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PubMed2005

Clinical Measures of Shoulder Mobility in the Professional Baseball Player.

Context: Professional baseball players must achieve a delicate balance between shoulder mobility and stability to attain optimal sports performance. The sport-specific demands of repetitive overhead throwing may result in an altered mobility-stability relationship.Objective: To evaluate clinical measures of shoulder mobility in professional baseball players in order to examine differences between the throwing and the nonthrowing shoulders and to describe chronic adaptations to throwing.Design: Descriptive.Setting: The athletic training room at Maryvale Baseball Park, Phoenix, AZ.Patients or Other Participants: Twenty-seven professional baseball players (20 pitchers, 7 position players; age = 20 +/- 1.6 years, height = 190.5 +/- 4.8 cm, mass = 91.6 +/- 9.6 kg) with no previous history of shoulder or elbow injury.Main Outcome Measure(s): We recorded scapular upward rotation at 4 levels of humeral elevation in the scapular plane (rest, 60 degrees , 90 degrees , 120 degrees ); posterior shoulder tightness; and passive, isolated glenohumeral joint internal and external range of motion.Results: Scapular upward rotation was significantly greater in the throwing shoulder (14.2 +/- 6.5 degrees ) than in the nonthrowing shoulder (10.6 +/- 6.1 degrees ) at 90 degrees of humeral elevation (P = .04). We observed no statistically significant difference in posterior shoulder tightness between the throwing (30.2 +/- 4.6 cm) and the nonthrowing (28.0 +/- 4.8 cm) shoulder (P = .09). In addition, the throwing shoulder exhibited a statistically significant decrease in isolated glenohumeral internal rotation (56.6 +/- 12.5 degrees ) compared with the nonthrowing shoulder (68.6 +/- 12.6 degrees ) (P = .001), with a concomitant increase in isolated glenohumeral external rotation (throwing = 108.9 +/- 9.0 degrees , nonthrowing = 101.9 +/- 5.9 degrees , P = .0014). An analysis of the total arc of motion (internal rotation + external rotation) revealed no statistically significant difference between sides (P = .15).Conclusions: The throwing shoulder exhibited significant differences in scapular and glenohumeral mobility compared with the nonthrowing shoulder. Further research is necessary to determine the relation of these adaptive changes, if any, to shoulder injury and disability.

Journal Article↗
PubMed2004

Predictive control of body mass trajectory in a two-step sequence.

During a step, the body enters a state of falling as a foot is lifted from the ground. This has important implications for the control of body trajectory when stepping in different directions. A model has been proposed in which the central nervous system controls body trajectory by a predictive, ballistic "throw" of the body occurring just before the stepping foot leaves the ground. Here we investigate this model and ask how far into the future the body trajectory is predetermined by this initial ballistic throw. We measured body centre-of-mass (CoM) and foot trajectories during two-step sequences involving stepping onto illuminated targets, one for each foot. The targets were varied spatially such that leading foot placement could be dissociated from final CoM position. The results showed that the body throw was altered when stepping in different directions. However, the throw varied only with leading foot placement and not with final CoM position. Thus, provided the leading foot was placed identically, the same throw was used for steps in which body trajectories would later diverge. Furthermore, these trajectories did not diverge while the stepping foot was in the air but occurred after it touched down. The results are consistent with the ballistic stepping model. However, they suggest that the throw is limited in its predictive capacity, being concerned only with where the stepping foot is to be placed rather than final CoM position. This constitutes a one-step-at-a-time strategy that allows the body to be safely "caught" between steps.

Biomechanical Phenomena↗
PubMed2005

Influence of hand grenade weight, shape and diameter on performance and subjective handling properties in relations to ergonomic design considerations.

Three hand-grenade design factors, namely shape (ball, oval, can), diameter (55, 60, and 65 mm) and weight (300, 400, and 500 g), were assessed. The objective criteria were (1) throwing distance from the grenade stop point to throwing point, and (2) error distance from the grenade stop point to the target. The subjective criteria were (3) the overall rating of handling (to hold and control) properties and (4) the rating of perceived exertions of throwing strength. Twenty ROC Army soldiers threw a Mark II practice grenade to familiarize them with the throwing procedure, and then, while standing, threw 21 experimental, mockup grenades at a target indicated by a flagpole 40 m away from the throwing point. Grenade weight had the greatest effect on both subjective and objective criteria. The 300 g grenade had the greatest throwing distance (38.6+/-6.5 m) and had the greatest accuracy (6.9+/-3.9 m). Grenade shape was also a significant influence based on both the subjective and objective criteria; with the ball shape being the best. Grenade diameter, within the range tested, did not affect either the subjective or objective criteria.

