With the passing of the Education Amendments of 1972, Title IX prohibited federally funded institutions from discriminating against individuals based on sex, providing greater opportunities for female participation in interscholastic athletics. In 1971, prior to the enactment of Title IX, the National Federation of State High School Associations reported that just under 300,000 girls participated in high school sports across the United States (US) [1]. By the 2009-2010 school year, participation grew to over three million [1]. Similar growth has been seen at the collegiate level. From 1977 to 2010, the number of women participating in collegiate athletics increased six-fold [1]. In a recent review of female participation in sports, the National Collegiate Athletic Association (NCAA) revealed that women comprise 47% of all Division I athletes [2].

Increased female participation in sports has led to a simultaneous rise in injury. For example, from 2007 to 2016, while female participation in adult ice hockey grew by 34%, emergency departments across the United States reported a 2.5-fold increase in adult female hockey injuries [3]. Between 2014 and 2019, the NCAA reported higher injury rates in female basketball players in both practice and competition [4]. Despite the rising trend, there remains a lack of research surrounding female athlete injuries, especially in the upper extremity. In general, while men are afflicted by shoulder injuries more often, primarily due to traumatic collisions, female athletes are more susceptible to injuries related to overuse, the rotator cuff, and joint laxity [3]. Moreover, women are more likely to have worse symptomatology and outcomes following shoulder injury and surgery when compared to men [3].

Several hypotheses concerning both intrinsic and extrinsic factors have been proposed to explain the differences in sports-related shoulder injuries between men and women. This chapter highlights various sex-based factors and describes the most common shoulder injuries in female athletes.