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PubMedDate not supplied

Internal impingement of the shoulder: a clinical and arthroscopic analysis.

Internal impingement was first described by Walch in 1992 and defined as contact between the supraspinatus tendon and posterior-superior glenoid rim with the shoulder in the cocked, throwing position of 90 degrees of abduction and maximum external rotation. The hypothesis of the study was that this contact may be seen in patients who are not throwing athletes nor in those who have instability. One hundred five consecutive patients who underwent shoulder arthroscopy were prospectively studied with preoperative history and physical examination. All patients underwent general anesthesia and arthroscopy with a standard posterior portal. With the patient under arthroscopy the arm was placed in abduction and external rotation until contact was made or until full elevation was reached. Eighty-five percent (N = 90) of the patients made contact between the rotator cuff and glenoid rim at an average of 95 degrees of abduction and 74 degrees of external rotation. No statistically significant relationship was seen (P > .05) between the position of contact at internal impingement and mechanism of injury, throwing versus nonthrowing, instability, rotator cuff tear, preoperative external rotation, or preoperative impingement signs. The intraoperative finding of contact of the rotator cuff to the posterosuperior glenoid with the arm in abduction and external rotation can occur in a wide spectrum of shoulder disease and is not limited to the throwing athlete. Not all patients with increased laxity and instability demonstrate this contact, suggesting that these factors may not be essential for internal impingement.

Arthroscopy↗
PubMed1999

Timing the Selection of Information During Rhythmic Catching.

Catching a ball requires that information be available close to the catch but early enough for prospective or corrective control. In the present experiment, 6 participants were asked to throw and catch a ball continuously for 1 min while wearing liquid-crystal goggles that restricted viewing to specific amounts of time at specific intervals. Participants were free to select the information by varying the frequency and phasing of throwing relative to the goggles. Video analysis revealed that they elected a frequency of throwing that matched the goggle frequency and chose to view the ball at or around its zenith. Earlier portions of the ball's trajectory were viewed as the goggle frequency increased. Despite variations in the viewing location, participants elected to view the ball on average 365 ms before the catch. Analysis of the hand's trajectory further revealed that the time interval (M = 82 ms) between the ball's zenith and the initiation of the final motion of the hand toward the catch did not vary as a function of the frequency of throwing. The authors conclude that the timing constraints imposed by the hand's movement are the basis for the selection of information for catching.

Journal Article↗
PubMed1992

The role of teacher knowledge in elementary physical education instruction: an exploratory study.

The purpose of this study was to describe how providing teachers with research based knowledge about developmental throwing can influence teachers' observational interpretations and their students' practice patterns. Eight kindergarten classroom teachers with high generic teaching skill competence taught a 6-week overhand throwing unit to the children in their intact classes. Prior to the unit, four of the teachers were randomly assigned to a 4-hour knowledge training program. The other four teachers served as a comparison group (underwent no knowledge training). During the unit, data from stimulated recall interviews were used to describe and compare the thoughts and knowledge concepts expressed by the two groups of teachers. The throwing practice experienced by the children in the knowledge-trained and comparison teachers' classes was videotaped and analyzed for frequency of opposite foot stepping. The knowledge acquired during training was associated with different patterns of skill observation. The knowledge concepts the teachers acquired during training formed the basis of many of their thoughts and were reflected in the instructional procedures implemented. The knowledge-trained teachers' classes demonstrated more than twice as many opposite foot throws during the unit than the comparison teachers' classes.

Achievement↗
PubMed1997

The effect of knowledge of results delay and the subjective estimation of movement form on the acquisition and retention of a motor skill.

This study examined the effects of knowledge of results (KR) delay and subjective estimation of movement form on the acquisition and retention of a motor skill. During acquisition, four groups of participants performed 60 trials of a throwing accuracy task under the following conditions: (a) immediate KR, (b) delayed KR, (c) immediate KR + form estimation, and (d) delayed KR + form estimation. Retention tests of throwing accuracy and outcome error estimation in the absence of visual KR were administered 5 min and 24 hours following acquisition. Throwing accuracy was significantly higher during acquisition but significantly lower during retention for immediate-KR participants than for delayed-KR participants. However, participants who estimated their movement form during acquisition produced significantly higher throwing accuracy and lower estimation error during retention than those who did not.

Analysis of Variance↗
PubMedDate not supplied

Influence of familiarization on a backward, overhead medicine ball explosive power test.

