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Wasserberger KW, Giordano KA, de Swart A, Barfield JW, Oliver GD. Energy generation, absorption, and transfer at the shoulder and elbow in youth baseball pitchers. Sports Biomech 2024; 23:1160-1175. [PMID: 34100333 DOI: 10.1080/14763141.2021.1933158] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/14/2021] [Indexed: 01/07/2023]
Abstract
Performance during the baseball pitch is dependent on the flow of mechanical energy through the kinetic chain. Little is known about energy flow during the pitching motion and it is not known whether patterns of energy flow are related to pitching performance and injury risk. Therefore, the purpose of this study was to quantify energy generation, absorption, and transfer across the shoulder and elbow during the baseball pitch and explore the associations between these energetic measures, pitch speed, and traditional measures of upper extremity joint loading. The kinematics of 40 youth baseball pitchers were measured in a controlled laboratory setting. Energy flow between the thorax, humerus, and forearm was calculated using a segmental power analysis. Regression analyses revealed that pitch speed was best predicted by arm cocking phase shoulder energy transfer to the humerus and peak elbow valgus torque was best predicted by arm acceleration-phase elbow energy transfer to the forearm. Additionally, energy transfer across the shoulder and elbow generally exhibited the strongest correlations to pitch speed and upper extremity joint loads. These data reinforce the importance of energy transfer through the kinetic chain for producing high pitch speeds and provide descriptive data for energy flow during baseball pitching not previously found in the literature.
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Affiliation(s)
- Kyle W Wasserberger
- Sports Medicine and Movement Laboratory, School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Kevin A Giordano
- Sports Medicine and Movement Laboratory, School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Anne de Swart
- Sports Medicine and Movement Laboratory, School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Jeff W Barfield
- Sports Medicine and Movement Laboratory, School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Gretchen D Oliver
- Sports Medicine and Movement Laboratory, School of Kinesiology, Auburn University, Auburn, AL, USA
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Gorti B, Stephenson C, Sethi M, Gross K, Ramos M, Seshadri D, Drummond CK. Overarm Training Tolerance: A Pilot Study on the Use of Muscle Oxygen Saturation as a Biomarker. SENSORS (BASEL, SWITZERLAND) 2024; 24:4710. [PMID: 39066108 PMCID: PMC11280755 DOI: 10.3390/s24144710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 07/14/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Ulnar collateral ligament (UCL) tears occur due to the prolonged exposure and overworking of joint stresses, resulting in decreased strength in the flexion and extension of the elbow. Current rehabilitation approaches for UCL tears involve subjective assessments (pain scales) and objective measures such as monitoring joint angles and range of motion. The main goal of this study is to find out if using wearable near-infrared spectroscopy technology can help measure digital biomarkers like muscle oxygen levels and heart rate. These measurements could then be applied to athletes who have been injured. Specifically, measuring muscle oxygen levels will help us understand how well the muscles are using oxygen. This can indicate improvements in how the muscles are healing and growing new blood vessels after reconstructive surgery. Previous research studies demonstrated that there remains an unmet clinical need to measure biomarkers to provide continuous, internal data on muscle physiology during the rehabilitation process. This study's findings can benefit team physicians, sports scientists, athletic trainers, and athletes in the identification of biomarkers to assist in clinical decisions for optimizing training regimens for athletes that perform overarm movements; the research suggests pathways for possible earlier detection, and thus earlier intervention for injury prevention.
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Affiliation(s)
- Bhargav Gorti
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (C.S.); (M.S.); (K.G.); (M.R.)
| | - Connor Stephenson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (C.S.); (M.S.); (K.G.); (M.R.)
| | - Maia Sethi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (C.S.); (M.S.); (K.G.); (M.R.)
| | - KaiLi Gross
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (C.S.); (M.S.); (K.G.); (M.R.)
| | - Mikaela Ramos
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (C.S.); (M.S.); (K.G.); (M.R.)
| | - Dhruv Seshadri
- Department of Biomedical Engineering, Lehigh University, Bethlehem, PA 18015, USA;
| | - Colin K. Drummond
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (C.S.); (M.S.); (K.G.); (M.R.)
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Saito A, Okada K, Shibata K, Sato H, Namiki Y, Terui Y, Kikuchi T. Elasticity of the Forearm Flexor-Pronator Muscles as a Risk Factor for Medial Elbow Injuries in Young Baseball Players: A Prospective Cohort Study of 314 Players. Am J Sports Med 2023; 51:3409-3415. [PMID: 37815055 DOI: 10.1177/03635465231202028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND Young baseball players with medial elbow injuries are known to have high forearm flexor-pronator muscle elasticity; however, the causal relationship between forearm muscle elasticity and the occurrence of medial elbow injuries remains unclear. PURPOSE/HYPOTHESIS The purpose of this study was to determine whether the forearm flexor-pronator muscle elasticity is a risk factor for medial elbow injury in young baseball players. It was hypothesized that high flexor carpi ulnaris (FCU) elasticity would be a risk factor for medial elbow injuries. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Young baseball players (aged 9-12 years) with no history of elbow injuries underwent examination during which the strain ratios (SRs) of the pronator teres, flexor digitorum superficialis, and FCU muscles were measured using ultrasound strain elastography as an index of elasticity. Additionally, the participants completed a questionnaire assessing age, height, weight, months of experience as a baseball player, position in baseball, number of training days per week, number of throws per day, and elbow pain during throwing; then the range of motion of the shoulder and hip internal/external rotation were measured. One year after the baseline measurements, the occurrence of new medial elbow injuries was evaluated. Multivariate logistic regression analysis was subsequently conducted to determine risk factors for medial elbow injuries. Cutoff points for significant SR values obtained from the multivariate logistic regression analysis were calculated using the receiver operating characteristic curve. RESULTS Of the 314 players, 76 (24.2%) were diagnosed with medial elbow injury. Multivariate logistic regression analysis showed that a 0.1 increase in the SR of the FCU muscle (odds ratio [OR], 1.211; 95% CI, 1.116-1.314) and number of throws per day (OR, 1.012; 95% CI, 1.001-1.022) were significantly associated with medial elbow injuries. Receiver operating characteristic curve analyses revealed that the optimal cutoff for the SR of the FCU muscle was 0.920 (area under the curve, 0.694; sensitivity, 75.0%; specificity, 56.7%). CONCLUSION Increased FCU elasticity is a risk factor for medial elbow injury. Evaluation of the FCU elasticity may be useful in identifying young baseball players at high risk of medial elbow injuries and may facilitate prevention of medial elbow injury. As shown by the results of multivariate logistic regression analysis, FCU elasticity itself may be useful in identifying young baseball players at high risk of elbow injuries. However, we believe that other factors, such as the number of pitches per day, need to be considered to improve its accuracy.
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Affiliation(s)
- Akira Saito
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | | | - Hiromichi Sato
- Department of Rehabilitation, Akita Kousei Medical Center, Akita, Japan
| | - Yusuke Namiki
- Department of Rehabilitation, Akita City Hospital, Akita, Japan
| | - Yoshino Terui
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Tsubasa Kikuchi
- Department of Occupational Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
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van Trigt B, van Hogerwou T, Leenen TAJR, Hoozemans MJM, van der Helm FCT, Veeger DHEJ. Magnitude and variability of individual elbow load in repetitive baseball pitching. Sci Rep 2023; 13:17250. [PMID: 37821633 PMCID: PMC10567693 DOI: 10.1038/s41598-023-44333-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023] Open
Abstract
In baseball pitchers the elbow is exposed to high and repetitive loads (i.e. external valgus torque), caused by pitching a high number of balls in a practice session or game. This can result in overuse injuries like the ulnar collateral ligament (UCL) injury. To understand injury mechanisms, the effect of repetitive pitching on the elbow load magnitude and variability was investigated. In addition, we explored whether repetitive pitching affects elbow muscle activation during pitching. Fifteen pitchers threw each 60 to 110 balls. The external valgus torque and electromyography of three elbow muscles were quantified during each pitch. Linear mixed model analyses were performed to investigate the effect of repetitive pitching. On a group level, the linear mixed models showed no significant associations of repetitive pitching with valgus torque magnitude and variability and elbow muscle activity. Significant differences exist between pitchers in their individual trajectories in elbow valgus torque and muscle activity with repetitive pitching. This shows the importance of individuality in relation to repetitive pitching. In order to achieve effective elbow injury prevention in baseball pitching, individual characteristics of changes in elbow load and muscle activity in relation to the development of UCL injuries should be investigated.
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Affiliation(s)
- Bart van Trigt
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
| | - Thomas van Hogerwou
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Ton A J R Leenen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 9, 1081 BT, Amsterdam, the Netherlands
| | - Marco J M Hoozemans
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 9, 1081 BT, Amsterdam, the Netherlands
| | - Frans C T van der Helm
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - DirkJan H E J Veeger
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
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Kuboi T, Tajika T, Endo F, Ichinose T, Sasaki T, Hamano N, Shitara H, Sakamoto M, Takagishi K, Chikuda H. Ultrasonographic appearance of the pronator quadratus muscle in high school baseball pitchers with and without elbow symptoms: a pilot study. J Ultrasound 2023; 26:627-633. [PMID: 35666460 PMCID: PMC10468450 DOI: 10.1007/s40477-022-00685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Earlier reports have described forearm flexor muscles as active stabilizers of the elbow to valgus stress during throwing motion. The pronator quadratus (PQ) muscle acts in coordination with the pronator teres muscle for forearm pronation. This study of high school pitchers was conducted to assess the association between sonographic appearance and a history of elbow symptoms. METHODS We examined 123 high school baseball pitchers, all of whom had completed a self-administered questionnaire, including items related to throwing-related elbow joint pain sustained during the prior year. Ultrasound examination was made of the pitchers with and without valgus stress of the medial aspect of the bilateral elbows. The sonographic appearance of the PQ was assessed on sagittal and axial images on the bilateral side. For participants with and without a history of elbow symptoms, we compared the maximum thickness of the PQ on sagittal and axial images of the throwing side. RESULTS Regarding maximum thickness of the PQ on the sagittal and axial images, a significant difference was found between the throwing and non-throwing sides (throwing side vs non-throwing side mean: sagittal 6.3 mm vs 5.7 mm, axial 8.2 mm vs 7.5 mm, 95% confidence interval: sagittal 0.41-0.70, p < 0.001, axial 0.53-0.82, p < 0.001). The maximum thickness of the PQ on axial images with elbow symptoms was significantly greater than the PQ thickness of those without elbow symptoms. Nevertheless, no association was found between elbow valgus instability and the maximum thickness of the PQ on sagittal and axial images of the throwing side. CONCLUSION Sonographic appearance of the PQ might be associated with elbow joint conditions in high school baseball players.
