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Thacher RR, Varady NH, Khilnani T, Camp CL, Dines JS. Current Concepts on the Management of Shoulder Instability in Throwing Athletes. Curr Rev Musculoskelet Med 2024; 17:353-364. [PMID: 38918331 PMCID: PMC11336015 DOI: 10.1007/s12178-024-09910-1] [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] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE OF REVIEW The management of shoulder instability in throwing athletes remains a challenge given the delicate balance between physiologic shoulder laxity facilitating performance and the inherent need for shoulder stability. This review will discuss the evaluation and management of a throwing athlete with suspected instability with a focus on recent findings and developments. RECENT FINDINGS The vast majority of throwing athletes with shoulder instability experience subtle microinstability as a result of repetitive microtrauma rather than episodes of gross instability. These athletes may present with arm pain, dead arms or reduced throwing velocity. Recent literature reinforces the fact that there is no "silver bullet" for the management of these athletes and an individualized, tailored approach to treatment is required. While initial nonoperative management remains the hallmark for treatment, the results of rehabilitation protocols are mixed, and some patients will ultimately undergo surgical stabilization. In these cases, it is imperative that the surgeon be judicious with the extent of surgical stabilization as overtightening of the glenohumeral joint is possible, which can adversely affect athlete performance. Managing shoulder instability in throwing athletes requires a thorough understanding of its physiologic and biomechanical underpinnings. Inconsistent results seen with surgical stabilization has led to a focus on nonoperative management for these athletes with surgery reserved for cases that fail to improve non-surgically. Overall, more high quality studies into the management of this challenging condition are warranted.
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Affiliation(s)
- Ryan R Thacher
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Tyler Khilnani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - Joshua S Dines
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Winkelmann MT, Achenbach L, Zeman F, Laver L, Walter SS. The throwing shoulder in youth elite handball: adaptions of inferior but not anterior capsule thickness differ between the two sexes. Res Sports Med 2023; 31:112-124. [PMID: 34176387 DOI: 10.1080/15438627.2021.1943391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim was to investigate side-to-side and sex differences of anterior and inferior capsule thickness (ACT, ICT) between the throwing and non-throwing shoulder (TS, NTS) in youth elite handball players. 125 youth female and male elite handball players (14.1±0.7yo) were assessed for ACT and ICT by ultrasound . ACT measurement was performed from anterior (3 o'clock) in upright position and for ICT from inferior (6 o'clock) in supine position. Measurements of ICT in the TS of all athletes (1.4±0.2 mm) differed significantly but marginally to those in the NTS (1.3±0.2 mm) (p = 0.001). Female (1.2±0.2 mm vs. 1.3±0.2 mm; p = 0.007) but not male youth players (1.4±0.2 mm vs. 1.4±0.2 mm, p = n.s.) demonstrated slight differences in ICT in the TS compared with the NTS. Although significant, the thickness in the TS compared to the NTS was within the measurement accuracy of the ultrasonic assessment. No difference in ACT was observed in the TS (1.4±0.3 mm) compared to the NTS (1.4±0.3 mm) for both sexes (n.s.).In conclusion, the anterior and inferior capsule thickness in youth elite handball athletes is not or only marginally different between throwing and non-throwing shoulders.
