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Arrigoni P, Cucchi D, Beltrame G, Ribolzi R, Ceccarelli C, Zaolino C, Ellenbecker T, Randelli PS. A low carrying angle is measured in elite tennis players just before ball impact during the forehand, suggesting a dynamic varus instant accommodation moving towards full extension. Knee Surg Sports Traumatol Arthrosc 2024; 32:29-36. [PMID: 38226669 DOI: 10.1002/ksa.12016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE The goal of this study was to use image analysis recordings to measure the carrying angle of elite male tennis players during the forehand stroke, with the hypothesis that elite tennis players overstress their elbow in valgus over the physiological degree in the frontal plane just before ball contact on forehand groundstrokes. METHODS The carrying angle of male tennis players ranked in the top 25 positions in the ATP ranking was measured on selected video frames with the elbow as close as possible to full extension just before the ball-racket contact in forehands. These frames were extracted from 306 videos professionally recorded for training purposes by a high-profile video analyst. All measures were conducted by three independent observers. RESULTS Sixteen frames were finally included. The mean carrying angle was 11.5° ± 4.7°. The intraclass correlation coefficient value was 0.703, showing good reliability of the measurement technique. The measured carrying angle was lower than what has been observed in historical cohorts using comparable measurement methodology, suggesting a possible instant varus accommodation mechanism before hitting the ball. CONCLUSIONS The observed decrease in the carrying angle is a consequence of an increase in elbow flexion position dictated by the transition from a closed to open, semi-open stances. As the elbow flexes during the preparation phase, it is less constrained by the olecranon and its fossa, increasing the strain on the medial collateral ligament and capsule structures. Moving towards full extension before the ball-racket contact, the elbow is dynamically stabilised by a contraction of the flexor muscles. These observations could provide a new explanation for medial elbow injuries among elite tennis players and drive specific rehabilitation protocols. STUDY DESIGN Descriptive epidemiology study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Paolo Arrigoni
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Giulia Beltrame
- Scuola Di Specializzazione in Ortopedia e Traumatologia Università Degli Studi Di Milano, Milan, Italy
| | - Romeo Ribolzi
- Scuola Di Specializzazione in Ortopedia e Traumatologia Università Degli Studi Di Milano, Milan, Italy
| | | | - Carlo Zaolino
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Todd Ellenbecker
- Medical Services, ATP Tour, Ponte Vedra Beach, Jacksonville, Florida, USA
- Rehab Plus Sports Therapy Scottsdale, Scottsdale, Arizona, USA
| | - Pietro S Randelli
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Università Degli Studi Di Milano, Milan, Italy
- Department of Biomedical Sciences for Health, Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Università Degli Studi Di Milano, Milan, Italy
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Pitsilos C, Gigis I, Chitas K, Papadopoulos P, Ditsios K. Systematic review of distal biceps tendon rupture in athletes: treatment and rehabilitation. J Shoulder Elbow Surg 2022; 31:1763-1772. [PMID: 35367620 DOI: 10.1016/j.jse.2022.02.027] [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: 12/18/2021] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal biceps tendon rupture is a rare injury associated with decreased elbow flexion and forearm supination strength. This impairment is not tolerated by high-demand patients like athletes. PURPOSE To review treatment and rehabilitation applied to injured athletes and study their impact in return to sports. METHODS MEDLINE, Cochrane, Web of Science, and Scopus online databases were searched. A systematic review was conducted using the PRISMA guidelines; studies published on distal biceps tendon rupture treatment and rehabilitation of athletes until June 30, 2021, were identified. A quantitative synthesis of factor related to return to preinjury sport activity was made. RESULTS Ten articles were identified, including 157 athletes. Mean age was 40.5 years, and the dominant arm was injured in 103 cases (66%). Rupture was acute in 121 athletes (77%), and the mean follow-up was 25.7 months. A hundred and fifty-three athletes (97.5%) successfully returned to sport within a mean time of 6.2 months. Surgical treatment was followed in all cases. One-incision technique was chosen in 115 (73%) and suture anchor fixation in 52 (33%) cases. No postsurgical immobilization was reported in 38 (24%) and immobilization for 2 weeks in 124 (79%) athletes. Decreased supination-pronation and flexion-extension arc was found in 63 (40%) and 27 (17%) cases, respectively. Earlier return to sport was associated with nondominant-side (P = .007) and acute (P < .001) injuries, participation in weightlifting (P = .001), double-incision approach (P = .005), cortical button fixation (P < .001), and absence of supination-pronation restriction (P = .032). Time of return to sport activity was independent of rehabilitation, including immobilization (P = .539) and strengthening (P = .155), and decreased flexion-extension arc (P = .059). CONCLUSION Athletes sustaining distal biceps tendon rupture have a high postoperative return to sport rate, independently of selected surgical technique or rehabilitation program. However, a relation between the surgical technique and time of return to sport was found. Rehabilitation did not influence time of return to sport.