Equipment Design↗
PubMed2005

Assessing the adequacy of endoscopically tied knots: a functional approach.

BACKGROUND AND STUDY AIMS: Endoscopic intracorporeal knots have potentially enormous applications in endoscopic surgery. We describe a method for testing the security of various types of endoscopically tied knots using a vessel perfusion manometer system. METHODS: A 4-cm segment of porcine splenic artery was placed on the mucosal surface of a pig stomach. The two ends of the vessel were brought out through the gastric wall and connected to a two-way manometer. One end was also joined to a pressure infusion bag. The stomach was mounted in an Erlangen training model. A long 3/0 nylon thread, previously introduced into the submucosal layer of the stomach and encircling the vessel, was brought out from the mouth. Three-throw square knots, Mayo knots, "surgeon's" knots and five-throw square knots were tied and pushed into place using a cap attached to a gastroscope. The pressure at the two ends of the artery was compared. If the pressure could be increased to over 200 mm Hg at one end without a change in the other, the knot was considered secure. RESULTS: Each type of knot was tested 12 times under endoscopic vision. The range for mean knotting time was 3.4 - 4.5 minutes. Five-throw knots took significantly longer to tie than three-throw knots (P < 0.005). There was one loose knot in each of the three-throw and Mayo groups, and three each in the "surgeon's" and five-throw groups (P > 0.05). CONCLUSIONS: This system is a reliable model for testing intracorporeal knots tied endoscopically. A three-half-hitches square knot with 3/0 nylon, tied using a flexible endoscope and knot-tightening cap, can withstand pressure up to 200 mm Hg.

Animals↗
PubMed1986

Performance of sliding knots in monofilament and multifilament suture material.

Three different sliding knots were tested using five recently developed monofilament and multifilament suture materials. The resorbable materials were polyglactin-910 (Vicryl), polyglycolic-acid (Dexon-Plus), polyglyconate (Maxon), and polydioxanone (PDS), and the nonresorbable material was polypropylene (Prolene). For each type of sliding knot, three or five throws of suture were tested. Knot strength was determined by the loop holding capacity, which was defined as the strength at which the knot broke, or at which slippage in the knot amounted to more than 2 mm. When the three kinds of sliding knots were compared, identical sliding knots with identical throws around a single suture were found to be the most unreliable. Nonidentical and parallel sliding knots differed little with respect to knot reliability. Five-throw knots were generally stronger than three-throw knots. However, the effect of adding two extra throws to three-throw sliding knots was only significant if monofilament suture material was used. Comparison of the different suture materials revealed major differences in knot holding ability. These findings indicate that knot strength is dependent on both the type of knot and the type of suture material, and surgeons should be cognizant of these variables.

Polydioxanone↗
PubMed1998

Glenohumeral joint: internal and external rotation range of motion in javelin throwers.

OBJECTIVE: To assess differences in glenohumeral joint rotatory range of movement in javelin throwers between the throwing and non-throwing arm. METHOD: A universal 360 degrees goniometer was used to assess glenohumeral joint external and internal rotation range in 90 degrees of shoulder abduction in a group of ten senior international javelin throwers. RESULTS: Both arms had significantly greater degrees of external than internal rotation (p < 0.01), and the throwing arm had significantly greater range of external rotation than the non-throwing arm (p < 0.01). CONCLUSIONS: The presence of an excessive range of external rotation in the throwing shoulder has the potential to increase eccentric load on the rotator cuff muscles and strain on the passive restraints of the glenohumeral joint. Both of these factors have been implicated in the pathological processes leading to injury in the overhead throwing athlete.

Analysis of Variance↗
PubMed2002

Dynamic coordination of body parts during prism adaptation.

We studied coordination across body parts in throwing during adaptation to prisms. Human subjects threw balls at a target before, during, and after wearing laterally shifting prism eyeglasses. Positions of head, shoulders, arm, and ball were video-recorded continuously. We computed body angles of eyes-in-head, head-on-trunk, trunk-on-arm, and arm-on-ball. In each subject, the gaze-throw adjustment during adaptation was distributed across all sets of coupled body parts. The distribution of coupling changed unpredictably from throw to throw within a single session. The angular variation among coupled body parts was typically significantly larger than angular variation of on-target hits. Thus coupled body parts changed interdependently to account for the high accuracy of ball-on-target. Principal components and Monte Carlo analyses showed variability in body angles across throws with a wide range of variability/stereotypy across subjects. The data support a model of a dynamic and generalized solution as evidenced by the distribution of the gaze-throw adjustment across body parts.

