Table 4 Summary of the main results
From: Risk factors for shoulder injuries in handball: systematic review
Independent Factors | Category | Injury type | Evidence of support | Grade of evidence | Details |
|---|---|---|---|---|---|
Muscle imbalances | Isokinetic Ratios | Acute and overuse | One moderate quality study | Limited evidence | Low conER/conIR strength at 240°/s and high eccIR/conER strength at 60°/s had a 2.5 times higher risk |
Isometric ER strength | Overuse | Four high-quality studies | Strong evidence | Decreased ER strength increases the risk | |
ROM imbalances | ER-IR ROM imbalance | Any shoulder injury | Two moderate-quality studies | Moderate evidence | No association with shoulder injuries |
TROM | Any shoulder injury and overuse injuries | Three moderate-quality studies | Moderate evidence | No association with shoulder injuries | |
Greater IR | Overuse | One moderate quality study | Limited evidence | 16% increased risk per five degrees change | |
|  | ER > 7.5° and GIRD > 7.5° | Overuse | One high-quality study | Moderate evidence | Higher risk in youth female players |
Scapula Dyskinesis | Obvious scapula dyskinesis | Acute and overuse | Two high-quality and three moderate-quality studies | Conflicting evidence | Three out of five studies found a positive association |
Joint position sense | Joint position error | Any shoulder injury | One moderate quality study | Limited evidence | No association with shoulder injuries |
Workload | One additional match/week | Overuse | One high-quality study | Moderate evidence | On average 31% increased risk for injury |
 > 60% increase in training load | Overuse | One moderate quality study | Limited evidence | Increased risk of injury compared to those with < 20% increase in training load | |
History of injury | Â | Overuse | One high-quality study | Moderate evidence | Â |
Sex | Females | Acute | Two high-quality studies | Strong evidence | Higher prevalence of shoulder injuries and higher odds of traumatic injuries |
Player’s position | Backcourt | Any shoulder injury | One high-quality study | Moderate evidence | Higher prevalence compared to 6 m players |
School grade | 1st, 2nd, or 3rd year student | Any shoulder injury | One high-quality study | Moderate evidence | No association with shoulder injuries |
Playing level | Regional vs national | Any shoulder injury | One high-quality study | Moderate evidence | No association with shoulder injuries |
Interaction of Factors | Injury type | Evidence of support | Grade of evidence | Details |
|---|---|---|---|---|
ER strength and increased workload | Acute and overuse | One moderate quality study | Limited evidence | Decreased ER strength increases the rate of shoulder injuries when load increases 20–60%/week or > 60%/week |
Obvious scapular dyskinesis and increased workload | Acute and overuse | Two moderate quality study | Limited evidence | Obvious scapula dyskinesis increases the rate of shoulder injuries when load increases 20–60%/week |