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Lee YY, Yang TH, Huang CC, Huang YC, Chen PC, Hsu CH, Wang LY, Chou WY. Ultrasonography has high positive predictive value for medial epicondyle lesions among adolescent baseball players. Knee Surg Sports Traumatol Arthrosc 2019; 27:3261-3268. [PMID: 30284010 DOI: 10.1007/s00167-018-5178-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/20/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Only few studies have investigated medial epicondyle (MEC) lesions, particularly in the 12-18 age group. To the best of our knowledge, no study has compared ultrasonography (US), radiography and magnetic resonance imaging (MRI) in detecting MEC lesions. The aims of this study were to examine the value of US for detecting MEC lesions and to investigate correlations among diagnostic tools. METHODS A prospective, comparative study was performed. Young baseball players from southern Taiwan were recruited, and basic characteristics, as well as passive range of motion (pROM) of the upper extremities, were recorded. Screening US was performed to identify MEC lesions, and players with MEC lesions received follow-up plain radiography and MRI. RESULTS A total of 299 young baseball players were screened using US, and 28 of 299 players with possible MEC lesions were identified with a positive predictive value (PPV) of 88% according to MRI findings. The MEC lesions were primarily comprised of unfused ossicles and bony fragmentation. Other diagnoses, including UCL strain and medial epicondylitis, were also found by MRI in players with abnormal US screening results. The pROM of shoulder external rotation (ER) of the throwing hand was significantly reduced in players with MEC lesions (p = 0.006). CONCLUSIONS Bony cortical discontinuity or fragmentation over the MEC warrants further research, and US provides good PPV for types of MEC lesions. Decreased shoulder ER may relate to MEC lesions and should be taken into consideration. The use of US may facilitate early detection and intervention. LEVEL OF EVIDENCE IV, Cross-sectional study.
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Affiliation(s)
- Yan-Yuh Lee
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China
| | - Tsung-Hsun Yang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China
| | - Chung-Cheng Huang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China
| | - Chia-Hao Hsu
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China.
| | - Wen-Yi Chou
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China.
- Medical Mechatronic Engineering Program, Cheng Shiu University, Kaohsiung, Taiwan, Republic of China.
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Hellem A, Shirley M, Schilaty N, Dahm D. Review of Shoulder Range of Motion in the Throwing Athlete: Distinguishing Normal Adaptations from Pathologic Deficits. Curr Rev Musculoskelet Med 2019; 12:346-355. [PMID: 31264172 PMCID: PMC6684718 DOI: 10.1007/s12178-019-09563-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Overhand (OH) throwers demonstrate a unique motion profile of the shoulder joint complex. This manuscript reviews normal adaptations in the OH thrower and contrast findings with pathologic motion deficits. RECENT FINDINGS Multiple adaptations in range of motion have been associated with increased risk for arm injury. The use of a more conservative cutoff value for glenohumeral internal rotation deficit and horizontal adduction in younger throwers may help reduce injury risk. Deficits in glenohumeral internal rotation, total range of motion, shoulder flexion, and external rotation insufficiency have all been proposed as means to identify OH throwers at risk for arm injury, but conflicting evidence exists. Understanding normal adaptation due to repetitive stress of throwing is essential to effective management of these athletes. Adaptive change in bone and soft tissues is normal and contributes to the unique motion profiles expected in throwers. The causative link between normal adaptation and shoulder and elbow injury remains uncertain.
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Affiliation(s)
- Aaron Hellem
- Department of Physical Medicine and Rehabilitation, Sports Medicine Center at Mayo Clinic Square, Mayo Clinic, 600 Hennepin Avenue #310, Minneapolis, MN, 55403, USA.
| | - Matthew Shirley
- Department of Orthopedic Surgery, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
| | - Nathan Schilaty
- Department of Orthopedic Surgery, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Diane Dahm
- Department of Orthopedic Surgery, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
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Abstract
Background: Contributing factors for arm injuries among baseball players have been
described. However, no review has systematically identified risk factors
with findings from prospective cohort studies. Purpose: To systematically review prospective cohort studies that investigated risk
factors for arm injury among baseball players. Study Design: Systematic review; Level of evidence, 3. Methods: Electronic databases were searched for relevant English-language studies.
