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Risk factors for overuse shoulder injuries in a mixed-sex cohort of 329 elite handball players: previous findings could not be confirmed
  1. Stig Haugsboe Andersson,
  2. Roald Bahr,
  3. Benjamin Clarsen,
  4. Grethe Myklebust
  1. Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  1. Correspondence to Stig Haugsboe Andersson, Oslo Sports Trauma Research Center Department of Sports Medicine Norwegian School of Sport Sciences PB 4014 Ullevål Stadion 0806 Oslo, Norway; s.h.andersson{at}


Background Shoulder injuries are common among handball players and predominantly characterised by overuse characteristics. Reduced total glenohumeral rotation, external rotation weakness and scapular dyskinesis have been identified as risk factors among elite male handball players.

Aim To assess whether previously identified risk factors are associated with overuse shoulder injuries in a large cohort of elite male and female handball players.

Methods 329 players (168 male, 161 female) from the two upper divisions in Norway were included and tested prior to the 2014–2015 season. Measures included glenohumeral internal and external rotation range of motion, isometric internal and external rotation strength, and assessment of scapular dyskinesis. Players were followed prospectively for one competitive season, with prevalence and severity of shoulder problems registered monthly using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. A severity score based on players’ questionnaire responses was used as the outcome measure in multivariable logistic regression to investigate associations between candidate risk factors and overuse shoulder injury.

Results No significant associations were found between total rotation (OR 1.05 per 5° change, 95% CI 0.98 to 1.13), external rotation strength (OR 1.05 per 10 N change, 95% CI 0.92 to 1.20) or obvious scapular dyskinesis (OR 1.23, 95% CI 0.25 to 5.99) and overuse shoulder injury. A significant positive association was found between greater internal rotation (OR 1.16 per 5° change, 95% CI 1.00 to 1.34) and overuse shoulder injury.

Conclusion None of the previously identified risk factors were associated with overuse shoulder injuries in a mixed-sex cohort of elite handball players.

  • throwing athletes
  • handball
  • overuse shoulder injuries
  • shoulder pain/epidemiology
  • risk factors

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  • Contributors SHA drafted the manuscript and performed the data analysis. SHA and the main supervisor, GM, are responsible for the overall content as guarantors.

  • Competing interests None declared.

  • Ethics approval The study was reviewed by the Regional Committee for Medical and Health Research Ethics (REK 2014/653 A), which concluded that, according to the Act on Medical and Health Research (the Health Research Act 2008), the study did not require full review by REK. The study was approved by the Norwegian Social Science Data Service (NSD 2014/38187).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are available upon request to SHA (