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PubMedDate not supplied

A surgical treatment for unstable osteochondritis dissecans lesions of the humeral capitellum in adolescent baseball players.

BACKGROUND: Various methods of surgical treatment for unstable osteochondritis dissecans lesions of the humeral capitellum have shown the potential to lead to osteoarthritis and poor functional results in throwing activities. PURPOSE: The purpose of this study was to evaluate the results of surgical treatment with pull-out wiring and bone grafting (as established by Kondo in 1989) in patients with unstable osteochondritis dissecans lesions of the humeral capitellum. STUDY DESIGN: Retrospective review. METHODS: Eleven male baseball players (average age, 14.7 years) with unstable osteochondritis dissecans lesions underwent internal fixation with pull-out wiring and bone grafting. Follow-up was an average 57 months. At an average 17 weeks after surgery, bony union of the osteochondritis dissecans lesion was radiographically confirmed and the wires were removed. Throwing was allowed beginning at 6 months after surgery. RESULTS: At follow-up, all patients had obtained pain relief, and all except one had returned to previous throwing levels. Radiographs showed good healing, and minimal degenerative changes were found in only three joints. CONCLUSION: Healing of osteochondritis dissecans lesions of the elbow can be achieved after fragment fixation with pull-out wiring and a bone grafting technique.

Adolescent↗
PubMedDate not supplied

Stress injury of the proximal ulna in professional baseball players.

BACKGROUND: To date, stress injury of the proximal ulna has been infrequently reported as a cause of elbow pain in the throwing athlete. PURPOSE: We describe a syndrome of osseous stress injury of the proximal ulna in the professional throwing athlete. STUDY DESIGN: Retrospective review. METHODS: We evaluated the clinical, radiographic, and magnetic resonance imaging findings of seven professional baseball players with osseous stress injury of the proximal ulna. RESULTS: Plain radiographs of the involved elbows failed to demonstrate any significant findings. All of the clinically significant lesions were detected with magnetic resonance imaging. In addition, magnetic resonance imaging was found to be of value in following the course of healing of the injuries. All of the lesions originated on the posteromedial aspect of the proximal ulna. The ulnar collateral ligament was intact in all seven athletes. One athlete had two occurrences of this injury. Six of the seven athletes returned to their previous level of play after a nonoperative course of treatment. CONCLUSIONS: We believe that this injury should be considered in the differential diagnosis of elbow pain in the throwing athlete. Magnetic resonance imaging is the diagnostic test of choice when this injury is suspected.

Adolescent↗
PubMed2004

Humeral torque in professional baseball pitchers.

BACKGROUND: Spontaneous fracture of the humeral shaft in throwers is a rare but well-known phenomenon. Although it has been hypothesized that the biomechanics of the throw cause such fractures, it is not clear how or when the fractures occur in the pitching motion. METHODS: The torque acting about the long axis of the humerus was calculated in 25 professional baseball pitchers throwing in game situations. RESULTS: Peak humeral axial torque reached a mean value of 92 +/- 16 Nm near the time of maximum shoulder external rotation at the end of the cocking phase. This torque tended to externally rotate the distal end of the humerus relative to its proximal end. The direction of the torque was consistent with the external rotation spiral fractures of the humerus noted to occur in throwers. The magnitude of the peak humeral torque averaged 48% of the theoretical torsional strength of the humerus, suggesting that repetitive stress plays a role in humeral shaft fractures. CONCLUSIONS: Fractures are most likely to occur near the time of maximum shoulder external rotation when humeral torque peaks. Pitchers whose elbows were more extended at stride foot contact tended to have lower peak humeral torques.

Adult↗
PubMed2005

Upper and lower extremity muscle fatigue after a baseball pitching performance.