Titles, abstracts, and full-text articles were screened by 2 blinded
reviewers to identify only prospective cohort studies and randomized
controlled trials. Two independent investigators screened each article for
appropriate criteria. Results: Fourteen prospective articles were selected for this review. Youth, high
school, and professional baseball players (N = 2426) were pooled, and 43
risk factors were assessed in relation to general arm, shoulder, and elbow
injuries. All studies evaluated players for at least 1 season. Deficits in
preseason shoulder range of motion and strength were significant risk
factors for general arm or shoulder injury among high school and
professional players. Elbow and shoulder varus torque at peak external
shoulder rotation during pitching, high pitch velocity, and shoulder
rotational and flexion deficits were risk factors for elbow injuries among
professional pitchers. Pitching >100 innings in 1 year, being aged 9 to
11 years, being a pitcher or catcher, training >16 hours per week, and
having a history of elbow pain were significant risk factors for elbow
injury among youth players. Conclusion: History of elbow pain and age had a high risk of associated elbow injury
among youth players. Training or pitching load also increased elbow injury
risk for youth athletes. Loss of shoulder range of motion appears to
increase risk for elbow injury among professional athletes. Single
time-point data collections per season, studies with the same sample
population, and studies with self-reported injury and risk factor data may
limit the interpretation of these findings. Health care professionals should
use caution when assessing injury risk during evaluation and making
decisions about the training workload and playing time of baseball
players.
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Affiliation(s)
- Cristine E Agresta
- Michigan Performance Research Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin Krieg
- Michigan Performance Research Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Bullock GS, Faherty MS, Ledbetter L, Thigpen CA, Sell TC. Shoulder Range of Motion and Baseball Arm Injuries: A Systematic Review and Meta-Analysis. J Athl Train 2018; 53:1190-1199. [PMID: 30525937 DOI: 10.4085/1062-6050-439-17] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Arm injuries in baseball players are a common problem. The identification of modifiable risk factors, including range of motion (ROM), is essential for injury prevention. The purpose of this review was to assess the methodologic quality and level of evidence in the literature and to investigate the relationship between shoulder ROM and the risk of arm injuries in baseball players. DATA SOURCES Relevant studies in PubMed, CINAHL, Embase, and SPORTDiscus published from inception to August 1, 2017. STUDY SELECTION Only studies that encompassed healthy baseball cohorts who were assessed for shoulder ROM and prospectively evaluated for injuries throughout a baseball season or seasons were included. DATA EXTRACTION Six articles met the search criteria. Only 3 studies were included in the meta-analysis due to disparate participant groups. DATA SYNTHESIS The modified Downs and Black scale (0-15 points) was used to analyze methodologic quality. Study quality ranged from 11 to 14. Four studies received high-quality (≥12) and 2 studies received moderate-quality (≥10) scores. The overall pooled analysis demonstrated that absolute and internal-rotation deficits (-5.93 [95% confidence interval {CI} = -9.43, -2.43], P < .001 and 4.28 [0.71, 7.86], P = .02, respectively) and absolute total ROM (TROM; -6.19 [95% CI = -10.28, -2.10]; P = .003) were predictors of injury, and these data exhibited homogeneity (absolute IR P value = .77, I2 = 0%; IR deficit P value = .41, I2 = 0%; absolute TROM P value = .78, I2 = 0%). No significance was observed for absolute external rotation (-2.86 [95% CI = -6.56, 0.83], P = .13), which had data with high heterogeneity ( P = .003; I2 = 83%). A deficit in horizontal adduction was a predictor of injury (-8.32 [95% CI = -12.08, -4.56]; P < .001); these data were homogeneous but yielded a moderate heterogenic effect ( P = .16; I2 = 50%). CONCLUSIONS High-quality evidence demonstrated that deficits in throwing-arm TROM and IR were associated with upper extremity injury in baseball players. Heterogeneity across studies for horizontal adduction suggested that this may be a modifiable risk factor for injury, but it requires further research.
