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PubMedDate not supplied

Little Leaguer's shoulder. A report of 23 cases.

Twenty-three cases of Little Leaguer's shoulder were reviewed including the history and physical examination findings, as well as bilateral internal and external rotation anteroposterior comparison radiographs of the proximal humerus. The average follow-up was 9.6 months (range, 1.5 to 54), and all patients were observed until they had either returned to baseball or their symptoms had resolved. The average age of the patients in this series was 14 years. The chief complaint in all patients was pain localizing to the proximal humerus during the act of throwing. The average duration of symptoms was 7.7 months. Nineteen patients (83%) were pitchers. Physical examination revealed tenderness to palpation over the proximal humerus in 20 patients (87%), with 16 (70%) demonstrating specific tenderness over the lateral aspect of the proximal humerus. Swelling, weakness, atrophy, and loss of motion were uncommon findings. All 23 patients demonstrated radiographic widening of the proximal humeral physis of the throwing arm on internal and external rotation comparison anteroposterior radiographs of the shoulder. All patients were treated with rest from baseball throwing for an average of 3 months. Twenty-one of the 23 patients (91%) returned to playing baseball and were asymptomatic. The classic radiographic finding of widening of the proximal humeral physis can easily be seen on bilateral anteroposterior internal and external rotation radiographs of the proximal humerus. Rest from throwing for at least 3 months is recommended, followed by a gradual return to throwing in an asymptomatic shoulder.

Adolescent↗
PubMed2006

Glenohumeral range of motion and stiffness in professional baseball pitchers.

PURPOSE: This study was conducted to perform kinematic measures in a group of asymptomatic professional baseball pitchers to determine side-to-side differences in passive glenohumeral range of motion (ROM) and stiffness. We hypothesized that the throwing shoulder in asymptomatic pitchers would display greater passive glenohumeral stiffness than the contralateral nonthrowing shoulder. METHODS: Thirty-four professional baseball pitchers had bilateral assessments for passive glenohumeral ROM and stiffness during a single test session. ROM and stiffness measures were obtained objectively using standard goniometry and instrumented stress arthrometry, respectively. RESULTS: The throwing shoulder had significantly less (-8.5 degrees) internal rotation and significantly more external rotation (5.1 degrees) than the nonthrowing shoulder (P < 0.01). Passive joint stiffness was not significantly different between the throwing and nonthrowing shoulder, and anterior joint stiffness was significantly greater than posterior joint stiffness for both shoulders (P < 0.05). CONCLUSIONS: The repetitive stress of long-term throwing creates altered glenohumeral rotational patterns in the throwing shoulder of the professional baseball pitcher without compromising the joint's passive restraining quality.

Adult↗
PubMed2005

Puncture wounds by driftwood catfish during bucket baths: local habits of riverside people and fish natural history in the Amazon.

OBJECTIVE: To assess the prevalence of stings by small spiny driftwood catfish (carataí) of the genus Centromochlus (Auchenipteridae) accidentally caught in buckets during bucket bathing by riverside people along the Brazilian Amazon and to determine the probability of catching specimens of these fish during random throws of a bucket into the river. METHODS: We interviewed 27 adult residents living at the confluence of the Negro and Solimões rivers in Brazil regarding whether or not they had ever been stung by driftwood catfish while bucket bathing. To assess the likelihood of catching catfish in bathing buckets, we randomly threw a typical plastic bucket used for bathing in 4 series of 10 throws into the river at dusk or night around a floating house. RESULTS: Seventeen of the 27 subjects (63%) reported being injured by driftwood catfish during bucket bathing. Three individuals (17.6%) had been injured 2 to 3 times, totaling 23 puncture accidents. All stings occurred at dusk or early night. In the 4 series of 10 bucket throws, we caught 3 driftwood catfish (in 1 series we did not catch any fish). Thus, the chance of catching a driftwood catfish in a single bucket throw at dusk was slightly less than 10%. CONCLUSIONS: The prevalence of stings by driftwood catfish to people bucket bathing in this section of the Brazilian Amazon is high, partly because of the relatively high chances of catching these small catfish during random throws of a bathing bucket into the river.

Adult↗
PubMed2002

Little league elbow: valgus overload injury in the paediatric athlete.

