Which Premier League Teams Have Medical Scans Done?
By Arasi Rex · Updated 15 August 2026 · 6 min read
Every one of the 20 Premier League clubs has the same incentive to do medical scans before confirming a signing. The squad rules do not let a club carry extra senior players, so a fitness mistake costs a place that cannot be replaced until the next window. The question is not which teams scan, but how they use the scan results.
The mechanism
The Premier League is a closed 20-club competition. Each club plays 38 matches, home and away, which makes 380 matches in a season. Three points for a win, one for a draw. That means every squad place has to earn points across a long season.
The hard limit is the 25-player squad list. Players over 21 must fit into that list, and at least 8 of the 25 must be homegrown. A homegrown player is someone trained in England or Wales for three years before turning 21. Under-21 players do not count against the 25.
This is where medical scans become a squad-building tool. A club cannot register more than 25 senior players, so every over-21 signing uses one of the limited places. If the player arrives with an injury that was not caught, the club has spent a place on a player who is not available. In a 38-match season, that is not merely bad luck. It is a structural disadvantage.
The substitution rules make the same point. A club can use five substitutes per match, in a maximum of three windows plus half-time. Those substitutes have to be ready to change a game. A squad filled with gambles on fitness will fail late in matches, when a club needs its fifth substitute to protect a lead or chase a goal.
| Squad rule | Impact |
|---|---|
| 25-player squad list | Over-21 players must fit into 25 names |
| Homegrown minimum | At least 8 of the 25 must be homegrown |
| Under-21 players | Not counted against the 25 |
| Five substitutes | Maximum five per match, in three windows plus half-time |
History/evolution
The league structure has not always been this tight. The Premier League was founded on 20 February 1992, when First Division clubs split away to sell their own broadcast deals. The opening season, 1992/93, had 22 clubs. By 1995/96 the league had settled on 20, and it has stayed there.
That change made the fixture list shorter but did not make it easier. A 22-club league would have meant a longer fixture list. With 20 clubs, each team plays 38. The reduction did not create more squad room; the 25-player cap still applies. So a club has fewer matches but the same need to keep a tight, fit group.
The five-substitute allowance is part of the modern answer. More substitutes means more players are involved on a matchday, and more of the squad has to be trusted to perform. Medical scans are the pre-season version of that trust.
Edge cases
The homegrown rule is the first edge case. At least 8 of the 25 over-21 players must be homegrown. That matters for medical decisions because the cost of a failed signing is not the same for every player. A non-homegrown player uses a place outside the homegrown quota, which can be harder to replace if the player cannot play. A homegrown player also has quota value, so a club may be more patient waiting for a scan to come back clean.
Under-21 players are the second edge case. They do not count against the 25, so a club can take a fitness gamble on a young player without sacrificing a senior slot. The same injury risk that would stop an over-21 signing might be acceptable for an under-21, because the squad list does not feel the cost. The player can be developed while he is still outside the senior limit.
The bottom of the table is the third edge case. The bottom three are relegated to the Championship, with three clubs coming up: two automatic places and one via play-off. A club fighting relegation cannot afford to burn a squad place on a player who is not fit. The margin between survival and relegation can be a single result, and a wasted place affects every match.
European qualification adds another layer. The top four go into the Champions League league phase, fifth and the FA Cup winner go to the Europa League, and the League Cup winner goes to the Conference League play-off. UEFA coefficient performance can add more Champions League places. A club in those competitions plays extra matches, which puts more strain on the same 25-man group. That is a strong argument for being strict with scans.
Why medical scans are done at every club
The structural answer is all 20 clubs, and the reason is in the rules. No club gets a larger squad to compensate for a bad medical result. No club gets an extra substitute because a player was rushed back from a scan. The 25-player limit, the homegrown quota, and the five-substitute rule apply equally across the league.
A club with a bigger budget can afford to sign more players, but it still cannot register more than 25 senior players. That is why the medical scan is not a small administrative step. It is a way of protecting one of the most valuable resources a Premier League club has: a place on the squad list. The teams that treat scans that way are the ones that avoid wasting places before the season starts.
That is the answer to the question behind the search. There is no special exemption for a title challenger, a newly promoted club, or a team in a European run. The 25-player rule binds them all, so the medical scan is a rare moment where the transfer process has to prove a player can do the actual job: play football at Premier League intensity.
Key takeaways
- All 20 Premier League clubs operate under the same 25-player senior squad limit, so fitness checks protect a scarce squad place.
- At least 8 of the 25 over-21 players must be homegrown, which changes the risk calculation when a signing has fitness doubts.
- Under-21 players do not count towards the 25, allowing clubs to take a chance on a young player without losing a senior spot.
- Five substitutes can be used per match across a maximum of three windows plus half-time, so match-ready squad depth matters more than raw numbers.
- The league settled at 20 clubs and 38 matches in 1995/96, creating the fixture load that makes medical judgments important.
FAQ
Do all Premier League clubs do medical scans?
Every club faces the same 25-player squad limit, so medical scans are done before an over-21 player joins. A player who fails a scan would occupy a place that could have been used on someone who can play immediately.
What is the homegrown rule?
At least 8 of the 25 players over 21 must be homegrown. A homegrown player is trained in England or Wales for three years before turning 21. Under-21 players do not count against the 25, so they do not affect the homegrown calculation.
How many substitutes can be used?
Five substitutes per match, in a maximum of three windows plus half-time. That is why a club needs more than a small group of trusted starters; the players coming off the bench have to be fit enough to handle the pace of a Premier League match.
Why does the Premier League have 20 teams?
The league started with 22 clubs in 1992/93 and reduced to 20 in 1995/96. Each club now plays 38 matches, home and away, and the bottom three are relegated to the Championship.