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Affiliation(s)
| | - Mallory S Faherty
- Michael W. Krzyzewski Human Performance Laboratory, Duke University, Durham, NC
| | - Leila Ledbetter
- Michael W. Krzyzewski Human Performance Laboratory, Duke University, Durham, NC
| | | | - Timothy C Sell
- Michael W. Krzyzewski Human Performance Laboratory, Duke University, Durham, NC
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Michener LA, Abrams JS, Bliven KCH, Falsone S, Laudner KG, McFarland EG, Tibone JE, Thigpen CA, Uhl TL. National Athletic Trainers' Association Position Statement: Evaluation, Management, and Outcomes of and Return-to- Play Criteria for Overhead Athletes With Superior Labral Anterior-Posterior Injuries. J Athl Train 2018; 53:209-229. [PMID: 29624450 DOI: 10.4085/1062-6050-59-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To present recommendations for the diagnosis, management, outcomes, and return to play of athletes with superior labral anterior-posterior (SLAP) injuries. BACKGROUND In overhead athletes, SLAP tears are common as either acute or chronic injuries. The clinical guidelines presented here were developed based on a systematic review of the current evidence and the consensus of the writing panel. Clinicians can use these guidelines to inform decision making regarding the diagnosis, acute and long-term conservative and surgical treatment, and expected outcomes of and return-to-play guidelines for athletes with SLAP injuries. RECOMMENDATIONS Physical examination tests may aid diagnosis; 6 tests are recommended for confirming and 1 test is recommended for ruling out a SLAP lesion. Combinations of tests may be helpful to diagnose SLAP lesions. Clinical trials directly comparing outcomes between surgical and nonoperative management are absent; however, in cohort trials, the reports of function and return-to-sport outcomes are similar for each management approach. Nonoperative management that includes rehabilitation, nonsteroidal anti-inflammatory drugs, and corticosteroid injections is recommended as the first line of treatment. Rehabilitation should address deficits in shoulder internal rotation, total arc of motion, and horizontal-adduction motion, as well as periscapular and glenohumeral muscle strength, endurance, and neuromuscular control. Most researchers have examined the outcomes of surgical management and found high levels of satisfaction and return of shoulder function, but the ability to return to sport varied widely, with 20% to 94% of patients returning to their sport after surgical or nonoperative management. On average, 55% of athletes returned to full participation in prior sports, but overhead athletes had a lower average return of 45%. Additional work is needed to define the criteria for diagnosing and guiding clinical decision making to optimize outcomes and return to play.