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Affiliation(s)
- Charalampos Pitsilos
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Ioannis Gigis
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Chitas
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Ditsios
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kirchhoff K, Beirer M, Völk C, Buchholz A, Biberthaler P, Kirchhoff C. [Lesions of the triceps tendon : Diagnostics, management, treatment]. Unfallchirurg 2021; 125:73-82. [PMID: 34910226 DOI: 10.1007/s00113-021-01103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
The triceps brachii muscle is the main extender of the elbow joint. Triceps tendon rupture or tearing presents a rare injury pattern in general. Distal tendon ruptures occur most commonly in the area of the insertion of the olecranon. Fractures of the radial head are reported as the most common concomitant injury. In many cases, pre-existing degenerative damage predisposes for tendon injury. These include local steroid injections, anabolic steroid abuse, renal insufficiency requiring dialysis, hyperparathyroidism, lupus erythematosus and Marfan's syndrome. However, the most frequent trauma mechanism is a direct fall onto the extended forearm or a blow to the elbow. Beside clinical examination and sonography, magnetic resonance imaging is the diagnostic gold standard. The treatment of triceps tendon injuries includes conservative as well as operative approaches, whereby the indications for surgical treatment must be generously considered depending on the patient's age, functional demands of the patient, involvement of the dominant extremity as well as on the extent of the tendon rupture.
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Affiliation(s)
- K Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - M Beirer
- Klinik für Unfallchirurgie und Orthopädie, Schwarzwald-Baar Klinikum, Klinikstr. 11, 78052, Villingen-Schwenningen, Deutschland
| | - C Völk
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - A Buchholz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - P Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - C Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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Abstract
Artistic gymnastics is a physically demanding sport that requires flexibility, agility, and extreme upper and lower body strength. The specific biomechanics of the sport leads to a unique injury profile. Gymnastic skills require intense upper body weight-bearing, placing unusual forces across the upper extremity joints and predisposing them to injury. In addition, the required body control during air aerobatics (tumbling, twisting, flipping) necessitates precise landing techniques to avoid spine and lower extremity injury. Common gymnastic injuries include those of the spine and upper extremity such as spondylolysis, shoulder instability, ulnar collateral ligament injuries, capitellar osteochondritis dissecans, and several wrist pathologies. Understanding the injury etiology, prevention, and treatment protocols is important for a successful recovery and return to sport.
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Erickson BJ, Chalmers PN, D'Angelo J, Ma K, Romeo AA. Open Reduction Internal Fixation of Medial Epicondyle Fractures After Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Orthop J Sports Med 2019; 7:2325967119852896. [PMID: 31259188 PMCID: PMC6585254 DOI: 10.1177/2325967119852896] [Citation(s) in RCA: 6] [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: 01/26/2023] Open
Abstract
Background: Ulnar collateral ligament reconstruction (UCLR) is a common procedure among professional baseball pitchers. An uncommon complication after UCLR is a fracture of the medial epicondyle at the level of the humeral tunnel, which requires open reduction internal fixation (ORIF). Purpose/Hypothesis: The purpose of this study was to determine the performance upon and rate of return to sport (RTS) in professional baseball pitchers after ORIF of the medial epicondyle and examine whether there is a difference in the RTS rate and performance between players who underwent ORIF and matched controls. It was hypothesized that there would be a high rate of RTS in professional baseball pitchers after ORIF of the medial epicondyle, with no difference between the ORIF and control groups in the rate of RTS or performance, specifically related to the primary performance outcome variables of win-loss percentage, walks plus hits per inning pitched, fielding independent pitching, and wins above replacement. Methods: All professional baseball pitchers who underwent ORIF of the medial epicondyle between 2010 and 2016 were included in this study. Demographic and performance data (preoperative and postoperative) were recorded for each player. Performance metrics were then compared between the ORIF and control (no history of UCLR or ORIF) groups. Results: Overall, 15 pitchers (80.0% starters, 73.3% right-handed) underwent ORIF of a medial epicondyle fracture. All had undergone prior UCLR using either the American Sports Medicine Institute (n = 9; 60.0%) or docking (n = 6; 40.0%) technique. ORIF techniques included fixation with 1 screw (n = 13; 86.7%) and fixation with suture anchors (n = 2; 13.3%). Eleven (73.3%) pitchers were able to return to sport (did not differ from controls; P = .537); 55% returned to the same level or higher. No significant differences existed in the primary performance outcome variables when comparing preoperative with postoperative performance. No significant differences in the primary performance outcome variables were seen between the ORIF and control groups after surgery, although players in the ORIF group pitched fewer innings than controls after surgery (P = .003). Conclusion: After ORIF of the medial epicondyle in professional pitchers with a history of UCLR, 73.3% were able to return to sport (only 55% of those who returned pitched at the same level or higher) without a significant decline in most performance variables when compared with their preoperative performance or matched controls. The number of innings pitched declined after surgery.
