Electromyography and high-speed film were used to examine the muscle activity in the elbows of pitchers with medial collateral ligament insufficiency compared to the activity in uninjured elbows. Ten competitive baseball pitchers with medial collateral insufficiency and 30 uninjured competitive pitchers were tested while throwing the fastball and the curveball. The extensor carpi radialis brevis and longus in the injured pitchers showed greater activity than in the uninjured pitchers for both pitches. The triceps, flexor carpi radialis, and pronator teres all showed less activity in the injured pitchers during the fastball, but only the triceps had less activity during the curveball. The differences were seen during the late cocking and acceleration phases, which place the greatest stress on the medial collateral ligament. If the flexor carpi radialis and pronator teres were substituting for the deficient medial collateral ligament and functioning as dynamic stabilizers, one would expect enhanced muscle activity. However, the opposite was found. This pattern of asynchronous muscle action with medial collateral ligament injury may predispose the joint to further injury. The muscular differences seen are critical to the understanding of the pathomechanics of patients with medial collateral ligament deficiency, and provide a basis for rehabilitation.

Adolescent↗

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Cost reductions. Part 1: An operations improvement process.

Today's nursing leaders are commonly expected to reduce labor costs. This two-part series provides a framework for achieving significant cost reductions in the nursing labor budget. Part One describes a process that has been used to identify and implement cost savings in varied hospital settings. Part Two will address organizational culture issues that can hamper or support cost savings.

Budgets↗

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Cost reductions Part 2: an organizational culture perspective.

Part One of this series described how an Operations Improvement process, computer simulation, and a focus on the dollars per patient day or unit of service ($PPD) can enhance a hospital's cost-reduction efforts. Part Two will address the organizational culture issues that can hamper or support nursing's cost-reduction efforts.

Cost Control↗