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Effort thrombosis in the elite throwing athlete.

BACKGROUND: Upper extremity vascular injuries are uncommon in the elite throwing athlete. However, the extreme stresses that are placed on the upper extremity of elite baseball players, especially pitchers, puts them at risk for such injuries. One such injury is upper extremity venous thrombosis or "effort thrombosis." PURPOSE: We wanted to review the common initial clinical symptoms and physical examination findings of effort thrombosis in elite baseball players and to review the associated clinical conditions such as hypercoagulable states and pulmonary embolism. STUDY DESIGN: Retrospective review of a series of cases. METHODS: A retrospective review of the medical records of a Major League Baseball organization and a Division I college was performed for the period 1987 to 1997. RESULTS: We located four cases of effort thrombosis involving elite baseball players. Contrast venography was used to confirm the diagnosis in all cases. All patients were successfully treated with transluminal catheter-directed urokinase thrombolysis followed by first rib resection and systemic anticoagulant therapy for up to 3 months. All four players returned to play at or above their previous level of competition with no long-term chronic sequelae. CONCLUSIONS: Prompt clinical recognition, diagnosis, and treatment of effort thrombosis in the elite baseball player provides the player with an excellent prognosis for return to the previous level of play.

Adult↗

Individual Differences in Interest and Narrative Writing

Two hundred twenty-four undergraduate students wrote about one-half of an inning of a baseball game and about one-half of a soccer game, counterbalanced, for 20 min each. Students then completed two six-item interest inventories-one each on the topics of baseball and soccer-and tests of baseball knowledge and soccer knowledge. Hierarchical regression analyses revealed that individual interest in baseball was significantly related to the proportions of game actions and irrelevant-nongame actions, controlling for gender, discourse knowledge, and topic knowledge. Topic knowledge was significantly related to thematic maturity, controlling for gender and discourse knowledge. Students wrote more topic-relevant information on the baseball story-a relatively high-interest topic-than on the soccer story, a relatively low-interest topic. Implications for the Flower and Hayes (1981) writing model and for assigning students writing topics are discussed.

Journal Article↗

Throwing in cricket.

This paper considers the kinematic characteristics of overarm throwing with particular emphasis on the techniques of throwing and pitching in baseball. The technique is subdivided into: (1) sequential pattern of throwing, (2) lead foot contact, (3) preparatory phase, (4) arm acceleration and (5) instant of ball release. Specific biomechanical principles that underpin throwing and their application within baseball are identified. The paper also presents a case study of the three-dimensional characteristics of throwing technique in cricket. The aim was to compare the skill in cricket to that previously researched in baseball. The findings for throwing in cricket are similar to those reported for baseball, indicating that there is a definite crossover in the rationale of how an individual should throw specific to the demands of cricket and baseball. The differences noted--greater elbow flexion at lead foot contact and less external rotation during the preparation phase--can be attributed to the demands placed on the fielder and pitcher specific to their respective sports.

Acceleration↗

Modeling gunshot bruises in soft body armor with an adaptive fuzzy system.

Gunshots produce bruise patterns on persons who wear soft body armor when shot even though the armor stops the bullets. An adaptive fuzzy system modeled these bruise patterns based on the depth and width of the deformed armor given a projectile's mass and momentum. The fuzzy system used rules with sinc-shaped if-part fuzzy sets and was robust against random rule pruning: Median and mean test errors remained low even after removing up to one fifth of the rules. Handguns shot different caliber bullets at armor that had a 10%-ordnance gelatin backing. The gelatin blocks were tissue simulants. The gunshot data tuned the additive fuzzy function approximator. The fuzzy system's conditional variance V[Y/X = x] described the second-order uncertainty of the function approximation. Handguns with different barrel lengths shot bullets over a fixed distance at armor-clad gelatin blocks that we made with Type 250 A Ordnance Gelatin. The bullet-armor experiments found that a bullet's weight and momentum correlated with the depth of its impact on armor-clad gelatin (R2 = 0.881 and p-value < 0.001 for the null hypothesis that the regression line had zero slope). Related experiments on plumber's putty showed that highspeed baseball impacts compared well to bullet-armor impacts for large-caliber handguns. A baseball's momentum correlated with its impact depth in putty (R2 = 0.93 and p-value < 0.001). A bullet's momentum similarly correlated with its armor-impact in putty (R2 = 0.97 and p-value < 0.001). A Gujarati-Chow test showed that the two putty-impact regression lines had statistically indistinguishable slopes for p-value = 0.396. Baseball impact depths were comparable to bullet-armor impact depths: Getting shot with a .22 caliber bullet when wearing soft body armor resembles getting hit in the chest with a 40-mph baseball. Getting shot with a .45 caliber bullet resembles getting hit with a 90-mph baseball.

