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PubMed1995

Shoulder Injuries in the Throwing Athlete.

The throwing athlete with shoulder pain presents a diagnostic and treatment challenge to the orthopaedic surgeon. Because pitching a baseball requires the arm to accelerate at 7,000 degrees per second, tremendous forces are experienced at the shoulder joint. Electromyographic studies have shown that the larger scapular and trunk muscles are primarily responsible for arm acceleration. The smaller and more fragile rotator cuff muscles play a significant role in decelerating the arm. During the entire throwing mechanism, the rotator cuff and the capsulolabral complex act to stabilize the humeral head on the glenoid fossa. As a result, the labrum, the capsule, and the rotator cuff are frequently the site of shoulder injury in throwers. The diagnosis of injury to these structures is based on the findings from the history, physical examination, and imaging studies. The majority of throwing injuries respond well to a carefully designed rehabilitation program. Athletes who do not improve within 6 months are candidates for surgical repair. The procedure is planned so as to minimize the amount of surgical trauma and thereby to facilitate an early return to sport. Arthroscopy is a valuable first step to confirm the pathologic diagnosis. The arthroscope alone is used to perform subacromial debridement, labral repair, or debridement of undersurface partial-thickness rotator cuff tears. If the athlete has clinical evidence of shoulder instability and arthroscopic evidence of capsular stretch, an open stabilization procedure is performed.

Journal Article↗
PubMedDate not supplied

Medial elbow problems in the overhead-throwing athlete.

The elbow is subjected to enormous valgus stresses during the throwing motion, which places the overhead-throwing athlete at considerable risk for injury. Injuries involving the structures of the medial elbow occur in distinct patterns. Although acute injuries of the medial elbow can occur, the majority are overuse injuries as a result of the repetitive forces imparted to the elbow by throwing. Injury to the ulnar collateral ligament complex results in valgus instability. Valgus extension overload leads to diffuse osseous changes within the elbow joint and secondary posteromedial impingement. Overuse of the flexor-pronator musculature may result in medial epicondylitis and occasional muscle tears and ruptures. Ulnar neuropathy is a common finding that may be due to a variety of factors, including traction, friction, and compression of the ulnar nerve. Advances in nonoperative and operative treatment regimens specific to each injury pattern have resulted in the restoration of elbow function and the successful return of most injured overhead athletes to competitive activities. With further insight into the relevant anatomy, biomechanics, and pathophysiology involved in overhead activities and their associated injuries, significant contributions can continue to be made toward prevention and treatment of these injuries.

Athletic Injuries↗
PubMed2000

Shoulder injury in the throwing athlete.

Successful nonoperative management of shoulder injury in the throwing athlete requires a comprehensive team approach. The cornerstone of management is physical therapy to restore strength, balance, and endurance to the shoulder girdle musculature followed by a return to a throwing program. The return to competitive throwing is usually a lengthy process requiring patience from the medical team and the athlete.

Athletic Injuries↗
PubMed2001

Diagnosis and treatment of shoulder injuries in the throwing athlete: the role of thermal-assisted capsular shrinkage.

The treatment of the throwing athlete is complex. Many factors enter into the decision regarding the nature and timing of appropriate intervention. Because of the nature of the mechanical aspects of the throwing motion, increased external rotation (overrotation) is often necessary to throw at a highly competitive level. This increased motion is associated with acquired increased glenohumeral laxity which, by itself, is generally not problematic. However, in the athlete with an overuse-type shoulder injury such as a SLAP lesion or a partial-thickness undersurface tear of the rotator cuff (internal impingement), it is perhaps the increase in glenohumeral laxity that allows such pathology to occur. A careful history and physical examination are important to determine the nature of the injury and the amount of laxity that may be present. Currently, we believe that addressing the capsular laxity arthroscopically at the same time that the intra-articular pathology is addressed is the best form of treatment for these athletes, and affords them the best chance of returning to competition at the same or higher level. Obviously, further follow-up is necessary to determine the long-term results of such treatment.

Athletic Injuries↗
PubMed2003

Rehabilitation programs and prevention strategies in adolescent throwing athletes.

A specific and early diagnosis must be made in the injured skeletally immature throwing athlete. A well-outlined program of rest, rehabilitation, and proper throwing techniques should be implemented and continued. Overuse injuries are preventable when biomechanics are sound and pitch counts are done with the limits enforced. Guidelines for inning limits, number of pitches, rest intervals, and throwing programs should be followed for adolescent pitchers because adolescents differ from adults. Information is included for specifications of the ball and helmet, as well as chest protective equipment. The goal should be for the Little League players to have fun and be injury free as they are competing, which gives them the best experience and allows continuation of athletic activities for a lifetime.

Adolescent↗
PubMed2006

Osteochondrosis dissecans of the shoulder glenoid fossa diagnosed in four throwing athletes.

