Prevention strategies and modifiable risk factors for upper extremity injury: a systematic review and meta-analysis for the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Objectives To examine injury prevention strategies and potentially modifiable risk factors (MRFs) for upper extremity (UE) injuries in female, woman and/or girl athletes (female/woman/girl). Design Systematic review with meta-analysis, semiquantitative analyses and Grading of Recommendations Assessment, Development and Evaluation in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data sources MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), APA PsycINFO (American Psychological Association Psychological Information Database), SPORTDiscus (Sports Discus Database), EMBASE (Excerpta Medica Database), and ERIC (Education Resources Information Center) (30 October 2023) and Cochrane Systematic Review Database and the Cochrane Central Register of Controlled Trials (CENTRAL) (25 November 2023). Eligibility Primary data studies with comparison group(s) assessing the association of prevention strategies and/or MRFs for sport-related UE injury, with ≥1 female/woman/girl in each study group. Results 55 studies (n=20 intervention, n=35 MRF) were included with 33 228 athletes (8642 female/woman/girl; 26%). Of these, 17 (31%) reported female/woman/girl-specific estimates and included five injury locations (n=3 general UE, n=12 shoulder, n=3 elbow, n=3 wrist/hand). One prevention strategy (n=5 shoulder-specific exercise programmes) and seven MRFs were identified, including less range of motion (n=6), less shoulder muscle strength (n=8), high training load (n=1), presence of scapular dyskinesis (n=3), high sport specialisation (n=2), equipment differences (n=1) and less sport-specific conditioning (n=1). Pooled data from three studies suggest that shoulder exercise programmes consisting of strength, stability/control and sport-specific exercises reduce shoulder injury rates by 51% (95% CI 0.30 to 079; I 2 0.0%; very-low certainty evidence) across paediatric (≤18 years) and adult handball and volleyball players. Conclusions Our understanding of female/woman/girl UE injury prevention is limited by heterogeneity across injury outcomes, interventions, MRFs and limited female/woman/girl athlete-specific data. Shoulder-specific strengthening and stability exercise programmes may be beneficial to reduce shoulder injury rates in female/woman/girl handball and volleyball players. Future research should prioritise female/woman/girl athletes to reduce the burden of UE injuries. PROSPERO registration number PROSPERO CRD42024494967.
Authors: Emily E Heming, Eric S Gibson, Kenzie B Friesen, Chelsea L Martin, Maitland Martin, Martin Asker, Cheri Blauwet, Garrett S Bullock, Hilde Fredriksen, Jean-Michel Galarneau, K Alix Hayden, Jae Hyung Lee, Andrea Britt Mosler, Grethe Myklebust, Babette M Pluim, Jane S Thornton, Jackie L Whittaker, Rod Whiteley, Kay M Crossley, Merete Møller, Carolyn A Emery
Institutions: University of Calgary, University of Saskatchewan, University of North Carolina at Chapel Hill, Sophiahemmet University College, Brigham and Women's Hospital, Harvard University, Spaulding Rehabilitation Hospital, Spaulding Hospital, University of Oxford, Wake Forest University Health Sciences, Wake Forest University, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, La Trobe University, Royal Dutch Lawn Tennis Federation, Health & Safety in Sports, University of Pretoria, Western University, International Olympic Committee, University of British Columbia, Arthritis Research Centre of Canada, Curtin University, Qatar Orthopaedic and Sports Medicine Hospital, University of Southern Denmark
Language: English
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Award: G103470996
OpenAlex ID: W4415524796