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Scapulothoracic kinematic pattern in the shoulder pain and scapular dyskinesis: A principal component analysis approach. J Biomech 2018; 77:138-145. [DOI: 10.1016/j.jbiomech.2018.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 12/16/2022]
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Pennock AT, Dwek J, Levy E, Stearns P, Manning J, Dennis MM, Davis-Juarez A, Bastrom T, Taylor KS. Shoulder MRI Abnormalities in Asymptomatic Little League Baseball Players. Orthop J Sports Med 2018; 6:2325967118756825. [PMID: 29511703 PMCID: PMC5826014 DOI: 10.1177/2325967118756825] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Youth baseball is extremely popular in the United States, but it has been associated with shoulder pain and injury. The incidence of shoulder abnormalities in this athletic population has yet to be defined. Purpose: To examine abnormalities noted on magnetic resonance imaging (MRI) in the shoulders of asymptomatic Little League baseball players and to correlate these findings with the players’ throwing history and physical examinations. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 23 Little League baseball players aged 10 to 12 years were recruited. All players underwent a comprehensive physical examination and responded to a questionnaire addressing their playing history and any arm or shoulder pain. Bilateral shoulder MRIs were performed and read in a blinded manner by 2 radiologists. Responses on the questionnaire and physical examination findings were compared between participants with and without positive MRI findings through use of chi-square test and analysis of variance. Results: The dominant arm was 8.5 times more likely to have an abnormality on MRI compared with the nondominant arm. In all, 12 players (52%) had 17 positive MRI findings in their throwing shoulder that were not present in their nondominant shoulder. These findings included edema or widening of the proximal humeral physis (n = 5), labral tear (n = 4), partial rotator thickness tear (n = 4), acromioclavicular joint abnormality (n = 2), subacromial bursitis (n = 1), and cystic change of the greater tuberosity (n = 1). Two primary risk factors were associated with an abnormal MRI: year-round play and single-sport athletes focusing solely on baseball (P < .05). Players with no risk factors, 1 risk factor, and both risk factors had a 25%, 71%, and 100% chance, respectively, of having an abnormal MRI. A majority of players (61%) had previously experienced shoulder pain, especially pitchers throwing curveballs and sliders (P < .05), but this was not associated with an abnormal MRI. Conclusion: Abnormalities seen on MRI involving the shoulder are common in Little League baseball players, especially those who are single-sport athletes playing year-round.
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Affiliation(s)
- Andrew T Pennock
- Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, California, USA.,Department of Orthopedic Surgery, University of California-San Diego, San Diego, California, USA
| | - Jerry Dwek
- Department of Radiology, Rady Children's Hospital, San Diego, California, USA
| | - Emily Levy
- Primary Care Sports Medicine, University of California-San Diego, San Diego,California, USA
| | - Philip Stearns
- Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, California, USA
| | - John Manning
- Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, California, USA.,Department of Orthopedic Surgery, University of California-San Diego, San Diego, California, USA
| | - M Morgan Dennis
- Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, California, USA
| | - Amanda Davis-Juarez
- Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, California, USA
| | - Tracey Bastrom
- Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, California, USA
| | - Kenneth S Taylor
- Primary Care Sports Medicine, University of California-San Diego, San Diego,California, USA
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Pytiak AV, Kraeutler MJ, Currie DW, McCarty EC, Comstock RD. An Epidemiological Comparison of Elbow Injuries Among United States High School Baseball and Softball Players, 2005-2006 Through 2014-2015. Sports Health 2017; 10:119-124. [PMID: 29068752 PMCID: PMC5857729 DOI: 10.1177/1941738117736493] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Pitching is a common mechanism of injury in baseball, with known risk factors for elbow injuries among adolescent pitchers. Hypothesis: Elbow injury rates and mechanisms will differ between high school baseball and softball players. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Methods: Baseball- and softball-related injury data from the 2005-2006 through 2014-2015 academic years were collected from the High School Reporting Information Online (RIO) Internet-based data collection tool. Athlete-exposure (AE) and injury data were collected by certified athletic trainers. Rate ratios (RRs) were calculated comparing injury rates in the 2 populations. Injury proportion ratios (IPRs) comparing elbow injuries in pitchers and nonpitchers were calculated as the proportion of all elbow injuries in pitchers divided by the proportion of all elbow injuries in nonpitchers. Results: A total of 214 elbow injuries in male baseball players occurred over 2,327,774 AEs, for an overall elbow injury rate of 0.92 per 10,000 AEs. A total of 75 elbow injuries were reported in female softball players over 1,731,644 AEs, for an overall rate of 0.43 per 10,000 AEs. The rate of elbow injury was significantly higher for baseball than softball (RR, 2.12; 95% CI, 1.64-2.77). A significantly greater proportion of elbow injuries in baseball were pitching-related compared with those from softball, with 50.2% occurring while pitching in baseball versus 11.0% in softball (IPR, 4.58; 95% CI, 2.35-8.93). If all injuries occurring during pitching were removed from both sports, the difference in elbow injury rate for baseball and softball would no longer be significant (RR, 1.19; 95% CI, 0.88-1.62). Conclusion: The rate of elbow injuries is significantly higher in baseball than softball. This is attributable to differences in rates of pitching-related injuries between these 2 groups. Clinical Relevance: These results demonstrate that overhand pitching increases risk of elbow injury in high school athletes.
