Preseason Screening Tests and Physical Assessments as Predictors of Injury in Handball Players: A Systematic Review

Background: Preseason screening is widely used in handball to identify athletes at increased risk of injury, yet the prognostic value of different screening approaches remains unclear. The aim of this study was to systematically review the evidence on preseason screening tests and physical assessments in relation to subsequent injury outcomes in handball players. Methods: A systematic review was conducted according to PRISMA guidelines. PubMed, MEDLINE, CINAHL, and Scopus were searched on 14 March 2026. The first 100 results from Google Scholar were also screened, and backward citation searching was performed. Eligible studies included handball players and examined preseason or baseline screening, functional, musculoskeletal, or physical performance assessments in relation to prospectively recorded injury outcomes. Two independent reviewers performed study selection, data extraction, and risk-of-bias assessment using the QUIPS tool. Due to substantial heterogeneity in screening tools, injury outcomes, and follow-up procedures, meta-analysis was not performed. Results: Eight studies were included. Most were prospective cohorts involving adolescent, youth elite, or elite adult handball players. Shoulder-specific screening variables, particularly external rotation strength, strength imbalances, total rotational motion, and selected rotational adaptations, showed more consistent associations with subsequent shoulder-related outcomes. In contrast, broader movement-screening tools, including the Functional Movement Screen, the 9+ screening battery, and the upper quarter Y-Balance Test, generally showed limited associations with overall injury outcomes. Conclusions: Shoulder-specific preseason assessments may be more closely associated with subsequent shoulder-related outcomes than broader movement-screening tools, although the available evidence remains limited, heterogeneous, and derived exclusively from observational studies.