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Affiliation(s)
- Moritz T Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Leonard Achenbach
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | - Lior Laver
- Department of Orthopaedics, Sports Medicine Unit, Hillel Yaffe Medical Center (HYMC), Hadera, Israel.,Rappaport Faculty of Medicine, Technion (Israel Institute of Technology), Halifax, Israel
| | - Sven S Walter
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
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Biagini EK, Peebles LA, Higgins M, Stamm M, Lefante JJ, Mulcahey MK. Return to Play After Shoulder Arthroscopy in Major League Baseball Pitchers vs Position Players. Orthop J Sports Med 2023; 11:23259671221150782. [PMID: 36762205 PMCID: PMC9905020 DOI: 10.1177/23259671221150782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 02/08/2023] Open
Abstract
Background Recovery from shoulder arthroscopy may vary between professional pitchers and position players in Major League Baseball (MLB). The time that it takes to return to play (RTP) and the level of skills to be regained after surgery are important factors for an athlete to consider when making career decisions. Purpose To identify MLB players who had arthroscopic shoulder surgery and observe their rates of RTP to MLB and the minor league, as well as to compare pre- and postinjury performance statistics and career metrics. Study Design Descriptive epidemiology study. Methods Public records (press releases, http://www.prosportstransactions.com, http://www.baseball-reference.com) were searched and analyzed to determine the number of days from shoulder arthroscopy to RTP and pre- and postinjury statistics for pitchers and position players in the MLB and minor league from 1998 to 2018. To meet inclusion criteria, a player must have undergone shoulder arthroscopy after having played at least 1 game in the MLB and had no identifiable concomitant injuries. Results Of 134 players, 89 (66.4%) returned to MLB. Fifty-four of 89 pitchers (60.7%) and 35 of 45 position players (77.8%) returned to MLB (P = .048). Forty-nine of 54 pitchers (90.7%) and 23 of 35 position players (65.7%) who returned to MLB returned to the minor league first. The mean time to RTP was 469.6 days (range, 100-1079 days) for pitchers and 301.6 days (range, 94-1488) for position players (P = .002). The WAR statistic (wins above replacement) for the pitchers decreased significantly (P = .004) after shoulder arthroscopy. Conclusion MLB position players returned to play at higher rates and more quickly than did pitchers. The WAR statistic declined in pitchers during the first season of RTP. Players undergoing arthroscopic shoulder surgery should be aware of these possible outcomes in time to RTP and postoperative performance.
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Affiliation(s)
- Emily K. Biagini
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Liam A. Peebles
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Margaret Higgins
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Michaela Stamm
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - John J. Lefante
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Mary K. Mulcahey
- School of Medicine, Tulane University, New Orleans, Louisiana, USA.,Mary K. Mulcahey, MD, School of Medicine, Tulane University, 1430 Tulane Ave, #8632, New Orleans, LA 70112, USA () (Twitter: @marykmulcaheymd)
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Doyscher RJ, Rühl L, Czichy B, Neumann K, Denecke T, Wolfarth B, Rodeo SA, Scheibel M. Bilateral glenohumeral internal rotation deficit (GIRD) in elite gymnasts. Arch Orthop Trauma Surg 2022; 143:2599-2608. [PMID: 35982278 PMCID: PMC10110687 DOI: 10.1007/s00402-022-04577-0] [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: 09/14/2021] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The "Glenohumeral Internal Rotation Deficit (GIRD)" is known as the difference in internal rotation range of motion (IRRM) between the dominant and non-dominant shoulder of overhead athletes as a result of asymmetric loading. As in contrast loading pattern in gymnastics are quite symmetric and structural changes often occur bilaterally, the question arises if GIRD might develop bilaterally in gymnasts as one source of common bilateral shoulder pathologies and to search for underlying structural adaptations. MATERIALS AND METHODS A group of 35 elite gymnasts (8-24 years) were recruited from a local Olympic Training Centre and compared to a paired cohort of 28 non-overhead athletes. Clinical examinations, digital range of motion (ROM)-measurement, ultrasonographic humeral torsion measurement, and standardized MRI scans of both shoulders were obtained and examined for structural pathologies, cross-sectional areas (CSA) of the rotator cuff muscles and capsular thickness. RESULTS ROM-measurements showed significant decrease in IRRM in the gymnasts groups by age, with IRRM of 48.6° (SD: 8.4°, CI 95%: 43.0-54.3°) at age group 1 (8-10 years) and IRRM of 10° (SD: 11.4°; CI 95%: 0-22.0°) at age group 4 (18-26 years), that was statistically significant for the entire cohort (p = 0.017) compared to the controls. CSA were not significantly different between the cohorts, while there was a slightly increased humeral retrotorsion in the gymnasts as well as a statistically significant posterior capsular thickening. CONCLUSION A new bilateral form of GIRD was identified in higher age groups of youth and senior elite gymnasts enrolled in this study. Despite to former definition of GIRD there was no compensatory increase in external rotation range of motion (ERRM) but an association with posterior capsular thickening, while there was no periscapular muscle hypertrophy. Humeral retrotorsion was also slightly increased in the gymnasts group.
