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PubMed2006

The modified docking procedure for elbow ulnar collateral ligament reconstruction: 2-year follow-up in elite throwers.

BACKGROUND: Ulnar collateral ligament injury is most common in the overhead-throwing athlete. Jobe et al published the first report of ulnar collateral ligament reconstruction in throwing athletes with a 62.5% success rate. Recently, Altchek developed a new docking technique for reconstruction of the ulnar collateral ligament. The authors report the first series using a further modification of the docking technique using a 4-strand palmaris longus graft for reconstruction of the ulnar collateral ligament. HYPOTHESIS: The modified docking technique yields a high rate of successful return to preinjury level of competition in elite baseball players. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The authors retrospectively reviewed 25 elite professional or scholarship collegiate baseball players who underwent elbow ulnar collateral ligament reconstruction using the modified docking procedure with a minimum 2-year follow-up. RESULTS: Twenty-three of 25 (92%) were able to return to their preinjury levels of competition. The mean time to return was 11.5 months (range, 10-16 months). Complications included 1 transient postoperative ulnar nerve neurapraxia and 1 stress fracture of the ulnar bone bridge that occurred at 14 months postoperatively, after a full return to pitching. CONCLUSION: The modified docking technique yields highly successful return to preinjury level of competition rates (92%) in a select group of elite baseball players.

Adult↗
PubMed2006

Nonunion of olecranon stress fractures in adolescent baseball pitchers: a case series of 5 athletes.

BACKGROUND: Adolescent athletes participating in overhead throwing sports suffer a variety of overuse elbow injuries, many of which have been well described in the literature. Nonunion stress fractures of the olecranon across the epiphyseal plate, however, have received little attention. PURPOSE: To describe this unusual clinical entity in the differential diagnosis of the adolescent athlete with elbow pain and to demonstrate that operative treatment is an effective means of quickly and safely returning the patient to sporting activities. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Five adolescent baseball pitchers (mean age, 15 years) who suffered chronic elbow pain and who were diagnosed with olecranon epiphyseal stress fracture nonunions were treated with open reduction and internal fixation using a 7.0 cancellous screw and washer with or without 18-gauge tension banding. RESULTS: Return to preoperative range of motion was achieved at a mean of 8.6 weeks (range, 3.4-16.6 weeks). Patients were clinically asymptomatic at a mean of 11 weeks (range, 7.7-13.6 weeks) after surgery. Radiographic evidence of stress fracture union was achieved at a mean of 15.4 weeks (range, 6.1-33 weeks), including 1 patient with a delayed union according to radiographs, which healed at 33 weeks. Patients were started on a light strengthening program at 5 to 7 weeks and a throwing progression program at 15.6 weeks (range, 6.4-28.1 weeks). All 5 patients were able to return to their previous level of activities, with a mean return time of 29.4 weeks (range, 18.9-40.4 weeks). CONCLUSION: Surgical management of olecranon apophysis stress fractures provided excellent results with minimal complications in this series of 5 consecutive cases.

Adolescent↗
PubMedDate not supplied

Pitcher's elbow in adolescents.

Intraarticular and periarticular changes of the elbow secondary to the throwing motion have been documented in pitchers of all ages, Although others have focused attention on children, this study evaluates a group of 73 older pitchers (average age 17 years). Forty-two (58%) players reported pain while throwing at the time of evaluation (before interscholastic play) or developed pain during the season. However, only four (5%) missed one or more pitching rotations. No significant relationships were found between occurrence of symptoms and number of seasons played, individual pitching traits, asymmetry on physical examination, or asymmetry on radiographic evaluation of the elbow. In the symptomatic group there tended to be a slightly greater number of seasons' experience (average 7.8 seasons vs. 6.0 seasons) and more players with asymmetry upon physical examination. We believe this study supports the concept that increasing age and exposure, along with other factors as yet unquantitated, may determine the occurrence of symptoms in pitchers.

Adolescent↗
PubMedDate not supplied

Recurrent subluxation of the glenohumeral joint.

Recurrent subluxation of the shoulder is a common condition. In our hospital, 30% of operations for shoulder instability were performed on patients who never had a frank dislocation but presented with symptoms of instability or, occasionally, simply with pain on throwing. The most common physical finding in this group was apprehension on abduction-external rotation. Thirty-four of the 50 shoulders with subluxation showed radiological changes consisting mainly of infraglenoid new bone formation. Six showed fracture of the anterior glenoid margin. Examination under anaesthesia demonstrated the instability on all cases in which it was tested. Thirty-three of the 50 shoulders had Bankart lesions and six had anterior glenoid margin fractures. Thirty-nine shoulders were treated by Putti-Platt repair and 10 had stapling alone. There was a tendency for loss of external rotation in patients with Putti-Platt reinforcement. We conclude that recurrent subluxation of the shoulder is a common injury that can be confirmed by demonstrating subluxation under anaesthesia, and Bankart repair alone is recommended if the athlete is to return to throwing activities.