This article describes a variety of elbow injuries often seen in young, throwing athletes. Understandings of normal skeletal development, as well as the biomechanics of throwing, provide a basis on which to evaluate, diagnose and manage "little league elbow". With emphasis on an anatomically-based differential diagnosis, the pathologic forces placed upon the young thrower's elbow, and the subsequent injury patterns, are reviewed. Medial side injuries are the most common and relate to chronic forces of valgus overload produced during the early and late cocking phases of throwing. The majority of this force is placed on the medial epicondyle and produces age-dependent injury patterns, such as apophysitis in childhood and epicondylar avulsion fractures in the more mature athlete. With repetitive valgus overload, lateral side injuries such as Panner's disease and osteochondritis dissecans of the capitellum and radial head become more apparent. These injuries relate to the compressive forces produced by the late cocking and early acceleration phases of throwing. Finally, posterior injury patterns consistent with olecranon apophysitis and posteromedial impingement, as well as flexion and capsular contracture, can be seen. The key in the treatment of "little league elbow" is prevention and this responsibility lies not only with the evaluating or team physician, but also with the coach, trainer, parents and officials. Proper throwing mechanics must be emphasised at an early age, and the determinants of elbow injury among young pitchers better understood. Early recognition and proper treatment of such injuries will then prevent later sequelae or functional disability.

Athletic Injuries↗
PubMed1978

Effects of special instruction and practice by preschool age children on performance of object projection and stability tests.

Four criterion measures were used to assess the vulnerability to change of two variables, stability and object projection, included in a perceptual-motor enhancement program for 60 boys and girls enrolled in a 20-wk., 20-session program, as were 36 male and female controls. Both samples ranged in age from 2 yr., 0 mo. to 5 yr., 8 mo., and all were within the normal range of development. Three beam-walking tests (the beam at different heights and angles) and the overhand throw comprised the criterion measures used for assessment of program effectiveness in stability and object projection. Stability measures were distance divided by time, and object projection scores were determined by velocity of the overhand throw. A three-factor analysis of covariance was utilized to determine significant main effects of age, sex, and treatment. No significant differences were observed. Analysis by age and sex were significantly different on the Inclined Beam test. Analysis by treatment yielded significant differences on the Inclined Beam test and the Overhand Throw. Analysis by age and by sex showed a significant difference in the performance of the Overhand Throw. In summary, performance status of the overhand throw by preschool age children can be improved beyond maturational expectations through guided instruction.

Age Factors↗
PubMedDate not supplied

Prism adaptation and aftereffect: specifying the properties of a procedural memory system.

Prism adaptation, a form of procedural learning, is a phenomenon in which the motor system adapts to new visuospatial coordinates imposed by prisms that displace the visual field. Once the prisms are withdrawn, the degree and strength of the adaptation can be measured by the spatial deviation of the motor actions in the direction opposite to the visual displacement imposed by the prisms, a phenomenon known as aftereffect. This study was designed to define the variables that affect the acquisition and retention of the aftereffect. Subjects were required to throw balls to a target in front of them before, during, and after lateral displacement of the visual field with prismatic spectacles. The diopters of the prisms and the number of throws were varied among different groups of subjects. The results show that the adaptation process is dependent on the number of interactions between the visual and motor system, and not on the time spent wearing the prisms. The results also show that the magnitude of the aftereffect is highly correlated with the magnitude of the adaptation, regardless of the diopters of the prisms or the number of throws. Finally, the results suggest that persistence of the aftereffect depends on the number of throws after the adaptation is complete. On the basis of these results, we propose that the system underlying this kind of learning stores at least two different parameters, the contents (measured as the magnitude of displacement) and the persistence (measured as the number of throws to return to the baseline) of the learned information.

Adaptation, Physiological↗
PubMed2001

Relationship between isokinetic strength of the internal and external shoulder rotators and ball velocity in team handball.

BACKGROUND: The purpose of this study was to examine the relationship between the rotational strength of shoulder and ball velocity in team handball players from various levels. METHODS: Three groups of young healthy, male subjects took part in the experiments: one group of 15 handball players, the best of League A1 scorers, another group of 12 handball players, the best of League A2 scorers and a random sample of 15 physical education students. Each subject was tested on a Cybex II isokinetic dynamometer. The concentric action of the internal and external rotation of the dominant shoulder was examined at 60, 180 and 300 deg/sec. Ball velocity was examined in three types of throw: (a) on the spot, (b) with a cross-over step, and (c) with a vertical jump. Statistical analysis was performed using the Pearson product-moment correlation and one-way analysis of variance. RESULTS: The differences of peak torque values of the internal and external shoulder rotation between the three groups were not statistically significant. The differences between groups regarding ball velocity in all types of throw were statistically significant (p<0.001). The relationship between IR and ER rotation of the shoulder and ball velocity was not statistically significant, except the jump shot. CONCLUSIONS: The main finding of this study was that peak torque of IR and ER of the shoulder was not a good indicator of throwing velocity at any type of throw, except the jump shot, in all subjects, regardless of their throwing ability.