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Affiliation(s)
- Ralf J Doyscher
- Center for Musculoskeletal Surgery and Department of Sports Medicine, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany.,Borussia VFL 1900 Moenchengladbach GmbH, Moenchengladbach, Germany
| | - Leopold Rühl
- Center for Musculoskeletal Surgery and Department of Sports Medicine, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Benjamin Czichy
- Center for Musculoskeletal Surgery and Department of Sports Medicine, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Konrad Neumann
- Institute for Biometry and Clinical Epidemiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Timm Denecke
- Clinic for Radiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,Clinic for Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Bernd Wolfarth
- Center for Musculoskeletal Surgery and Department of Sports Medicine, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Scott A Rodeo
- Sports Medicine & Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Markus Scheibel
- Center for Musculoskeletal Surgery and Department of Sports Medicine, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany. .,Department of Shoulder and Elbow Surgery, Schulthess Clinic Zurich, Zurich, Switzerland.
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Beletsky A, Okoroha KR, Cabarcas B, Garcia GH, Gowd AK, Meyer J, Vadhera AS, Singh H, Gursoy S, White GM, Davidson J, Nicholson GP, Chahla J, Verma NN. Magnetic Resonance Imaging Findings of the Asymptomatic Shoulder May Impact Performance, Not Future Injury List Placement in Major League Baseball Pitchers. Arthrosc Sports Med Rehabil 2022; 4:e487-e493. [PMID: 35494266 PMCID: PMC9042760 DOI: 10.1016/j.asmr.2021.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate preseason shoulder magnetic resonance images (MRIs) obtained from pitchers entering either major or minor league baseball (MLB) and correlate findings with subsequent injury, operative repair, and placement on the injured list (IL). Methods Preseason-MRI of the throwing shoulders of professional-level baseball pitchers, taken during routine evaluations at a single organization (2004-2017) were retrospectively reviewed. Publicly available databases were queried to exclude pitchers with known injuries prior to pre-signing imaging. Three blinded reviewers reviewed all MRI scans independently to evaluate for the presence of abnormalities in the rotator cuff (RTC), labrum, capsule, long-head of the biceps tendon (LHBT), and humeral head. Binary imaging findings were correlated to future placement on the IL for subsequent shoulder complaints. Bivariate statistics using Student’s t-tests and Fisher exact tests (both α = .05) were used in this study. Results A total of 38 asymptomatic pitchers with shoulder MRIs were included. Pitchers had a mean (±SD) age of 28.2 ± 4.9 and had pitched an average of 119.6 ± 143.8 career games. Pitchers with partial articular-sided RTC tears (P = .04) or intra-articular BT hyperintensity (P = .04) on preseason MRI demonstrated an association with the need for future surgery. Pitchers with evidence of labral heterogeneity demonstrated greater total career pitch counts (10,034.1 vs 2,465.3; P = .04). Evidence of a posterior-superior humeral cyst was associated with decreased strikeouts per 9 innings (6.1 vs 8.0; P = .039) and total strikeout percentage (16.1% vs 23.2%; P = .04). Conclusion Although there was a significant difference in the percent of various radiographic findings between the injured and healthy cohort, no MRI findings were predictive of future IL placement or duration of placement. The presence of a posterior superior humeral cyst was associated with decreased strikeout rates at 2 and 3 years, the presence of a labral tear was associated with decreased earned run average (ERA) at 3 years and decreased career strikeout percentages, and increased capsular signal was associated with decreased 5-year ERA. Level of Evidence Level IV, retrospective study.
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Abstract
Posterior shoulder instability occurs when the labrum detaches posteriorly from the glenoid owing to significant trauma and is a relatively uncommon type of shoulder dislocation. Although posterior instability has often been treated with open shoulder stabilization, modern arthroscopic procedures are being rapidly pursued by surgeons as an improved option because of decreased invasiveness and reduced operative times. Arthroscopic stabilization of the posterior glenoid labrum typically involves 2 working portals, but the procedure still yields successful results when performed with a single posterior portal and a suture passer. Our technique involves 1 less portal to reduce invasiveness, lower the risk of nerve damage, and decrease the operative time and postoperative pain. The purpose of this article is to describe an arthroscopic posterior stabilization technique with a single working portal.