BACKGROUND: Previous studies have estimated joint torques and electromyogram activity associated with the pitching motion. Although previous studies have investigated the influence of extended pitching (fatigue) on kinematic and kinetic parameters, no attempts have been made to quantify the fatigue associated with a pitching performance. PURPOSE: Considering previous investigations on muscle activity during pitching, this study investigated muscle fatigue in upper and lower extremity muscle groups after a pitching performance. STUDY DESIGN: Descriptive laboratory study. METHODS: Thirteen baseball pitchers from 4 universities and 1 independent minor league team were tested before and after 19 games. Pitchers threw an average of 99 pitches during an average of 7 innings. Shoulder, scapular, and lower extremity muscle strengths were assessed using a handheld dynamometer before and after the pitching performances. RESULTS: Baseline strength tests revealed that the pitching arm was 12% weaker (P=.02) in the empty can test (supraspinatus) compared to the contralateral side. Postgame shoulder strength tests revealed selective fatigue of 15% in shoulder flexion (P=.02), 18% fatigue in internal rotation (P=.03), and 11% fatigue in shoulder adduction (P = .01). Minimal fatigue was noted in the empty can test, scapular stabilizers, and hip musculature. CONCLUSIONS: A trend toward significant baseline strength in internal rotation together with significant selective postgame fatigue on internal rotation of the dominant upper extremity indicate that the internal rotators experience a high performance demand during pitching. Weakness in the empty can test on the dominant arm combined with minimal postgame fatigue was surprising given that studies and injury patterns have indicated a high performance demand on the supraspinatus during pitching.

Adult↗
PubMed2006

Nonunion of olecranon stress fractures in adolescent baseball pitchers: a case series of 5 athletes.

BACKGROUND: Adolescent athletes participating in overhead throwing sports suffer a variety of overuse elbow injuries, many of which have been well described in the literature. Nonunion stress fractures of the olecranon across the epiphyseal plate, however, have received little attention. PURPOSE: To describe this unusual clinical entity in the differential diagnosis of the adolescent athlete with elbow pain and to demonstrate that operative treatment is an effective means of quickly and safely returning the patient to sporting activities. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Five adolescent baseball pitchers (mean age, 15 years) who suffered chronic elbow pain and who were diagnosed with olecranon epiphyseal stress fracture nonunions were treated with open reduction and internal fixation using a 7.0 cancellous screw and washer with or without 18-gauge tension banding. RESULTS: Return to preoperative range of motion was achieved at a mean of 8.6 weeks (range, 3.4-16.6 weeks). Patients were clinically asymptomatic at a mean of 11 weeks (range, 7.7-13.6 weeks) after surgery. Radiographic evidence of stress fracture union was achieved at a mean of 15.4 weeks (range, 6.1-33 weeks), including 1 patient with a delayed union according to radiographs, which healed at 33 weeks. Patients were started on a light strengthening program at 5 to 7 weeks and a throwing progression program at 15.6 weeks (range, 6.4-28.1 weeks). All 5 patients were able to return to their previous level of activities, with a mean return time of 29.4 weeks (range, 18.9-40.4 weeks). CONCLUSION: Surgical management of olecranon apophysis stress fractures provided excellent results with minimal complications in this series of 5 consecutive cases.

Adolescent↗
PubMedDate not supplied

An analysis of 100 symptomatic baseball players.

The management of baseball elbow injuries, both operative and nonoperative, was usually successful, permitting continued high-level athletic participation. Surgery was particularly effective in those cases with loose bodies. In the shoulder, symptoms occurred in the anterior and posterior regions. Each area presented difficulties in accurate diagnosis. The management of anterior symptoms was primarily nonoperative, surgery being reserved as a salvage procedure. In the posterior capsular syndrome, the source of pain is still unclear.

Athletic Injuries↗
PubMedDate not supplied

Correctable elbow lesions in professional baseball players: a review of 25 cases.

In a retrospective study, 20 of 25 professional baseball pitchers (mean age, 24 years; range, 19 to 28 years) who had had a reconstructive surgical procedure on the dominant elbow had satisfactory results (able to return to competitive throwing for one full season or more after surgery). Gentle motion wasinitiated 1 week after the operation on each patient. Exercises for mobilization and muscle strengthening of grip, arm, and shoulder were increased until throwing was initiated 10 to 12 weeks postoperatively. Throwing was gradually increased over several weeks from 30 feet at no more than half speed for 15 min to 60 feet at three-quarter speed. Pitchers were instructed to warm up before throwing and warm down and to continue this practice after they began competitive throwing. The longest period of follow-up had been 4 years (mean, 2.8 years). Four of the 25 pitchers had unsatisfactory results (released from their team in less than one full season because of ineffective pitching and were not picked up by another team). The cause of the release of the other patient-player is controversial. This 25-patient group is too small and the follow-up period is too short for definite conclusions. Our evidence does suggest that surgical procedures directed at medial soft tissue and posterior intra-articular changes carry better prognosis for competitive throwers than other procedures. The radiohumeral articular condition should be evaluated at surgery.