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Affiliation(s)
- Andrew V Pytiak
- Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado
| | - Matthew J Kraeutler
- Department of Orthopaedics, Seton Hall-Hackensack Meridian School of Medicine, South Orange, New Jersey
| | - Dustin W Currie
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - R Dawn Comstock
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
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59
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Camp CL, Zajac JM, Pearson DB, Sinatro AM, Spiker AM, Werner BC, Altchek DW, Coleman SH, Dines JS. Decreased Shoulder External Rotation and Flexion Are Greater Predictors of Injury Than Internal Rotation Deficits: Analysis of 132 Pitcher-Seasons in Professional Baseball. Arthroscopy 2017; 33:1629-1636. [PMID: 28865566 DOI: 10.1016/j.arthro.2017.03.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/08/2017] [Accepted: 03/29/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aims of this work were to (1) describe normal range of motion (ROM) profiles for elite pitchers, (2) describe the characteristics of shoulder and elbow injuries in professional pitchers over a 6-year period in one Major League Baseball organization, and (3) identify ROM measures that were independently associated with a future shoulder or elbow injury. METHODS Over 6 seasons (2010-2015), a preseason assessment was performed on all pitchers invited to Major League Baseball Spring Training for a single organization. ROM measures included shoulder flexion, horizontal adduction, external rotation (ER), internal rotation, as well as elbow flexion and extension, were measured for both the dominant and nondominant arm, and total range of motion and deficits were calculated. All noncontact shoulder and elbow injuries were identified. Using multivariate binomial logistic regression analysis to control for age, height, weight, and all other ROM measures, the factors associated with an increased risk of subsequent shoulder or elbow injury were identified. RESULTS A total of 53 shoulder (n = 25) and elbow (n = 28) injuries occurred during 132 pitcher seasons (n = 81 pitchers). The most significant categorical risk factor associated with increased elbow injury rates was the presence of a shoulder flexion deficit >5° (odds ratio [OR] 2.83; P = .042). For continuous variables, the risk of elbow injury increased by 7% for each degree of increased shoulder ER deficit (OR 1.07; P = .030) and 9% for each degree of decreased shoulder flexion (OR 1.09; P = .017). None of the measures significantly correlated with shoulder injuries. CONCLUSIONS Preseason shoulder ER and flexion deficits are independent risk factors for the development of elbow injuries during the upcoming season. Although prior work has supported the importance of reducing glenohumeral internal rotation deficits in pitchers, this study demonstrates that deficits in shoulder ER and flexion are more significant predictors of subsequent elbow injury. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Christopher L Camp
- Mayo Clinic Department of Orthopedics, Sports Medicine Center, Rochester, Minnesota, U.S.A..