Computer Simulation↗

Prosthesis motility with and without intraorbital implants in the anophthalmic socket.

Ocular prosthesis motility was measured and compared in 15 patients with a primary baseball implant after enucleation of an eye, in 11 patients with a secondary baseball implant, in 12 patients with an Allen implant, and in 11 patients without any intraorbital implant. In all patients a noticeable lag of movement of the prosthetic eye was measured: in the extreme directions of gaze the excursions of the prosthesis were far less in comparison with the contralateral normal eye. For normal eye movement round the primary position of gaze, however, the prosthesis motility in the primary baseball and Allen implant group appeared to be sufficient to give a lifelike appearance. The average motility of the prostheses in these two groups did not differ. The motility in the secondary baseball group and in the group without an implant was evidently worse. In the last group the prosthesis motility was most impaired. We conclude that the insertion of an implant, even when inserted some time after the enucleation (a secondary implant), improves the motility of the prosthesis markedly. We recommend the primary baseball implant as the correction of choice after enucleation.

Adolescent↗

Quantitative ultraviolet skin exposure in children during selected outdoor activities.

We determined the cumulative exposure of 3 body sites to ultraviolet radiation from sunlight for 126 children observed from 1-3 d during a variety of common recreational activities at a girl scout camp, baseball camp and community baseball field. Median arm exposure to children playing baseball at a camp ranged from 27.6% to 33.2% of the possible ambient exposure. These exposures are similar to adult exposures reported for comparable activities. Median exposure to the arm at the girl scout camp during mixed activities ranged from 9.0% to 26.5% of possible ambient exposure. At the girl scout camp, exposure both within and between activity groups varied substantially and were more variable than the baseball players' exposure. Arm exposure was greater than cheek and forehead exposure for all subject groups, with an arm-to-cheek exposure ratio ranging from 1.7 to 2.3. For organized sports, such as baseball, it may be possible to assign a single exposure estimate for use in epidemiologic studies or risk estimates. However, for less uniform outdoor activities, wide variability in exposure makes it more difficult to predict an individual's exposure.

Adolescent↗

Biomechanics of the elbow in sports.

In throwing activities, the elbow is sometimes stressed to its biomechanical limits. In this article, forces, torques, angular velocities, and muscle activity about the elbow are reviewed for the baseball pitch, the football pass, the javelin throw, the windmill softball pitch, the tennis serve, and the golf swing. The elbow goes through rapid extension in baseball pitching (about 2400 degrees/s) and rapid flexion in the javelin throw (about 1900 degrees/s). During baseball pitching, the elbow joint is subject to a valgus torque reaching 64 Nm, and requires proximal forces as high as 1000 N to prevent elbow distraction. The ulnar collateral ligament (UCL) rupture in baseball pitching, lateral epicondylitis in the tennis backhand, and other injury mechanisms are also discussed.

Baseball↗

Variables influencing medical usage rates, injury patterns, and levels of care for mass gatherings.

