title: Effect of Pitching Consecutive Days in Youth Fast-Pitch Softball Tournaments on Objective Shoulder Strength and Subjective Shoulder Symptoms.
abstract: BACKGROUND
  The windmill pitching motion has been associated with risk for shoulder injury. Because there are no pitching limits on youth fast-pitch softball pitchers, these athletes often pitch multiple games across consecutive days. Strength changes, fatigue levels, and shoulder pain that develop among female fast-pitch pitchers over the course of consecutive days of pitching have not been investigated.
  
  
  OBJECTIVE
  Over the course of 2- and 3-day fast-pitch softball tournaments, pitchers will develop progressive objective weakness and increased subjective shoulder fatigue and pain without complete recovery between days.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  Fourteen female fast-pitch softball pitchers between the ages of 14 and 18 years were evaluated for strength and fatigue changes across 2- and 3-day tournaments. At the beginning and end of each day of tournament play, pitchers were asked to quantify shoulder fatigue and shoulder pain levels of their dominant throwing arm using a 10-point visual analog scale (VAS). Shoulder abduction, flexion, external rotation, internal rotation, elbow flexion, and elbow extension strength measurements were gathered using a handheld dynamometer.
  
  
  RESULTS
  Over the course of an average single day of tournament participation, pitchers developed significant increases in VAS scores for shoulder fatigue (median, 2.0; 95% CI, 1.3-3.0) and pain (median, 1.3; 95% CI, 0.5-2.3) and significant strength loss in all tested motions. Pitchers also developed significant increases in VAS shoulder fatigue (median, 3.5; 95% CI, 1.5-5.5), VAS shoulder pain (median, 2.5; 95% CI, 1.0-4.5), and strength loss in all tested motions over the entire tournament. Shoulder pain, fatigue, and strength do not fully recover between days. The accumulation of subjective shoulder pain and fatigue over the course of tournament play were closely correlated.
  
  
  CONCLUSIONS
  Among youth female fast-pitch softball pitchers, there is a progressive increase in shoulder fatigue, pain, and weakness over the course of 2- and 3-day tournaments without full recovery between consecutive days of pitching.
authors.affiliation: Washington University in St Louis School of Medicine, St Louis, Missouri, USA.
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Skillington
authors.affiliation: Department of Orthopedics, Washington University in St Louis School of Medicine, St Louis, Missouri, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Brophy
authors.affiliation: Department of Orthopedics, Washington University in St Louis School of Medicine, St Louis, Missouri, USA.
authors.forename: Rick W
authors.initials: RW
authors.lastname: Wright
authors.affiliation: Department of Orthopedics, Washington University in St Louis School of Medicine, St Louis, Missouri, USA.
authors.forename: Matthew V
authors.initials: MV
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D018771:Arthralgia / Q000503:physiopathology; D001484:Baseball / Q000293:injuries*; D003163:Competitive Behavior / Q000502:physiology; D003430:Cross-Sectional Studies; D004550:Elbow / Q000503:physiopathology; D005260:Female; D006801:Humans; D018763:Muscle Fatigue / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology*; D016059:Range of Motion, Articular; D012399:Rotation; D000070599:Shoulder Injuries / Q000503:physiopathology*; D012785:Shoulder Joint / Q000503:physiopathology*; D020069:Shoulder Pain / Q000209:etiology; D000092464:Elbow Injuries
keywords: fast-pitch; female athlete; softball; tournament