The aim of this study was to report 4 observations of osteochondrosis dissecans (OCD) of the shoulder glenoid fossa diagnosed in throwing athletes. A retrospective review of medical and radiological records of throwing athletes, performed for the period 1992 to 2002, revealed 215 studies of the shoulder. The patients were elite throwing athletes suffering for recurrent shoulder pain. Four cases (1.86%) of OCD of the glenoid fossa were identified; conventional radiographs of the shoulder were taken for all patients followed by MR examination. All cases received a definitive surgical diagnosis.

Adult↗
PubMedDate not supplied

Glenohumeral joint laxity and stiffness in the functional throwing position of high school baseball pitchers.

CONTEXT: Repetitive overhead throwing has been theorized to result in chronic adaptations to the capsuloligamentous restraints of the glenohumeral joint. OBJECTIVE: To compare glenohumeral joint laxity and stiffness between the throwing and nonthrowing shoulders of high school baseball pitchers. DESIGN: Repeated measures. SETTING: High school athletic training facilities. PATIENTS OR OTHER PARTICIPANTS: Twenty-two asymptomatic high school baseball pitchers (age = 16.50 +/- 0.74 years, height = 178.51 +/- 7.66 cm, mass = 75.43 +/- 13.24 kg) from a sample of convenience. MAIN OUTCOMES MEASURE(S): We used computerized stress arthrometry to measure glenohumeral joint laxity and stiffness. Anterior glenohumeral joint laxity and stiffness measures were obtained with the shoulder in 90 degrees of abduction and both neutral rotation and 90 degrees of external rotation. Posterior laxity and stiffness measures were obtained with the shoulder in 90 degrees of abduction and neutral rotation. RESULTS: No clinically significant differences were found for glenohumeral laxity or stiffness between sides. However, a statistically significant main effect for position was present for both laxity and stiffness. Anterior glenohumeral joint laxity in the 90 degrees external rotation position was significantly decreased and stiffness was increased in this position compared with the anterior at neutral and posterior at neutral positions. CONCLUSIONS: Glenohumeral joint laxity decreases and stiffness increases in the functional throwing position of 90 degrees of abduction and 90 degrees of external rotation. No clinically significant side-to-side differences or directional differences were found in high school baseball pitchers.

Journal Article↗
PubMed1990

Axillary artery compression and thrombosis in throwing athletes.

A 28-year-old major league baseball pitcher sustained an axillary artery thrombosis which was successfully treated with intraarterial urokinase. Subsequent angiography and duplex scanning with the arm elevated in the pitching position demonstrated inducible compression of the axillary artery by the humeral head as well as compression at the thoracic outlet. To determine the incidence of axillary and subclavian artery compression and to investigate the mechanism of injury, brachial artery blood pressures and duplex scans of the subclavian and axillary arteries were performed in both the neutral position and the throwing position in the 92 extremities of 19 major league baseball pitchers, 16 non-pitching major league players, and 11 nonathlete controls. A drop in blood pressure of greater than 20 mm Hg was noted in the position in 56% of extremities tested, with a loss of a detectable blood pressure in 13%. Compression of the axillary artery by the humeral head was documented in 83% of extremities, but in only 7.6% was a greater than 50% stenosis inducible. No statistical difference was found in the incidence of arterial compression between the three groups tested or between their dominant and nondominant extremities. Dissection of the axillary artery in two cadavers documented that abduction and external rotation of the arm causes compression of the axillary artery by the humeral head, which acts as a fulcrum. We conclude that the repetitive mechanical trauma of the throwing motion can cause intermittent compression and contusion of the axillary artery by the humeral head and predisposes the athlete who throws to thrombosis of the axillary artery.

Adult↗
PubMed1998

Pediatric throwing injuries about the elbow.

Pediatric elbow injuries that result from repetitive throwing-type activities are common. These injuries differ from those seen in adults, because of anatomic differences. The purpose of this paper is twofold: first, to review the anatomy of the elbow and the mechanics of the throwing motion about the elbow, and second, to discuss the diagnosis, treatment, rehabilitation, and prevention of pediatric throwing injuries of the elbow.

Adolescent↗
PubMed1997

A biomechanical study of fast throwing movements of the shoulder in baseball pitching.

OBJECTIVE: To define the biomechanic function of the shoulder in fast throwing movements in baseball pitching. METHODS: Using NAC high-speed video and PIAS LA-555 computer system, overhand pitching movements carried out by 12 healthy Japanese professional baseball pitchers were analyzed in three dimensions. The pitching motion was displayed as stick to sick figures dynamically. RESULTS: Pitching motion was a combination of translational and rotational movements. Acceleration and deceleration, being two typical motion patterns, worked sequentially through the anatomic link system from the pivot leg to the pitching hand. During the acceleration phase, the shoulder joint acted as a junction point and a fulcrum, supporting the rotational acceleration motion, shoulder forward flexion and elbow extension. According to the changing glenohumeral angles of the pitching shoulder, shearing force turned into tension force which worked on the anterior shoulder structures and then shifted to the posterior part of the joint. CONCLUSIONS: In fast throwing motion, the shoulder functions as an important fulcrum to support the pitching arm during the acceleration phase. Avoiding excessive stress and shearing force on the joint components and enhancing coordination of muscle action are important to a successful throwing motion and the prevention of shoulder injury.

