The aim of this study was to examine the relationship between shoulder alignment and elbow angle during the delivery action of fast-medium bowlers. The elbow and upper trunk alignment were recorded for 13 high-performance bowlers (mean age 20 years) using a 12-camera Vicon motion analysis system operating at 250 Hz. The three highest velocity trials for "good'' and "short'' length deliveries were analysed. Results showed that bowlers with a more front-on shoulder alignment at backfoot impact and when the upper arm was horizontal to the ground experienced a significantly greater elbow flexion-extension range when compared with those who had a more side-on orientation at the same point in the delivery action. Bowlers with greater shoulder counter-rotation also recorded higher elbow flexion and subsequently extension during the period from upper arm horizontal to ball release. Shoulder alignment and elbow angles were similar for "short'' and "good'' length deliveries. It was concluded that bowlers with a more front-on shoulder orientation at back-foot impact demonstrated a higher elbow extension from upper arm horizontal to ball release and are therefore more likely to infringe International Cricket Council elbow tolerance levels, compared with those who adopt a more side-on shoulder orientation at back-foot impact.