Predictive Value Of Preseason Screening In Collegiate Baseball Pitchers

OBJECTIVES: High level baseball pitchers are prone to shoulder and elbow injuries, resulting in significant morbidity and missed time from sport. This is the first study to use both subjective and objective preseason evaluations of baseball pitchers to predict injuries that occur in-season. We hypothesize that athletes reporting unfavorable scores on subjective questionnaires, and athletes falling outside the established pre-season normative values for objective data are more likely to develop injuries in season. METHODS: Over three collegiate baseball seasons from 2011 through 2013, a cohort of collegiate Division I baseball pitchers underwent both objective and subjective evaluation prior to the start of the fall collegiate season. Preseason analysis included range of motion (ROM) in 5 planes, upper extremity manual muscle testing (MMT), Functional Movement Screen (FMS) assessment, a Kerlan-Jobe Orthopaedic Clinic (KJOC) Overhead Athlete Shoulder and Elbow score, an Upper Extremity Patient History (UEPH) questionnaire, and a Modified American Shoulder Elbow Score (MASES) questionnaire. This cohort was monitored over the course of the subsequent season for the development of injury and missed game time. A descriptive analysis for each questionnaire and all objective variables was performed. Univariate and multivariate regression models were used to explore potential risk factors for upper extremity (UE) injuries. Scatter plots, Spearman's correlation coefficients, and corresponding p-values were used to examine the relationship between subjective responses, objective physical parameters, and injury days missed. RESULTS: Forty-two athletes participated in the study over three consecutive collegiate baseball seasons. Our preseason normative values for ROM, MMT, and the KJOC questionnaire are shown in Tables 1, 2, and 3. The mean KJOC score for our cohort was 86.93/100 (SD 12.49), and the mean MASES score was 88.4/100 (SD 21.7). The mean FMS score in our cohort was 15/21 (SD 3). Injury data for our cohort are shown in Table 4. After three full seasons, a lower KJOC score significantly correlated with injury days missed (Spearman's rho = 0.63, P-value 0.0122). Through the first two seasons, pitchers with a 1% higher UE rating on the UEPH questionnaire had 9.5% lower odds of developing injury during the season (OR 0.9149, 95% CI 0.8525-0.9819, P Value 0.014). Pitchers reporting every 1 unit higher of subjective instability had 61.27% higher odds of developing an UE injury (OR 0.6127, 95% CI 1.1044-2.3549, P value 0.013). However, by the end of the third season, and after adjusting for the use of pain medication, these variables failed to reach significance in our multiple regression analysis. Dominant shoulder TAM, rotator cuff strength, and glenohumeral internal rotation deficit (GIRD) were not predictive of injury in our cohort; although having over 5 degrees of difference in TAM vs the non-dominant shoulder approached significance (P-value 0.0598). CONCLUSION: This is the first study to demonstrate predictive value of subjective questionnaires. The KJOC Overhead Athlete Shoulder and Elbow Score can be used as part of the standardized preseason athlete evaluation to target pitchers at risk for developing injuries in-season. Objective parameters - notably TAM, GIRD, and rotator cuff strength - were not predictive of injuries in our cohort, which contradicts prior reports. To our knowledge, normative FMS data has not yet been established in baseball pitchers.