Athletic Injuries↗
PubMedDate not supplied

Thoracic outlet syndrome in a throwing athlete diagnosed with MRI and MRA.

Thoracic outlet syndrome comprises the clinical manifestations in the arm caused by compression of the neurovascular bundle as it leaves the thoracic inlet. The neurovascular bundle is composed of the subclavian artery, the subclavian vein, and the brachial plexus. The symptoms of thoracic outlet or inlet syndrome are most often caused by compression of the nerves of the brachial plexus, which is involved in up to 98% of cases; the remainder are due to vascular compression. MRI with MRA demonstrates well the anatomy of the brachial plexus as well as any vascular compression or occlusion. The relationship of the axillary and subclavian vein to the first rib and subclavius muscle also can be demonstrated. We present a college baseball player who presented with numbness in the fingers of his throwing hand when throwing a baseball. Evaluation with spin-echo and two-dimensional time-of-flight MR angiographic (MRA) imaging of the thoracic outlet region revealed obstruction of the subclavian vein with the arm abducted. To our knowledge, no such cases have been diagnosed previously with MRI.

Adult↗
PubMed2005

Succession after stand replacing disturbances by fire, wind throw, and insects in the dark Taiga of Central Siberia.

The dark taiga of Siberia is a boreal vegetation dominated by Picea obovata, Abies sibirica, and Pinus sibirica during the late succession. This paper investigates the population and age structure of 18 stands representing different stages after fire, wind throw, and insect damage. To our knowledge, this is the first time that the forest dynamics of the Siberian dark taiga is described quantitatively in terms of succession, and age after disturbance, stand density, and basal area. The basis for the curve-linear age/diameter relation of trees is being analyzed. (1) After a stand-replacing fire Betula dominates (4,000 trees) for about 70 years. Although tree density of Betula decreases rapidly, basal area (BA) reached >30 m2/ha after 40 years. (2) After fire, Abies, Picea, and Pinus establish at the same time as Betula, but grow slower, continue to gain height and eventually replace Betula. Abies has the highest seedling number (about 1,000 trees/ha) and the highest mortality. Picea establishes with 100-400 trees/ha, it has less mortality, but reached the highest age (>350 years, DBH 51 cm). Picea is the most important indicator for successional age after disturbance. Pinus sibirica is an accompanying species. The widely distributed "mixed boreal forest" is a stage about 120 years after fire reaching a BA of >40 m2/ha. (3) Wind throw and insect damage occur in old conifer stands. Betula does not establish. Abies initially dominates (2,000-6,000 trees/ha), but Picea becomes dominant after 150-200 years since Abies is shorter lived. (4) Without disturbance the forest develops into a pure coniferous canopy (BA 40-50 m2/ha) with a self-regenerating density of 1,000 coniferous canopy trees/ha. There is no collapse of old-growth stands. The dark taiga may serve as an example in which a limited set to tree species may gain dominance under certain disturbance conditions without ever getting monotypic.

Animals↗
PubMed2004

Discrimination of functionally appropriate and inappropriate throwing tools by captive tufted capuchins (Cebus apella).

A tool-throwing task was used to test whether capuchin monkeys understand the difference between functionally appropriate and functionally inappropriate tools. A group of monkeys was trained to obtain a sticky treat from a container outside their enclosure using a projectile attached to one end of an anchored line. Subsequently, these monkeys were given choice tests between functional and nonfunctional versions of tools used in training. A different feature of the tool was varied between alternatives in each choice test. The monkeys chose to use functional tools significantly more often than nonfunctional tools in early exposures to each choice test. A second experiment tested whether these subjects, as well as a second group of minimally trained participants, could distinguish between functional and nonfunctional tools that appeared different from those used in training. A new set of design features was varied between tools in these choice tests. All participants continued to choose functional tools significantly more often than nonfunctional tools, regardless of their tool-throwing experience or the novel appearance of the tools. These results suggest that capuchin monkeys, like chimpanzees studied in similar experiments, are sensitive to a variety of functionally relevant tool features.

Animals↗
PubMed1986

A kinematic study of center of mass motions in the hammer throw.