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Affiliation(s)
- Takuro Kuboi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tsuyoshi Tajika
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan.
| | - Fumitaka Endo
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Masaaki Sakamoto
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8514, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Sada Hospital, 2-3-28 Watanabedori, Fukuoka Chuo-ku, Fukuoka, 810-0004, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Nara M, Samukawa M, Oba K, Ishida T, Takahashi Y, Kasahara S, Tohyama H. Repetitive pitching decreases the elbow valgus stability provided by the flexor-pronator mass: the effects of repetitive pitching on elbow valgus stability. J Shoulder Elbow Surg 2023; 32:1819-1824. [PMID: 37172887 DOI: 10.1016/j.jse.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/10/2023] [Accepted: 03/22/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Baseball pitching induces a large elbow valgus load, stressing the ulnar collateral ligament (UCL). Flexor-pronator mass (FPM) contraction contributes to valgus stability; however, repetitive baseball pitching may weaken the FPM contractile function. The present study investigated the effects of repetitive baseball pitching on the medial valgus stability measured using ultrasonography. We hypothesized that repetitive pitching would decrease elbow valgus stability. METHODS This was a controlled laboratory study. Fifteen young male baseball players at the collegiate level (age: 23.0 ± 1.4 years) were enrolled. The medial elbow joint space was measured using ultrasonography (B-mode, 12-MHz linear array transducer) in the following three conditions: at rest (unloaded), under 3 kg valgus load (loaded), and under valgus load with maximal grip contraction to activate FPM (loaded-contracted). All measurements were performed before and after the pitching tasks, which comprised five sets of 20 pitches. Two-way repeated-measures analysis of variance was applied to determine changes in the medial elbow joint space. The post hoc test with Bonferroni adjustment was applied to assess the changes within the time and condition. RESULTS The medial elbow joint space was significantly greater under the loaded than the unloaded and loaded-contracted conditions both before and after pitching (P < .001). In the loaded-contracted condition, the medial elbow joint space significantly increased after repetitive baseball pitching (P < .001). CONCLUSIONS The results of the present study indicated that repetitive baseball pitching reduced the elbow valgus stability. This reduction could be attributed to the decreased FPM contractile function. Insufficient contraction may increase the tensile load on the UCL with pitching. FPM contraction plays a role in narrowing the medial elbow joint space; however, repetitive baseball pitching reduced the elbow valgus stability. It has been suggested that sufficient rest and recovery of the FPM function are required to reduce the UCL injury risk.
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Affiliation(s)
| | - Mina Samukawa
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan.
| | - Kensuke Oba
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Tomoya Ishida
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | | | - Satoshi Kasahara
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Harukazu Tohyama
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
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7
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Yanai T, Onuma K, Crotin RL, Monda D. A novel method intersecting three-dimensional motion capture and medial elbow strength dynamometry to assess elbow injury risk in baseball pitchers. Sci Rep 2023; 13:12253. [PMID: 37507460 PMCID: PMC10382501 DOI: 10.1038/s41598-023-39504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023] Open
Abstract
In baseball pitching, resultant elbow varus torque reaches the peak value of 50-120 N m, exceeding the joint failure limit that risks damage to the ulnar collateral ligament (UCL). In-vivo methodology is lacking to assess whether pitchers have sufficient muscular strength to shield UCL and how strongly the elbow musculature must contract to minimize valgus loading on UCL. This study introduces a method to assess relative percentages of muscular varus strength required to unload the UCL. The maximum voluntary isometric varus strength (MVIVS) produced by the medial elbow musculature and the maximum resultant varus torques at elbow in pitching fastballs and other types were measured for two professional pitchers. Simulation was conducted to determine the relative percentages of MVIVS required to unload the UCL to varying degrees and the impact of athletes' previous UCL reconstruction on the relative percentages was examined. The maximum resultant varus torque in pitching was found to range 72-97%MVIVS depending on the type of pitch. The elbow musculature had to produce 21-49%MVIVS to avoid acute failure of intact UCL whereas the corresponding requirements were 39-63%MVIVS for UCL reconstructed joint. The method offers new insight into baseball pitcher's training/rehabilitation and physical assessment to reduce the risk of UCL injury.
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Affiliation(s)
- Toshimasa Yanai
- Research Institute of Baseball Science and Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, 359-1192, Japan.
| | - Kengo Onuma
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Ryan L Crotin
- Human Performance Laboratories, Louisiana Tech University, Ruston, LA, USA
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
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Sakurai M, Barrack AJ, Lobb NJ, Wee CP, Diaz PR, Michener LA, Karduna AR. Collegiate baseball pitchers demonstrate a relationship between ball velocity and elbow varus torque, both within and across pitchers. Sports Biomech 2023:1-9. [PMID: 37114500 PMCID: PMC10611893 DOI: 10.1080/14763141.2023.2205380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
High elbow varus torque during baseball pitching has been identified as a potential cause of ulnar collateral ligament injury in baseball pitchers. In general, elbow varus torque increases as ball velocity increases across pitchers. However, studies incorporating within-subject analyses report that not all professional pitchers have a positive relationship between elbow varus torque and ball velocity (T-V relationship). It remains unknown whether collegiate pitchers show the same trend as professionals in their T-V relationships. The current study investigated the T-V relationship of collegiate pitchers focusing on both across and within pitchers. Division 1 collegiate pitchers (n = 81) were assessed for elbow torque and ball velocity during pitching. Both across- and within-pitcher T-V relationships were significant (p < 0.05) using linear regression. However, more variance in elbow varus torque was explained using the within-pitcher relationship (R2 = 0.29) than the across-pitcher relationship (R2 = 0.05). Of the 81 pitchers, nearly half (n = 39) had significant T-V relationships, while the other half (n = 42) did not. Our findings indicate that the T-V relationship should be assessed on an individual basis as T-V is pitcher-specific.
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Affiliation(s)
- M Sakurai
- Department of Human Physiology, University of Oregon, Eugene, Oregon, USA
| | - A J Barrack
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - N J Lobb
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - C P Wee
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - P R Diaz
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - L A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - A R Karduna
- Department of Human Physiology, University of Oregon, Eugene, Oregon, USA
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Nicholson KF, Mylott JA, Hulburt TC, Hamer TJ, Bullock GS. Kinematic and kinetic comparison between preprofessional pitchers from the Dominican Republic and the United States. Front Sports Act Living 2023; 5:1152474. [PMID: 37143585 PMCID: PMC10151486 DOI: 10.3389/fspor.2023.1152474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Introduction Pitching biomechanical efficiency is defined as the association between pitch velocity and arm kinetics. Pitching mechanics inefficiency, an increase in arm kinetics without the resultant increase in pitch velocity, can lead to increased arm strain, increasing arm injury risk. The purpose of this study was to compare arm kinetics, elbow varus torque and shoulder force, in preprofessional United States (US) and Dominican Republic (DR) pitchers. Kinematics that are known to influence elbow varus torque and shoulder force as well as a representative of pitch velocity (hand velocity) were also compared. Methods A retrospective review was performed on baseball pitchers from the DR and US who participated in biomechanical evaluations conducted by the University biomechanics laboratory personnel. Three-dimensional biomechanical analyses were performed on US (n = 37) and DR (n = 37) baseball pitchers. Potential differences between US and DR pitchers were assessed through analysis of covariance with 95% confidence intervals [95% confidence Interval (CI)]. Results Preprofessional DR pitchers experienced increased elbow varus torque compared with their US counterparts [DR: 7.5 (1.1); US: 5.9 (1.1) %BWxH; Beta: -2.0 (95% CI: -2.7, -1.2) %BWxH], despite throwing fastballs with slower hand velocity [DR: 3,967.1 (939.4); US: 5,109.1 (613.8) °/s; Beta: 1,129.5 (95% CI: 677.5, 1,581.4) °/s]. DR and US pitchers demonstrated similar shoulder force [DR: 136.8 (23.8); US: 155.0 (25.7); Beta: 0.4 (95% CI: -1.2, 19.7) %BW]. Discussion Increased elbow varus torque although decreased hand velocity suggests inefficient pitching mechanics among DR pitchers. Inefficient pitching mechanics and increased elbow torque should be considered when developing training programs and pitching plans for professional pitchers from the Dominican Republic.
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Affiliation(s)
- Kristen F. Nicholson
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston Salem, NC, United States
- Correspondence: Kristen F. Nicholson
| | - Joseph A. Mylott
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Tessa C. Hulburt
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Tyler J. Hamer
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, United States
| | - Garrett S. Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston Salem, NC, United States
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC, United States
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, United Kingdom
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10
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Onuma K, Yanai T. A method for measuring muscle strength in restraining valgus joint angulation: Elbow varus muscle strength against valgus loading. J Biomech 2023; 147:111427. [PMID: 36621094 DOI: 10.1016/j.jbiomech.2022.111427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/31/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023]
Abstract
Skeletal muscle works as a dynamic joint stabilizer, assisting the underlying ligaments in restricting joint angulation by actively resisting external loads. Despite its clinical importance, little is known about the muscle strength required to produce torque to help ligaments restrict joint angulation within the physiological range permitted by the joint structure. In this study, we introduce a method for measuring the strength of the elbow musculature in restraining valgus angulation and present the values obtained in 20 healthy young men. Each participant was fastened to a Biodex dynamometer, with the elbow joint flexed to 90° and the varus-valgus axis aligned to the dynamometer's rotation axis. Maximal voluntary isometric ramp contraction of shoulder internal rotators was performed while the humeroulnar joint gap was monitored with an ultrasound apparatus. The largest torque recorded while the humeroulnar joint gap did not exceed a predetermined individualized threshold was considered to be the elbow varus strength of the participant. The elbow varus strength of the dynamic stabilizer was found to be 41 ± 12 Nm, which agreed with the value estimated by our musculoskeletal model. The inter-operator reliability test indicated excellent reliability (ICC (2,1) = 0.91). These findings suggest that the present method is valid for measuring the strength of the elbow musculature in restraining the valgus angulation. Measurements of this aspect of strength are expected to provide insights for understanding and preventing elbow injuries.