OBJECTIVES: Mass gatherings create difficult environments for which to plan emergency medical responses. The purpose of this study was to identify those variables that are associated with increased medical usage rates (MURs) and certain injury patterns that can be used to facilitate the planning process. METHODS: Patient information collected at three types of mass gatherings (professional American football and baseball games and rock concerts) over a three-year period was reviewed retrospectively. Specific variables were abstracted: (1) event type; (2) gender; (3) age; (4) weather; and (5) attendance. All 216 events (total attendance 9,708,567) studied were held in the same metropolitan region. All MURs are reported as patients per 10,000 (PPTT). RESULTS: The 5,899 patient encounters yielded a MUR of 6.1 PPTT. Patient encounters totaled 3,659 for baseball games (4.85 PPTT), 1,204 for football games (6.75 PPTT), and 1,036 for rock concerts (30 PPTT). The MUR for Location A concerts (no mosh pits) was 7.49 PPTT, whereas the MUR for the one Location B concert (with mosh pits) was 110 PPTT. The MUR for Location A concerts was higher than for baseball, but not football games (p = 0.005). Gender distribution was equal among patrons seeking medical care. The mean values for patient ages were 29 years at baseball games, 33 years at football games, and 20 years at concerts. The MUR at events held when the apparent temperature was 80 degrees F significantly lower statistically than that at events conducted at temperatures <80 degrees F were (18 degrees C) (4.90 vs. 8.10 PPTT (p = 0.005)). The occurrence of precipitation and increased attendance did not predict an increased MUR. Medical care was sought mostly for minor/basic-level care (84%) and less so for advanced-level care (16%). Medical cases occurred more often at sporting events (69%), and were more common than were cases with traumatic injuries (31%). Concerts with precipitation and rock concerts had a positive association with the incidence of trauma and the incidence of injuries; whereas age and gender were not associated with medical or traumatic diagnoses. CONCLUSIONS: Event type and apparent temperature were the variables that best predicted MUR as well as specific injury patterns and levels of care.

Adult↗

Biomechanics of youth windmill softball pitching.

BACKGROUND: Limited research attention has been paid to the potentially harmful windmill softball pitch. No information is available regarding lower extremity kinetics in softball pitching. HYPOTHESIS: The stresses on the throwing arm of youth windmill pitchers are clinically significant and similar to those found for college softball pitchers. STUDY DESIGN: Descriptive laboratory study. METHODS: Three-dimensional, high-speed (240-Hz) video and stride foot force plate (1200 Hz) data were collected on fastballs from 53 youth softball pitchers. Kinematic parameters related to pitching mechanics and resultant kinetics on the throwing-arm elbow and shoulder joints were calculated. Kinetic parameters were compared to those reported for baseball pitchers. RESULTS: Elbow and shoulder joint loads were similar to those found for baseball pitchers and college softball pitchers. Shoulder distraction stress averaged 94% body weight for the youth pitchers. Stride foot ground reaction force patterns were not similar to those reported for baseball pitchers. Vertical and braking force components under the stride foot were in excess of body weight. CONCLUSIONS: Excessive distraction stress and joint torques at the throwing-arm elbow and shoulder are similar to those found in baseball pitchers, which suggests that windmill softball pitchers are at risk for overuse injuries. Normative information regarding upper and lower extremity kinematics and kinetics for 12- to 19-year-old softball pitchers has been established.

Adolescent↗

Kinematics and kinetics of elite windmill softball pitching.

BACKGROUND: A significant number of time-loss injuries to the upper extremity in elite windmill softball pitchers has been documented. The number of outings and pitches thrown in 1 week for a softball pitcher is typically far in excess of those seen in baseball pitchers. Shoulder stress in professional baseball pitching has been reported to be high and has been linked to pitching injuries. Shoulder distraction has not been studied in an elite softball pitching population. HYPOTHESIS: The stresses on the throwing shoulder of elite windmill pitchers are similar to those found for professional baseball pitchers. STUDY DESIGN: Descriptive laboratory study. METHODS: Three-dimensional, high-speed (120 Hz) video data were collected on rise balls from 24 elite softball pitchers during the 1996 Olympic Games. Kinematic parameters related to pitching mechanics and resultant kinetics on the throwing shoulder were calculated. Multiple linear regression analysis was used to relate shoulder stress and pitching mechanics. RESULTS: Shoulder distraction stress averaged 80% of body weight for the Olympic pitchers. Sixty-nine percent of the variability in shoulder distraction can be explained by a combination of 7 parameters related to pitching mechanics. CONCLUSION: Excessive distraction stress at the throwing shoulder is similar to that found in baseball pitchers, which suggests that windmill softball pitchers are at risk for overuse injuries. Normative information regarding upper extremity kinematics and kinetics for elite softball pitchers has been established.

