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PubMed1999

Decision training: the effects of complex instruction, variable practice and reduced delayed feedback on the acquisition and transfer of a motor skill.

Novice, intermediate and advanced baseball hitters followed a 7-week training programme, in which they received either behavioural training or decision training. Participants in the behavioural training group received simple-to-complex instruction, variable practice and an abundance of feedback throughout the acquisition period; the decision training group received complex instruction, variable practice and reduced delayed feedback. As predicted, the intermediate and advanced hitters who received decision training hit at a lower level (%) during acquisition but at a higher level during a transfer test in week 7. Novices in the behavioural training group were better than novices in the decision training group over both acquisition and transfer trials.

Adolescent↗
PubMed1986

Electromyography and motion analysis of the upper extremity in sports.

This article reviews the results of studies using electromyographic recordings to determine muscle function during athletic activities. Electromyographic recordings were synchronized with high-speed film to provide information on shoulder muscle firing patterns during baseball pitching, swimming, tennis, and golf. The information obtained about the contributions of specific muscles during these activities may be useful in developing effective injury prevention and rehabilitation strategies.

Baseball↗
PubMed2006

Rare bilateral C6 spondylolysis and spondylolisthesis in an adolescent athlete: evaluation with magnetic resonance imaging and multidetector computerized tomography.

STUDY DESIGN: Case report. OBJECTIVE: To show a rare case of cervical spondylolysis and spondylolisthesis secondary to bilateral stress fractures at the pedicle laminar junction of C6 in a 16-year-old athlete playing high school baseball. SUMMARY OF BACKGROUND DATA: The patient presented with 3 months of neck pain and intermittent right arm radicular symptoms. METHODS: Plain radiographs and multidetector computerized tomography (CT) of the cervical spines. RESULTS: Plain radiographs revealed loss of lower cervical lordosis. Multidetector CT indicated bilateral C6 spondylolysis. Magnetic resonance imaging showed bilateral marrow edema at the pedicle laminar junction of C6. Treatment included placing his neck in a Philadelphia collar for 6 weeks. Follow-up CT revealed progression of healing. CONCLUSION: Early diagnosis and appropriate management of these cases are important to promote healing.

Adolescent↗
PubMed2005

Catastrophic spine injuries in sports.

Catastrophic spine injuries in sports are rare but tragic events. The sports with the highest risk of catastrophic spinal injuries are football, ice hockey, wrestling, diving, skiing and snowboarding, rugby, cheerleading, and baseball. A common mechanism of injury for all at-risk sports is an axial compression force to the top of the head with the neck slightly flexed. We review common mechanisms of injury and prevention strategies for spine injuries in the at-risk sports.

Adult↗
PubMed2006

Evaluation and treatment of medial ulnar collateral ligament injuries in the throwing athlete.

Medial ulnar collateral ligament (UCL) injuries are common and are seen most frequently in baseball pitchers. Appropriate recognition, treatment, and rehabilitation are necessary to ensure the best chance for return to preinjury levels of participation. Participation in competitive sports may be disrupted for 6 months to 1 year when treated optimally. Abstinence from play may be prolonged when treatment is delayed or if conservative treatment fails; this delay carries significant consequences to the professional, collegiate, and high school athlete. The orthopedic literature is replete with recommendations for the care of these athletes. These recommendations are generally based on retrospective reviews. The purposes of this paper are 3-fold: to provide background knowledge on this injury, to synthesize the current knowledge on the diagnosis, treatment, and rehabilitation of athletes with medial UCL injuries, and lastly, to provide a treatment algorithm for athletes with UCL injuries.

Arm Injuries↗
PubMed2006

The pediatric overhead athlete: what is the real problem?

OBJECTIVE: The purposes of this article are to examine shoulder and elbow injuries in pediatric athletes, to evaluate the pathophysiology and pathomechanics that may be associated with the pathoanatomy, and to present suggestions for the prevention of those injuries. DATA SOURCES: This article will review the published sports medicine literature on these topics in baseball and tennis injuries and present a kinetic chain-based perspective on the possible causative factors that are present in the young thrower. RESULTS: The published literature shows that there are multiple intrinsic and extrinsic factors that contribute to the risk of injury in young throwing athletes. These factors appear to develop over time; if not recognized or addressed early, they have undesirable outcomes. CONCLUSIONS: A multitude of factors, including anatomical, biomechanical, and environmental concerns, can contribute to the dysfunction of the shoulder and elbow in young overhead athletes. Understanding the force-generating and load-absorbing processes of the body will help clinicians, coaches, and others prevent or limit the deleterious effects of such occurrences.