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Affiliation(s)
- Kengo Onuma
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | - Toshimasa Yanai
- Faculty of Sport Sciences, Waseda University, Saitama, Japan.
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11
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Lobb NJ, Lu Z, Long E, Chow K, Michener LA. Sonographic morphological and qualitative deficits in the elbow ulnar collateral ligament and ulnohumeral joint in throwing arms of asymptomatic collegiate baseball pitchers. Skeletal Radiol 2023; 52:31-37. [PMID: 35864196 DOI: 10.1007/s00256-022-04116-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The ulnar collateral ligament (UCL) supports the medial elbow against valgus torque and is commonly injured in baseball pitchers. Changes in UCL morphology and pathology occur with long-term pitching, with more severe findings at higher competition levels. We examined the bilateral differences and the relationship between UCL morphology, pathology, and ulnohumeral joint laxity in asymptomatic collegiate pitchers using ultrasound. MATERIALS AND METHODS Division I college pitchers (n = 41) underwent ultrasound scans of their bilateral medial elbows, both at rest and in a valgus-stressed position. The presence of enthesopathy, calcifications, and degeneration was assessed qualitatively. UCL thickness and ulnohumeral joint gap were measured with online calipers. The bilateral differences were analyzed using paired t-tests and chi-square analysis, and the relationships between thickness, gapping, and degenerative changes were analyzed using regression analyses. RESULTS The throwing arm demonstrated greater distal UCL thickness (mean difference (MD) = 0.2 mm (95%CI = 0.1-0.3), p < 0.01), resting and stressed gap (MD = 0.3 mm (95%CI = 0.0-0.7), p = 0.04; MD = 0.4 (95%CI = 0.0-0.9), p = 0.02), and greater prevalence of degeneration and enthesopathy (p = 0.03) compared bilaterally. Enthesopathy and calcifications predicted increased distal UCL thickness (p = 0.04; p = 0.02). Degenerative scores predicted increased stressed-resting ulnohumeral joint gap (p < 0.01). CONCLUSION In the throwing arms of collegiate pitchers, ultrasound demonstrated UCL thickening, enthesopathy/intra-ligamentous calcification, and greater laxity of the ulnohumeral joint relative to the non-throwing arm. Degeneration of the UCL, not thickness, was related to greater elbow joint gapping. This study demonstrates the utility of ultrasound for examining sonographic characteristics of the UCL in a sample of college pitchers.
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Affiliation(s)
- Nicholas J Lobb
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar Street, CHP 155, Los Angeles, CA, 90089, USA.
| | - Ziang Lu
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Emma Long
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar Street, CHP 155, Los Angeles, CA, 90089, USA
| | - Kira Chow
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar Street, CHP 155, Los Angeles, CA, 90089, USA
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12
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Taneja K, He X, He Q, Zhao X, Lin YA, Loh KJ, Chen JS. A Feature-Encoded Physics-Informed Parameter Identification Neural Network for Musculoskeletal Systems. J Biomech Eng 2022; 144:121006. [PMID: 35972808 PMCID: PMC9632475 DOI: 10.1115/1.4055238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/05/2022] [Indexed: 11/08/2022]
Abstract
Identification of muscle-tendon force generation properties and muscle activities from physiological measurements, e.g., motion data and raw surface electromyography (sEMG), offers opportunities to construct a subject-specific musculoskeletal (MSK) digital twin system for health condition assessment and motion prediction. While machine learning approaches with capabilities in extracting complex features and patterns from a large amount of data have been applied to motion prediction given sEMG signals, the learned data-driven mapping is black-box and may not satisfy the underlying physics and has reduced generality. In this work, we propose a feature-encoded physics-informed parameter identification neural network (FEPI-PINN) for simultaneous prediction of motion and parameter identification of human MSK systems. In this approach, features of high-dimensional noisy sEMG signals are projected onto a low-dimensional noise-filtered embedding space for the enhancement of forwarding dynamics prediction. This FEPI-PINN model can be trained to relate sEMG signals to joint motion and simultaneously identify key MSK parameters. The numerical examples demonstrate that the proposed framework can effectively identify subject-specific muscle parameters and the trained physics-informed forward-dynamics surrogate yields accurate motion predictions of elbow flexion-extension motion that are in good agreement with the measured joint motion data.
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Affiliation(s)
- Karan Taneja
- Department of Structural Engineering, University of California San Diego, La Jolla, CA 92093
| | - Xiaolong He
- Department of Structural Engineering, University of California San Diego, La Jolla, CA 92093
| | - QiZhi He
- Department of Civil, Environmental, and Geo-Engineering, University of Minnesota, Minneapolis, MN 55455
| | - Xinlun Zhao
- Department of Structural Engineering, University of California San Diego, La Jolla, CA 92093
| | - Yun-An Lin
- Department of Structural Engineering, University of California San Diego, La Jolla, CA 92093
| | - Kenneth J. Loh
- Department of Structural Engineering, University of California San Diego, La Jolla, CA 92093
| | - Jiun-Shyan Chen
- Department of Structural Engineering, University of California San Diego, La Jolla, CA 92093
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13
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Kirloskar KM, Civilette MD, Rate WR, Cohen AS, Haislup BD, Nayar SK, Bodendorfer BM, Gould HP. The 50 most impactful articles on the medial ulnar collateral ligament: An altmetric analysis of online media. SAGE Open Med 2022; 10:20503121221129921. [PMID: 36451777 PMCID: PMC9703534 DOI: 10.1177/20503121221129921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/14/2022] [Indexed: 06/22/2024] Open
Abstract
The purpose of this study was to use the Altmetric Attention Score to determine the 50 most impactful medial ulnar collateral ligament articles in online media and compare their characteristics to the most-cited medial ulnar collateral ligament articles in the scientific literature. The Altmetric database was queried to identify all published articles about the medial ulnar collateral ligament, and this list was stratified by the Altmetric Attention Score to identify the 50 highest scoring articles. Several data elements were extracted, including article topic, article type, journal name, and the number of online mentions on Facebook, Twitter, news, and other platforms. Each article's geographic origin was determined based on the institutional affiliation of the first author. Our index search yielded 1283 articles published between 1987 and 2020, from which the 50 articles with the highest Altmetric Attention Scores were included for analysis. Altmetric Attention Scores of the top 50 medial ulnar collateral ligament articles ranged from 20 to 482 (median: 32, interquartile range: 20-62). The most common article type was original research (72%), and the most common topic was epidemiology/risk factors (26%). A majority of studies were Level 3 (36%) or Level 4 evidence (36%). Of the top 50 medial ulnar collateral ligament articles, 94% originated from the United States. A few articles had a high Altmetric Attention Score, suggesting that medial ulnar collateral ligament research does not generate consistently high online attention. The lack of Level 1 studies suggests the need for high-level studies on the medial ulnar collateral ligament. Most studies originated in the United States and were published in the American Orthopaedic Society for Sports Medicine-affiliated journals. The medial ulnar collateral ligament articles included in this study differed substantially from a previous report of the most-cited medial ulnar collateral ligament articles in the literature, suggesting that alternative metrics add a unique dimension to understanding the overall impact of published research on the medial ulnar collateral ligament.
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Affiliation(s)
| | | | - William R Rate
- Georgetown University School of Medicine, Washington, DC, USA
| | - Andrew S Cohen
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Brett D Haislup
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Suresh K Nayar
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Blake M Bodendorfer
- Division of Sports Medicine and Shoulder Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Heath P Gould
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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14
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Tsubono K, Kudo R, Yokota H, Hirabayashi R, Sekine C, Maruyama S, Shagawa M, Togashi R, Yamada Y, Edama M. Changes in medial elbow joint space with differences in contraction strength of flexor-pronator muscle under elbow valgus stress. J Shoulder Elbow Surg 2022; 31:2011-2016. [PMID: 35550429 DOI: 10.1016/j.jse.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/20/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The relationship between contraction strength of the flexor-pronator muscles (FPMs) and elbow valgus braking function has not been clarified. HYPOTHESIS/PURPOSE The purpose of this study was to investigate changes in medial elbow joint space when there is a difference in contraction strength of FPMs under elbow valgus stress. METHODS Subjects were 20 healthy male university students, and the elbow joint on the nondominant hand side was used for measurements. The body position for limb measurement was sitting in a chair, with the shoulder abducted 60° and in 90° of external rotation, with 90° of elbow flexion. At first, maximum voluntary contraction (MVC) of the FPMs by grip motion was measured using a hand grip dynamometer under 60-N valgus stress. Contraction strengths of 10% MVC, 30% MVC, and 50% MVC were used. Ultrasonographic images of the medial elbow joint space (JS) were taken in the starting limb position. Using the Telos device system, load was then gradually increased by +10 N/s, and at the time of 60-N valgus stress, an image of the JS was taken. Furthermore, the subject adjusted to the set contraction strength (for about 5 sec) with 60-N valgus stress applied, and an image of the JS was taken while maintaining the set contraction strength. Each MVC condition (10% MVC, 30% MVC, and 50% MVC) was performed randomly. Three ultrasonographic images were taken within 10 seconds, and the average value of the three images was adopted as the JS. RESULTS Compared with the JS under 60-N valgus stress, the JS was significantly reduced under 60-N valgus stress + 50% MVC. No significant difference was observed between the starting limb position and 60-N valgus stress + 50% MVC. CONCLUSION FPMs may require muscle activity ≥50% MVC to brake 60-N elbow valgus stress.
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Affiliation(s)
- Kei Tsubono
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryodai Kudo
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mayuu Shagawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryoya Togashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Yuki Yamada
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.
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Namiki Y, Saito A, Okada K. The relationship between changes in elbow valgus laxity and forearm flexor strength during repetitive pitching. Sports Biomech 2022:1-12. [PMID: 36134569 DOI: 10.1080/14763141.2022.2125822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
This study examined the changes in the medial elbow joint space width and forearm flexor strength due to repetitive pitching and analysed the relationships among these factors. Thirty-one collegiate baseball players pitched seven sets of 15 pitches each. The medial elbow joint space width, grip strength, and forearm flexor strengths were measured before pitching and after each set. These parameters were compared at baseline and after pitching for each set. Additionally, the relationships between changes in the medial elbow joint space and forearm flexor strength were examined for each set. The medial elbow joint space width significantly increased after four sets compared to baseline values. Compared to baseline values, grip strength decreased significantly after one set, wrist flexion and radial deviation after six, and ulnar deviation after five. However, changes in the medial joint space compared to baseline values after each set were not significantly correlated with changes in forearm flexor strength variables. Therefore, repetitive pitching causes an increase in elbow valgus laxity and a decrease in forearm flexor strength. However, the decrease in forearm muscle strength does not explain the increase in elbow valgus laxity.