Adult↗

Improved curveball hitting through the enhancement of visual cues.

This study investigated the effectiveness of using visual cues to highlight the seams of baseballs to improve the hitting of curveballs. Five undergraduate varsity baseball team candidates served as subjects. Behavior change was assessed through an alternating treatments design involving unmarked balls and two treatment conditions that included baseballs with 1/4-in. and 1/8-in. orange stripes marking the seams of the baseballs. Results indicated that subjects hit a greater percentage of marked than unmarked balls. These results suggest that the addition of visual cues may be a significant and beneficial technique to enhance hitting performance. Further research is suggested regarding the training procedures, effect of feedback, rate of fading cues, generalization to live pitching, and generalization to other types of pitches.

Adult↗

A developmental and psychoeducational approach to reducing conflict and abuse in little league and youth sports. The sport psychiatrist's role.

To stress a point made earlier, whether backyard or Little League, the tone of the youth sports experience is greatly influenced by the player and team selection process. All possible steps should therefore be taken to ensure that the draft is held on high moral ground, and that the adult participants, even on the Major Little League level, behave cooperatively rather than competitively. If it is the community's hope that Little League will "build character, and not characters," it must embrace Shields and Bredemeier's work and flood the Draft Room with the four virtues of compassion, fairness, sportspersonship, and integrity. In one attempt to achieve fairness and balance, some leagues enter player evaluations into a data base and allow a properly programmed computer to project equal teams. It might be best, however, to borrow a page from backyard baseball, and make team selection a more cooperative venture. Wolff has proposed such a draft model. He recommends that each child's name be placed on a big blackboard at the beginning of the draft. All assembled give their assessment of each child's baseball ability, and a consensus skill-level number (one through five) is entered next to each player's name. If there are 72 names, and the league wishes to form six teams of 12 players each, dividing up the rated players so that the skill levels balance would assure everyone (coaches, parents, the league, and by extension, the community) that the teams were of relatively equal strength. No coach at this point would know to which team he or she was being assigned, so there would be no motive for "stacking" a given team. Each team would be designated by a letter of the alphabet, and the six letters would be thrown into a hat. The six coaches would then blindly pick a team from the hat. If a coach desired that his or her child play on his or her team, fair adjustments (trades) could be made subject to majority agreement. The three draft models can be summarized as follows: Draft Model 1 Public tryouts Previous year rating Coach makes selections Can be very competitive, lacking in "character" Can result in very unequal teams Draft Model 2 Player evaluations placed into a data base Properly programmed computer projects equal teams Draft Model 3 All names placed on a blackboard Relative merits of players discussed Equal team drawn up and placed into a hat Adjustments can be made for coach's child If practical, this author suggests that coaches not pick a name for the team until the first team meeting or practice, when that task can be given to the children. In a symbolic way, this returns some of the sport to them while encouraging social interaction among new teammates, and helping the coach detect who the leaders are. Names of professional teams in the major sports, especially baseball, are to be avoided, as they fuel longstanding unconscious associations and fantasies, and may subtly tilt all participants toward the professional "win at all costs" mentality. No one draft model is perfect for every town, and even the most ethical attempt to achieve balance among teams can be severely tested by parents who request that their athlete be placed on the same team as another child for social or car pool reasons. Such requests are not inviolate, however. For example, they do not usually dictate placement in school classes, and car pools are frequently disrupted when children, in individual sports such as Tae Kwan Do, reach different ability levels, and so attend practices at different times. Baseball is no longer the national pasttime and, as we approach the millennium, American children have too many other attractive, competing interests and time demands to spontaneously organize a pick-up game. One coach shared with the author that his saddest moment in CAP League came when he arrived at 6 PM at a field that had been "reserved" for his team, and found a group of boys who were playing a pick-up game. The coach's impulse was to set his boys fre

Baseball↗

Effects of domain knowledge, working memory capacity, and age on cognitive performance: an investigation of the knowledge-is-power hypothesis.

