Injury and Economic Burden of Shoulder and Elbow Injuries in Major League Baseball Pitchers: A Retrospective 11-Year Analysis (2015-2025)

Background: Shoulder and elbow injuries are a significant source of morbidity among Major League Baseball (MLB) pitchers, yet comprehensive injury and economic burden analyses remain limited. Purpose: To quantify the epidemiological and economic burden of shoulder and elbow injuries among MLB pitchers from 2015 to 2025, including trends in injury incidence and salary lost over time. Study Design: Descriptive epidemiological study. Methods: All MLB pitcher injured list (IL) placements for shoulder and elbow injuries from 2015 to 2025 were identified using publicly available databases (ie, Fangraphs, Spotrac). Salary lost was calculated using the daily rate methodology and adjusted for inflation in US dollars, based on the 2025 inflation rate. Injury incidence rates were calculated per 1000 athlete-exposures. Linear regression assessed temporal trends in injury costs and incidence. Results: A total of 1122 MLB pitchers sustained shoulder or elbow IL placements during the study period, comprising 2365 total IL stints and $3.33 billion in cumulative salary lost. Elbow injuries accounted for 68.3% ($2.28 billion) and shoulder injuries 31.7% ($1.06 billion). Ulnar collateral ligament (UCL) injuries were the costliest diagnosis ($1.29 billion, 539 events). Significant increasing trends were observed for overall injury incidence (slope = 0.187 per 1000 athlete-exposures per year, P < .001), with elbow incidence rising 2.9 times faster than shoulder incidence (elbow slope = 0.140 per 1000 athlete-exposures per year, P < .001; shoulder slope = 0.047 per 1000 athlete-exposures per year, P = .022). Relief pitchers demonstrated 27.4 IL days per 1000 pitches compared to 15.3 for starters, representing approximately 80% higher injury burden per pitch. Conclusion: Shoulder and elbow injuries among MLB pitchers represent a substantial and growing time-loss and economic burden, with cumulative salary lost exceeding $3.3 billion over the study period. Elbow injuries accounted for most of this burden, and UCL injuries represented the single costliest injury category. These findings quantify the considerable financial and roster burden associated with shoulder and elbow IL placements among MLB pitchers.