Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Health Sciences


Rehabilitation Sciences

First Advisor

Dr. Timothy Uhl

Second Advisor

Dr. Dana Howell


Participation in high school sports has seen a steady increase over the past four decades. With nearly eight million student-athletes participating, careful monitoring of injuries related to their participation is imperative. Injury surveillance efforts through national databases have produced a multitude of studies detailing injuries that occur in specific sports, specific body parts, or particular diagnoses. The lower extremity tends to be injured more frequently than the upper extremity resulting in various comprehensive analyses on that particular body area. Currently, there are no comprehensive reports on the epidemiology of injury to the upper extremity in student-athletes participating in high school sports.

The first purpose of this dissertation was to describe time-loss injuries that affected six specific body areas of the upper extremity: shoulder/clavicle, upper arm, elbow, forearm, wrist, and hand/fingers. The second purpose was to investigate non-time-loss injuries to the six body areas, specifically the associated mechanisms of those injuries. The third purpose was to determine time to return to play after injury to each of the six body areas previously mentioned.

The first study demonstrated that the shoulder/clavicle and hand/fingers accounted for more than two-thirds of all time-loss upper extremity injuries. These injuries were primarily sprains, fractures, and contusions caused by a contact mechanism. In the second study, results demonstrated that for non-time-loss injuries, the hand/fingers sustained more injuries than all other areas. Diagnoses were predominantly sprains and contusions as a result of a contact mechanism. In the third study, time-to-event analysis techniques were used to provide probability estimates on return to play after a time-loss injury. After post-hoc analysis, there was no significant difference in time to return among the six body parts of the upper extremity. From a clinical perspective, the difference in time to return to play would have an impact on the number of competitions an athlete would miss during a week as the median days to return ranged from 6 days to 14 days. When comparing time to return between fractured body areas, time to return after a shoulder/clavicle fracture was statistically longer than forearm, wrist, or hand/finger fractures. Time to return for shoulder sprains was statistically longer than hand/finger sprains. Overall, 50% of upper extremity injuries returned to play in 7 days or less unless it was a shoulder/clavicle or forearm fracture.

These results provide much needed information regarding how the upper extremity is affected due to injury caused by participation in high school athletics. Clinically, this research adds a comprehensive analysis of time-loss and non-time-loss injuries to the upper extremity in a wide variety of sports. This research adds to the sequence of injury prevention to be used by stakeholders to improve safety and focus interventions

Digital Object Identifier (DOI)