Adolescent↗
PubMed1999

Clinical profile of commotio cordis: an under appreciated cause of sudden death in the young during sports and other activities.

Not particularly well recognized are athletic field catastrophes in which virtually instantaneous cardiac arrest is produced by nonpenetrating chest blows in the absence of heart disease or identifiable morphologic injury to the chest wall or heart (commotio cordis). To better characterize the clinical profile of this syndrome, we have assembled 70 cases, including 34 occurring during organized competitive athletics and 36 others that occurred during informal recreational sports at home, school or the playground, or during nonsporting activities. Ages were 2 to 38 (mean age: 12) with 70% < 16 years old. Most common sports involved were youth baseball (n = 40), softball (n = 7), and ice hockey (n = 7). Seven (10%) of the 70 commotio cordis victims, including six with documented ventricular fibrillation, have survived the consequences of their chest blow. Eleven of the events (16%) occurred despite the presence of chest padding believed to be potentially protective. Four victims experienced modest chest blows while in circumstances completely unrelated to sports activities; three of the four individuals who delivered these blows were ultimately convicted of criminal acts within the justice system. An experimental model of low-energy chest wall impact demonstrates that commotio cordis events are due largely to the exquisite timing of blows during a narrow window within the repolarization phase of the cardiac cycle, 15 to 30 msec prior to the peak of the T wave.

Adolescent↗
PubMed2006

Scapulothoracic latent muscle reaction timing comparison between trained overhead throwers and untrained control subjects.

AIM: This study evaluated select scapulothoracic muscles for training-induced latent muscle reaction timing (LMRT) changes. Comparisons were also made between the dominant and non-dominant upper extremities and between individual muscles. MATERIALS AND METHODS: Fifteen male trained overhead throwers (college baseball pitchers) and 15 male untrained, age-matched control subjects participated in this study. Scapulothoracic muscle activation data were collected as subjects attempted to stop a variably timed, sudden glenohumeral joint internal rotation perturbation. RESULTS: Training group differences were not evident for LMRT (P=0.56), however upper extremity dominance (P=0.003) and test muscle (P=0.0002) displayed significant differences. Dominant upper extremity upper trapezius muscle LMRT (72.5+/-26 ms) occurred later than non-dominant upper trapezius muscle LMRT (60.0+/-14.1 ms, P=0.001). Dominant upper extremity middle trapezius-rhomboid muscle LMRT (60.0+/-16.2 ms) occurred later than non-dominant middle trapezius-rhomboid muscle LMRT (50.2+/-12.6 ms, P=0.004). Dominant upper extremity upper trapezius muscle LMRT also occurred later than serratus anterior (55.7+/-16.0 ms, P=0.001) and middle trapezius-rhomboid LMRT (60.2+/-16 ms, P=0.003). Mean overall dominant upper extremity LMRT (62.7+/-19.4 ms) was delayed compared with mean overall non-dominant upper extremity LMRT (53.9+/-12.4 ms, P=0.003). CLINICAL CONSEQUENCES: Although training was not found to influence scapulothoracic LMRT, differences were observed between the dominant and non-dominant upper extremities. Consistent LMRT delays at the dominant upper extremity suggest possible neuromuscular timing differences to enable prolonged glenohumeral joint and scapulothoracic articulation acceleration before deceleration through eccentric muscle activation. Both trained and untrained overhead throwers displayed this response. Variable perturbation test velocities, and in-season testing of larger subject groups may be needed to better elucidate the more subtle differences associated with training.

Adolescent↗
PubMed2005

Interventions to prevent softball related injuries: a review of the literature.

