Bony Anatomy, Soft-Tissue Adaptations and Neuromuscular Risk Factors of Shoulder Injury in Handball Players: A Narrative Review.
5 affiliations
- 1School of Physical Education and Sports Science, Department of Competitive Sports, Division of Team Handball, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece.
- 2Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, 62122 Serres, Greece.
- 31st Orthopaedic Department, George Papanikolaou General Hospital, Medical School, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece.
- 4Department of Orthopaedic Surgery, Sports Trauma Unit, St. Luke's Hospital, 55236 Thessaloniki, Greece.
- 5Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece.
Abstract
Handball is a high-intensity contact sport that imposes significant mechanical stress on the shoulder joint through repetitive, high-velocity overhead throwing, predisposing athletes to a wide spectrum of shoulder injuries. This narrative review examines the factors associated with shoulder injuries in handball players, highlighting underlying structural, adaptive and functional mechanisms across male and female athletes. A literature search of PubMed/MEDLINE was conducted to synthesize current evidence on bony anatomy, soft tissue adaptations and neuromuscular characteristics in handball cohorts. Factors associated with shoulder injury or symptoms can be broadly categorized into three conceptual domains: (i) bony anatomy and structural features, (ii) soft tissue adaptations and (iii) dynamic functional and neuromuscular factors. Bony factors include reduced acromiohumeral distance, increased humeral retrotorsion as a sport-specific skeletal adaptation and variations in glenoid morphology that may influence glenohumeral stability. Soft tissue adaptations include posterior capsular tightness, anterior capsular laxity and alterations in shoulder range of motion, particularly glenohumeral internal rotation deficit (GIRD) accompanied by external rotation gain (ERG), which may influence glenohumeral kinematics and potentially contribute to shoulder symptoms or overuse conditions. Beyond these structural features, dynamic functional factors, including shoulder rotator muscle strength imbalances, impaired scapular control and training-load management, play a central role in injury development. Therefore, a comprehensive assessment encompassing anatomical correlates, soft tissue characteristics and functional/neuromuscular characteristics may support the development of targeted injury-prevention and rehabilitation strategies in handball players.
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BibTeX
@article{papadopoulou2026bony,
title = {{Bony Anatomy, Soft-Tissue Adaptations and Neuromuscular Risk Factors of Shoulder Injury in Handball Players: A Narrative Review.}},
author = {Zacharoula Papadopoulou and Angelo V Vasiliadis and Eleni Maria Vrampa and Nikiforos Galanis},
journal = {Clinics and practice},
year = {2026},
month = oct,
doi = {10.3390/clinpract16100195},
url = {https://europepmc.org/article/MED/42930380},
note = {CC BY},
}
RIS
TY - JOUR
TI - Bony Anatomy, Soft-Tissue Adaptations and Neuromuscular Risk Factors of Shoulder Injury in Handball Players: A Narrative Review.
AU - Zacharoula Papadopoulou
AU - Angelo V Vasiliadis
AU - Eleni Maria Vrampa
AU - Nikiforos Galanis
PY - 2026
DA - 2026/10/20
JO - Clinics and practice
DO - 10.3390/clinpract16100195
UR - https://europepmc.org/article/MED/42930380
AB - Handball is a high-intensity contact sport that imposes significant mechanical stress on the shoulder joint through repetitive, high-velocity overhead throwing, predisposing athletes to a wide spectrum of shoulder injuries. This narrative review examines the factors associated with shoulder injuries in handball players, highlighting underlying structural, adaptive and functional mechanisms across male and female athletes. A literature search of PubMed/MEDLINE was conducted to synthesize current evidence on bony anatomy, soft tissue adaptations and neuromuscular characteristics in handball cohorts. Factors associated with shoulder injury or symptoms can be broadly categorized into three conceptual domains: (i) bony anatomy and structural features, (ii) soft tissue adaptations and (iii) dynamic functional and neuromuscular factors. Bony factors include reduced acromiohumeral distance, increased humeral retrotorsion as a sport-specific skeletal adaptation and variations in glenoid morphology that may influence glenohumeral stability. Soft tissue adaptations include posterior capsular tightness, anterior capsular laxity and alterations in shoulder range of motion, particularly glenohumeral internal rotation deficit (GIRD) accompanied by external rotation gain (ERG), which may influence glenohumeral kinematics and potentially contribute to shoulder symptoms or overuse conditions. Beyond these structural features, dynamic functional factors, including shoulder rotator muscle strength imbalances, impaired scapular control and training-load management, play a central role in injury development. Therefore, a comprehensive assessment encompassing anatomical correlates, soft tissue characteristics and functional/neuromuscular characteristics may support the development of targeted injury-prevention and rehabilitation strategies in handball players.
SN - 2039-7275
SN - 2039-7283
ER -