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7
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Comfort SM, Peebles AM, Ruzbarsky JJ, Akamefula RA, Provencher MT. Arthroscopic Labral Repair Using Knotless Suture Anchors in the Setting of a 270° Labral Tear of the Shoulder. Arthrosc Tech 2021; 10:e2319-e2324. [PMID: 34754740 PMCID: PMC8556671 DOI: 10.1016/j.eats.2021.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023] Open
Abstract
Extensive glenoid labral tears, whether the result of repetitive instability or first-time dislocation, compromise the mechanical stability of the glenohumeral joint due to disruption of the anterior, inferior, posterior, and/or superior portions of the labrum. These lesions often result in recurrent multiplanar instability and pain that is nonresponsive to conservative management and difficult to diagnose due to variability in clinical presentation and advanced imaging findings. Arthroscopic repair techniques to address symptomatic shoulder instability have showed positive patient-reported outcomes, low failure rates, and high return-to-sport rates. The evolution of knotless suture anchors offers a fixation method that has proven to be functionally equivalent to knotted suture anchors while avoiding the risks of knotted anchors (knot loosening, knot migration, articular abrasion) and allowing easier placement and decreased operative time. The purpose of this technique is to describe our preferred method to treat a 270° labral tear through arthroscopic knotless anchor repair and demonstrate the expanded application of this technique for extensive glenoid labral pathology.
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Affiliation(s)
| | | | - Joseph J. Ruzbarsky
- Steadman Philippon Research Institute, Vail, Colorado, United States,The Steadman Clinic, Vail, Colorado, United States
| | | | - Matthew T. Provencher
- Steadman Philippon Research Institute, Vail, Colorado, United States,The Steadman Clinic, Vail, Colorado, United States,Address correspondence to CAPT Matthew T. Provencher, M.D., M.B.A., M.C., U.S.N.R. (Ret.), Steadman Philippon Research Institute, The Steadman Clinic, 181 W Meadow Drive, Suite 400, Vail, CO 81657, U.S.A.
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8
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Thomas SJ, Cobb J, Sheridan S, Rauch J, Paul RW. Chronic Adaptations of the Posterior Rotator Cuff in Professional Pitchers. Am J Sports Med 2021; 49:892-898. [PMID: 33591811 DOI: 10.1177/0363546520988688] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Because of the large forces and high frequency of throwing, the upper extremity experiences repetitive stresses that lead to acute and chronic adaptations. While the importance of pennation angle and muscle thickness as predictors of muscle force production has been shown in other populations and other joints, there has been little research done that examines these variables in the shoulders of baseball players. PURPOSE (1) To examine the chronic effect pitching has on the rotator cuff muscle architecture (pennation angle and muscle thickness) in healthy professional baseball pitchers, and (2) to examine the correlation between muscle architecture and clinical measures of strength and range of motion (ROM). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Twenty-eight healthy professional pitchers were recruited during the 2019 spring training. Internal rotation (IR) and external rotation (ER) strength were measured with a handheld dynamometer and IR and ER ROM were measured with an inclinometer. A diagnostic ultrasound machine was utilized to capture images of humeral retroversion, as well as the pennation angle and muscle thickness of the infraspinatus and teres minor muscles. ImageJ software was used to quantify the pennation angle and muscle thickness. RESULTS There were no significant differences between the dominant and nondominant arms for ER or IR strength. Also, no pennation angle and muscle thickness differences were found between the dominant and nondominant arms. A weak positive relationship between infraspinatus muscle thickness (superficial and total) and ER strength (P = .016, R = 0.287 and P = .009, R = 0.316) and a moderate negative relationship between soft tissue glenohumeral internal rotation deficit (GIRD) and the bilateral difference of the teres minor deep pennation angle (R = -0.477, P = .008) were observed. No other significant relationships were noted. CONCLUSION Our results are contrary to current literature as we expected to see a stronger dominant arm, with a larger pennation angle and greater muscle thickness. Interestingly, we found that ER strength was positively related to only the thickness of the infraspinatus muscle, and that soft tissue GIRD was positively related to only the side-to-side adaptation of the pennation angle within the deep portion of the teres minor. This suggests that when posterior shoulder tightness occurs, specifically the architecture of the teres minor muscle is involved. However, the organization to which these players belonged has a very extensive training protocol throughout the year that emphasizes bilateral training during a large majority of the exercises. Therefore, the results may not be generalizable to all professional players.