Domain knowledge facilitates performance in many cognitive tasks. However, very little is known about the interplay between domain knowledge and factors that are believed to reflect general, and relatively stable, characteristics of the individual. The primary goal of this study was to investigate the interplay between domain knowledge and one such factor: working memory capacity. Adults from wide ranges of working memory capacity, age, and knowledge about the game of baseball listened to, and then answered questions about, simulated radio broadcasts of baseball games. There was a strong facilitative effect of preexisting knowledge of baseball on memory performance, particularly for information judged to be directly relevant to the baseball games. However, there was a positive effect of working memory capacity on memory performance as well, and there was no indication that domain knowledge attenuated this effect. That is, working memory capacity contributed to memory performance even at high levels of domain knowledge. Similarly, there was no evidence that domain knowledge attenuated age-related differences (favoring young adults) in memory performance. We discuss implications of the results for understanding proficiency in cognitive domains from an individual-differences perspective.

Adolescent↗

Isokinetic performance at diagonal pattern and shoulder mobility in elite overhead athletes.

The purpose of this study was to measure isokinetically glenohumeral joint movement peak torque and work in professional basketball, volleyball, handball and baseball players and determine whether significant differences exist between the dominant and non-dominant extremity in athletes and controls. Eighty healthy professional overhead athletes (basketball, volleyball, handball and baseball players) and 20 controls were tested bilaterally on a CYBEX 6000 isokinetic dynamometer at 60 degrees and 180 degrees s(-1) for diagonal pattern of the glenohumeral joint. A standardized protocol and testing guidelines were strictly followed. The range of motion of internal rotation (IR) on the dominant side of baseball players was significantly smaller than those on the dominant side of basketball, handball and volleyball players, and controls (P<0.01). Flexion/abduction/external rotation were consistently higher on the dominant arm (8.5%) for peak torque at 60 degrees s(-1) in baseball players, and bilateral ratios were lower on the dominant arm (14.8%) for peak torque at 180 degrees s(-1) in basketball players. The results of this study are important for the application and interpretation of isokinetic data and flexibility and mobility characteristics on unilaterally dominant overhead athletes. Functional weakness in external rotators, mobility impairments in IR and muscle imbalance have been shown in the dominant arm of these overhead athletes.

Adult↗

Protective headgear for midwestern agriculture: a limited wear study.

Baseball caps are popular with farm workers, but have been criticized because they do not sufficiently shade the face, neck, and ears. U.S. Environmental Protection Agency standards require workers to wear chemical-resistant hoods or chemical-resistant hats with wide brims during the application of pesticides whose labels call for head protection. In this study, four farm workers wore baseball caps and two alternative types of headgear with wide brims for 20 to 36 hours during planting of corn and soybeans to compare performance features and practicality. Afterwards, researchers analyzed the headgear fabrics by gas chromatography or high-performance liquid chromatography to determine the levels at which five herbicides were deposited on the headgear: 2,4-D, metolachlor, acetochlor, ethalfluralin, and glyphosate. Chemical analysis revealed that 12 percent of specimens had detectable residue: levels of glyphosate in the nanograms-per-square-centimeter (ng/cm2) range and levels of 2,4-D in the micrograms-per-square-centimeter (microgram/cm2) range. Workers, however, preferred the baseball caps because of problems with the wind and feelings of embarrassment about wearing other types of headgear. An acceptable, protective substitute for the baseball cap has yet to be designed.

Adult↗

Traumatic brain injury in high school athletes.