This study examined the influence of familiarization with the backward, overhead medicine ball throw test of explosive power. Male rugby players (N = 28) aged 15 to 16 (M +/- SD = 15.1 +/- 0.5) years completed the medicine ball throw six times. Repeated measures ANOVA indicated that the distance thrown differed across trials (F5,135 = 12.83, p < 0.01). Least significant differences post hoc multiple comparisons revealed significant differences between a number of trials; however, no significant difference was evident between the fifth and sixth trials (Mdiff = .005, p > 0.05). Typical error of measurement became less as trials progressed, with the typical error of measurement being 0.10 m between the fifth and sixth trials indicating little within subject variation between medicine ball throws following a familiarization period. The backward, overhead medicine ball throw may be a practical, reliable method to assess total body, explosive power of male teen-aged rugby players; however, completion of at least 5 to 6 practice trials is suggested for participants to obtain a stable score.

Adolescent↗
PubMed2001

Longitudinal study of elbow and shoulder pain in youth baseball pitchers.

PURPOSE: Previous studies among young pitchers have focused on the frequency and description of elbow injuries. The purpose of this study was to evaluate the frequency of elbow and shoulder complaints in young pitchers and to identify the associations between pitch types, pitch volume, and other risk factors for these conditions. METHODS: A prospective cohort study of 298 youth pitchers was conducted over two seasons. Each participant was contacted via telephone after each game pitched to identify arm complaints. Generalized estimating equations were used to assess associations between arm complaints and independent variables. RESULTS: The frequency of elbow pain was 26%; that of shoulder pain, 32%. Risk factors for elbow pain were increased age, increased weight, decreased height, lifting weights during the season, playing baseball outside the league, decreased self-satisfaction, arm fatigue during the game pitched, and throwing fewer than 300 or more than 600 pitches during the season. Risk factors for shoulder pain included decreased satisfaction, arm fatigue during the game pitched, throwing more than 75 pitches in a game, and throwing fewer than 300 pitches during the season. CONCLUSION: Arm complaints are common, with nearly half of the subjects reporting pain. The factors associated with elbow and shoulder pain were different, suggesting differing etiologies. Developmental factors may be important in both. To lower the risk of pain at both locations, young pitchers probably should not throw more than 75 pitches in a game. Other recommendations are to remove pitchers from a game if they demonstrate arm fatigue and limit pitching in nonleague games.

Alabama↗
PubMed2003

Rehabilitation of the thrower's elbow.

The elbow joint is susceptible to injuries in the overhead athlete due to the large amount of forces observed during the act of throwing. Injuries often occur due to repetitive microtrauma nature of throwing. Rehabilitation following injury or surgery to the throwing elbow is vital to fully restore normal function and return the athlete to competition as quickly and safely as possible. Rehabilitation of the elbow, whether post-injury or postsurgical, must follow a progressive and sequential order to ensure that healing tissues are not overstressed. Emphasis is placed on restoring full motion, muscular strength, and neuromuscular control. The purpose of this article is to provide an overview of a multiphased rehabilitation program for the thrower's elbow. In addition, rehabilitation for specific nonoperative and postoperative pathologies often observed in the throwing athlete is discussed.

Journal Article↗
PubMed2006

Behavioural responses of dairy cattle to the stable fly, Stomoxys calcitrans, in an open field environment.

Individual cows (25 in each of four herds) were monitored 8-10 times weekly for 12 weeks (stable fly season) on a southern California dairy, with 100 observations per cow. The numbers of biting stable flies, Stomoxys calcitrans (L.) (Diptera: Muscidae) on the front legs and the frequencies of four fly-repelling behaviours per 2-min observation period [head throws, front leg stamps, skin twitches (panniculus reflex) and tail flicks] were recorded. Fly numbers varied, peaking at 3.0-3.5 flies per leg in week 9 (late May). Weekly herd mean frequencies of fly-repelling behaviours were highly dependent on fly numbers, with a linear regression r(2) > 0.8. Head throws and stamps were less frequent than skin twitches and tail flicks. Individual cows differed in numbers of stable flies and behaviours. Behaviours were correlated with flies for individual cows, but at a lower level than were herd means (r = 0.3-0.7). Cows that stamped more within a herd tended to have lower fly counts; other fly-repelling behaviours were less effective. Cows maintained ranks within a herd with regard to fly numbers (r = 0.47), head throws (0.48), leg stamps (0.64), skin twitches (0.69) and tail flicks (0.64). Older cows tended to harbour higher fly numbers and to stamp less relative to younger adult cows. Ratios of leg stamps and head throws to fly numbers dropped significantly through time, suggesting habituation to pain associated with fly biting. Tail flicks were not effective for repelling Stomoxys, but were easiest to quantify and may help in monitoring pest intensity. At this low-moderate fly pressure, no consistent impacts on milk yield were detected, but methods incorporating cow behaviour are recommended for future studies of economic impact.