| | - John M Zajac
- New York Mets Baseball Club, New York, New York, U.S.A
| | | | - Alec M Sinatro
- Sports Medicine and Shoulder Service Hospital for Special Surgery, New York, New York, U.S.A
| | - Andrea M Spiker
- Sports Medicine and Shoulder Service Hospital for Special Surgery, New York, New York, U.S.A
| | - Brian C Werner
- Sports Medicine and Shoulder Service Hospital for Special Surgery, New York, New York, U.S.A
| | - David W Altchek
- Sports Medicine and Shoulder Service Hospital for Special Surgery, New York, New York, U.S.A
| | - Struan H Coleman
- Sports Medicine and Shoulder Service Hospital for Special Surgery, New York, New York, U.S.A
| | - Joshua S Dines
- Sports Medicine and Shoulder Service Hospital for Special Surgery, New York, New York, U.S.A
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60
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Hickey D, Solvig V, Cavalheri V, Harrold M, Mckenna L. Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. Br J Sports Med 2017; 52:102-110. [DOI: 10.1136/bjsports-2017-097559] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2017] [Indexed: 11/04/2022]
Abstract
BackgroundIt is unclear whether the presence of scapular dyskinesis increases the risk of developing shoulder pain in asymptomatic athletes.ObjectivesTo determine whether the presence of scapular dyskinesis in asymptomatic athletes increases the risk of developing shoulder pain by systematic review and meta-analysis.MethodsA systematic search was conducted in the Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database and SPORTDiscus. Prospective studies that assessed athletes for scapular dyskinesis and recorded incidents of shoulder pain were included. Study quality was assessed using the Downs and Black checklist. Meta-analysis was conducted to derive a pooled risk ratio (RR) for the development of shoulder pain in athletes with scapular dyskinesis compared with those without scapular dyskinesis.ResultsFive studies were included with a total of 419 athletes. Of the athletes with scapular dyskinesis, 35% (56/160) experienced shoulder pain during the follow-up, whereas 25% (65/259) of athletes without scapular dyskinesis experienced symptoms. The presence of scapular dyskinesis at baseline indicated a 43% increased risk of a shoulder pain event over a 9 to 24 months follow-up (RR=1.43, 95% CI 1.05 to 1.93).ConclusionsAthletes with scapular dyskinesis have 43% greater risk of developing shoulder pain than those without scapular dyskinesis.
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61
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Lange T, Struyf F, Schmitt J, Lützner J, Kopkow C. The reliability of physical examination tests for the clinical assessment of scapular dyskinesis in subjects with shoulder complaints: A systematic review. Phys Ther Sport 2017; 26:64-89. [DOI: 10.1016/j.ptsp.2016.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/01/2016] [Accepted: 10/31/2016] [Indexed: 12/19/2022]
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Pytiak AV, Stearns P, Bastrom TP, Dwek J, Kruk P, Roocroft JH, Pennock AT. Are the Current Little League Pitching Guidelines Adequate? A Single-Season Prospective MRI Study. Orthop J Sports Med 2017; 5:2325967117704851. [PMID: 28567429 PMCID: PMC5439649 DOI: 10.1177/2325967117704851] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Little League throwing guidelines have recently been implemented in an attempt to lessen the growing number of elbow injuries occurring in youth baseball players. Hypothesis/Purpose: The purpose of this study was to examine pre- and postseason changes seen on magnetic resonance imaging (MRI) in youth baseball players’ elbows in an attempt to identify risk factors for pain and MRI abnormalities, with a particular focus on the current Little League guidelines. We hypothesized that MRI abnormalities would be common in pitchers with high pitch counts and poor guideline compliance. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective study of Little League players aged 10 to 13 years was performed. Players were recruited prior to the start of the season and underwent bilateral elbow MRI as well as a physical examination and completed a questionnaire addressing their playing history and arm pain. At the end of the season, a repeat MRI and physical examination were performed. MRIs were read by blinded radiologists. During the season, player statistics including innings played, pitch counts, and guideline compliance were recorded. Physical examination findings and player statistics were compared between subjects with and without MRI changes utilizing chi-square and analysis of variance techniques. Results: Twenty-six players were enrolled. Despite 100% compliance with pitching guidelines, 12 players (48%) had abnormal MRI findings, and 28% experienced pain during the season. There was a significant difference in distal humeral physeal width measured pre- to postseason (1.54 vs 2.31 mm, P < .001). There was a significant loss of shoulder internal rotation during the season, averaging 11°. While pitch counts, player position, and throwing curveballs/sliders were not significantly associated with changes seen on MRI, year-round play was associated with abnormalities (P < .05). Much lower compliance (<50%) was observed with nonenforced guidelines, including avoidance of single-sport specialization, year-round play, and throwing curveballs/sliders. Conclusion: Arm pain and MRI abnormalities of the medial elbow are common in Little League baseball players who comply with the Little League throwing guidelines, especially those playing year-round.