Adaptation, Physiological↗
PubMedDate not supplied

An electromyographic analysis of the shoulder during a medicine ball rehabilitation program.

We used dynamic electromyography and a motion analysis system to describe the muscle firing patterns in 10 shoulder muscles and the basic kinematics of a two-handed overhead medicine ball throw. Ten healthy male subjects with no history of shoulder injury were evaluated. The two-handed medicine ball throw was divided into three phases for analysis: cocking, acceleration, and deceleration. The average duration of the throw was 1.92 seconds; the cocking phase represented 56%, the acceleration phase 15.5%, and the deceleration phase 28.5% of the throw. In the cocking phase, the upper trapezius, pectoralis major, and anterior deltoid muscles showed high activity ( > 40% to 60% maximum manual test), and the rotator cuff muscles had moderate activity ( > 20% to 40%). In the acceleration phase, five of the muscles demonstrated high levels of activity ( > 40% to 60%) and the upper trapezius and lower subscapularis muscles had very high levels of activity ( > 60%). Analysis of the deceleration phase revealed high activity in the upper trapezius muscle and moderate activity in all other muscles except the pectoralis major. Our findings support the use of medicine ball training as a bridge between static resistive training and dynamic throwing in the rehabilitation of the overhead athlete. This training technique provides a protective method of strengthening that closely simulates portions of the throwing motion.

Acceleration↗
PubMed2006

Effects of an entire season on physical fitness changes in elite male handball players.

PURPOSE: Fifteen elite male handball players were studied to examine the effects of an entire season of play on physical fitness and throwing velocity. METHODS: One repetition maximal bench press (1RMBP), jumping explosive strength, power-load relationship of the leg and arm extensor muscles, 5- and 15-m sprint running time, endurance running, and handball throwing velocity (standing and three-step running throw) were assessed on four times (T1, T2, T3, and T4), during a 45-wk season. Individual volumes and intensities of training and competition were quantified for 11 activities. RESULTS: From T1 to T3, significant increases occurred in free fatty mass (1.4%), 1RMBP (1.9%), standing throwing velocity (6.5%), and three-step throwing velocity (6.2%). No significant changes were observed throughout the season in endurance running and explosive strength-related variables. Significant correlations (P < 0.05-0.01) were observed between strength training time and changes in standing throwing velocity as well as between high-intensity endurance training time and changes in endurance running. In addition, linear inverse relationships were observed between low-intensity endurance training time and changes in muscle power output of the lower extremities. CONCLUSION: The handball season resulted in significant increases in maximal and specific strength of the upper-extremity but not in the lower-extremity actions. The correlations observed suggest that training time at low intensity should be given less attention, whereas the training stimuli for high-intensity endurance running and leg strength training should be given more careful attention in the full training season program.

Adult↗
PubMed2005

The acute effects of prior dynamic resistance exercise using different loads on subsequent upper-body explosive performance in resistance-trained men.

The purpose of this study was to determine if explosive upper-body performance could be improved when it was preceded by conditioning contraction protocols that incorporate resistance exercise. Providing that performance was enhanced, it was also the intention to determine the optimal conditioning contraction load for enhancing performance. Eight recreationally trained men completed 4 experimental sessions. Each session consisted of a warm-up, 3 bench press throws (pre), a conditioning protocol, and 3 bench press throws (post). The different conditioning protocols consisted of 5 bench press repetitions using 100, 75, or 50% of 5 repetition maximum (5RM) strength. The fourth protocol, in which no repetitions were completed, acted as a control. Participants performed each conditioning protocol on a different day, and the order in which the protocols were performed was randomized. Average power, assessed during the bench press throws, was determined for the starting segment and the end segment (point of bar release) for each throw. Comparisons in average power, for each segment of the bench press 1RM, were made between the pre- and postconditioning protocol bench press throws. None of the conditioning protocols had an effect on bench press throw performance in either of the 2 segments of the movement. The results suggest there is no performance advantage when explosive upper-body movement is preceded by resistance exercise of varying loads. Alternatively, the performance of a set of resistance exercise did not compromise explosive upper-body performance. Considering this, training methods that combine both resistance exercise and plyometric-like exercise may offer a practical and time-efficient training system.

Adaptation, Physiological↗
PubMed2002

Ultrasonographic assessment of the ulnar collateral ligament and medial elbow laxity in college baseball players.