Analysis of Variance↗
PubMedDate not supplied

Knot security of suture materials.

The knot security of chromic gut, polyglycolic acid, polyglactin 910, polydioxanone, polypropylene, and monofilament nylon size 2-0 suture materials were tested biomechanically in vitro. Twenty reproducible knots were tied and incubated in canine serum at 37 degrees for 24 hours before testing. A "secure knot" was defined as a knot that, when tested to failure, broke rather than untied by slippage. The minimum number of throws necessary to make a secure, snug (1500 g tension) square knot was three for gut, polyglycolic acid, polyglactin 910, and polypropylene and four for polydioxanone and nylon. All throws including the first were counted. With all suture materials tested, surgeon's knots were as secure as square knots. Only gut, polyglycolic acid, and polydioxanone granny knots were as secure as square knots; no loosely tied (500 g tension) asymmetric square knots were as secure as snug square knots, and only polydioxanone and polypropylene loose square knots were as secure as snug square knots. Square knots used to start a continuous pattern required one additional throw with gut, polydioxanone, and nylon. Square knots used to end a continuous pattern required two to three additional throws with all materials tested.

Catgut↗
PubMed1978

Specific and varied practice of motor skill.

To assess the potential effect of specific and varied practice on the development of motor schema, 64 children in two age groups (8 yr. and 12 yr.) were tested on a simple throwing task at the beginning and end of a 12-wk. physical education program. For the throwing test the children were assigned to either a specificity or a schema group (varied practice). The task was performed without visual feedback, but knowledge of results was given after each trial. Prior to both tests at the criterion target, the specific group was given practice throws using the criterion target distance, whereas the schema group practiced on two other targets. No differences were found between the two groups at the beginning of the program but on the posttest those children receiving a variety of practice on the throwing task performed significantly better than the specific-practice group. Thus it was suggested that a varied practice schedule may facilitate the initial formation of motor schema, and this process may be enhanced by participation in a physical education program.

Child↗
PubMedDate not supplied

Arthroscopic removal of symptomatic Bennett lesions in the shoulders of baseball players: arthroscopic Bennett-plasty.

BACKGROUND: Bennett lesions are often observed in throwing athletes, and, although usually asymptomatic, they can sometimes become painful and disturb an athlete's throwing ability. Because it is clinically difficult to determine whether a Bennett lesion is symptomatic or whether pain is from another lesion, the outcome of surgical treatment is variable. HYPOTHESIS: Arthroscopic resection of Bennett lesions diagnosed according to our criteria and arthroscopic treatment of associated lesions performed simultaneously were effective for treatment of baseball players with symptomatic Bennett lesions. STUDY DESIGN: Prospective cohort study. METHODS: The following criteria for diagnosis of a symptomatic Bennett lesion were used to identify 16 baseball players who later underwent arthroscopic removal of the symptomatic Bennett lesion (arthroscopic Bennett-plasty): 1) detection of a bony spur at the posterior glenoid rim on radiographs; 2) posterior shoulder pain during throwing, especially in the follow-through phase; 3) tenderness at the posteroinferior aspect of the glenohumeral joint; and 4) relief of pain by injection of local anesthesia. RESULTS: After a minimum follow-up of 1 year, there was no tenderness at the posteroinferior aspect of the glenohumeral joint in any of the patients. Throwing pain disappeared in 10 shoulders and was mitigated in 6 shoulders. Eleven patients returned to baseball at their previous level of competition. CONCLUSIONS: Accurate diagnosis and minimally invasive arthroscopic surgery are important for appropriate treatment of baseball players with symptomatic Bennett lesions.

Adolescent↗
PubMedDate not supplied

Evidence of subclinical medial collateral ligament injury and posteromedial impingement in professional baseball players.