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Affiliation(s)
- Yusuke Namiki
- Department of Rehabilitation, Akita City Hospital, Akita, Japan
| | - Akira Saito
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
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16
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Ikezu M, Kudo S, Edama M, Ueda M, Kubo T, Hirata M, Watanuki M, Takeuchi H, Kaneiwa J, Iizuka Y, Hayashi H. Sites of flexor-pronator muscle injury and relationship between ulnar collateral ligament injury and flexor-pronator muscle injury in baseball players: a retrospective cohort study. J Shoulder Elbow Surg 2022; 31:1588-1594. [PMID: 35189370 DOI: 10.1016/j.jse.2022.01.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/07/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ulnar collateral ligament (UCL) and flexor-pronator muscle (FPM) injuries are common in baseball players. However, the sites of FPM injuries and the relationship between UCL and FPM injuries in baseball players have not been fully clarified. The purpose of this study was to identify the sites of FPM injuries and to determine the relationships of location and severity of UCL injury with the presence of FPM injuries in baseball players. METHODS UCL and FPM injuries were diagnosed using magnetic resonance imaging in 99 baseball players. The sites of FPM injuries were identified on coronal, sagittal, and axial images. UCL injury severity was classified into four grades: chronic changes, low-grade partial tear, high-grade partial tear, and complete tear. UCL injury location was classified as proximal UCL tear or distal UCL tear. All images were assessed by a musculoskeletal radiologist and an orthopedic surgeon. RESULTS Combined UCL and FPM injuries were observed in 45 of 99 players, of which 40 of 45 (89%) involved injury of the flexor digitorum superficialis (FDS). All FDS injuries were in the deep layer of the muscle belly. There was no significant difference between the severity of UCL injury and presence of FPM injuries (P = .352). There was a significant association of distal UCL tears with FPM injuries (P < .001). CONCLUSION FDS injury occurs most commonly in the muscle belly of the second and fifth digits. There may be no relationship between the severity of UCL injury and presence of FPM injury in baseball players. FPM injuries may be a contributing factor in the failure of nonoperative management of distal UCL tears in baseball players.
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Affiliation(s)
- Masahiro Ikezu
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan; Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan.
| | - Shintarou Kudo
- Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan; AR-Ex Medical Research Center, Tokyo, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mizuho Ueda
- Department of Radiology, Saku Central Hospital, Nagano, Japan
| | - Takanori Kubo
- Department of Orthopaedic Surgery, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Masazumi Hirata
- Department of Orthopaedic Surgery, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Makoto Watanuki
- Department of Orthopaedic Surgery, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Hiroki Takeuchi
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan; AR-Ex Medical Research Center, Tokyo, Japan
| | - Jumpei Kaneiwa
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan; AR-Ex Medical Research Center, Tokyo, Japan
| | - Yasuhiko Iizuka
- Department of Radiology, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Hidetoshi Hayashi
- Department of Orthopaedic Surgery, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
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17
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Medial elbow joint space gapping associated with repetitive baseball pitching in preadolescent baseball players. J Shoulder Elbow Surg 2022; 31:1035-1041. [PMID: 34968691 DOI: 10.1016/j.jse.2021.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The baseball pitching motion creates valgus stress to the medial elbow, which contributes to increased medial elbow joint space gapping. The musculoskeletal systems of preadolescent baseball players are immature compared with those of adults, but it is unclear whether the repetitive pitching action causes an increase in medial elbow joint space gapping. This study aimed to examine differences in medial elbow joint space gapping based on the pitch count of preadolescent baseball players compared with those of adult players. METHODS The participants were 11 healthy preadolescent baseball players and 12 college students with baseball experience. They threw 60 maximal-effort pitches arranged into 4 sets of 15 pitches. The medial elbow joint space was measured ultrasonographically with the forearm weight before pitching and following every set of 15 pitches. Repeated-measures analysis of variance and the Bonferroni post hoc test were used to compare the medial elbow joint space among the 5 pitching sets (before pitching and after 15, 30, 45, and 60 pitches) and between the groups of preadolescent baseball players and college students. RESULTS There was no significant change in the medial elbow joint space gapping of the dominant elbow based on age/pitch count (F = 0.42, P = .796). There was a significant effect of pitch count (F = 30.28, P < .001) and between-group effects (F = 4.56, P = .045). The medial elbow joint space gapping increased significantly after 60 pitches in preadolescent baseball players (P = .023) and college students (P = .021). The medial elbow joint space gapping in preadolescent baseball players was significantly wider than that in college students (P = .007 before pitching, P = .027 at 15 pitches). CONCLUSION Sixty repetitive pitches contributed to an increase in the medial elbow joint space gapping, regardless of age. The results of this study provide further evidence when considering pitching limitations.
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Jennings D, Reaves SK, Sklar J, Brown C, McPhee J, Hazelwood SJ, Klisch SM. Baseball Pitching Arm 3-D Inertial Parameter Calculations from Body Composition Imaging and a Novel Overweight Measure for Youth Pitching Arm Kinetics. J Biomech Eng 2021; 144:1122988. [PMID: 34729604 DOI: 10.1115/1.4052890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Indexed: 11/08/2022]
Abstract
Many baseball pitching studies have used inverse dynamics to assess throwing arm kinetics as high and repetitive kinetics are thought to be linked to pitching injuries. However, prior studies have not used participant-specific body segment inertial parameters (BSIPs) which are thought to improve analysis of high-acceleration motions and overweight participants. This study's objectives were to 1) calculate participant-specific BSIPs using DXA measures, 2) compare inverse dynamic calculations of kinetics determined by DXA-calculated BSIPs (full DXA-driven inverse dynamics) against kinetics using the standard inverse dynamics approach with scaled BSIPs (scaled inverse dynamics), and 3) examine associations between full DXA-driven kinetics and overweight indices: body mass index (BMI) and segment mass index (SMI). Eighteen participants (10-11 years old) threw 10 fastballs that were recorded for motion analysis. DXA scans were used to calculate participant-specific BSIPs (mass, center of mass, radii of gyration) for each pitching arm segment (upper arm, forearm, hand), BMI, and SMI. The hypotheses were addressed with t-tests and linear regression analyses. The major results were that 1) DXA-calculated BSIPs differed from scaled BSIPs for each pitching arm segment, 2) calculations for shoulder, but not elbow, kinetics differed between the full DXA-driven and scaled inverse dynamics analyses, and 3) full DXA-driven inverse dynamics calculations for shoulder kinetics were more strongly associated with SMI than with BMI. Results suggest that using participant-specific BSIPs and pitching arm SMIs may improve evidence-based injury prevention guidelines for youth pitchers.
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Affiliation(s)
- Dalton Jennings
- Biomedical Engineering, College of Engineering, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Scott K Reaves
- Food Science & Nutrition, College of Agriculture, Food, and Environmental Sciences, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Jeff Sklar
- Statistics, College of Science and Mathematics, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Colin Brown
- Systems Design Engineering, Waterloo Engineering, University of Waterloo, Waterloo, ON, Canada
| | - John McPhee
- Systems Design Engineering, Waterloo Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Scott J Hazelwood
- Biomedical Engineering, College of Engineering, California Polytechnic State University, San Luis Obispo, CA, USA; Mechanical Engineering, College of Engineering, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Stephen M Klisch
- Biomedical Engineering, College of Engineering, California Polytechnic State University, San Luis Obispo, CA, USA; Mechanical Engineering, College of Engineering, California Polytechnic State University, San Luis Obispo, CA, USA
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19
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Crotin R, Ramsey D. Grip Strength Measurement in Baseball Pitchers: A Clinical Examination to Indicate Stride Length Inefficiency. Int J Sports Phys Ther 2021; 16:1330-1337. [PMID: 34631254 PMCID: PMC8486408 DOI: 10.26603/001c.28086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ulnar collateral ligament injuries are rampant in the sport of baseball where kinetic chain impacts, stemming from misappropriation of stride length or changes that occur in competition due to fatigue, have not been evaluated for dynamic elbow stability effects. HYPOTHESIS/PURPOSE To examine the relationship between clinical measures of grip strength and altered stride length in baseball pitchers. It is believed that shorter stride lengths would reduce grip strength in baseball pitchers. STUDY DESIGN Crossover Study Design. METHODS A total of 19 uninjured pitchers (15 collegiate and 4 high school) (age 18.63 ± 1.67 years, height 1.84 ± 0.054 m, mass 82.14 ± 0.054 kg) threw two simulated 80-pitch games at ±25% of their desired stride length recorded by motion capture with two force plates and a radar gun to track each throw. A handheld grip dynamometer was used to record the mean change in grip strength after games from baseline measures. Pairwise comparisons at baseline and post-game denoted grip strength changes and dominant grip strength offsets for stride length conditions. RESULTS Subjects with shorter stride lengths revealed a significant decline in grip strength in the dominant arm from baseline (pre-game; 45.1 kg vs. post-game; 43.2 kg, p=0.017, ES=0.28), however all other tests involving dominant grip strength changes and offset analyses were not statistically different for under-stride and over-stride length conditions. CONCLUSIONS Clinical evaluation of grip strength has the potential to identify altered lower body mechanics and may be considered as a safe and effective monitoring strategy to integrate with motion capture in determining optimal stride lengths for baseball pitchers. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Ryan Crotin
- ArmCare.com; Department of Exercise Science, School of Public Health and Health Professions, University at Buffalo; Sports Performance Research Institute New Zealand, Auckland University of Technology; Human Performance Laboratories, Department of Kinesiology, Louisiana Tech University
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20
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Matsuzawa K, Edama M, Ikezu M, Otsuki T, Maruyama S, Sato N. Contributions of the Third and Fourth Digits and the Second and Fifth Digits of the Flexor Digitorum Superficialis Muscle to Elbow Valgus Stability. Orthop J Sports Med 2021; 9:23259671211026247. [PMID: 34541011 PMCID: PMC8445534 DOI: 10.1177/23259671211026247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Thiel cadavers have been reported to have lifelike flexibility and mechanical properties, but whether they are useful for measurement of the ulnohumeral joint space (JS) is unclear. The contributions of the third and fourth digits and the second and fifth digits of the flexor digitorum superficialis (FDS) to elbow valgus stability are also unknown. Purpose: To (1) clarify whether Thiel cadavers can be used for JS measurement on ultrasound and (2) identify the contributions to valgus stability of the third and fourth digits and the second and fifth digits of the FDS. Study Design: Descriptive laboratory study. Methods: In experiment 1 (12 elbows from human volunteers and 12 elbows from Thiel cadavers), valgus stress was increased gradually from 0 to 30 to 60 N, and the JS was compared on ultrasound between groups at each load. In experiment 2 (13 elbows from Thiel cadavers), specimens were divided into 2 groups, and the JS was measured for group 1 with the FDS intact, with tendinous insertions of the third and fourth digits cut (3/4-cut state), and with tendinous insertions of all fingers cut (all-cut state); and for group 2 at intact FDS, with tendinous insertions of the second and fifth digits cut (2/5-cut state), and at all-cut. Results: In experiment 1, the rate of change of the JS increased significantly with elbow valgus stress in both humans and Thiel cadavers, with no significant difference between groups. In experiment 2, the JS was significantly greater in the 3/4- and 2/5-cut states compared with the intact state at both 30 N (Δ3/4-cut vs intact = 0.23 mm [P = .01]; Δ2/5-cut vs intact = 0.32 mm [P = .02]) and 60 N (Δ3/4-cut vs intact = 0.33 mm [P = .002]; Δ2/5-cut vs intact = 0.37 mm [P = .04]). There was no significant difference in JS measurements between the 3/4- and 2/5-cut states at any load. Conclusion: Thiel cadavers showed JS changes similar to those of humans when valgus stress was applied. The third and fourth digits and the second and fifth digits of the FDS were involved in valgus stability, and there was no difference in their respective contributions. Clinical Relevance: This study may help in identifying function of the FDS based on structure.