BACKGROUND: The prevalence of medial elbow instability is high in athletes who throw, such as baseball players. The aim of this study was to assess the medial aspect of the elbow with ultrasonography to detect changes in baseball players. METHODS: Ultrasonography of the medial aspect of the elbow was performed, while gravity stress was applied with the elbow in 90 degrees of flexion, on thirty college baseball players (twelve pitchers and eighteen fielders) to assess medial joint laxity and deformity of the ulnar collateral ligament. The dominant (throwing) extremity was compared with the contralateral extremity. Clinical data were correlated with ultrasonographic findings. RESULTS: The medial joint space was significantly wider on the throwing side than it was on the contralateral side (2.7 mm and 1.6 mm, respectively; p < 0.01), and the proximal part of the ulna was shifted significantly laterally on the throwing side (p < 0.01). Angular deformity of the ulnar collateral ligament was found in five subjects, and it was significantly associated with lateral shift of the proximal part of the ulna (p < 0.01). Medial elbow pain was associated with widening of the medial joint space (p < 0.05) and with the presence of angulation of the ulnar collateral ligament (p < 0.01). CONCLUSIONS: Medial elbow laxity and elbow valgus on the throwing side of baseball players were increased compared with those in nonplayers. Angular deformity of the ulnar collateral ligament suggests that the ligament bends over the distal-medial edge of the trochlea. Ultrasonography can provide useful information about the condition of the ulnar collateral ligament and about medial elbow laxity in athletes who throw.

Adolescent↗
PubMed2006

Scapular dysfunction in throwers with pathologic internal impingement.

STUDY DESIGN: Case control group study. OBJECTIVES: To compare scapular position and orientation between baseball players with and without pathologic internal impingement. BACKGROUND: Scapular dysfunction has been implicated as a contributor to throwing-related pathologic internal impingement of the shoulder due to its role in increasing the contact between the greater tuberosity and posterior-superior glenoid, thereby impinging the posterior rotator cuff tendon(s) and labrum. However, to date, no definitive data demonstrate this scapular dysfunction in throwing athletes. The purpose of this study was to assess, in a controlled laboratory environment, whether scapular position and orientation would be different in throwing athletes diagnosed with pathologic internal impingement than in a control group of throwing athletes. METHODS AND MEASURES: Eleven throwing athletes diagnosed with pathologic internal impingement, using both clinical examination and a magnetic resonance arthrogram, were demographically matched with a control group of 11 throwers with no history of upper extremity injury. An electromagnetic tracking device was used to measure scapular internal/external rotation, anterior/posterior tilt, upward/downward rotation, sternoclavicular protraction/retraction, and elevation/depression during humeral elevation within the scapular plane. Comparisons were made between groups with analysis of variance models (P<.05). RESULTS: The individuals in the pathologic internal impingement group demonstrated statistically significant increased sternoclavicular elevation when elevating their humerus from 30 degrees to 120 degrees (P = .002) and from 60 degrees to 120 degrees (P = .003), compared to the control group. Furthermore, these patients also had increased posterior scapular tilt position (P = .016). No statistically significant differences were present in any other scapular variables measured. CONCLUSIONS: Based on the results of this study, throwing athletes diagnosed with pathologic internal impingement present with statistically significant increases in sternoclavicular elevation and scapular posterior tilt position during humeral elevation in the scapular plane.

Adult↗
PubMed2002

Knot security in laparoscopic surgery. A comparative study with conventional knots.

BACKGROUND: Few comparative studies have evaluated conventional and laparoscopic knots. The objective of this study was to evaluate laparoscopic knot reliability and identify which type of knot is most secure. METHODS: Seven types of knots were compared; each one was conventionally tied with four and six throws and similarly by laparoscopy. Dinsmore nomenclature for knots was used. A tension meter was used to evaluate knot reliability, using the loop method, and percentage of failure by slipping and tensile strength was calculated for each group. RESULTS: When S=S=S=S and S=S=S=S=S=S geometry are excluded, there was no difference between laparoscopic and conventional knot. A significant difference between four- and six-throw knots was shown. Excluding S=S=S=S=S=S geometry, all knots in the conventional six-throw group were secure. Intracorporeal 2X1X1X1X1 and 1X1X1X1X1X1 and extracorporeal SXS#SXS#SXS six-throw laparoscopic group knots were secure. CONCLUSIONS: Laparoscopic knots are as secure as conventional knots. All knots must be made with six throws because security is maximized.

Humans↗
PubMed2006

Indirect ultrasound measurement of humeral torsion in adolescent baseball players and non-athletic adults: reliability and significance.