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Affiliation(s)
- Stephen J Thomas
- Department of Exercise Science, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Justin Cobb
- Department of Orthopedics, Einstein Healthcare Newtwork, Philadelphia, Pennsylvania, USA
| | - Scott Sheridan
- Major League Baseball Umpire Association, New York, New York, USA
| | | | - Ryan W Paul
- Rothman Orthopaedic Institute, Bryn Mawr, Pennsylvania, USA
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Matsel KA, Butler RJ, Malone TR, Hoch MC, Westgate PM, Uhl TL. Current Concepts in Arm Care Exercise Programs and Injury Risk Reduction in Adolescent Baseball Players: A Clinical Review. Sports Health 2021; 13:245-250. [PMID: 33514287 DOI: 10.1177/1941738120976384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Awareness of important injury risk factors associated with excessive pitching volume has been highlighted in the literature, but injury rates remain high. Shoulder pain in baseball players is associated with various changes in musculoskeletal movements, which presents as measurable impairments throughout the kinetic chain. Baseball coaches and rehabilitation professionals have utilized exercise programs targeting strength and flexibility of the throwing arm to prevent injuries. The purpose of this review is to summarize the current evidence regarding the effectiveness of arm care exercise programs in reducing upper extremity injury rates in adolescent baseball players. EVIDENCE ACQUISITION A search of electronic databases, including CINAHL with full text, MEDLINE, and SPORTDiscus was conducted to retrieve available articles in English from the years 2010 through 2020. The search terms injury prevention, exercise, and adolescent baseball were used. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Improving shoulder internal rotation range of motion by stretching the posterior shoulder muscles daily was associated with a 36% risk reduction of shoulder and elbow injuries. Group-based arm care exercise programs that target multiple musculoskeletal impairments demonstrated an approximately 50% reduced risk of elbow injury. CONCLUSION For adolescent baseball players, arm care injury prevention programs focusing on important musculoskeletal impairments are effective at reducing injury incidence rates. Multimodal injury prevention programs that improve multiple musculoskeletal impairments are more comprehensive and may result in better injury reduction than programs focusing on a singular impairment.
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Affiliation(s)
- Kyle A Matsel
- University of Kentucky, Lexington, Kentucky.,University of Evansville, Evansville, Indiana
| | - Robert J Butler
- Saint Louis Cardinals Baseball Organization, St Louis, Missouri
| | | | | | | | - Tim L Uhl
- University of Kentucky, Lexington, Kentucky
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10
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Barnamehei H, Tabatabai Ghomsheh F, Safar Cherati A, Pouladian M. Kinematic models evaluation of shoulder complex during the badminton overhead forehand smash task in various speed. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Winkelmann MT, Walter SS, Laver L, Zeman F, Fehske K, Achenbach L. Increased posterior shoulder capsule thickness in youth elite handball players: a sonographic investigation. J Shoulder Elbow Surg 2021; 30:194-199. [PMID: 32807372 DOI: 10.1016/j.jse.2020.04.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE Range of motion adaptations in the shoulders of overhead throwing athletes have been reported, but knowledge about the development of soft-tissue adaptations is limited. The purpose of this study was to investigate differences in posterior shoulder capsule thickness and internal rotation between the throwing and non-throwing shoulder. METHODS On the basis of the sample size calculation, we assessed 63 youth elite handball players (33 boys and 30 girls, mean age: 13.6 ± 0.9 years) for glenohumeral internal and external rotational range of motion, humeral retrotorsion, and posterior capsule thickness (PCT) with a manual goniometer and a portable ultrasound device and calculated sports-specific differences between the throwing and non-throwing shoulder as well as correlations with PCT. RESULTS Youth handball players showed side-to-side differences in internal rotation, external rotation, and humeral retrotorsion between the throwing and non-throwing shoulder. Posterior shoulder capsules were 1.21 times thicker (95% confidence interval: 1.1-1.3) in the throwing shoulder than in the non-throwing shoulder (1.3 ± 0.3 mm vs. 1.2 ± 0.2 mm, P < .0001). Loss of internal rotation did not correlate with PCT. CONCLUSIONS In youth elite handball athletes, posterior shoulder tightness and subsequent sports-specific loss of internal rotation in the throwing shoulder are not related to PCT. Thus, in this age class, other (soft-tissue) factors must be responsible for this condition.
