Salamh Paul, Bullock Garrett, Chester Rachel, Daniell Helena, Cook Chad, DeLang Matthew, Tucker Hannah-Rose, Walker Douglas, Lewis Jeremy
Int J Sports Phys Ther. 2025 Mar 1;20(3):315-332. doi: 10.26603/001c.129462. eCollection 2025.
There is a high incidence of shoulder injuries among overhead athletes. Identifying and understanding risk factors for these injuries, particularly those that can be modified, is a necessary step towards being able to effectively develop and implement shoulder specific injury prevention programs. Therefore, the purpose of this systematic review was to identify risk factors associated with a new onset of shoulder pain and injury among the athletic population.
Systematic Review.
A systematic review of the literature was performed within PubMed, Embase, AMED, CINAHL, and EmCare databases. Studies were screened utilizing the following inclusion criteria; (a) athletes currently pain free or no history of pain at baseline, (b) athletes with shoulder and or arm pain originating from a musculoskeletal shoulder problem (c) risk factors captured prospectively (d) pathoanatomy and biomechanics in isolation or in addition to personal characteristics, etc. (e) reporting relative risk, odds ratios, and/or hazard ratios and (f) follow up ≥ 6 months. Due to data heterogeneity, only a descriptive data synthesis was performed. Data were extracted and underwent risk of bias assessment utilizing the Quality in Prognosis Studies (QUIPS) tool. PRISMA guidelines were utilized throughout.
Nineteen papers were included. A total of four studies investigated baseball, five handball, three swimming, two tennis, two military, one cricket, one American football, and one with multiple sports, totaling 7,802 athletes. The risk of bias among the included studies was rated from moderate to low overall with no single study being identified as high risk of bias. All studies designs were a level of evidence of II except for two studies that were level III. The most significant risk factors included range of motion, reduced strength, history of local/regional musculoskeletal pain, previous injury, and training load. There are inconsistencies in how injury and pain are defined within studies.
Many risk factors are easily objectifiable and modifiable which may help in developing shoulder injury mitigation strategies. Three of the five significant risk factors for injury can be identified by objective pre-screening measures. While previous pain and injury cannot be mitigated, training loads should be closely monitored and adapted according to other risk factors and the athlete's response.
上肢运动的运动员肩部损伤发生率较高。识别并了解这些损伤的风险因素，尤其是那些可以改变的因素，是有效制定和实施肩部特定损伤预防计划的必要步骤。因此，本系统评价的目的是确定运动员群体中新发肩部疼痛和损伤的相关风险因素。
系统评价。
在PubMed、Embase、AMED、CINAHL和EmCare数据库中对文献进行系统评价。利用以下纳入标准筛选研究；（a）运动员在基线时目前无疼痛或无疼痛史，（b）因肌肉骨骼肩部问题导致肩部和/或手臂疼痛的运动员，（c）前瞻性捕捉风险因素，（d）孤立或除个人特征等之外的病理解剖学和生物力学，（e）报告相对风险、比值比和/或风险比，（f）随访≥6个月。由于数据异质性，仅进行了描述性数据综合。利用预后研究质量（QUIPS）工具提取数据并进行偏倚风险评估。全程采用PRISMA指南。
纳入19篇论文。共有4项研究调查了棒球运动员，5项研究调查了手球运动员，3项研究调查了游泳运动员，2项研究调查了网球运动员，2项研究调查了军人，1项研究调查了板球运动员，1项研究调查了美式足球运动员，1项研究调查了多个运动项目的运动员，共计7802名运动员。纳入研究的偏倚风险总体评定为中度至低度，没有一项研究被确定为高偏倚风险。除两项研究为III级证据外，所有研究设计均为II级证据。最显著的风险因素包括活动范围、力量减弱、局部/区域肌肉骨骼疼痛史、既往损伤和训练负荷。研究中对损伤和疼痛的定义存在不一致。
许多风险因素易于客观化和改变，这可能有助于制定减轻肩部损伤的策略。五项主要损伤风险因素中有三项可通过客观的预筛查措施识别。虽然既往疼痛和损伤无法减轻，但应密切监测训练负荷，并根据其他风险因素和运动员的反应进行调整。
2级。
