A Prospective Analysis of Scapular Positioning Patterns and Shoulder and Elbow Injury Susceptibility in Professional Baseball Pitchers

<b>Background/Objectives</b>: Baseball pitchers accumulate extreme upper extremity forces during the repetitive, high-velocity motion of throwing, which can lead to shoulder dysfunction and overuse injuries. Although scapular dyskinesis has been linked to various shoulder pathologies, there is a lack of evidence on the specific scapular patterns predisposing pitchers to injury. <b>Methods</b>: A total of 85 professional pitchers from a single professional baseball organization participated in the entirety of this study. All subjects had their scapular positions and motion patterns measured via a digital goniometer prior to the beginning of a competitive season. Scapular upward/downward rotation, anterior/posterior tilt, and internal/external rotation were assessed with the shoulder at rest and during elevation to 120° in the scapular plane. Overuse injuries of the shoulder/elbow sustained during the subsequent competitive season were documented by the team's medical staff, with statistical comparisons between the injured (<i>n</i> = 34) and non-injured (<i>n</i> = 51) group for each scapular measure. <b>Results</b>: Pitchers who sustained shoulder/elbow injuries demonstrated significantly more scapular anterior tilt during humeral elevation compared to those without an injury (<i>p</i> = 0.04). The difference in anterior tilt between the two groups was 3.8° and had a medium effect size, suggesting clinical relevance. No significant between-group differences were found in any other scapular positions or motions (<i>p</i> > 0.22). <b>Conclusions</b>: Pitchers with increased scapular anterior tilt were more likely to sustain a shoulder/elbow injury, highlighting this kinematic feature as a potential risk factor. This finding suggests that anterior tilt might contribute to soft tissue strain, increasing injury susceptibility in pitchers.