Adult↗
PubMedDate not supplied

Isokinetic evaluation of shoulder rotational strength in high school baseball pitchers.

Isokinetic, shoulder rotational strength was evaluated in 26 high school baseball pitchers before the start of spring practice. Using the Cybex II (Cybex, Division of Lumex, Inc., Ronkonkoma, NY), test data were gathered on the dominant and nondominant shoulders in the supine 90 degrees abducted test position (90 degrees AbTP) and the standing neutral test position (neutral TP). Tests were performed at 90 and 240 deg/sec. The HUMAC (Computer Sports Medicine, Inc., Flemington, NJ) computer system was used to analyze data. Means and standard deviations for peak torque, total work, peak torque to body weight ratios, and agonist/antagonist ratios are presented. Comparison of dominant to non-dominant sides and 90 degrees AbTP to neutral TP values are reported. Peak torque and total work values for the throwing side internal rotators were significantly higher than the nonthrowing side in all tests. Pitching side external rotators failed to show this dominance. External/internal rotation ratios for peak torque and total work were significantly lower on the pitching side, suggesting a relative imbalance of cuff musculature compared to the nonpitching shoulder. Significant differences existed between data gathered in the two different test positions. In the 90 degrees AbTP, external rotation peak torque and total work values and external/internal rotation peak torque and total work ratios were higher than the equivalent values gathered in the neutral TP. Internal rotation peak torque and total work values tended to be higher in the neutral TP than in the 90 degrees AbTP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Upper extremity range of motion and isokinetic strength of the internal and external shoulder rotators in major league baseball players.

Forty-one professional baseball players volunteered for upper extremity range of motion measurements and isokinetic testing for internal and external shoulder rotation. Pitchers demonstrated 9 degrees more external shoulder rotation with the arm abducted, 5 degrees more forearm pronation, and 9 degrees less shoulder extension on the dominant side compared with the dominant side of position players. Pitchers also demonstrated 9 degrees more external rotation in abduction, 5 degrees less shoulder flexion, 11 degrees less horizontal extension, 15 degrees less internal rotation in abduction, 6 degrees less elbow extension, 4 degrees less elbow flexion, and 5 degrees less forearm supination on the dominant side compared with their nondominant side. Position players demonstrated 8 degrees more external rotation in abduction, 14 degrees less horizontal extension, and 8 degrees less elbow extension on the dominant side compared with their nondominant side. Greater torque was produced by pitchers compared with position players for the dominant and nondominant arm at all test speeds for both mean peak and mean average torque. Greater torque was produced by the dominant arm compared with the nondominant arm also at all test speeds for both of these measurements. No difference was found between the rotation ratios for either arm, for either group, for all speeds.

Adaptation, Physiological↗
PubMedDate not supplied

Electromyographic analysis of the glenohumeral muscles during a baseball rehabilitation program.

Many exercises are used to strengthen the glenohumeral muscles, but there have been limited studies to evaluate the exercises. Thus, the purpose of this study was to decide how the muscles responsible for humeral motion can best be exercised in a rehabilitation program for the throwing athlete. Dynamic, fine wire, intramuscular electromyography was carried out in 15 normal male volunteers performing 17 shoulder exercises derived from a shoulder rehabilitation program used by professional baseball clubs. The four rotator cuff muscles were studied, as well as other positioners of the humerus, including the pectoralis major, latissimus dorsi, and three portions of the deltoid. The electromyographic activity was synchronized with cinematography and averaged over 30 degrees arcs of motion. An exercise was considered to be a significant challenge for a muscle if it generated at least 50% of its predetermined maximum contraction over three consecutive arcs (i.e., a 90 degrees range). Four exercises were consistently found to be among the most challenging exercises for every muscle. These shoulder exercises consisted of 1) elevation in the scapular plane with thumbs down, 2) flexion, 3) horizontal abduction with arms externally rotated, and 4) press-up. This study documents that the minimum for an effective and succinct rehabilitation protocol for the glenohumeral muscles would include these exercises.

Adult↗
PubMedDate not supplied

Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. Evaluation in 25 baseball players with surgical confirmation.

