Objectives: Electronic sports (esports) have grown tremendously in the past decade with an estimated market value of $493 million in 2017 and an expected growth to $2.3 billion dollars by the end of 2022. Additionally, colleges are embracing this growing culture with over 200 varsity esports programs as of May 2022, up from 7 varsity programs just two years earlier. Despite its growing success, little has been studied on the injuries of these athletes. Prior studies have noted that injuries to professional esports players have forced them to miss significant time and in some instances, into an early retirement. Due to poor posture, a sedentary lifestyle, and repetitive hand motions, the most common injuries to esports athletes include injuries to the hand, wrist, back and neck. The purpose of this study is to investigate the prevalence of injuries sustained through collegiate esports players and explore the injuries’ impacts on their careers. The authors hypothesized that athletes who spend more time practicing and playing competitively in esports will report an increased history of musculoskeletal injury. Methods: A list of collegiate esports athletes was collected from publicly available sources. Athletes with available contact information were sent a self-reporting questionnaire. The questionnaire examined variables including length of time playing esports, hours/day playing esports, esports-related injury history, surgeries needed, and missed competition time. Demographic and workload data were then compared between injured and uninjured athletes. Results: Overall, 153 collegiate esports athletes (88% male, aged 18-42 years) were included, with 41 (26.8%) having experienced at least one injury from esports. As demonstrated in Table 1, of the 41 injured athletes, 3 (7.3%) required surgery, 17 (41.5%) had multiple injuries, and 7 (17.1%) missed competition time for an average of 3.0 ± 2.3 weeks. Athletes who have been on their respective college team longer (1.7 ± 0.9 vs. 2.0 ± 1.0 years, p=0.026) and who spent more hours per day practicing had a higher injury incidence (p=0.012). There was no difference in current age, sex, age at which athletes began competing in esports, and scholarship status between groups (all p>0.05). When analyzing the 41 athletes who experienced an injury, the most common injury was to the wrist with 25 total injuries. There were 11 neck, 10 back, 9 finger, 8 hand, 6 elbow, and 4 thumb injuries. Conclusions: Collegiate esports players who trained for more hours per day and played competitive collegiate esports for more years were more likely to have experienced an esports-related injury. Interestingly, while hours per day was a significant risk factor for injury, the number of days per week had was not a significant risk factor for injury, possibly indicating that injuries are sustained through continuous and excessive playing rather than intermittent playing over a longer period. The three most common injury locations were to the wrist, back, and neck, while shoulder and thumb injuries were the least common. Fortunately, only a small portion of athletes who experienced an injury were forced to miss competition time, and even fewer required surgery. With this being the largest investigation into collegiate esports-related injuries, future medical research can help collegiate and professional programs place a greater emphasis on the management and prevention of esports-related injuries. [Table: see text]