A National Evaluation of Upper Extremity Weightlifting Injury Surveillance: The High Risk in Youth and Adults With an Underutilization in Older Adults

Background: Weightlifting improves physical fitness; however, injuries can lead to impaired functionality and long-term complications. Data on weightlifting-related injuries are limited. Purpose: To evaluate the epidemiologic trends of weightlifting-associated upper extremity injuries, further stratified by age. Study Design: Descriptive epidemiologic study. Methods: This analysis used the National Electronic Injury Surveillance System (NEISS) database, including all patients presenting to the emergency department (ED) with a primary upper extremity weightlifting injury between 2021 and 2024. Outcomes included patient demographic characteristics, final diagnosis, primary body region injured, and mechanism of injury (MOI). Patients were stratified into 4 age groups: pediatric (<18 years), young adult (18-39 years), middle-age (40-64 years), and geriatric (≥65 years). Chi-square tests and post hoc comparisons were used to evaluate categorical variables. Linear and logistic regression analyses were used to evaluate associations between age groups. Statistical significance was predetermined at <.05. Results: After application of inclusion and exclusion criteria, 3189 upper extremity weightlifting injuries (national estimate [NE] = 127,667) were analyzed. Across all ages, sprain/strain (NE = 36,054; 26.2%), fracture/crush/avulsion (NE = 22,388; 15.8%), and laceration/puncture (NE = 9020; 7.2%) were the most common diagnoses. Injuries most frequently involved the shoulder (NE = 45,825; 33.8%), finger (NE = 32,398; 28.1%), and upper arm (NE = 7827; 8.8%). The most common MOIs were drop/crush injuries (NE = 34,757; 30.1%), pulling movements (NE = 14,232; 10.5%), and overhead movements (NE = 11,110; 8.3%). Pediatric patients were 2.5 times more likely to sustain finger injuries (odds ratio [OR], 2.536; 95% CI, 2.191-2.935; P < .001) and injuries from drop/crush mechanisms (OR, 2.484; 95% CI, 2.166-2.849; P < .001) compared with all other age groups. The geriatric age group was 2 times more likely to sustain injuries from pushing movements (OR, 2.037; 95% CI, 1.326-3.130; P < .001) compared with all other age groups. Conclusion: Sprain/strain and fracture/crush/avulsion were frequent upper extremity weightlifting injuries, often secondary to drop/crush injuries and overhead movements. Pediatric athletes were more likely to sustain finger and drop/crush injuries, whereas shoulder injuries affected all adult age groups. The low proportion of geriatric weightlifters suggests there may be underuse of a sport effective in combating osteoporosis. These insights into overall and age-specific injury patterns can help shape evidence-based recommendations to reduce the overall injury burden and promote safe resistance training.