Prevalence of upper extremity pain and disability in elite football, ice hockey and floorball players

In athletes, injuries and medical conditions affecting the upper extremities are quite common. However, there has been limited research on the occurrence of joint pain in the peripheral upper extremities among elite athletes. Thus, this study aimed to determine how prevalent upper limb pain and disability are among team sports players, particularly in football, ice hockey and floorball. We also aimed to compare the severity of pain and disability among these sports and assess the risk of developing upper limb pain in athletes. This cross-sectional study was conducted between June 2021 and September 2022, involving 388 male elite athletes from national-level sports clubs. The prevalence of shoulder pain and disability was determined using the Shoulder Pain and Disability Index (SPI). Assessment of elbow pain and disability was conducted using the Oxford Elbow Score (OES), while wrist pain and disability were evaluated through the Patient-Rated Wrist Evaluation (PRWE). Significant differences in total SPI, OES and PRWE scores were observed among all groups. Ice hockey players experienced the highest levels of shoulder and wrist pain. Compared to football and floorball players, ice-hockey players had a 2.13 times higher risk of shoulder pain, with a pain incidence of 40.8%. Ice hockey also had a 1.71 times higher risk of wrist pain than football, with a pain prevalence of 26.3%. Notably, floorball players exhibited the most pronounced elbow pain, with a 13.18-fold higher risk than football and ice-hockey players and a pain prevalence of 67.2%. The study findings suggest that ice hockey players experience the highest pain levels in their right limbs, whereas football players have the lowest pain levels, underscoring the importance of dedicating more attention to developing innovative, effective and advanced preventive programs for athletes.

Shoulder joint pain; Disability index; Oxford elbow score; Wrist evaluation; Male athletes

[1] Ornon G, Ziltener J-L, Fritschy D, Menetrey J. Epidemiology of injuries in professional ice hockey: a prospective study over seven years. Journal of Experimental Orthopaedics. 2020; 7: 87.

[2] Bizzoca D, Moretti L, Rifino F, Dibello D, Moretti B. Upper limb injures in young athletes. Minerva Orthopedics. 2021; 72: 84–92.

[3] Eerkes K. Volleyball injuries. Current Sports Medicine Reports. 2012; 11: 251–256.

[4] Jonasson P, Halldin K, Karlsson J, Thoreson O, Hvannberg J, Swärd L, et al. Prevalence of joint-related pain in the extremities and spine in five groups of top athletes. Knee Surgery, Sports Traumatology, Arthroscopy. 2011; 19: 1540–1546.

[5] White CA, O’Connor SJ, Sestak TR, Fox ES, Cagle PJ. Shoulder injuries in ice hockey players: prevalence, common management, and return to play. Journal of Orthopaedics. 2023; 35: 145–149.

[6] de Souza Lima EB, de Godoy GP, Osés GL, Lara PHS, Ribeiro LM, Andreoli CV, et al. Epidemiology of upper limb injuries in two major Brazilian soccer championships from 2016 to 2019. Journal of Experimental Orthopaedics. 2022; 9: 120.

[7] Sprouse B, Alty J, Kemp S, Cowie C, Mehta R, Tang A, et al. The football association injury and illness surveillance study: the incidence, burden and severity of injuries and illness in men’s and women’s international football. To be published in Sports Medicine. 2020. [Preprint].

[8] Velarde-Sotres Á, Bores-Cerezal A, Mecías-Calvo M, Barcala-Furelos M, Aparicio-Obregón S, Calleja-González J. Detection of upper limb asymmetries in athletes according to the stage of the season—a longitudinal study. International Journal of Environmental Research and Public Health. 2022; 19: 849.

[9] Daniel WW. Biostatistics: a foundation for analysis in the health sciences, 11th Edition. 2018. Available at: https://www.wiley.com/en-us/Biostatistics%3A+A+Foundation+for+Analysis+in+the+ Health+Sciences%2C+11th+Edition-p-9781119496571 (Accessed: 03 January 2023).

[10] Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis & Rheumatism. 1991; 4: 143–149.

[11] Roy J-S, MacDermid JC, Woodhouse LJ. Measuring shoulder function: a systematic review of four questionnaires. Arthritis and Rheumatism. 2009; 61: 623–632.

[12] Hill CL, Lester S, Taylor AW, Shanahan ME, Gill TK. Factor structure and validity of the shoulder pain and disability index in a population-based study of people with shoulder symptoms. BMC Musculoskeletal Disorders. 2011; 12: 8.

[13] Dawson J, Doll H, Boller I, Fitzpatrick R, Little C, Rees J, et al. The development and validation of a patient-reported questionnaire to assess outcomes of elbow surgery. The Journal of Bone and Joint Surgery. 2008; 90: 466–473.

[14] Jonsson EÖ, Wänström J, Björnsson Hallgren H, Adolfsson L. The Oxford Elbow Score demonstrated good measurement properties when used with a shortened 7-day recall period. JSES International. 2023; 7: 499–505.