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Affiliation(s)
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - John D'Angelo
- Office of the Commissioner of Major League Baseball, New York, New York, USA
| | - Kevin Ma
- Office of the Commissioner of Major League Baseball, New York, New York, USA
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Carr JB, Chicklo B, Altchek DW, Dines JS. On-field Management of Shoulder and Elbow Injuries in Baseball Athletes. Curr Rev Musculoskelet Med 2019; 12:67-71. [PMID: 30887285 PMCID: PMC6543043 DOI: 10.1007/s12178-019-09535-9] [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] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW The goal of this review article is to help medical personnel of all levels and backgrounds identify and appropriately manage on-field acute shoulder and elbow injuries in the baseball athlete. This article discusses the most common acute shoulder and elbow injuries in baseball players along with recommendations for appropriate on-field management. RECENT FINDINGS Shoulder and elbow injuries are very common in baseball players and can be problematic because of the unique demands placed on the shoulder and elbow during the throwing and swinging motions. While many shoulder and elbow injuries in baseball players are chronic, some acute injuries, including dislocations and fractures, require urgent on-field management. Evaluation should begin with a broad assessment to rule out life-threatening emergencies prior to performing a neurovascular evaluation of the affected extremity. Red-flag signs during examination, such as difficulty breathing, asymmetric pulses, weakness, and limb discoloration, require emergent treatment. In the absence of an emergency, the evaluating medical team should complete a basic neurovascular exam before performing any further on-field care. Contusions, dislocations, and fractures are the most commonly seen acute shoulder and elbow injuries in baseball athletes. Athletic trainers and physicians caring for these athletes should be familiar with these injuries and their appropriate on-field management.
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Affiliation(s)
- James B Carr
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, 525 E. 71st Street, New York, NY, 10021, USA.
| | - Brian Chicklo
- Department of Athletic Training, New York Mets Professional Baseball Team, New York, NY, USA
| | - David W Altchek
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, 525 E. 71st Street, New York, NY, 10021, USA
| | - Joshua S Dines
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, 525 E. 71st Street, New York, NY, 10021, USA
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Abstract
PURPOSE OF REVIEW The purposes of this review are to discuss the management of shoulder and elbow fractures in athletes to optimize the return to sport and to highlight treatment impact on the return to play. RECENT FINDINGS Fractures of the shoulder and elbow can have profound implications in an athlete career. Recent technique of fractures management trended toward to preserve soft tissue which is critical for an early recovery in athletic population. Arthroscopy presents a strong interest for the treatment of intra-articular fracture, and minimally invasive approach as developed in humeral shaft fracture can be considered to avoid soft tissue damage. Non-articular, stable, and minimally displaced fractures are mainly treated conservatively. However, we encourage a more aggressive approach in shoulder and elbow injuries in the athletes including minimally invasive and stable fixation to preserve vascularity and muscle environment.
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Affiliation(s)
- M Burnier
- Department of Orthopedic Surgery, Mayo Clinic and Mayo College of Medicine, Gonda 14, 200 First Street SW, Rochester, MN, 55905, USA
| | - J D Barlow
- Department of Orthopedic Surgery, Mayo Clinic and Mayo College of Medicine, Gonda 14, 200 First Street SW, Rochester, MN, 55905, USA
| | - J Sanchez-Sotelo
- Department of Orthopedic Surgery, Mayo Clinic and Mayo College of Medicine, Gonda 14, 200 First Street SW, Rochester, MN, 55905, USA.
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Haws BE, Stone AV, Usoro AO, Marquez-Lara A, Mannava S, Freehill MT. Optimal management of physeal elbow injuries in the skeletally immature athlete remains undefined: a systematic review. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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