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Affiliation(s)
- Kanta Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Division of Gross Anatomy and Morphogenesis, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masahiro Ikezu
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic, Tokyo Arthroscopy Center, Tokyo, Japan
| | - Tomofumi Otsuki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Noboru Sato
- Division of Gross Anatomy and Morphogenesis, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Shitara H, Tajika T, Kuboi T, Ichinose T, Sasaki T, Hamano N, Endo T, Kamiyama M, Miyamoto R, Nakase K, Yamamoto A, Kobayashi T, Takagishi K, Chikuda H. Pronation and palmar pinch improve the stability of the medial elbow joint space in high school baseball pitchers. J Shoulder Elbow Surg 2021; 30:2120-2126. [PMID: 33567354 DOI: 10.1016/j.jse.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/21/2020] [Accepted: 12/27/2020] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We aimed to investigate the contributions of grip, pronation, and pinch to stabilization of the medial elbow joint space; examine their relationship with muscle strength; and assess the effect of stabilization on the medial elbow joint space in baseball pitchers. METHODS In this controlled laboratory study, we measured the medial elbow joint space using ultrasound during the following conditions: unloading; loading; and loading with grip, pronation, and pinch. To evaluate changes in the medial elbow joint space as a result of various conditions, 1-way repeated-measures analysis of variance and post hoc analysis for multiple comparisons were performed. To investigate whether strong or weak muscle strength improved the medial elbow joint space during the loaded condition, Pearson correlation analysis was performed. Finally, a post hoc power analysis was performed. RESULTS We enrolled 121 pitchers. The medial elbow joint space in the loaded condition, loaded condition with full grip, and loaded condition with full pinch was significantly larger than that in the unloaded condition. The medial elbow joint space in the loaded condition with full grip, loaded condition with full pronation, and loaded condition with full palmar pinch was significantly smaller than that in the loaded condition. A post hoc power analysis showed that the power of the 1-way repeated-measures analysis of variance was 100%. The strengths of the full grip and palmar pinch were significantly correlated with a reduced gap distance of the medial elbow joint space (P < .001 for both). CONCLUSION In high school baseball pitchers, pronation and palmar pinch contraction significantly improved the gap distance of the medial elbow joint space in the loaded condition and during grip contraction. Moreover, the grip and palmar pinch strengths were significantly correlated with stabilizing effects on the medial elbow joint space.
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Affiliation(s)
- Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan.
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takuro Kuboi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takafumi Endo
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masataka Kamiyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ryosuke Miyamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kurumi Nakase
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Atsushi Yamamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsutomu Kobayashi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
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22
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Van Trigt B, Vliegen LW, Leenen TA, Veeger DH. The ulnar collateral ligament loading paradox between in-vitro and in-vivo studies on baseball pitching (narrative review). Int Biomech 2021; 8:19-29. [PMID: 33998377 PMCID: PMC8130712 DOI: 10.1080/23335432.2021.1916405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ulnar collateral ligament (UCL) weakening or tears occur in 16% of professional baseball pitchers. To prevent players from sustaining a UCL injury, it is important to understand the relationship between the UCL properties and elbow stabilizers with the load on the UCL during pitching. In-vitro studies showed that the ultimate external valgus torque of 34 Nm would rupture the UCL, which is in apparent conflict with the reported peak valgus torques in pitching (40–120 Nm). Assuming both observations are correct, the question rises why ‘only’ 16 out of 100 professional pitchers sustain a UCL rupture. Underestimation of the effect of other structures in in-vivo studies is most likely the explanation of this mismatch because the calculated in-vivo torque also includes possible contributions of functional and structural stabilizers. In-vitro studies show that the flexor-pronator mass has the potential to counteract valgus torque directly, whereas the elbow flexor-extensor muscles combined with the humeroradial joint might have an indirect effect on valgus torque by increasing the joint compression force. Accurate experimental electromyography data and a more detailed (musculoskeletal)mechanical model of the elbow are needed to investigate if and to what extent the structural and functional stabilizers can shield the UCL during pitching.
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Affiliation(s)
- Bart Van Trigt
- Department of Biomechanical Engineering, Delft University of Technology, CD Delft, The Netherlands
| | - Liset W Vliegen
- Department of Biomechanical Engineering, Delft University of Technology, CD Delft, The Netherlands
| | - Ton Ajr Leenen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, BT Amsterdam, The Netherlands
| | - DirkJan Hej Veeger
- Department of Biomechanical Engineering, Delft University of Technology, CD Delft, The Netherlands
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23
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Zaremski JL, Pazik M, Dean CW, Vijayaraghavan N, Fethiere NP, Farmer KW, Horodyski MB. Forearm flexor injury is associated with medial ulnar collateral ligament injury in throwing athletes. PM R 2021; 14:949-954. [PMID: 33743179 DOI: 10.1002/pmrj.12592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/25/2021] [Accepted: 03/08/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Elbow ulnar collateral ligament (UCL) injuries have become increasingly common in throwing athletes. The forearm flexors (FF) have been studied as biomechanical stabilizers for the medial elbow. However, there are no studies investigating the association of concomitant UCL injuries and FF injuries in throwing athletes. OBJECTIVE To determine if throwing athletes with a complete UCL injury had a greater likelihood of concomitant FF injury than those with a partial UCL injury. DESIGN Descriptive retrospective epidemiological study. SETTING Academic, tertiary care medical center. PATIENTS Throwing related UCL injuries in patients aged 12-24 years. INTERVENTIONS/METHODS Electronic medical records and key word searches identified all patients from January 1, 2010 to December 31, 2019. A board certified and fellowship trained musculoskeletal radiologist reviewed all advanced imaging studies. RESULTS Fifty-four patients (46 male, 8 female, mean age 17.1 years, SD 2.3) were included. Fifty-four UCL injuries (21 complete ruptures, 16 proximal partial injuries, 17 distal partial injuries) were confirmed by magnetic resonance imaging (MRI). Twenty-eight FF injuries (22 strains, 6 tears) were diagnosed with MRI and/or MRI-arthrogram. There was a significant association between sustaining a FF injury and UCL reconstruction (UCL-R) (X2 = [1, N = 54], = 3.97, P = .046) (15/22, 68.2%), as well as FF injury and UCL injury location (X2 = [1, N = 33], = 3.86, P = .049) (10/17, distal partial UCL injury, 58.8%). Analysis of FF injury and complete UCL tear is not significant (X2 = [1, N = 54], = 3.02, P = .08) (14/21, 66.7%). CONCLUSIONS The data indicate that FF injury is associated with UCL injury in throwing athletes. Future prospective studies should investigate causation versus correlation of FF and UCL injury in throwing athletes. The results of this study have applications to multiple sports medicine areas that include but are not limited to surgical, nonsurgical, prehabilitation, rehabilitation, and sports performance. This study reveals a strongly significant association between FF injury and concomitant UCL injury in throwing athletes.