Adult↗
PubMed2005

On-the-Field Resistance-Tubing Exercises for Throwers: An Electromyographic Analysis.

Context: Athletes who throw commonly use rubber-tubing resistance exercises in the field setting to assist with warm-up before throwing. Yet no researchers have described which muscles are being activated or which exercises are most effective during rubber-tubing exercises used by throwers for warm-up.Objective: To describe the effectiveness of 12 rubber-tubing resistance exercises commonly used by throwers in activating the shoulder muscles important for throwing.Design: Descriptive research design.Setting: An applied biomechanics research laboratory.Patients or Other Participants: Fifteen physically active male subjects with no history of shoulder injury.Main Outcome Measure(s): Subjects randomly performed 12 rubber-tubing resistance exercises while we assessed muscle activation of the subscapularis, supraspinatus, teres minor, and rhomboid major by indwelling electromyography. Activation of the sternal portion of the pectoralis major, anterior deltoid, middle deltoid, latissimus dorsi, serratus anterior, biceps brachii, triceps brachii, lower trapezius, and infraspinatus muscles was assessed by surface electromyography.Results: Performance of 7 exercises (external rotation at 90 degrees of abduction, throwing deceleration, humeral flexion, humeral extension, low scapular rows, throwing acceleration, and scapular punch) resulted in the highest level of muscle activation of all muscles tested.Conclusions: These 7 exercises exhibited moderate activation (>20% maximal voluntary isometric contraction) in each muscle of the rotator cuff, the primary humeral movers, and the scapular stabilizer muscles. The results suggest that these exercises are most effective in activating the muscles important to the throwing motion and may be beneficial for throwers during their prethrowing warm-up routine.

Journal Article↗
PubMed2006

Adaptations to humeral torsion in medieval Britain.

Adaptations to the humeral torsion angle have been identified in the professional throwing athlete. This movement pattern increases the humeral torsion angle, and also increases the extent of external rotation movements in the dominant, throwing limb when compared with the nondominant limb. The purpose of this paper is to test the hypothesis that the humeral torsion angle is an adaptation to upper limb use. This project examines the humeral torsion angle in a number of medieval British populations, as well as a modern cadaver-based sample. The results identify significant differences in the humeral torsion angle both between and within male (P < 0.001, ANOVA) and female (P < 0.014, ANOVA) populations, although the results are not consistent with expected behavior patterns. Statistically significant differences between males and females within the same site were identified in 2 of the 5 samples examined. The mean level of bilateral asymmetry does not approach that reported for the professional throwing athlete. However, a number of individuals have high levels of asymmetry in excess of that identified in the professional throwing athlete. This analysis demonstrates the need for individual rather than population-based analyses, as the heterogeneity within population samples obscures individual variation in activity patterns. The diversity within British medieval society and a lack of specific known behaviors prevent further identification of the functional significance of the humeral torsion angle within the archaeological record examined here.

Adaptation, Physiological↗
PubMed1992

Knotting technique and suture materials.

Three groups of knots were examined using six no. 1 (metric 4) suture materials to identify the most effective and efficient knotting techniques. The three groups were the square or reef knot, the surgeon's knot and a double throw knot. Sequential single additional throws were added to these in order to determine when the strength of the knot reached the breaking force of the material, thus nullifying the need for additional throws. This strength was reached in all cases by a maximum of two additional throws. Suture materials examined were the non-absorbable monofilaments nylon and polypropylene, the absorbable monofilaments polyglyconate and polydioxanone and the braided materials polyglactin and polyglycolic acid, both coated. These were examined for their knot-holding capacity and breaking force to determine the best materials, which were polypropylene, polyglyconate and polyglycolic acid.

Suture Techniques↗
PubMed1998

Kinematics of the glenohumeral joint with Bankart lesion and repair.

