulder injury (P=.031). There was an association between the ratio of PER/IR strength and incidence of shoulder injury (P=.037) and some evidence for an association with overall incidence of throwing-related injury (P=.051). No associations were noted in the subgroup of players with prior surgery. Conclusion: Preseason weakness of external rotation and SS strength is associated with in-season throwing-related injury resulting in surgical intervention in professional baseball pitchers. Thus, preseason strength data may help identify players at risk for injury and formulate strengthening plans for prevention.