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Affiliation(s)
- Jason L Zaremski
- Divisions of PM&R, Sports Medicine, & Research, Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Marissa Pazik
- Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Cooper W Dean
- Department of Radiology, University of Florida, Gainesville, Florida, USA
| | | | | | - Kevin W Farmer
- Division of Sports Medicine (Surgery), Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Mary Beth Horodyski
- Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida, USA
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24
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Chalmers PN, English J, Cushman DM, Zhang C, Presson AP, Yoon S, Schulz B, Li B. The ulnar collateral ligament responds to stress in professional pitchers. J Shoulder Elbow Surg 2021; 30:495-503. [PMID: 32650069 DOI: 10.1016/j.jse.2020.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Our purpose with this study was to determine the response of the ulnar collateral ligament (UCL) in professional pitchers after exposure to a season of pitching and to rest during an off-season. METHODS In a prospective study supported by Major League Baseball, all pitchers within a single professional baseball club were enrolled. An ultrasound of the ligament was then performed by a single fellowship-trained ultrasonographer at the beginning of the season (T1), the end of the season (T2), and the beginning of the following season (T3). We measured the UCL thickness and ulnotrochlear joint opening at 30° of flexion with and without stress. Two ultrasound images were saved. Inter- and intra-rater reliability were determined. A multivariable analysis was conducted. RESULTS A total of185 total pitchers were included: 94 pitchers at T1, 83 at T2, and 118 at T3. These pitchers had 12 [7, 15] (median [interquartile range]) years of pitching experience and had a peak velocity of 95 [93, 97] miles/hour. Intra- and inter-rater reliability were excellent. The baseline UCL thickness was associated with peak velocity (P = .031) and prior UCL reconstruction (P = .024). After accounting for pitching experience, peak velocity, and prior UCL reconstruction, thickness increased during the season (P = .002) and decreased during the off-season (P = .001). After accounting for these same variables, valgus laxity at 30° increased during the season (P = .002) and decreased during the off-season (P = .029). CONCLUSION The UCL responds to stress in professional pitchers by becoming thicker and more lax, and responds to rest by becoming thinner and less lax.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Joy English
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Daniel M Cushman
- Division of Physical Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Division of Sports Medicine, Kerlan-Jobe Orthopaedic Institute, Los Angeles, CA, USA
| | - Steve Yoon
- Division of Sports Medicine, Kerlan-Jobe Orthopaedic Institute, Los Angeles, CA, USA
| | - Brian Schulz
- Division of Sports Medicine, Kerlan-Jobe Orthopaedic Institute, Los Angeles, CA, USA
| | - Bernard Li
- Sports Science and Player Performance, Los Angeles Angels, Anaheim, CA, USA
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25
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The Effects of Differences in the Morphologies of the Ulnar Collateral Ligament and Common Tendon of the Flexor-Pronator Muscles on Elbow Valgus Braking Function: A Simulation Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041986. [PMID: 33670789 PMCID: PMC7923208 DOI: 10.3390/ijerph18041986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 01/17/2023]
Abstract
The anterior bundle (AB) and posterior bundle (PB) of the ulnar collateral ligament and the anterior common tendon (ACT) and posterior common tendon (PCT) of the flexor-pronator muscles have an independent form and an unclear form. The purpose of this study was to clarify the effect of differences in the morphologies of the AB, PB, ACT, and PCT on the elbow valgus braking function. This investigation examined three elbows. In the classification method, the AB, PB, ACT, and PCT with independent forms constituted Group I; the AB, ACT, and PCT with independent forms and the PB with an unclear form constituted Group II; the AB, PB, ACT, and PCT with unclear forms constituted Group III. The strains were calculated by simulation during elbow flexion at valgus at 0° and 10°. At 0° valgus, Group I and Group II showed similar AB and PCT strain patterns, but Group III was different. At 10° valgus, most ligaments and tendons were taut with increasing valgus angle. The average strain patterns of all ligaments and tendons were similar for the groups. The AB, PB, ACT, and PCT may cooperate with each other to contribute to valgus braking.
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26
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Dowling B, McNally MP, Chaudhari AMW, Oñate JA. A Review of Workload-Monitoring Considerations for Baseball Pitchers. J Athl Train 2021; 55:911-917. [PMID: 32991703 DOI: 10.4085/1062-6050-0511-19] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Because of the unique demands of a pitch, baseball players have the greatest percentage of injuries resulting in surgery among high school athletes, with a majority of these injuries affecting the shoulder and elbow due to overuse from throwing. These injuries are believed to occur because of repeated microtrauma to soft tissues caused by the repetitive mechanical strain of throwing. Researchers and practitioners have suggested that baseball pitchers' workloads are a significant risk factor for injury in adolescent players, resulting in lost time and slowing of performance development. The purpose of our review was to investigate the current research relative to monitoring workload in baseball throwers and discuss techniques for managing and regulating cumulative stress on the arm, with a focus on preventing injury and optimizing performance in adolescent baseball pitchers.
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Affiliation(s)
- Brittany Dowling
- Midwest Orthopaedics at Rush, Sports Performance Center, Oak Brook, IL
| | | | - Ajit M W Chaudhari
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - James A Oñate
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus.,Human Performance Collaborative, The Ohio State University, Columbus
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27
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Scarborough DM, Linderman SE, Sanchez JE, Berkson EM. Kinematic Sequence Classification and the Relationship to Pitching Limb Torques. Med Sci Sports Exerc 2021; 53:351-359. [PMID: 32701873 DOI: 10.1249/mss.0000000000002471] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The kinematic sequence (KS) during a baseball pitch provides insight into an athlete's ability to efficiently transfer energy and develop segmental velocities, to assess the quality of body segment position and control. Study purposes were 1) to introduce the four-category Kinematic Sequence Classification System and 2) to compare elbow and shoulder torques and shoulder distraction force across the KS categories performed during the fastball pitch. METHODS Thirty baseball pitchers (20.0 ± 3.1 yr) underwent 3D biomechanical pitch analyses of 249 fastball pitches. Seventeen distinct KS patterns were identified and assigned into four categories: 1) The proximal-to-distal (PDS) group includes the KS closest to theoretical ideal order of the five body segments (pelvis → trunk → arm → forearm → hand). The other categories were defined based on the segment where the first out-of-sequence peak angular velocity occurred: 2) distal upper extremity (DUE), 3) proximal upper extremity, and 4) pelvis/trunk. Throwing limb shoulder distraction force and shoulder and elbow torques were calculated. Linear mixed model analyses compared variables across KS categories. RESULTS Average elbow valgus torques differed significantly across all categories, P = 0.023, and were greater for the DUE (73.99 ± 20.84 N·m) than the PDS (61.35 ± 16.79 N·m), P = 0.006. Shoulder external rotation torques were significantly different, P = 0.033, across categories. CONCLUSION The PDS group demonstrated less mechanical stresses on the throwing shoulder and elbow but was observed in only 12% of pitches. The DUE group was the most common and generated the greatest elbow valgus and shoulder external rotation torques. The KS can inform coaches and sports medicine clinicians where the greatest torques are incurred by a pitcher. A KS classification system may serve as a screening tool or target pitching instruction for injury avoidance.
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Affiliation(s)
| | - Shannon E Linderman
- Sports Medicine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Javier E Sanchez
- Sports Medicine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
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28
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Tanaka H, Hayashi T, Inui H, Muto T, Tsuchiyama K, Ninomiya H, Nakamura Y, Kobashi S, Nobuhara K. Stride-Phase Kinematic Parameters That Predict Peak Elbow Varus Torque. Orthop J Sports Med 2020; 8:2325967120968068. [PMID: 33403214 PMCID: PMC7745573 DOI: 10.1177/2325967120968068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background: During baseball pitching, a high amount of elbow varus torque in the arm cocking-to-acceleration phase is thought to be a biomechanical risk factor for medial elbow pain and injury. The biomechanics of the stride phase may provide preparation for the arm cocking-to-acceleration phase that follows it. Purpose: To determine the kinematic parameters that predict peak elbow varus torque during the stride phase of pitching. Study Design: Descriptive laboratory study. Methods: Participants were 107 high school baseball pitchers (age range, 15-18 years) without shoulder or elbow problems. Whole-body kinematics and kinetics during fastball pitching were analyzed using 3-dimensional measurements from 36 retroreflective markers. A total of 26 kinematic parameters of the upper and lower limbs during the stride phase leading up to the stride foot contact were extracted for multiple regression analysis to assess their combined effect on the magnitude of peak elbow varus torque. Results: Increased wrist extension, elbow pronation, knee flexion on the leading leg, knee extension on the trailing leg at stride foot contact, and upward displacement of the body’s center of mass in the stride phase were significantly correlated with decreased peak elbow varus torque (all P < .05). Moreover, 38% of the variance in peak elbow varus torque was explained by a combination of these 5 significant kinematic variables (P < .001). Conclusion: We found that 5 kinematic parameters during the stride phase and the combination of these parameters were associated with peak elbow varus torque. The stride phase provides biomechanical preparation for pitching and plays a key role in peak elbow varus torque in subsequent pitching phases. Clinical Relevance: The present data can be used to screen pitching mechanics with motion capture assessment to reduce peak elbow varus torque. Decreased peak elbow varus torque is expected to reduce the risk of elbow medial pain and injury.
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Affiliation(s)
- Hiroshi Tanaka
- Nobuhara Hospital and Institute of Biomechanics, Tatsuno, Japan
| | - Toyohiko Hayashi
- Graduate School of Science and Technology, Niigata University, Niigata, Japan
| | - Hiroaki Inui
- Nobuhara Hospital and Institute of Biomechanics, Tatsuno, Japan
| | - Tomoyuki Muto
- Nobuhara Hospital and Institute of Biomechanics, Tatsuno, Japan
| | - Kohnan Tsuchiyama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroki Ninomiya
- Nobuhara Hospital and Institute of Biomechanics, Tatsuno, Japan
| | - Yasuo Nakamura
- Faculty of Health and Sports Science, Doshisha University, Kyotanabe, Japan
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29
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Matsuzawa K, Edama M, Ikezu M, Kaneko F, Hirabayashi R, Kageyama I. The origin structure of each finger in the flexor digitorum superficialis muscle. Surg Radiol Anat 2020; 43:3-10. [PMID: 32564110 DOI: 10.1007/s00276-020-02522-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The flexor digitorum superficialis muscle (FDS) is considered the most important of the forearm flexors for maintaining elbow valgus stability. However, the relationships between the origin structure of each finger of the FDS and the anterior oblique ligament (AOL) of the ulnar collateral ligament and the common tendon (CT) in the proximal part, and morphological features are unclear. The purpose of this study was to clarify the relationships between the origin structure of each finger of the FDS and the AOL and the CT, as well as to clarify the morphological features of the muscle belly of each finger of the FDS. METHODS This study examined 20 elbows. The origin of each finger was examined. Muscle mass, muscle fiber bundle length, and the pennation angle of each finger were also measured. RESULTS In all cases, the third and fourth digits originated from the radius, the anterior common tendon (ACT), and the posterior common tendon (PCT). The second and fifth digits (18 elbows) or an independent fifth digit (2 elbows) originated from the ACT, the PCT, the AOL, and other soft tissues of the elbow. Muscle mass and muscle fiber bundle length in the muscle belly of the third and fourth digits were significantly heavier and longer, respectively, than in the muscle belly of the second and fifth digits. CONCLUSION Because the second and fifth digits or an independent fifth digit originated from the AOL, their contraction may cause tension in the AOL.
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Affiliation(s)
- Kanta Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan.
