2017 ISAKOS Biennial Congress ePoster #2408


The Epidemiology of Elbow Injuries in US High School Baseball and Softball Athletes: Does Pitching Style Matter?

Andrew Pytiak, MD, Denver, CO UNITED STATES
Dustin Currie, MPH, Aurora, Colorado UNITED STATES
Matthew J. Kraeutler, MD, Cedar Grove, NJ UNITED STATES
Eric C. McCarty, MD, Boulder, CO UNITED STATES
Dawn Comstock, PhD, Aurora, Colorado UNITED STATES

University of Colorado Denver, Aurora, Colorado, UNITED STATES

FDA Status Not Applicable


This descriptive epidemiology study demonstrates that there is a significantly higher elbow injury rate in high school baseball compared to softball athletes, and that this difference is attributable to injuries sustained while pitching.



The objective of this study was to compare elbow injury rates between high school baseball and softball players and to identify any contributing factors.

Study Design:
Descriptive epidemiology study.


Baseball- and softball-related injury data from the 2005/06-2014/15 academic years
were collected from 100 nationally representative high schools via the High School Recording Information Online internet-based data collection tool. Athlete exposure (AE) and injury data were collected by certified athletic trainers. Elbow injury rates were calculated as the number of injuries per 10,000 athlete exposures. Rate ratios (RRs) were calculated comparing injury rates in the two populations. Injury proportion ratios (IPRs) comparing elbow injuries in pitchers and non-pitchers were calculated as the proportion of all pitcher injuries occurring to the elbow divided by the proportion of all non-pitcher injuries occurring to the elbow.


A total of 214 boys’ baseball elbow injuries occurred in 2,327,774 AEs for an overall elbow injury rate of 0.92 per 10,000 AE. In girls’ softball, 75 elbow injuries were reported in 1,731,644 AEs for an overall rate of 0.43 per 10,000 AEs. The elbow injury rate was significantly higher in baseball than softball (RR: 2.12, 95% CI: 1.64, 2.77). In addition, injuries to the elbow represented a significantly higher proportion of all baseball injuries (9.2%) than softball injuries (3.6%) (IPR: 2.58, 95% CI: 1.99, 3.33). A significantly higher proportion of baseball elbow injuries were pitching-related compared to softball elbow injuries with 50.2% occurring while pitching in baseball vs. 11.0% in softball (IPR: 4.58, 95% CI: 2.35, 8.93). If all injuries occurring during the activity of pitching are removed from both baseball and softball, the difference between elbow injury rate in baseball and softball would no longer be significant (non-pitching RR: 1.19, 95% CI: 0.88, 1.62).


The rate of elbow injuries is significantly higher in baseball than softball. This is attributable to differences in rates of pitching-related injuries between these two groups. Our results demonstrate that overhand pitching increases risk of elbow injury in the high school athlete.