OBJECTIVES: To examine the published evidence on interventions to prevent softball related injuries among adults, and to encourage more epidemiologic research as a foundation for future softball injury prevention efforts. METHODS: The authors reviewed literature identified from six electronic databases for studies on softball related injuries. The search was limited to studies written in the English language, published between 1970 and 2002, and involving adult populations. Research was excluded that evaluated baseball ("hard ball") related injuries or was aimed at injury treatment. Identified studies were categorized by study design. Intervention/prevention papers were evaluated further and described in detail. RESULTS: The search strategy identified 39 studies specifically related to softball. Most studies were case reports/case series (n=13) or descriptive studies (n=11); only four were analytic or intervention/prevention studies. Studies collected data in a variety of ways, often without denominator data to permit calculation of injury rates. Studies also did not differentiate between slow or fast pitch softball activities and most did not mention the type of softball that was used. CONCLUSIONS: Surprisingly few studies exist on interventions to reduce injuries during softball, one of the most popular recreational sports in the US. Of the existing literature, much attention has been on sliding related injuries, which comprise only a segment of softball injuries. Basic epidemiologic studies describing the nature, severity, and risk factors for softball injuries in a variety of populations are needed, followed by additional intervention evaluation studies aimed at modifiable risk factors.

Adult↗
PubMed2000

Dangerous impact--commotio cordis.

Sudden death following blunt chest trauma is a frightening occurrence known as 'commotio cordis' or 'concussion of the heart'. It is speculated that commotio cordis could be caused by ventricular fibrillation secondary to an impact-induced energy that was transmitted via the chest wall to the myocardium during its vulnerable repolarization period. We describe a survivor of commotio cordis caused by a baseball. In this patient, an initial ventricular fibrillation was documented and converted by direct current defibrillation. Serial electrocardiographic changes (bifascicular conduction block and T wave inversion in precordial leads) were noticed in this patient. Our case suggested that coronary vasospasm might also play a role in commotio cordis.

Baseball↗
PubMedDate not supplied

A clinical and roentgenographic study of Little League elbow.

BACKGROUND: Comparisons of medial elbow injury rate and the incidence of clinical and radiographic findings among Little League baseball players have not been documented. HYPOTHESIS: Injury rate and clinical and radiographic findings in Little Leaguers of different positions may be similar. STUDY DESIGN: Survey and retrospective review. METHODS: Altogether, 343 Little Leaguers (120 pitchers, 40 catchers, and 183 fielders) participated in the study. The survey (including age, playing position, playing experience, and symptoms), clinical examination, and roentgenogram of both elbows were obtained for analysis using Pearson's chi-square test. RESULTS: Clinically, 58% of the pitchers presented with soreness compared to 63% in catchers and 47% in fielders. Radiographic examination revealed hypertrophy of the medial humeral epicondyle in all pitchers and catchers and 90% of the fielders. Separation of the medial epicondyle was found in 63% of pitchers, 70% of catchers, and 50% of fielders, while fragmentation was found in 19% of pitchers, 40% of catchers, and 15% of fielders. In subjects with separation or fragmentation, 49% and 56% complained of elbow soreness, respectively. CONCLUSION: Similar rates of medial elbow changes in Little Leaguers may imply that the roentgenological changes of the medial epicondyle could be an adaptive yet physiological reaction to the excessive valgus stress of throwing. The higher incidence of medial epicondylar separation and fragmentation in catchers that has not been reported before may be secondary to the increased stress placed on the elbow when throwing from the squatting position.

Athletic Injuries↗
PubMedDate not supplied

Avulsion fracture of the ulnar sublime tubercle in overhead throwing athletes.

BACKGROUND: Injuries to the ulnar collateral ligament are relatively common in throwing athletes and result from either acute traumatic or repeated valgus stress to the elbow. Avulsion fracture of the sublime tubercle of the ulna is a rarely reported site of ulnar collateral ligament injury. PURPOSE: We retrospectively reviewed our cases of ulnar collateral ligament injuries to study avulsion fractures of the sublime tubercle of the ulna. STUDY DESIGN: Case series. METHODS: Data, including radiographs and magnetic resonance imaging scans, were obtained by review of hospital and office records and by follow-up examination. Of 33 consecutive patients treated for ulnar collateral ligament injuries, 8 had avulsion fractures of the sublime tubercle of the ulna. All eight were male baseball players with dominant arm involvement, an average age of 16.9 years, and an average follow-up of 23.6 months. RESULTS: Six of eight patients had failure of nonoperative treatment and required surgical repair. Two of the six underwent ulnar collateral ligament reconstruction and four had direct repair of the sublime tubercle avulsion with bioabsorbable suture anchors. At last follow-up, all eight had returned to their preinjury level of activity. No patient had residual medial elbow pain or laxity. CONCLUSIONS: Diagnosis of sublime tubercle avulsion fracture is made with history, physical examination, and radiographic studies. Magnetic resonance imaging can help identify an avulsion fracture not visible radiographically and can help determine whether direct repair or reconstruction is needed.