BACKGROUND: Recognition and treatment of elbow conditions such as medial collateral ligament injury and posteromedial impingement are increasing in throwing athletes. Magnetic resonance imaging may provide pivotal information in the management of these athletes. Knowledge of the utility of magnetic resonance imaging has become widespread throughout the baseball community. However, data on the frequency and extent of asymptomatic magnetic resonance imaging findings in the elbows of this throwing population are lacking . HYPOTHESIS: Abnormalities in the throwing elbows of asymptomatic professional baseball players compared to the nonthrowing elbows are frequently seen in magnetic resonance images. STUDY DESIGN: Descriptive anatomical study. METHODS: Sixteen asymptomatic professional baseball players with no history of injury underwent bilateral elbow magnetic resonance imaging using a standardized sequencing protocol. The magnetic resonance images were reviewed, in a blinded fashion, by 2 musculoskeletal radiologists and 1 orthopaedic surgeon. RESULTS: Medial collateral ligament abnormalities (including thickening, signal heterogeneity, or discontinuity) were present in 87% of players' dominant elbows. Findings consistent with posteromedial impingement were present in 13 of 16 subjects. There was a significant correlation between medial collateral ligament thickening and posteromedial subchondral sclerosis (P = .04). The throwing elbow was correctly identified in all 16 subjects. No significant correlation between magnetic resonance imaging findings and age could be detected. CONCLUSIONS: This study demonstrates a high rate of abnormal magnetic resonance imaging findings in asymptomatic throwers' elbows. These baseline findings must be considered when magnetic resonance imaging is being used as a factor in treatment decisions.

Adolescent↗
PubMed2005

Biomechanics of the shoulder in youth baseball pitchers: implications for the development of proximal humeral epiphysiolysis and humeral retrotorsion.

BACKGROUND: The effects of repetitive throwing on the shoulders of developing athletes are not well understood because of the paucity of data describing the biomechanics of youth pitchers and the plasticity of the developing skeleton. HYPOTHESIS: The direction and magnitude of the stresses that exist at the proximal humeral physis during the fastball pitching motion are consistent with the development of proximal humeral epiphysiolysis (Little League shoulder) and/or humeral retro-torsion. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 14 elite youth baseball pitchers (mean age, 12.1 +/- 0.4 years) were filmed from the front and dominant side while throwing fastballs in a simulated game. The net force and torque acting on the humerus throughout the throwing motion were calculated using standard biomechanical techniques. RESULTS: The external rotation torque about the long axis of the humerus reached a peak value of 17.7 +/- 3.5 N.m (2.7% +/- 0.3% body weight x height) just before maximum shoulder external rotation. A shoulder distraction force of 214.7 +/- 47.2 N (49.8% +/- 8.3% body weight) occurred at, or just after, ball release. CONCLUSION: Shear stress arising from the high torque late in the arm-cocking phase is large enough to lead to deformation of the weak proximal humeral epiphyseal cartilage, causing either humeral retrotorsion or proximal humeral epiphysiolysis over time. The stresses generated by the external rotation torque are much greater than those caused by distraction forces generated during the pitching motion of youth baseball pitchers. CLINICAL RELEVANCE: The motion of throwing fastballs by youth baseball pitchers results in force components consistent with proposed mechanisms for 2 clinical entities.

Baseball↗
PubMedDate not supplied

The strength characteristics of internal and external rotator muscles in professional baseball pitchers.

The purpose of this study was to establish a data base regarding the isokinetic muscular performance characteristics of the external/internal rotator muscles of professional baseball pitchers. One hundred fifty healthy professional baseball pitchers were evaluated by use of a Biodex isokinetic dynamometer. The subjects tested had a mean age of 23.4 years and a mean body weight of 199 pounds. Isokinetic tests were performed concentrically at 180 and 300 deg/sec for both the throwing and nonthrowing shoulders. Testing procedures regarding positioning and stabilization followed established guidelines. The testing protocol and actual test repetitions were standardized for each subject. Statistical analysis was performed using the Pearson Product Moment Correlation and paired t-tests. Determination of the correlation coefficient was made at the P < 0.05 level of significance. Test results for bilateral comparison of mean peak torque for the throwing and nonthrowing shoulders indicated no statistically significant difference between the internal rotators at both test speeds, or for the external rotators at 300 deg/sec. There was a significant statistical difference at the 180 deg/sec test speed for the external rotators. The external/internal rotator strength ratio indicated a 65% ratio at 180 deg/sec and a 61% ratio at 300 deg/sec. Data were also collected for mean peak torque/body weight ratios of the throwing shoulder to establish a data base in professional throwers. This study offers clinical relevance in establishing a muscle performance profile for the professional thrower. This data base can therefore be used as criteria that should be met before an injured pitcher can be returned to throwing at the professional baseball level.

Adolescent↗
PubMedDate not supplied

Functional anatomy of the flexor pronator muscle group in relation to the medial collateral ligament of the elbow.