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Affiliation(s)
- Andrew V Pytiak
- Orthopedics & Scoliosis Division, Rady Children's Hospital, San Diego, California, USA.,Department of Orthopedic Surgery, University of California, San Diego, California, USA
| | - Phillip Stearns
- Orthopedics & Scoliosis Division, Rady Children's Hospital, San Diego, California, USA
| | - Tracey P Bastrom
- Orthopedics & Scoliosis Division, Rady Children's Hospital, San Diego, California, USA
| | - Jerry Dwek
- Department of Radiology, Rady Children's Hospital, San Diego, California, USA
| | - Peter Kruk
- Department of Radiology, Rady Children's Hospital, San Diego, California, USA
| | - Joanna H Roocroft
- Orthopedics & Scoliosis Division, Rady Children's Hospital, San Diego, California, USA
| | - Andrew T Pennock
- Orthopedics & Scoliosis Division, Rady Children's Hospital, San Diego, California, USA.,Department of Orthopedic Surgery, University of California, San Diego, California, USA
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Shitara H, Yamamoto A, Shimoyama D, Ichinose T, Sasaki T, Hamano N, Ueno A, Endo F, Oshima A, Sakane H, Tachibana M, Tomomatsu Y, Tajika T, Kobayashi T, Osawa T, Iizuka H, Takagishi K. Shoulder Stretching Intervention Reduces the Incidence of Shoulder and Elbow Injuries in High School Baseball Players: a Time-to-Event Analysis. Sci Rep 2017; 7:45304. [PMID: 28345616 PMCID: PMC5366891 DOI: 10.1038/srep45304] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/22/2017] [Indexed: 11/28/2022] Open
Abstract
We prospectively evaluated the effects of a prevention program on the incidence of shoulder and elbow injuries in high school baseball pitchers. Ninety-two pitchers participated in this study and were taught to perform stretching and strength exercises aimed at improving shoulder external rotation strength in the preseason. The pitchers freely chose to participate in one of four groups [SM-group: performed both exercises, S-group: performed stretching exercise only, M-group: performed strength training only, and N-group: performed neither intervention]. Injury was defined as inability to play for ≥8 days because of shoulder/elbow symptoms. Kaplan-Meier survival curves were generated and hazard ratios (HRs) for injury occurrence were calculated using multivariate Cox regression. Log-rank test was used for between-group comparisons of survival distributions. The injuries occurred in 25, 35, and 57% of participants and median times to injury were 89, 92, and 29.5 days in the S- (n = 32), SM- (n = 46), and N- (n = 14) group, respectively. Nobody chose M-group. HRs were 0.36 and 0.47 for the S- and SM-group, respectively, based on the N-group. The incidence of injury was significantly lower in the S-group than in the N-group (p = 0.04). Daily posterior shoulder stretching may reduce the incidence of the injuries in high school baseball pitchers.
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Affiliation(s)
- Hitoshi Shitara
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Atsushi Yamamoto
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Daisuke Shimoyama
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Noritaka Hamano
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Akira Ueno
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Fumitaka Endo
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Atsufumi Oshima
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Hideo Sakane
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Masahiro Tachibana
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Yusuke Tomomatsu
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Tsuyoshi Tajika
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Tsutomu Kobayashi
- Department of Physical Therapy, Takasaki University of Health and Welfare, 37-1 Nakaorui, Takasaki, Gunma 370-0033, Japan
| | - Toshihisa Osawa
- Department of Orthopedic Surgery, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu, Takasaki, Gunma 370-0829, Japan
| | - Haku Iizuka
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Kenji Takagishi
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan.,Department of Orthopedic Surgery, Saint Pierre Hospital, 786-7 Kamisano, Takasaki, Gunma 370-0857, Japan
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