Prevalence and symptom severity of thrower’s shoulder in elite youth handball players

Objective To identify the prevalence and severity of overuse shoulder symptoms in elite youth handball players. Methods Six-hundred and sixty (52.3% boys) elite youth handball players were followed prospectively for one season during the seasons 2016-17, 2017-18, 2018-19, and 2019-20. Players completed standardized questionnaires throughout the season and reported any overuse shoulder symptoms. The Western Ontario Shoulder Instability Index (WOSI) questionnaire was distributed five times per season. Latent class analysis (LCA) was carried out to identify different symptom patterns. Results Of 660 athletes, 148 (22.4%) (50% boys, age: 14.1 ± 0.7 years) reported shoulder problems in at least one WOSI questionnaire. The average symptom severity was 457.8 ± 352.0 points (range 4 to 1834). The questions with the highest average scores were about the lack of strength (31.3 ± 27.5), the concern that the shoulder will get worse (29.5 ± 28.5), and clicking, cracking, or snapping of the shoulder (29.3 ± 30.9). No statistically significant sex-related differences were identified across the four WOSI domains. LCA showed no discernible pattern of symptom distribution. Conclusion The prevalence of overuse shoulder symptoms is high and presents as a multi-faceted problem in elite youth handball. The WOSI questionnaire indicates symptom severity rather than distinct symptom patterns.