Adolescent↗
PubMedDate not supplied

Head-first versus feet-first sliding: a comparison of speed from base to base.

BACKGROUND: Two basic baseball sliding techniques, feet-first and head-first, are taught at all levels of play. Because of the risk for injury to the upper extremities and the cervical spine during head-first sliding, it is potentially more dangerous than feet-first sliding. There is an assumption among coaches that head-first sliding is more aggressive and faster, but there has been no scientific study to prove this claim. PURPOSE: The purpose of this study was to determine which technique provides a faster slide into the base. STUDY DESIGN: Controlled field study. METHODS: A total of 60 players ranging from Little League to college level was analyzed. Each athlete was evaluated three times from a standing start at first base to either a head-first or feet-first touch of second base. Each athlete was also timed in a 40-yard sprint and his or her preferred sliding technique was recorded. RESULTS: We found no statistically significant difference in speed between head-first and feet-first sliding at all levels of play in this study.

Adolescent↗
PubMedDate not supplied

Prevalence of the Bennett lesion of the shoulder in major league pitchers.

BACKGROUND: The Bennett lesion is a mineralization of the posterior inferior glenoid noted in overhead throwing athletes. Although previous studies have debated appropriate treatment of the lesion, no studies have indicated the lesion prevalence in throwing athletes. HYPOTHESIS: The Bennett lesion is more common than previously believed and may represent an asymptomatic finding. STUDY DESIGN: Uncontrolled retrospective review. METHODS: Fifty-five asymptomatic major league pitchers underwent routine preseason radiographic screening. Radiographs were reviewed for the presence of a Bennett's lesion. Player demographics, pitching, and baseball records were reviewed to obtain the patient's dominant arm, age, years and innings pitched, and time on the disabled list or surgery. RESULTS: Twelve pitchers (22%) were noted to have a radiographic Bennett lesion. No statistically significant difference was noted in age, years pitched, or innings pitched between pitchers with and without a Bennett lesion. No player who demonstrated a Bennett lesion required surgical treatment for shoulder pain during his time with the club. Two players required time on the disabled list, but neither player had complaints of posterior shoulder pain. CONCLUSIONS: This lesion is a relatively common finding in major league pitchers. Concomitant pathology should be suspected when evaluating throwers with posterior shoulder pain and this lesion.

Adult↗
PubMed2005

Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes.

PURPOSE: To evaluate the results of arthroscopic repair of type II superior labral anterior posterior lesions of the shoulder in overhead athletes. HYPOTHESIS: Such repair is useful for overhead athletes in terms of postoperative sports activity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The study group was composed of 40 patients with a mean age of 24 years (range, 15-38 years); mean follow-up was 41 months (range, 24-58 months). They were divided into an overuse (n=22) and a trauma group (n=18). The authors used 2 suture anchors loaded with a nonabsorbable suture at the 11-o'clock and 1-o'clock positions through the anterosuperior and lateral trans-rotator cuff portal. A modified Rowe score and postoperative athletic activities were evaluated. RESULTS: After arthroscopic repair, mean modified Rowe scores improved from 27.5 to 92.1 points (P<.0001). Rated on this scale, the results were excellent in 30 (75%), good in 6 (15%), and fair in 4 (10%) athletes; there were no poor results. Satisfactory outcomes were achieved in 36 (90%) of these patients; 30 (75%) experienced a return to the preinjury level. The complete return rate of baseball players in the overuse group was lower than that of other overhead athletes in the trauma group. CONCLUSION: Arthroscopic superior labral repair is a safe and reliable procedure in overhead athletes.