A Bankart repair is performed to reduce abnormal translations of the humeral head on the glenoid due to a Bankart lesion, a separation of the capsulolabral complex from the glenoid rim. However, this is often accompanied by a loss of rotational range of motion that may lead to decreased function and osteoarthritis. This loss of rotation, coupled to the goal of reducing humeral translations, may be a result of the amount of imbrication of the capsule during repair. To determine the effects of capsular imbrication, we investigated how two Bankart repairs (2.5 and 5.0 mm of capsular imbrication) and a Bankart lesion altered the translations and rotations of the human glenohumeral joint in vitro. Coupled moments were applied to the unconstrained humerus in abduction-adduction, in flexion-extension, and to simulate the cocked phase of throwing. Motion was measured with an electromagnetic system. There were no differences in the kinematics between the intact specimens and those with a Bankart lesion or between normal specimens and the first (2.5 mm) Bankart repair. The first repair significantly reduced external rotation for the cocked phase of throwing compared with the Bankart lesion: from 46.8 +/- 23.6 degrees to 32.4 +/- 14.2 degrees (+/-SD). The second (5.0 mm) Bankart repair produced significantly different posterior translation (-4.7 +/- 3.9 mm) of the humeral head relative to the glenoid compared with normal (5.1 +/- 4.7 mm anterior) and the first repair (6.1 +/- 8.3 mm anterior), as the humerus moved from full flexion to full extension. Differences were also found for all rotations in the cocked phase of throwing. For the second repair, the humerus extended 24.3 degrees and externally rotated 18.6 degrees less than normal and was abducted 15.4 degrees more. These results indicate that both Bankart repairs do little to affect humeral translations with unconstrained moment loading but that rotations are affected during the cocked phase of throwing, with significant losses of external and extension rotations.

Biomechanical Phenomena↗
PubMed1992

Hand preference and age in the United States.

A survey of 1,177,507 U.S. men and women between the ages of 10 and 86 included questions regarding hand preference for writing and throwing. Three effects were observed. Individuals with at least some left motoric bias comprised a smaller percent of the population with advancing age. This finding provides large-scale confirmation of a previously described phenomenon. Among sinistrals, concordance for writing and throwing was 2.2 times as prevalent as left-writing with right-throwing, and 4.1 times as prevalent as right-writing with left-throwing. These sinistral subpopulations displayed distinct and stable prevalence prior to age 50 and changing patterns of prevalence subsequent to age 50. The results confirm a decrease with age in the prevalence of sinistrality, but indicate that age-specific rates of mixed- and left-handedness are distinct. The implications for hypotheses regarding age-related change in the prevalence of sinistrality are discussed.

Adolescent↗
PubMed2005

Cubital tunnel syndrome in adolescent baseball players: a report of six cases with 3- to 5-year follow-up.

In this case report, we describe the clinical features and surgical outcome of cubital tunnel syndrome in adolescent baseball players. Two infielders, 2 pitchers, and 2 catchers who suffered cubital tunnel syndrome during adolescence (average age, 14 years) were surgically treated. Symptoms of medial elbow pain first appeared during throwing in competition games in summer or autumn seasons. After the onset, they suffered limitation of elbow extension and weakness on grabbing balls. They could not throw because of recurrent medial elbow pain. Laxity of the medial collateral ligament was not detected by stress radiography. Duration of symptoms from the onset to surgery was less than 6 months for 2 patients, 1 year for 2, and longer than 2 years for 2 patients. Anterior subcutaneous transposition of the ulnar nerve relieved symptoms up to 3.3 postoperative years. Medial protrusion of the triceps muscle was observed to cause irritation of the ulnar nerve. Fibrosis surrounding the ulnar nerve was observed without pseudoneuroma. Throwing performance returned completely to competitive level in 5 months postoperatively in 5 of 6 patients. Early diagnosis of cubital tunnel syndrome in adolescent baseball players is very important. Anterior subcutaneous transposition of the ulnar nerve relieves symptoms and restores throwing function.

Adolescent↗
PubMed2005

Facioscapulohumeral muscular dystrophy presenting as shoulder pain in a baseball player.

Facioscapulohumeral muscular dystrophy is a commonly occurring myopathy that affects the facial and periscapular musculature. We describe a case in a high school throwing athlete that presented as shoulder pain with throwing a baseball. The patient has begun an intensive physical therapy training program that targets his weak scapular stabilizers as well as altering his throwing mechanics. His symptoms have improved, and he is able to continue competing in throwing sports at a high level.

Adolescent↗
PubMed2004

History and examination of the thrower's elbow.