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan.,Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
| | - Masahiro Ikezu
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Fumiya Kaneko
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
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30
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Algorithm to compute muscle excitation patterns that accurately track kinematics using a hybrid of numerical integration and optimization. J Biomech 2020; 107:109836. [DOI: 10.1016/j.jbiomech.2020.109836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 04/24/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022]
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31
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Hoshika S, Nimura A, Takahashi N, Sugaya H, Akita K. Valgus stability is enhanced by flexor digitorum superficialis muscle contraction of the index and middle fingers. J Orthop Surg Res 2020; 15:121. [PMID: 32238189 PMCID: PMC7110663 DOI: 10.1186/s13018-020-01640-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/20/2020] [Indexed: 02/06/2023] Open
Abstract
Background Flexor digitorum superficialis (FDS) muscle provides dynamic stabilization and medial elbow support for ulnar collateral ligament (UCL). The FDS contraction significantly affects the medial joint distance (MJD) through grip contraction. However, it remains unclear whether FDS activity alone contributes to medial elbow stability, or together with the activation of the flexor digitorum profundus during grip contraction, and which finger’s FDS is the main contributor to elbow stability. We investigated the resistive effects of isolated FDS contraction in individual fingers against valgus stress in the elbow joint using stress ultrasonography (US). Methods We investigated 17 healthy males (mean age, 27 ± 5 years). Valgus stress US was performed using the Telos device, with the elbow at 30° flexion. MJD was measured for each arm during 3 separate conditions: at rest (unloaded), under valgus load (50 N) (loaded), and under valgus load with FDS contracted in individual fingers (loaded-contracted). Results MJD was significantly longer when loaded (5.4 ± 0.4 mm) than unloaded (4.1 ± 0.2 mm, P = 0.007) or loaded-contracted (4.6 ± 0.3 mm, P = 0.003) for each finger. When loaded-contracted, MJD differed statistically between the index and ring fingers (P = 0.03) and between the middle and ring fingers (P = 0.04). However, the difference between the index and middle fingers was not statistically significant (P = 0.08). Conclusions Individual FDS contraction, particularly of the index and middle fingers, contributes most to stabilization against valgus stress. Thus, injury care programs should incorporate FDS exercises of these fingers.
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Affiliation(s)
- Shota Hoshika
- Shoulder & Elbow Service, Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan.,Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Norimasa Takahashi
- Shoulder & Elbow Service, Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan
| | - Hiroyuki Sugaya
- Shoulder & Elbow Service, Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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32
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Tajika T, Oya N, Ichinose T, Shimoyama D, Sasaki T, Hamano N, Shitara H, Yamamoto A, Takagishi K, Chikuda H. Relationship between the elbow joint valgus instability and forearm flexor muscle strength in high school pitchers with and without symptom. J Orthop Surg (Hong Kong) 2020; 27:2309499019832664. [PMID: 30827176 DOI: 10.1177/2309499019832664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Earlier reports describe forearm flexor muscles as active stabilizers of the elbow to valgus stress during throwing motion. Given high school pitchers' history of elbow symptoms, this study assesses its relation to elbow valgus joint instability and forearm flexor muscle strength. METHODS Ultrasound examination was made for 132 high school baseball pitchers with and without valgus stress of the medial aspect of the bilateral elbows. They had completed a self-administered questionnaire related to self-satisfaction score (0-100) for pitching performance and throwing-related elbow joint pain sustained during the prior year. Using a digital manual muscle strength meter, we examined the grip strength and muscle strength of the flexor carpi ulnaris (FCU). For participants with and without a history of elbow symptom, we compared differences of ulnohumeral joint space width with and without valgus stress and grip and FCU muscle strength. RESULTS For ulnohumeral joint width difference with and without valgus stress, pitchers with an elbow symptom and those without elbow symptom history on the throwing side were not significantly different. No difference was found in the grip strength or FCU muscle strength of the throwing side for each group. Positive significant association was found between FCU muscle strength on the pitching side and the self-evaluation score for pitching performance ( r = 0.27, p = 0.002). However, no association was found between the elbow valgus instability and the forearm flexor muscle strength. CONCLUSION FCU muscle strength might influence high school baseball pitching performance.
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Affiliation(s)
- Tsuyoshi Tajika
- 1 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Noboru Oya
- 1 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tsuyoshi Ichinose
- 1 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Daisuke Shimoyama
- 2 Department of Orthopaedic Surgery, Saint-Pierre Hospital, Gunma, Japan
| | - Tsuyoshi Sasaki
- 1 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Noritaka Hamano
- 1 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hitoshi Shitara
- 1 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Atsushi Yamamoto
- 3 Department of Orthopaedic Surgery, Keiyu Orthopaedic Hospital, Gunma, Japan
| | - Kenji Takagishi
- 2 Department of Orthopaedic Surgery, Saint-Pierre Hospital, Gunma, Japan
| | - Hirotaka Chikuda
- 1 Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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Sterner JA, Reaves SK, Aguinaldo AL, Hazelwood SJ, Klisch SM. Inverse dynamics analysis of youth pitching arm kinetics using body composition imaging. Sports Biomech 2020; 21:993-1007. [DOI: 10.1080/14763141.2020.1715470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jay A. Sterner
- Mechanical Engineering, College of Engineering, Cal Poly State University, San Luis Obispo, CA, USA
| | - Scott K. Reaves
- Food Science & Nutrition, College of Agriculture, Food, and Environmental Sciences, Cal Poly State University, San Luis Obispo, CA, USA
| | - Arnel L. Aguinaldo
- Kinesiology, College of Kinesiology, Point Loma Nazarene University, San Diego, CA, USA
| | - Scott J. Hazelwood
- Mechanical Engineering, College of Engineering, Cal Poly State University, San Luis Obispo, CA, USA
- Biomedical Engineering, College of Engineering, Cal Poly State University, San Luis Obispo, CA, USA
| | - Stephen M. Klisch
- Mechanical Engineering, College of Engineering, Cal Poly State University, San Luis Obispo, CA, USA
- Biomedical Engineering, College of Engineering, Cal Poly State University, San Luis Obispo, CA, USA
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Aguinaldo AL, Escamilla RF. Induced power analysis of sequential body motion and elbow valgus load during baseball pitching. Sports Biomech 2020; 21:824-836. [PMID: 32022646 DOI: 10.1080/14763141.2019.1696881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The flow of mechanical energy of segmental motion during baseball pitching is poorly understood, particularly in relation to the valgus torque at the elbow which is prone to pitching-related injuries. This study employed an induced power analysis to determine the components of muscle and velocity-dependent torques that contribute to the power of throwing arm segments when the elbow is under valgus load during the arm-cocking phase of pitching. The 3D throwing kinematics and kinetics of 10 adult pitchers were included in this analysis. Pitchers threw with a maximum elbow valgus torque of 73 ± 20 N•m. The trunk flexion and rotation components of the velocity-dependent torque were the greatest contributors to the work of the forearm at -0.53 ± 0.22 J/kg and -0.43 ± 0.21 J/kg, respectively. Approximately 86% of the total energy transferred through the elbow by the velocity-dependent torque was due to trunk motion, which appears to drive the power of accelerating the throwing elbow in valgus. These results support the importance of trunk motion as a key component in the development of elbow torque and ball velocity. Therefore, this study has practical implications for baseball pitchers seeking to minimise injury risk while improving performance.
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Affiliation(s)
- Arnel L Aguinaldo
- Department of Kinesiology, Point Loma Nazarene University, San Diego, CA, USA
| | - Rafael F Escamilla
- Department of Physical Therapy, California State University, Sacramento, CA, USA
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Imaging of the post-operative medial elbow in the overhead thrower: common and abnormal findings after ulnar collateral ligament reconstruction and ulnar nerve transposition. Skeletal Radiol 2019; 48:1843-1860. [PMID: 31203406 DOI: 10.1007/s00256-019-03246-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 02/02/2023]
Abstract
Ulnar collateral ligament (UCL) reconstruction is now being performed more commonly and on younger patients than in prior decades. As a result, radiologists will increasingly be asked to evaluate elbow imaging of patients presenting with pain who have had UCL reconstruction. It is essential for radiologists to understand the normal and abnormal imaging appearances after UCL reconstruction and ulnar nerve transposition, which is also commonly performed in overhead-throwing athletes. Doing so will allow radiologists to provide accurate interpretations that appropriately guide patient management.
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Tajika T, Oya N, Ichinose T, Hamano N, Sasaki T, Shimoyama D, Shitara H, Yamamoto A, Kobayashi T, Sakamoto M, Takagishi K, Chikuda H. Flexor pronator muscles' contribution to elbow joint valgus stability: ultrasonographic analysis in high school pitchers with and without symptoms. JSES Int 2019; 4:9-14. [PMID: 32544928 PMCID: PMC7075757 DOI: 10.1016/j.jses.2019.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Few researchers have examined the different contributions of flexor-pronator muscles to valgus stress in high school baseball pitchers with and without elbow symptoms. This study used ultrasonography to assess these muscles' dynamic contributions to elbow valgus joint stability in high school pitchers. Methods A self-administered questionnaire on throwing-related elbow joint pain sustained during the prior year was completed by 89 high school baseball pitchers. Gravity stress ultrasonographic elbow examinations with 30° of flexion were done before and after isometric contraction of the flexor-pronator muscles. For study participants with and without a history of elbow symptoms, we compared differences of ulnohumeral joint space without gravity stress and isometric contraction of the flexor-pronator muscles and with gravity stress only and with isometric contraction of the flexor-pronator muscles under gravity stress. Results For each pitcher, the ulnohumeral joint space in the condition with valgus stress was significantly larger than in the condition without valgus stress. Also, the ulnohumeral joint space in the condition with valgus stress was significantly larger than in the condition with valgus stress and flexor-pronator isometric muscle contraction. Participants with and without elbow symptom history showed no differences of ulnohumeral joint space in the unloaded and loaded flexor-pronator muscle contracted conditions. Conclusion Ultrasonographic assessment demonstrated that flexor-pronator muscles contribute to elbow valgus stability. No difference was found in the flexor-pronator muscle contribution in high school baseball pitchers with and without elbow symptom history.
