Evaluating Risk Factors for Biceps Tendon Injuries in Softball Players: A Systematic Review

Abstract

Objective: Softball players commonly suffer overuse injuries due to the demands of repetitive throwing. The biceps tendon plays an important role in stabilizing the shoulder during the windmill pitch. The purpose of this study was to evaluate the measures used to identify and study biceps tendon pathology in softball players. Design: This was a systematic review. Setting: PubMed MEDLINE, Ovid MEDLINE, and EMBASE were searched. Participants: Studies that investigated biceps tendon injuries in softball players. Interventions: None. Main Outcome Measures: Range of motion (ROM), strength, and visual analog scale data were collected. Results: Of 152 search results, 18 were included. A total of 536 of 705 athletes (76%) were softball players (average age 14-25 years). Five of 18 articles (27.7%) studied changes in external rotation with the shoulder at 90 degrees of abduction, and 4 of 18 (22.2%) studied internal rotation. Two of 18 studies (11.1%) examined ROM or strength changes in forward flexion. Conclusions: While researchers agree that the windmill pitch places significant stress on the biceps tendon, our study finds that the metrics used to evaluate shoulder pathology in these players primarily evaluate the rotator cuff without isolating the biceps tendon. Future studies should include clinical tests and biomechanical metrics more specific to identifying biceps and labral pathology (eg, strength, fatigue, and ROM in glenohumeral forward flexion, elbow flexion, and forearm supination) and attempt to clarify differences in pathology between pitchers and position players to better characterize the frequency and severity of biceps tendon pathology in softball players.