Overhead throwing motion imparts enormous forces on the elbow. Repetitive near-failure loads lead to chronic adaptive changes and occasionally acute injury to bone, ligaments, and the elbow's muscle-tendon complexes. Physicians treating the thrower must thoroughly understand the complex anatomy and function of the elbow joint and throwing biomechanics to diagnose and treat elbow pathology. Evaluation of elbow pain begins with a thorough, detailed throwing history, including symptom duration, location of pain, timing during 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 often lead the astute clinician to the proper diagnosis and treatment without reliance on ancillary testing.

Adolescent↗
PubMed2004

Temporal and spatial factors reflecting performance improvement during learning three-ball cascade juggling.

Beek and van Santvoord [Beek, P. J., & van Santvoord, A. A. M. (1992). Journal of Motor Behavior, 24, 85-94] proposed a three-stage model of learning to juggle based on group analyses of temporal measures. Here, we examined in detail how the temporal and spatial features of juggling evolved in eight individual participants progressing from the second to the third stage of learning. During the second stage, the dwell ratio, defined as the ratio of the time that the juggler holds a ball between catch and toss and the hand cycle time (HCT), was stable when it was about 0.83. The subjects with a dwell ratio near this value and controlled throws exhibited stable juggling, whereas the subjects with a dwell ratio of 0.80 or smaller exhibited unstable juggling. Compared to the former group, the latter group had a longer time from the throw of a ball to the arrival at its zenith (TZ), and a shorter time between the arrival of an airborne ball at its zenith and the subsequent throw (IZR). The latter group also exhibited larger variability in the dwell ratio and IZR. With practice, the subjects appropriated, on average, the duration of TZ and IZR to the dwell ratio and improved the ability to accurately throw balls by changing the motions of the limb segments involved. Although these changes helped to stabilize the performance during the second stage, the variability problem was not sufficiently resolved. Only two out of eight subjects passed on to the third stage by the last (10th) Session. They achieved small variability in IZR, dwell ratio, and flight paths of the ball while juggling with short HCTs and small dwell ratios. These results suggest that the reduction of variability in these variables was essential to pass on to the third stage.

Adolescent↗
PubMed2005

Changes in patterns of scaphoid and lunate motion during functional arcs of wrist motion induced by ligament division.

PURPOSE: To determine the in vitro motion of the scaphoid and lunate during wrist circumduction and wrist dart-throw motions and to see how these motions change after the ligamentous stabilizers of the scaphoid and lunate are sectioned in a manner simulating scapholunate instability. METHODS: Twenty-one fresh-frozen cadaver forearms were moved through a dart-throw motion and a circumduction motion using a wrist joint simulator. Scaphoid and lunate motion were measured with the wrist ligaments intact and after sectioning of the scapholunate interosseous ligament, the scaphotrapezium ligament, and the radioscaphocapitate ligament. RESULTS: In the intact wrist the scaphoid and lunate moved more during circumduction than during the dart-throw motion. With ligamentous sectioning the scaphoid flexed more and the lunate extended more during both the circumduction and dart-throw motions. During the circumduction motion both before and after sectioning the global motion of the scaphoid was greater than that of the lunate. After sectioning the scaphoid motion increased and the lunate motion decreased. CONCLUSIONS: The scaphoid and lunate motions were observed to change remarkably after ligamentous sectioning. The observed changes in carpal motion correlate with the clinical observation that after ligamentous injury arthritic changes occur in the radioscaphoid joint and not in the radiolunate joint. Analysis of the injured wrist in positions that combine flexion-extension and radial-ulnar deviation may allow noninvasive diagnosis of specific wrist ligament injuries.

Adult↗
PubMed1999

Randomized in vitro and in vivo evaluation of different biopsy needles and devices for breast biopsy.

In an experimental study (in vitro and in vivo) we evaluated the efficacy of various biopsy needles/devices for breast biopsy. In vitro, biopsies of five human cadaveric breast specimens were performed using 33 different needles/devices ranging from 14 to 20-gauge. Of these 33 needles/devices, 22 optimally performing needles were selected for the in vivo study. In the clinical part of the study, 44 breast lesions were randomly biopsied with each of the 22 needles/devices under stereotactic guidance. Tissue specimens were analysed quantitatively and qualitatively. Several automatic long-throw guns (Acecut, Asap, Biopty, Magnum) obtained greater tissue areas and had a better histopathologic score than the conventional type of a side-notch needle like Trucut, an aspiration needle like Surecut, or an end-cut needle like Autovac. The automatic long-throw guns performed better than the short-throw Monopty gun. Regardless of needle size (14-20-gauge), breast biopsies should be routinely performed with automated long-throw side-notch guns (Acecut, Asap, Biopty, Magnum).

Adult↗