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Affiliation(s)
- Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Noboru Oya
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Daisuke Shimoyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | | | - Tsutomu Kobayashi
- Department of Physical Therapy, Takasaki University of Health and Welfare, Takasaki-shi, Gunma, Japan
| | - Masaaki Sakamoto
- Department of Physical Therapy, Graduate School of Health Sciences, Gunma University, Maebashi, Gunma, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Sada Hospital, Fukuoka Chuo-ku, Fukuoka, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Jordan D, Schimoler P, Kharlamov A, DeMeo PJ, Miller MC. Correlation of Force to Deformation of the Anterior Bundle of the Medial Collateral Ligament Through Consideration of Band Laxity. J Orthop Res 2019; 37:2027-2034. [PMID: 31081556 DOI: 10.1002/jor.24344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/23/2019] [Indexed: 02/04/2023]
Abstract
The anterior bundle of the medial collateral ligament (AMCL) resists the loads that arise at the elbow during overhand throwing and has commonly been divided into posterior and anterior bands. While these anterior and posterior bands have been thought to bear the load at different flexion angles, any transition of the load distribution between the two bands is poorly understood and has not considered laxity (slack). This study considers the AMCL as three bands and quantifies the mechanical response to vertical distraction, simulating valgus-load joint opening, through the sequential superposition of the band responses after the elimination of inherent laxity. Eight cadaveric elbow specimens were used for the study. The intact AMCL of each specimen was tested under vertical distraction in a specialized load frame at four elbow flexion angles and then subsequently retested after two longitudinal transections. The greatest laxity at full extension and full flexion belonged to the posterior (1.9 mm) and anterior (2.4 mm) band, respectively. At the lesser and higher flexion angles, the greatest structural stiffness belonged to the anterior and middle band. The overall AMCL was the most structurally stiff at 60°, with approximately 150 N of force required for 2% elongation. This study shows that the different bands of the AMCL may have different load bearing properties at different flexion angles, causing each band to support different proportions of an imposed load. The presence of the laxity may impose a load-bearing delay, causing load-bearing in each band to begin asynchronously. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2027-2034, 2019.
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Affiliation(s)
- David Jordan
- Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patrick Schimoler
- Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania.,Orthopaedic Surgery, Allegheny General Hospital, 10th Floor, S. Tower, 320 E. North Avenue, Pittsburgh, Pennsylvania, 15212
| | - Alexander Kharlamov
- Orthopaedic Surgery, Allegheny General Hospital, 10th Floor, S. Tower, 320 E. North Avenue, Pittsburgh, Pennsylvania, 15212
| | - Patrick J DeMeo
- Orthopaedic Surgery, Allegheny General Hospital, 10th Floor, S. Tower, 320 E. North Avenue, Pittsburgh, Pennsylvania, 15212
| | - Mark Carl Miller
- Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania.,Orthopaedic Surgery, Allegheny General Hospital, 10th Floor, S. Tower, 320 E. North Avenue, Pittsburgh, Pennsylvania, 15212
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Mechanical misconceptions: Have we lost the “mechanics” in “sports biomechanics”? J Biomech 2019; 93:1-5. [DOI: 10.1016/j.jbiomech.2019.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 01/01/2023]
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Darke JD, Dandekar EM, Aguinaldo AL, Hazelwood SJ, Klisch SM. Effects of Game Pitch Count and Body Mass Index on Pitching Biomechanics in 9- to 10-Year-Old Baseball Athletes. Orthop J Sports Med 2018; 6:2325967118765655. [PMID: 29687013 PMCID: PMC5900828 DOI: 10.1177/2325967118765655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Pitching while fatigued and body composition may increase the injury risk in youth and adult pitchers. However, the relationships between game pitch count, biomechanics, and body composition have not been reported for a study group restricted to 9- to 10-year-old athletes. Hypothesis: During a simulated game with 9- to 10-year-old athletes, (1) participants will experience biomechanical signs of fatigue, and (2) shoulder and elbow kinetics will correlate with body mass index (BMI). Study Design: Descriptive laboratory study. Methods: Thirteen 9- to 10-year-old youth baseball players pitched a simulated game (75 pitches). Range of motion and muscular output tests were conducted before and after the simulated game to quantify fatigue. Kinematic parameters at foot contact, maximum external rotation, and maximum internal rotation velocity (MIRV), as well as maximum shoulder and elbow kinetics between foot contact and MIRV were compared at pitches 1-5, 34-38, and 71-75. Multivariate analyses of variance were used to test the first hypothesis, and linear regressions were used to test the second hypothesis. Results: MIRV increased from pitches 1-5 to 71-75 (P = .007), and head flexion at MIRV decreased from pitches 1-5 to 34-38 (P = .022). Maximum shoulder horizontal adduction, external rotation, and internal rotation torques increased from pitches 34-38 to 71-75 (P = .031, .023, and .021, respectively). Shoulder compression force increased from pitches 1-5 to 71-75 (P = .011). Correlations of joint torque/force with BMI were found at every pitch period: for example, shoulder internal rotation (R2 = 0.93, P < .001) and elbow varus (R2 = 0.57, P = .003) torques at pitches 1-5. Conclusion: Several results differed from those of previous studies with adult pitchers: (1) pitch speed remained steady, (2) shoulder MIRV increased, and (3) shoulder kinetics increased during a simulated game. The strong correlations between joint kinetics and BMI reinforce previous findings that select body composition measures may be correlated with pitching arm joint kinetics for youth baseball pitchers. Clinical Relevance: The results improve our understanding of pitching biomechanics for 9- to 10-year-old baseball pitchers and may be used in future studies to improve evidence-based injury prevention guidelines.
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Affiliation(s)
- Jim D Darke
- Biomedical Engineering Department, California Polytechnic State University, San Luis Obispo, California, USA
| | - Eshan M Dandekar
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, California, USA
| | - Arnel L Aguinaldo
- Department of Kinesiology, Point Loma Nazarene University, San Diego, California, USA
| | - Scott J Hazelwood
- Biomedical Engineering Department, California Polytechnic State University, San Luis Obispo, California, USA
- Mechanical Engineering Department, California Polytechnic State University, San Luis Obispo, California, USA
| | - Stephen M Klisch
- Biomedical Engineering Department, California Polytechnic State University, San Luis Obispo, California, USA
- Mechanical Engineering Department, California Polytechnic State University, San Luis Obispo, California, USA
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Pexa BS, Ryan ED, Myers JB. Medial Elbow Joint Space Increases With Valgus Stress and Decreases When Cued to Perform A Maximal Grip Contraction. Am J Sports Med 2018. [PMID: 29513547 DOI: 10.1177/0363546518755149] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous research indicates that the amount of valgus torque placed on the elbow joint during overhead throwing is higher than the medial ulnar collateral ligament (UCL) can tolerate. Wrist and finger flexor muscle activity is hypothesized to make up for this difference, and in vitro studies that simulated activity of upper extremity musculature, specifically the flexor digitorum superficialis and flexor carpi ulnaris, support this hypothesis. PURPOSE To assess the medial elbow joint space at rest, under valgus stress, and under valgus stress with finger and forearm flexor contraction by use of ultrasonography in vivo. STUDY DESIGN Controlled laboratory study. METHODS Participants were 22 healthy males with no history of elbow dislocation or UCL injury (age, 21.25 ± 1.58 years; height, 1.80 ± 0.08 m; weight, 79.43 ± 18.50 kg). Medial elbow joint space was measured by use of ultrasonography during 3 separate conditions: at rest (unloaded), under valgus load (loaded), and with a maximal grip contraction under a valgus load (loaded-contracted) in both limbs. Participants lay supine with their arm abducted 90° and elbow flexed 30° with the forearm in full supination. A handgrip dynamometer was placed in the participants' hand to grip against during the contracted condition. Images were reduced in ImageJ to assess medial elbow joint space. A 2-way (condition × limb) repeated-measures analysis of variance and Cohen's d effect sizes were used to assess changes in medial elbow joint space. Post hoc testing was performed with a Bonferroni adjustment to assess changes within limb and condition. RESULTS The medial elbow joint space was significantly larger in the loaded condition (4.91 ± 1.16 mm) compared with the unloaded condition (4.26 ± 1.23 mm, P < .001, d = 0.712) and the loaded-contracted condition (3.88 ± 0.94 mm, P < .001, d = 1.149). No significant change was found between the unloaded and loaded-contracted conditions ( P = .137). CONCLUSION Medial elbow joint space increases under a valgus load and then decreases when a maximal grip contraction is performed. This indicates that wrist and finger flexor muscle contraction may assist in limiting medial elbow joint space, a result similar to findings of previous research in vitro. CLINICAL RELEVANCE Muscle activation of the upper extremity limits the medial elbow joint space, suggesting that injury prevention programs for throwing athletes should incorporate exercises for the elbow, wrist, and hand to limit excessive medial elbow joint space gapping during activities that create high valgus load.
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Affiliation(s)
- Brett S Pexa
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Neuromuscular Research Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eric D Ryan
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Neuromuscular Research Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph B Myers
- Tampa Bay Rays Baseball Organization, St. Petersburg, Florida, USA
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Molenaars RJ, Hilgersom NFJ, Doornberg JN, van den Bekerom MPJ, Eygendaal D. Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Surgical Simulations Based on Limited Quantitative Data: Understanding How Musculoskeletal Models Can Be Used to Predict Moment Arms and Guide Experimental Design. PLoS One 2016; 11:e0157346. [PMID: 27310013 PMCID: PMC4911128 DOI: 10.1371/journal.pone.0157346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/29/2016] [Indexed: 12/21/2022] Open
Abstract
The utility of biomechanical models and simulations to examine clinical problems is currently limited by the need for extensive amounts of experimental data describing how a given procedure or disease affects the musculoskeletal system. Methods capable of predicting how individual biomechanical parameters are altered by surgery are necessary for the efficient development of surgical simulations. In this study, we evaluate to what extent models based on limited amounts of quantitative data can be used to predict how surgery influences muscle moment arms, a critical parameter that defines how muscle force is transformed into joint torque. We specifically examine proximal row carpectomy and scaphoid-excision four-corner fusion, two common surgeries to treat wrist osteoarthritis. Using models of these surgeries, which are based on limited data and many assumptions, we perform simulations to formulate a hypothesis regarding how these wrist surgeries influence muscle moment arms. Importantly, the hypothesis is based on analysis of only the primary wrist muscles. We then test the simulation-based hypothesis using a cadaveric experiment that measures moment arms of both the primary wrist and extrinsic thumb muscles. The measured moment arms of the primary wrist muscles are used to verify the hypothesis, while those of the extrinsic thumb muscles are used as cross-validation to test whether the hypothesis is generalizable. The moment arms estimated by the models and measured in the cadaveric experiment both indicate that a critical difference between the surgeries is how they alter radial-ulnar deviation versus flexion-extension moment arms at the wrist. Thus, our results demonstrate that models based on limited quantitative data can provide novel insights. This work also highlights that synergistically utilizing simulation and experimental methods can aid the design of experiments and make it possible to test the predictive limits of current computer simulation techniques.
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