Accurate clinical interpretation of shoulder rotation range requires knowledge of the contribution of humeral torsion. This study compares the reliability of indirectly measuring humeral torsion using ultrasound visualisation with direct palpation and compares the degree of humeral torsion in a non-throwing adult population with a population of elite adolescent baseballers. The reliability of a novel method of indirectly measuring humeral torsion using palpation and ultrasound was established prior to using the ultrasound method to determine the amount of humeral torsion in both humeri of a group of 16 non-throwing subjects and 36 elite adolescent baseball players. Excellent inter-tester reliability was found for the ultrasound method of measuring humeral torsion in each arm (ICC 2,1: 0.98 and 0.94) but poor reliability for the direct palpation method (ICC 2,1: 0.51 and 0.49). Using the ultrasound method, side-to-side differences in humeral torsion ranged from 0 to 13 degrees for the non-throwing group and 0 to 29 degrees for the baseball players. This side-to-side difference was significant in the baseball players (p<0.001) but not significant in the non-throwing group (p=0.43). Whilst side-to-side differences in humeral torsion were noted between all subjects irrespective of arm dominance, only throwers demonstrated consistently greater humeral retrotorsion in their throwing arm. A reliable clinical tool for estimating humeral torsion, such as that employed in this study, will allow for a more valid prescription of interventions for the treatment of shoulder dysfunction.

Adolescent↗
PubMed2000

Predicting combinations of left and right asymmetries.

This paper explains how combinations of asymmetries for pairs of laterality variables may be predicted. It shows that many pairs combine as expected by chance, plus the influence of the RS+ gene hypothesised by Annett (1978, 1985). These include: eye dominance with writing hand, with throwing hand, and with foot for kicking; nonright handedness with planum temporale asymmetry, with asymmetry of the parietal operculum, and the association between these two anatomical asymmetries. Handedness for writing and throwing, and hand and foot preferences are more strongly associated, suggesting the presence of an additional influence. The reliability of the present analyses was supported by replication, especially in findings for hand preferences for writing and throwing described by Gilbert and Wysocki (1992). The relative frequencies of discordant patterns of preference, LR (writing, throwing) versus RL, are a function of the frequencies of the two variables in the population. These differ between age groups and also with the classification of 'either' hand preferences. Patterns of preference for writing, throwing and eye-dominance (RRR, RRL etc) are related in an orderly manner to differences between the hands for peg moving time. The success of the present application of the RS theory strengthens the argument that individual differences for hand preference depend on a continuous distribution of asymmetry, not on the 'types' commonly assumed in the literature.

Adult↗
PubMed1992

Information feedback and the learning multiple-degree-of-freedom activities.

The influence of information feedback on the learning of a multiple-degree-of-freedom activity, the overhand throw, was investigated. During learning, feedback was presented in the form of knowledge of results, knowledge of performance, knowledge of performance with attention-focusing cues, or knowledge of performance with error-correcting transitional information. Across 12 practice sessions, performance was assessed with respect to both throwing distance and throwing form. Subjects provided with knowledge of performance along with transitional information demonstrated significant gains in throwing distance, compared with subjects receiving knowledge of performance or knowledge of results alone. Movement form ratings followed the same trend. Providing learners with cues to focus their attention on the relevant aspects of knowledge of performance or directly providing transitional information was a better aid to the acquisition of throwing form than providing knowledge of results or knowledge of performance alone. These results support the hypothesis that knowledge of results may not be the most potent form of feedback in multiple-degree-of-freedom activities and that knowledge of performance, when combined with additional information, can lead to significant gains in skill acquisition.

Journal Article↗
PubMed2005

Diagnosis, treatment, and rehabilitation of the thrower's elbow.

The overhead throwing motion generates enormous force in the elbow. Repetitive near failure loads lead to chronic adaptive changes and occasionally acute injury. The physician caring for the thrower must understand the complex anatomy and function of the elbow joint, along with the biomechanics of throwing, to accurately diagnose and treat elbow pathology. Evaluation of elbow pain in the throwing athlete must begin with a thorough and detailed throwing history including duration of symptoms, location of pain, timing during the phases of throwing motion, and associated symptoms. Physical examination should include inspection, range of motion, palpation, and specific tests to better define the pathology. A detailed history and physical examination will allow the astute clinician to obtain the proper diagnosis and start the appropriate operative or nonoperative treatment often without reliance on ancillary testing. Treatment and rehabilitation of these injuries must be tailored to the pathology present and focused towards a return to the athlete's activity.

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↗