A Clinician’s Guide to Evaluating and Managing Shoulder Overuse Injury in Softball Pitchers

BACKGROUND: Approximately one-third of softball pitchers sustain a pitching-related injury across a single season, with the throwing shoulder being the most frequently injured site. Overuse is a commonly proposed mechanism given the repetitive and high-stress placed on the biceps-labral complex. CLINICAL QUESTION: How can clinicians evaluate and manage shoulder overuse injury in softball pitchers? KEY RESULTS: Clinical evaluation of softball pitchers should include a comprehensive patient history, physical examination, and appropriate imaging. Understanding injury mechanisms and risks will help clinicians assess and treat injuries effectively. Management should include a rehabilitation program that extends beyond the pitching shoulder to address the whole kinetic chain, with a focus on the lumbopelvic-hip complex. CLINICAL APPLICATION: Our model was designed by an interdisciplinary team for clinicians seeking to evaluate softball pitchers with shoulder overuse injury and develop rehabilitation programs that support return-to-play. This model can be used to implement evidence-based evaluation and management methods to improve athlete care.