Risk Contributors for Shoulder Injuries Among Adolescent Tennis Participants: A Prospective Group Study.

Abstract

Background: Tennis is a popular sport among adolescents, but the repetitive overhead motions can lead to shoulder injuries. The risk factors for shoulder injuries in this population are not well understood.

Purpose: To identify risk factors for shoulder injuries in adolescent tennis players and examine potential interactions between these factors.

Study design: Cohort study; Level of evidence, 2.

Methods: Adolescent tennis players (N = 350; aged 12-18 years) were followed for 24 months. Baseline data on demographics, tennis experience, training volume, physical characteristics, and psychological factors were collected. Shoulder injuries (defined as any shoulder pain or dysfunction requiring ≥48 hours of time loss from tennis participation and medical attention) were recorded monthly. Cox proportional HR analysis with univariate and multivariate models was used to identify risk factors, with statistical significance set at P < .05.

Results: A total of 88 players (25.1%) sustained shoulder injuries. Significant risk factors included age (hazard ratio [HR], 1.42; 95% CI, 1.16-1.74), years of playing tennis (HR, 1.25; 95% CI, 1.10-1.42), weekly training hours (HR, 1.18; 95% CI, 1.09-1.28), shoulder external/internal rotation strength ratio (HR, 3.12; 95% CI, 1.63-5.98), scapular dyskinesis (HR, 2.76; 95% CI, 1.46-5.22), and high levels of competitive anxiety (HR, 2.15; 95% CI, 1.24-3.73). Playing on hard courts increased injury risk compared with clay (HR, 1.68; 95% CI, 1.05-2.69) or grass courts (HR, 1.92; 95% CI, 1.14-3.24). Significant interactions were found between age and training volume (P = .01) and between shoulder strength ratio and scapular dyskinesis (P = .02).

Conclusion: Our study demonstrated that multiple interacting factors contribute to shoulder injury risk in adolescent tennis players. Age, tennis experience, training volume, shoulder muscle imbalance, scapular dyskinesis, competitive anxiety, and playing surface were identified as significant risk factors. These findings can guide the development of targeted prevention strategies to reduce shoulder injury risk in adolescent tennis players.