[15] John M, Angst F, Awiszus F, Pap G, Macdermid JC, Simmen BR. The patient-rated wrist evaluation (PRWE): cross-cultural adaptation into German and evaluation of its psychometric properties. Clinical and Experimental Rheumatology. 2008; 26: 1047–1058.

[16] Eliašová A, Kollárová B, Kľoc P, Reľovská M, Miženková Ľ, Rybárová D, et al. Methodology for the evaluation of the results of surgical treatment of upper limb injuries. In Slovak; 2014. Available at: https://www.pulib.sk/web/pdf/web/viewer.html?file=/web/kniznica/elpub/dokument/Eliasova4/subor/9788055510552.pdf (Accessed 28 August 2023).

[17] Asker M, Hägglund M, Waldén M, Källberg H, Skillgate E. The effect of shoulder and knee exercise programmes on the risk of shoulder and knee injuries in adolescent elite handball players: a three-armed cluster randomised controlled trial. Sports Medicine—Open. 2022; 8: 91.

[18] Arabi E, Nazemzadegan GH. Comparison of upper limb disability in overhead women athletes of handball, volleyball, softball, and swimming. Physical Treatments. 2021; 11: 103–110.

[19] Silva Barros BR da, Cavalcanti IBS, Silva Júnior N da, Sousa C de O. Correlation between upper limb function and clinical measures of shoulder and trunk mobility and strength in overhead athletes with shoulder pain. Physical Therapy in Sport. 2022; 55: 12–20.

[20] Oliveira VMA de, Pitangui ACR, Gomes MRA, Silva HA da, Passos MHPD, Araújo RC de. Shoulder pain in adolescent athletes: prevalence, associated factors and its influence on upper limb function. Brazilian Journal of Physical Therapy. 2017; 21: 107–113.

[21] Shannon N, Cable B, Wood T, Kelly J. Common and less well-known upper-limb injuries in elite tennis players. Current Sports Medicine Reports. 2020; 19: 414–421.

[22] Watson L, Hoy G, Wood T, Pizzari T, Balster S, Barwood S, et al. Posterior shoulder instability in tennis players: aetiology, classification, assessment and management. International Journal of Sports Physical Therapy. 2023; V18: 769–788.

[23] Hides JA, Leung FT, Watson K, Trojman A, Grantham B, Mendis MD. Trunk muscle size and function in volleyball players with and without injuries to the head, neck and upper limb. Physical Therapy in Sport. 2022; 54: 1–7.

[24] Hamano N, Shitara H, Tajika T, Ichinose T, Sasaki T, Kuboi T, et al. Relationship between upper limb injuries and hip range of motion and strength in high school baseball pitchers. Journal of Orthopaedic Surgery. 2021; 29: 23094990211003347.

[25] Tajika T, Oya N, Kuboi T, Endo F, Ichinose T, Shimoyama D, et al. Risk factors for throwing-related shoulder and elbow pain in adolescent baseball players: a prospective study of physical and developmental factors. Orthopaedic Journal of Sports Medicine. 2021; 9: 23259671211017129.

[26] Giannatos V, Panagopoulos A, Antzoulas P, Giakoumakis SI, Lakoumentas J, Kouzelis A. Functional performance of the upper limb and the most common boxing-related injuries in male boxers: a retrospective, observational, comparative study with non-boxing population. BMC Sports Science, Medicine & Rehabilitation. 2022; 14: 1–11.

[27] Turnagöl HH, Koșar Șükran N, Güzel Y, Aktitiz S, Atakan MM. Nutritional considerations for injury prevention and recovery in combat sports. Nutrients. 2021; 14: 53.

[28] Bampouras TM, Wilson AJ, Papadopoulos K. Upper limb muscle strength and knee frontal plane projection angle asymmetries in female water-polo players. To be published in Sports Biomechanics. 2021. [Preprint].

[29] King M, Lewis A, Watson K, Bill V. 209 Performance of inertial measurement units to classify different upper limb activities in elite women’s water polo: a cross sectional study. British Journal of Sports Medicine. 2021; 55: A1–A188.

[30] Tedesco LJ, Swindell HW, Anderson FL, Jang E, Wong TT, Kazam JK, et al. Evaluation and management of hand, wrist and elbow injuries in ice hockey. Open Access Journal of Sports Medicine. 2020; 11: 93–103.

[31] Sonesson S, Dahlström Ö, Panagodage Perera NK, Hägglund M. Risk factors for injury and illness in youth floorball players—a prospective cohort study. Physical Therapy in Sport. 2023; 59: 92–102.

[32] Bowers AL, Baldwin KD, Sennett BJ. Athletic hand injuries in intercollegiate field hockey players. Medicine and Science in Sports and Exercise. 2008; 40: 2022–2026.

[33] Palmer D, Cooper D, Whittaker JL, Emery C, Batt ME, Engebretsen L, et al. Prevalence of and factors associated with osteoarthritis and pain in retired Olympians compared with the general population: part 2—the spine and upper limb. British Journal of Sports Medicine. 2022; 56: 1132–1140.