Adolescent↗
PubMed2005

Arthroscopic treatment of posterolateral elbow impingement from lateral synovial plicae in throwing athletes and golfers.

BACKGROUND: Although elbow pain is common in throwing athletes and golfers, posterolateral impingement from a hypertrophic synovial plica is a rare but possibly underdiagnosed condition. PURPOSE: To evaluate the clinical results of arthroscopic treatment of symptomatic lateral elbow plicae in this athletic population. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twelve patients, 9 male and 3 female, whose mean age was 21.6 years (range, 17-33 years), were reviewed. There were 7 baseball pitchers, 2 softball players, and 3 golfers. All patients had diagnosed isolated lateral elbow plica; none had lateral epicondylitis, instability, osteochondritis dissecans, arthritis, loose bodies, or nerve conditions. The mean time from onset of symptoms to treatment was 9.25 months (range, 3-24.5 months). At a mean follow-up of 33.8 months (range, 24-65.5 months), patients were evaluated with a questionnaire and examination, based on the American Shoulder and Elbow Surgeons standardized elbow assessment and previously reported elbow outcome score. RESULTS: Posterolateral elbow pain was present in all patients. Fifty-eight percent (7 of 12 patients) complained of clicking or catching, whereas only 25% (3 of 12) experienced swelling or effusion. At elbow arthroscopy, a thickened synovial lateral plica was debrided in all cases. Ninety-two percent (11 of 12 patients) reported an excellent outcome with a mean elbow score of 92.5 points (maximum, 100 points). Return to competitive play averaged 4.8 months (range, 3-9.5 months). One patient with a fair outcome developed medial elbow instability that later required reconstructive surgery. CONCLUSION: Posterolateral elbow impingement from hypertrophic synovial plicae can cause significant pain and disability in throwing athletes and golfers. With careful diagnosis and exclusion of other elbow problems, treatment with arthroscopic debridement and focused rehabilitation is highly successful and allows these athletes to return to their previous level of play.

Adolescent↗
PubMedDate not supplied

Surgical management of osteochondritis dissecans of the capitellum.

Ten cases of osteochondritis dissecans of the humeral capitellum which were treated surgically are reviewed. All 10 cases were males and involved the dominant side. The ages at surgery ranged from 13 to 17 years. Follow-up ranged from 1 to 7 years. All of the youths had competed in organized athletics, either baseball or football. By position there were three pitchers, two catchers, two infielders, and one outfielder; in addition there were one quarterback and one linebacker. Only one patient presented with locking of the elbow, whereas the others presented with pain and limitation of extension. The locked elbow was explored immediately and the others were explored after immobilization failed to relieve their symptoms. In seven of the joints a loose fragment of the capitellum was found lying either in the joint or in a defect in the capitellum. The fragment had multiple small holes. In three cases there was no loose fragment. In this situation a corticol window was cut above the capitellum. The capitellum was then drilled and bone was grafted from above. Over all, there were one excellent, six good, one fair, and two poor results. There seemed to be little difference between curretting alone or curetting and drilling. The cases with the cartilage intact and bone grafted from above did worse, with one fair and one poor result of three cases. The two poor results required further surgery, which consisted of partial excision of the capitellum. All cases lacked elbow extension before and after surgery, but nine of 10 gained some motion after surgery. Pre- and postoperative x-rays are shown in this report and a brief review of the literature concerning osteochondritis dissecans is presented.

Adolescent↗
PubMedDate not supplied

Valgus extension overload in the pitching elbow.

Five baseball pitchers, three college and two professional, with an average age of 24 years, exhibited pain between the acceleration phase and follow-through phase of the pitching motion. This caused the players to be unable to continue at the level of competition necessary to play. A significant osteophyte on the posteromedial aspect of the olecranon process was identified in all pitchers. This caused impingement with the articular wall of the olecranon fossa and often created an area of chondromalacia. The more commonly identified posterior osteophyte was present in all cases. However, if just this posterior osteophyte is removed, the described lesion will be missed, with resultant persistent disability. Surgical excision of the posteromedial osteophyte through a relatively atraumatic posterolateral approach allowed early return of function without morbidity. With an average follow up of 1 year, all of the pitchers returned for one full season at maximum effectiveness.

Adult↗