A prospective study was completed on 25 baseball players with medial side elbow pain. They were evaluated preoperatively with both computed tomography arthrogram and magnetic resonance imaging examinations of the elbow to assess the ulnar collateral ligament. At surgery, 16 of 25 patients had an abnormal ulnar collateral ligament and 9 patients had a normal ulnar collateral ligament. The computed tomography arthrogram detected abnormalities in 12 of the 14 patients with ulnar collateral ligament tearing (sensitivity, 86%). The magnetic resonance imaging scan indicated abnormalities in 8 of 14 patients (sensitivity, 57%). The specificity of the computed tomography arthrogram was 91% and the magnetic resonance imaging was 100%. A newly described "T-sign" was seen on the computed tomography arthrogram in the patients with an undersurface tear of the ulnar collateral ligament. This represented the dye leaking around the detachment of the ulnar collateral ligament from its bony insertion but remaining contained within the intact superficial layer of the ulnar collateral ligament and capsule. Both the computed tomography arthrogram and the magnetic resonance imaging scan were accurate in diagnosing a complete tear of the ulnar collateral ligament preoperatively in all cases. The main advantage of the computed tomography arthrogram was in evaluating the partial undersurface tear.

Adolescent↗
PubMedDate not supplied

Outcome of elbow surgery in professional baseball players.

We reviewed the records of 72 professional baseball players who underwent arthroscopic or open elbow surgery. The most common diagnoses were posteromedial olecranon osteophyte (65%), ulnar collateral ligament injury (25%), and ulnar neuritis (15%). Intraarticular loose bodies were found in 39% of the patients. Fifty-nine patients (82%) were observed for a minimum of 24 months, with an average of 42 months' followup. Forty-seven players (80%) returned to play for a minimum of one season (73% at the same or higher level of play), and 17% of the players retired initially because of their elbow injury. One third of the players required two or more surgical procedures, with 25% of these patients requiring an ulnar collateral ligament reconstruction after removal of a posteromedial olecranon osteophyte. The patients with posteromedial olecranon osteophytes had the highest rate of reoperation, and patients who underwent ulnar collateral ligament reconstruction had a higher rate of return to play. The incidence of ulnar collateral ligament injuries was most likely underestimated in this group of athletes, with initial treatment directed at the secondary injuries instead of the primary ulnar collateral ligament injury.

Adult↗
PubMedDate not supplied

Shoulder motion and laxity in the professional baseball player.

We studied 148 professional baseball players with no history of shoulder problems to assess range of motion and laxity of their dominant and nondominant shoulders. There were 72 pitchers and 76 position players. Average external rotation with the arm in 90 degrees of abduction was statistically greater and average internal rotation was statistically less in the dominant shoulders than in the nondominant shoulders, both in pitchers and position players. There was no statistical difference in forward elevation of external rotation with the arm at the side of the body in either group. Both dominant and nondominant shoulders of pitchers had greater average range of motion in forward elevation and external rotation (both at the side and at 90 degrees of abduction) and less average internal rotation than those of position players. Regarding laxity testing, 61% of dominant shoulders in pitchers had a sulcus sign, as compared with 47% in position players. Also, this degree of inferior laxity was significantly greater in pitchers than in position players. Differences in range of motion and laxity exist in the throwing shoulder of athletes involved in overhead throwing motions and should be considered in rehabilitation protocols and surgical repair.

Adolescent↗
PubMedDate not supplied

Characteristic ground-reaction forces in baseball pitching.

Overhand throwing requires contributions from and interaction between all limb segments. Most previous investigations have concentrated on the throwing arm itself, yet poor mechanics at the arm may originate in the lower extremities. Multicomponent ground-reaction forces of both the push-off and landing limbs were measured in six collegiate and one high school level baseball pitchers. Full body kinematics were simultaneously recorded to correlate phases in the pitching cycle with the force data. Pitchers were found to generate shear forces of 0.35 body weight in the direction of the pitch with the push-off leg and to resist forces of 0.72 body weight with the landing leg. Wrist velocity was found to correlate highly with increased leg drive. This study validates the clinical impression that the lower extremity is an important contributor to the throwing motion. Based on this study, strengthening of the lower extremities could be inferred to be important both to enhance performance and to avoid injury.

Adolescent↗
PubMedDate not supplied

An aneurysm involving the axillary artery and its branch vessels in a major league baseball pitcher. A case report and review of the literature.