CONTEXT: The potential seriousness of mild traumatic brain injury (MTBI) is increasingly recognized; however, information on the frequency of MTBI among high school athletes is limited. OBJECTIVE: To identify the type, frequency, and severity of MTBI in selected high school sports activities. DESIGN: Observational cohort study. SETTING AND PARTICIPANTS: Two hundred forty-six certified athletic trainers recorded injury and exposure data for high school varsity athletes participating in boys' football, wrestling, baseball and field hockey, girls' volleyball and softball, boys' and girls' basketball, and boys' and girls' soccer at 235 US high schools during 1 or more of the 1995-1997 academic years. MAIN OUTCOME MEASURES: Rates of reported MTBI, defined as a head-injured player who was removed from participation and evaluated by an athletic trainer or physician prior to returning to participation. National incidence figures for MTBI also were estimated. RESULTS: Of 23566 reported injuries in the 10 sports during the 3-year study period, 1219 (5.5%) were MTBIs. Of the MTBIs, football accounted for 773 (63.4%) of cases; wrestling, 128 (10.5%); girls' soccer, 76 (6.2%); boys' soccer, 69 (5.7%); girls' basketball, 63 (5.2%); boys' basketball, 51 (4.2%); softball, 25 (2.1%); baseball, 15 (1.2%); field hockey, 13 (1.1%); and volleyball, 6 (0.5%). The injury rates per 100 player-seasons were 3.66 for football, 1.58 for wrestling, 1.14 for girls' soccer, 1.04 for girls' basketball, 0.92 for boys' soccer, 0.75 for boys' basketball, 0.46 for softball, 0.46 for field hockey, 0.23 for baseball, and 0.14 for volleyball. The median time lost from participation for all MTBIs was 3 days. There were 6 cases of subdural hematoma and intracranial injury reported in football. Based on these data, an estimated 62816 cases of MTBI occur annually among high school varsity athletes participating in these sports, with football accounting for about 63% of cases. CONCLUSIONS: Rates of MTBI vary among sports and none of the 10 popular high school sports we studied is without the occurrence of an MTBI. Continued involvement of high school sports sponsors, researchers, medical professionals, coaches, and sports participants is essential to help minimize the risk of MTBI.

Adolescent↗

Posterior shoulder pain in throwing athletes with a Bennett lesion: factors that influence throwing pain.

A Bennett lesion is a bony spur at the posterior glenoid that is often seen in baseball players and usually asymptomatic. However, it sometimes becomes painful, but the mechanism of throwing pain is still unknown. The purposes of this study were to identify clinical characteristics associated with the Bennett lesion causing shoulder pain (painful Bennett lesion) and to try to predict which type of Bennett lesion might become painful. Several clinical factors in 51 consecutive baseball players who underwent arthroscopic surgery were investigated. Of these baseball players, 24 had a bony spur: 13 were diagnosed as having a painful Bennett lesion and 11 were diagnosed as having an asymptomatic Bennett lesion, according to our previously reported criteria. The other 27 players did not have a bony spur. Posterior joint laxity, no deficit of internal rotation, and an avulsed fragment on computed tomography scan were determined to be the characteristic clinical features in the shoulders with a painful Bennett lesion.

Adolescent↗

Impact of Yankee Stadium Bat Day on blunt trauma in northern New York City.

STUDY OBJECTIVE: To determine the incidence of blunt trauma in northern New York City before and after the distribution of 25,000 baseball bats at Yankee Stadium. DESIGN: Prospective multicenter study, including ten days before and ten days after Bat Day (June 3, 1990). SETTING: Ten emergency departments in the Bronx and northern Manhattan. TYPE OF PARTICIPANT: All patients presenting to the ED with baseball bat injuries. INTERVENTIONS: Each hospital collected the following data for each subject: date and time of injury, patient's age and sex, extent of injury, whether a Yankee bat was used, presence of loss of consciousness, results of computed tomography scan of the brain (if performed), history source, and disposition of the patient. Average daily atmospheric temperature was recorded for each day of the study. MEASUREMENTS AND MAIN RESULTS: Seventy-seven patients sustained bat injuries, 38 (49%) before and 36 (47%) after Bat Day. There were no significant differences between the two groups with respect to age, sex, time of injury, number and distribution of fractures and lacerations, incidence of loss of consciousness, source of history, or dispostion. There was a positive association between the number of cases on a given day and the average temperature that day (r = .5; P < .01). CONCLUSION: The distribution of 25,000 wooden baseball bats to attendees at Yankee Stadium did not increase the incidence of bat-related trauma in the Bronx and northern Manhattan. There was a positive correlation between daily temperature and the incidence of bat injury. The informal but common impressions of emergency clinicians about the cause-and-effect relationship between Bat Day and bat trauma were unfounded.

Adolescent↗