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Affiliation(s)
- Moritz T Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Sven S Walter
- Department for Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany.
| | - Lior Laver
- Department for Othopedics, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Florian Zeman
- Department for Clinical Studies, Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | - Kai Fehske
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Leonard Achenbach
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
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12
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Ejnisman B, Lara PHS, Ribeiro LM, Belangero PS. Pitcher Shoulder: Update Article. Rev Bras Ortop 2020; 56:275-280. [PMID: 34239190 PMCID: PMC8249072 DOI: 10.1055/s-0040-1702958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 12/05/2019] [Indexed: 11/08/2022] Open
Abstract
Most shoulder injuries occur due to repetitive overhead movements. Before studying the treatment of these shoulder injuries, it is paramount that health professionals have an understanding of the etiology of and the underlying mechanisms for shoulder pathologies. The act of overhead throwing is an eloquent full-body motion that requires tremendous coordination from the time of force generation to the end of the pitch. The shoulder is a crucial component of the upper-body kinetic chain, as it transmits force created in the lower body to the arm and hand to provide velocity and accuracy to the pitch.
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Affiliation(s)
- Benno Ejnisman
- Grupo de Ombro e Cotovelo, Centro de Traumatologia do Esporte, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Paulo Henrique Schmidt Lara
- Grupo de Ombro e Cotovelo, Centro de Traumatologia do Esporte, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Leandro Masini Ribeiro
- Grupo de Ombro e Cotovelo, Centro de Traumatologia do Esporte, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Paulo Santoro Belangero
- Grupo de Ombro e Cotovelo, Centro de Traumatologia do Esporte, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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13
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Stelter J, Malik S, Chiampas G. The Emergent Evaluation and Treatment of Shoulder, Clavicle, and Humerus Injuries. Emerg Med Clin North Am 2020; 38:103-124. [DOI: 10.1016/j.emc.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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14
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Rose MB, Noonan T. Glenohumeral internal rotation deficit in throwing athletes: current perspectives. Open Access J Sports Med 2018; 9:69-78. [PMID: 29593438 PMCID: PMC5865552 DOI: 10.2147/oajsm.s138975] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Glenohumeral internal rotation deficit (GIRD) is an adaptive process in which the throwing shoulder experiences a loss of internal rotation (IR). GIRD has most commonly been defined by a loss of >20° of IR compared to the contralateral shoulder. Total rotational motion of the shoulder is the sum of internal and external rotation and may be more important than the absolute value of IR loss. Pathologic GIRD has been defined as a loss of IR combined with a loss of total rotational motion. The leading pathologic process in GIRD is posterior capsular and rotator-cuff tightness, due to the repetitive cocking that occurs with the overhead throwing motion. GIRD has been associated with numerous pathologic conditions, including posterior superior labral tears, partial articular-sided rotator-cuff tears, and superior labral anterior-to-posterior tears. The mainstay of treatment for patients with GIRD is posterior capsular stretching and strengthening to improve scapular mechanics. In patients who fail nonoperative therapy, shoulder arthroscopy can be performed. Arthroscopic surgery in the high-level throwing athlete should be to restore them to their functional baseline with the minimum amount of intervention possible.
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Affiliation(s)
- Michael B Rose
- Steadman Hawkins Clinic, University of Colorado School of Medicine, Denver, CO, USA
| | - Thomas Noonan
- Steadman Hawkins Clinic, University of Colorado School of Medicine, Denver, CO, USA
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Abstract
PURPOSE OF REVIEW To discuss the clinical significance of the most common hip and groin injuries in baseball players, as well as an algorithmic approach to diagnosis and treatment of these injuries. RECENT FINDINGS (a) Limitations in throwing velocity, pitch control, and bat swing speed may be secondary to decreased mobility and strength within the proximal kinetic chain, which must harness power from the lower extremities and core. (b) Approximately 5.5% of all baseball injuries per year involve the hip/groin and may lead to a significant amount of time spent on the disabled list. Injuries involving the hip and groin are relatively common in baseball players. Our knowledge of the mechanics of overhead throwing continues to evolve, as does our understanding of the contribution of power from the lower extremities and core. It is paramount that the team physician be able to accurately diagnose and treat injuries involving the hip/groin, as they may lead to significant disability and inability to return to elite levels of play. This review focuses on hip- and groin-related injuries in the baseball player, including femoroacetabular impingement, core muscle injury, and osteitis pubis.
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Affiliation(s)
- Ryan A Mlynarek
- Sports Medicine and Hip Preservation, Hospital for Special Surgery, New York, NY, USA. .,Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA.
| | - Struan H Coleman
- Sports Medicine and Hip Preservation, Hospital for Special Surgery, New York, NY, USA
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