Eight highly-skilled hammer throwers were studied using film analysis procedures. The location and velocity of the center of mass (c.m.) of each thrower, hammer and thrower-hammer system were calculated. The vertical component of motion of all three c.m.s followed cyclic patterns with one fluctuation per turn. The fluctuation of the c.m. of the thrower was ahead of that of the hammer by approximately a third of a cycle, and this made the periods of upward vertical acceleration of the system c.m. coincide approximately with the double-support phases. In the horizontal direction, the c.m.s of the thrower and of the hammer followed roughly trochoid patterns as a result of the combination of rotation with forward displacement across the throwing circle. Their rotations were out of synchrony by approximate synchrony with the hammer, or an essentially straight trajectory. The results of this study suggest that the investigation of the hammer throw might be facilitated by the use of a quasi-inertial non-rotating reference frame that follows the general motion of the system c.m. while ignoring its fluctuations within each turn.

Humans↗
PubMed2006

Ulnar collateral ligament reconstruction in elite throwing athletes.

PURPOSE: Ulnar collateral ligament (UCL) injuries may result in disabling valgus instability in throwing athletes. We evaluated the docking technique for UCL reconstruction and describe a modification to the technique. METHODS: UCL surgery was indicated in 20 high-level baseball players (13 professional and 7 collegiate) based on medial elbow pain preventing effective throwing, clinically apparent medial elbow laxity, and magnetic resonance arthrogram consistent with UCL injury. The mean age was 21.7 years (range, 17.9 to 25.3 years). One patient had previous UCL reconstruction. One had previous arthroscopic elbow debridement. The mean time between injury and treatment was 73 days. Reconstruction was performed via a muscle-splitting approach and the docking technique with palmaris or gracilis graft. For the initial 12 patients, a 2-strand construct was used; however, during the study period, we developed and began using a 3-strand construct with a double anterior bundle and a single posterior bundle, which was used in the next 8 patients. The ulnar nerve was not routinely transposed unless there were preoperative ulnar nerve symptoms (1 patient). Two patients had osteophyte debridement. One had removal of a loose body. RESULTS: Patients were followed up for a mean of 41.9 months (range, 6.4 to 67.1 months). One player was lost to follow-up and could not be identified on a professional roster. Of the remaining 19 patients, 18 returned to their previous level of participation or higher. Two were occasional pitchers who did not wish to return to pitching but continued to play other positions. They were clinically and functionally asymptomatic. The mean time to return to play was 13.1 months (range, 6.3 to 21.3 months). By use of the Timmerman-Andrews 100-point subjective scoring system, the mean preoperative score was 77.0 (range, 65 to 80) and the mean postoperative score was 98.2 (range, 85 to 100). By use of the Conway-Jobe scoring system, the outcome was rated as excellent in 17 patients and good in 2. One patient underwent subsequent ulnar nerve transposition and returned to the previous level of professional play. CONCLUSIONS: UCL reconstruction with the docking technique is a reproducible and safe operation that can reliably return athletes to a high level of participation with limited adverse effects. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Adult↗
PubMed2004

Nerve injuries in the throwing elbow.

The unique anatomy of the elbow combined with the angular velocity and stresses placed across this hinge joint while throwing can cause a large number of pathologic changes associated with nerves. Although the ulnar nerve is the most commonly injured, neuropathies are also seen with the branches of the median and radial nerves. These neuropathies are typically responsive to rest, activity modification, ice, splinting, and anti-inflammatories. A graduated return to throwing is then needed before returning to play. When conservative measures fail, surgical decompression is warranted, but results have been less than perfect.

Athletic Injuries↗
PubMed2006

Relationships between throwing mechanics and shoulder distraction in collegiate baseball pitchers.

A distraction force occurs at the shoulder joint in all throwing motions. At the professional level, the relationship between this force and pitching mechanics has been explained. Three-dimensional, high-speed (240 Hz) video data were collected on fastballs from 48 collegiate baseball pitchers. Kinematic parameters related to pitching mechanics and resultant kinetics on the throwing arm elbow and shoulder joints were calculated. Multiple linear regression analysis was used to investigate the relationships between shoulder distraction and pitching mechanics. Shoulder distraction stress averaged 81% body weight for the collegiate pitchers. The mean ball velocity was 81 mph. Ten parameters of pitching mechanics accounted for 89% of the variance in shoulder distraction. Two of the variables (maximum shoulder abduction torque and elbow angle at release) previously shown to affect shoulder distraction in professional baseball pitchers appear to be important for collegiate pitchers as well. These data provide a scientific basis for clinicians, athletes, and coaches to establish methods to reduce distraction force at the shoulder joint through modification of pitching mechanics.

Adult↗
PubMed2000

The painful shoulder in the throwing athlete.

Successful nonoperative treatment of shoulder injuries in the throwing athlete requires a team approach. The physician, physical therapist, and athletic trainer work together with the athlete to determine a diagnosis and design a treatment protocol. Injury recovery requires restoration of muscle strength and balance followed by a careful return to a throwing program.

Athletic Injuries↗