Baseball pitchers appear to be prone to aneurysms of the axillary artery and its branches. The cause is probably related to repetitive compression of or tension on the vessels at the level of the pectoralis minor muscle and the humeral head, which is exacerbated by the pitching motion. The incidence of aneurysms of the axillary artery and its branches among pitchers and other athletes is not known, nor is it clear whether pitchers who are at high risk of vascular injury can be identified before irreversible damage to the vessels has occurred. Perhaps patients who have documented compression or occlusion of the vessel with the arm in the abducted, externally rotated position are at higher risk. Screening pitchers to identify those with axillary artery compression, aneurysm, or thrombosis has also not been shown to be effective. Certainly, many pitchers will have some level of compression of the axillary artery with their arm in the pitching position but will never develop any clinical abnormality requiring treatment. Screening would therefore probably lead to a high false-positive rate. It is clear, however, that pitchers who complain of ischemia-type symptoms such as early fatigue or who have evidence of emboli require a complete evaluation to rule out any abnormality of the axillary artery or one of its branches. Orthopaedic surgeons who see pitchers and other athletes involved in repetitive overhead motions need to be aware of this disorder so that they order the appropriate tests and obtain a vascular consultation--and make a prompt diagnosis. Treatment will vary depending on the type of lesion and on which vessel or vessels are involved, and should be decided on by the team of surgeons treating the patient.

Adult↗
PubMed2001

Tarsal navicular fractures in major league baseball players at bat.

Tarsal navicular fractures in athletes, although rare, can present both a diagnostic and therapeutic dilemma. Failure to recognize this injury and initiate treatment early can have devastating consequences. The physician must have a high index of suspicion for the injury in any patient with midfoot pain after a direct blow. Two case reports of tarsal navicular fractures sustained by baseball players at bat in which the diagnosis was not made early are presented.

Adult↗
PubMed1990

[A study on the effect of water intake of umpires during a baseball game in a summer-heat environment].

The purpose of this study was to examine the effect of umpires' intake of water during a summertime baseball game, on serum and urinary biochemical elements, body weight and physiological factors. Twenty-eight umpires were classified into two groups. Group W was composed of 14 umpires who had water while those who did not were group C. Group W had 250 ml of water that was cooled to about 5 degrees C after the 5th inning of the game. The game was played in the following environment: atmosphere temperature was 31 degrees C; wet-bulb temperature was 26 degrees C; blackglove temperature was 40 degrees C; the velocity of the wind was 1.18 m/sec in bright sunshine on a hot and moist day. The results obtained were as follows. In group W, more body weight was lost than in group C, but statistically there was no significant difference. Urinary volume in group W became smaller than in group C, but statistically there was no significant difference. Water in blood increased in group W and decreased in group C but statistically there was significant difference. In both groups, oral temperature decreased, but only in group C was there a statistically significant difference. Although the intake of water increased the volume of perspiration, it did not dilute the concentrated blood, suppress the rise of body temperature, or result in a rise of low blood pressure.

Adult↗
PubMed2004

Effect of 12 weeks of wrist and forearm training on high school baseball players.

This study examined the effect of 12 weeks of wrist and forearm training on male high school baseball players (mean age = 15.3 +/- 1.1 years). Participants (N = 43) were tested for 10 repetition maximum (RM) wrist barbell flexion, wrist barbell extension, dominant (D) and nondominant (ND) hand-forearm supination, D and ND forearm pronation, D and ND wrist radial deviation, D and ND wrist ulnar deviation, D and ND grip strength, and a 3RM parallel squat (PS) and bench press (BP). Group 1 (n = 23) and group 2 (n = 20), randomly assigned by a stratified sampling technique, performed the same resistance exercises while training 3 days a week for 12 weeks according to a stepwise periodized model. Group 2 also performed wrist and forearm exercises 3 days a week for 12 weeks to determine if additional wrist and forearm training provided further wrist and forearm strength improvements. All wrist and forearm strength variables were measured before and after 12 weeks of training. The 3RM PS and BP were measured at 0 and after 4, 8, and 12 weeks of training. Both groups significantly increased wrist and forearm strength (kg +/- SD) except 10RM D and ND forearm supination for group 1 (p < 0.05). Group 2 showed statistically greater improvements (p < 0.05) in all wrist and forearm strength variables than did group 1 except for D and ND grip strength. Predicted 1RM (kg +/- SD) PS and BP increased significantly (p < 0.05) after weeks 4, 8, and 12 for both groups. These data indicate that a 12-week stepwise periodized training program can significantly increase wrist, forearm, PS, and BP strength for both groups. Additionally, group 2 had further wrist and forearm strength gains.

Adaptation, Physiological↗