To describe the relationship of the pronator teres, flexor carpi radialis, flexor digitorum superficialis, and flexor carpi ulnaris muscles to the medial collateral ligament at 30 degrees, 90 degrees, and 120 degrees of elbow flexion, we dissected 11 cadaveric specimens. The flexor carpi ulnaris muscle is the predominant musculotendinous unit overlying the medial collateral ligament in the majority of cases and is the only one at 120 degrees of elbow flexion. The flexor digitorum superficialis muscle is the only other significant contributor. The medial collateral ligament is the primary stabilizer of the medial elbow with elbow flexion greater than 30 degrees, as in throwing. The flexor carpi ulnaris muscle, because of its position directly over the medial collateral ligament, and the flexor digitorum superficialis muscle, with its near proximity and relatively large bulk, are the specific muscles best suited to provide medial elbow support. This is especially relevant to overhand throwing athletes who encounter extreme valgus force across the elbow during the cocking and acceleration phases of the throwing motion. Exercise and conditioning of the medial elbow musculature, specifically the flexor digitorum superficialis muscle and the flexor carpi ulnaris muscle, may prevent injury or assist in rehabilitation of medial elbow instability, especially in overhand throwing athletes.

Acceleration↗
PubMedDate not supplied

The abductor and adductor strength characteristics of professional baseball pitcherse.

The purpose of this investigation was to establish a data base regarding the isokinetic muscular performance characteristics of the abductor and adductor muscles of professional baseball pitchers. Eighty-three healthy professional baseball pitchers (mean age, 22.6 years; mean weight, 199 pounds) were evaluated by use of a Biodex isokinetic dynamometer. Isokinetic tests were performed concentrically at 180 and 300 deg/sec for both the throwing and nonthrowing shoulders. The testing protocol and test repetitions were standardized for each subject. Statistical analysis was performed using a paired t-test. Determination of the correlation coefficient was made at the P < 0.05 level of significance. Test results for bilateral comparisons of mean peak torque for the throwing and nonthrowing shoulders demonstrated a significant difference in adductor values between the dominant and nondominant shoulders at both test speeds. There were no significant differences between extremities for the shoulder abductor muscles. The abductor-to-adductor muscle ratios between the throwing and nonthrowing shoulders were also statistically significant at both test speeds. Throwing arm values were 82.5% at 180 deg/sec and 93.8% at 300 deg/sec compared with only 66.0% and 70.3%, respectively, for the nonthrowing shoulders.

Acceleration↗
PubMed2003

Maximum strength-power-performance relationships in collegiate throwers.

Presently the degree to which peak force influences power production or explosive performance such as strength training movements or throwing (shot-put and weight-throw) is unclear. This study describes the relationships between a measure of maximum strength, isometric peak force (IPF), dynamic peak force (PF), peak power (PP), the 1-repetition movement power snatch (SN), and throwing ability over an 8-week training period. Five male and 6 female (n = 11) well-trained collegiate throwers participated. PF was measured using an AMTI force plate; PP was measured using an infrared-ultrasonic tracking device (V-Scope, Lipman Electronics). Clean pulls from the midthigh position were assessed isometrically and dynamically at a constant load, 30% and 60% of IPF. Specific explosive strength was evaluated using an SN and using the shot-put (SP) and weight-throw (WGT) measured under meet conditions. Variables (PF, PP, SN) were assessed 3 times at 0 weeks, 4 weeks, and 8 weeks. Each measurement period preceded a field meet by 3 days. Peak force, peak rate of force development, and PP increased over the 8 weeks. Correlation coefficients (r) indicate that IPF is strongly related to dynamic PF and PP 30%, 60% of the IPF. Furthermore, strong correlations were found for the SN and the distance for the SP and WGT, and these relationships tended to increase over time. Results suggest that maximum strength (i.e., IPF) is strongly associated with dynamic PF. In addition, maximum strength is strongly associated with PP even at relatively light loads such as those associated with sport-specific dynamic explosiveness (i.e., SN, SP, WGT).

Adolescent↗
PubMed1985

Practice variability and children's motor behavior.

This research investigated Schmidt's variability-of-practice prediction and the breadth-of-a-movement class. Schmidt's hypothesis was tested by varying the parameters of ball and distance in overarm throwing. Breadth-of-a-movement class was tested by employing two novel tasks not previously used in variability-of-practice designs. 203 kindergarten and first-grade subjects were randomly assigned to one of four conditions, three experimental and one control. Experimental subjects performed 45 trials in their respective training conditions, weight, distance, weight/distance, in one session. Two novel striking tasks were administered to all subjects pre- and posttest to assess the variability-of-practice hypothesis, and the generalizability of overarm throwing and striking. Variability-of-practice in the overarm throw appeared to strengthen the striking schemas of the kindergarten boys. Results suggest some support for the inclusion of throwing and striking in a single-movement class. The concept, breadth of movement class, however, requires further study.

Child↗