Athletic Injuries↗
PubMedDate not supplied

The surgical treatment of osteochondritis of the capitellum.

This paper reviews 14 patients who underwent elbow arthrotomy for osteochondritis of the capitellum. The etiology in 7 of the 14 cases appears to be the result of repeated trauma from throwing sports. Five of the 14 described a singular significant traumatic episode, and in 2 of the 14, a clear etiology is uncertain. The diagnostic features including signs, symptoms, and elbow range of motion are examined. The operative findings are correlated with plain x-ray films of the elbow in all cases and with an elbow arthrogram in 11 out of 14 cases. The average length of followup was 24 months. The postoperative range of motion was increased an average of 18 degrees. Eighty-six percent (12 out of 14) patients returned to organized, competitive athletic activity without restrictions. The Little League background of those patients with apparent repetitive microtrauma to the elbow is examined in terms of length of pitching experience and types of pitches thrown. In addition, the throwing mechanism of these patients is evaluated with respect to the type of delivery at possible risk for the development of osteochondritis. We conclude that after a failure of conservative therapy, surgical treatment, including removal of the intraarticular loose bodies, excision of capitellar lesions, and curettage to bleeding bone can be expected to produce pain relief and improvement in joint motion. A return to organized competitive sport activities can be expected.

Adolescent↗
PubMedDate not supplied

Rehabilitation of the pitching shoulder.

Shoulder pain is a common complaint among baseball pitchers. Frequently, the nature of shoulder pathology can be traced to lack of flexibility and muscular imbalance. This paper describes: the normal biomechanics of a properly functioning shoulder during a baseball pitch, pathomechanics of shoulder problems, flexibility requirements of the throwing shoulder, and the muscular balance necessary for an effective throwing shoulder. Appropriate examination procedures are described along with remedial exercises which ensure normal glenohumeral motion and integrated muscle action.

Athletic Injuries↗
PubMedDate not supplied

Comparative functional analysis of the Bristow, Magnuson-Stack, and Putti-Platt procedures for recurrent dislocation of the shoulder.

Literature on anterior shoulder instability deals most often with elimination of recurrence following reconstruction. We analyzed the subjective function, loss of motion and shoulder strength of three operative procedures: Magnuson-Stack, Bristow, and Putti-Platt. A retrospective review of 27 patients, 9 in each surgical group, with no postoperative dislocations or on-going pain was performed. All patients were male, right hand dominant with the right shoulder affected. Average time of followup was 6.75 years (range, 4.2 to 10.3 years). All patients completed a questionnaire and had their range of motion measured by a hand-held goniometer and their shoulder strength tested on the Cybex II Dynomometer. Peak torque as a percent of body weight and side-to-side differences were calculated for six arm positions and compared to nine right hand dominant controls of similar age and recreational activity. Sixty percent returned to throwing sport. One Magnuson-Stack and Bristow patient felt full functional return to preinjury level. Three patients in each of these two groups returned to unmodified throwing sport whereas no Putti-Platt patient attained this level. Deficit of external rotation at shoulder neutral measured 4.7 degrees, Magnuson-Stack; 12.2 degrees, Bristow; and 21.8 degrees, Putti-Platt. At 90 degrees shoulder abduction, similar deficits in external rotation measured 6.4 degrees, 11.6 degrees, and 28.8 degrees respectively. These values were statistically significant employing analysis of variance. We compared the operative groups as a whole to the controls and compared the operative groups to each other.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Inferior capsular shift procedure for anterior-inferior shoulder instability in athletes.

Sixty-eight shoulders in 63 athletic patients with anterior-inferior glenohumeral instability underwent an anterior-inferior capsular shift procedure. Shoulders with glenoid fractures, predominantly posterior instability, or routine, unidirectional anterior instability were not included in this study. There were 42 men and 21 women, with an average age of 23 years. Forty-two repairs were performed on the dominant arm. All 31 overhead throwing athletes had their dominant arms repaired. Forty-six shoulders had histories of recurrent anterior dislocations, while 22 shoulders had recurrent subluxation. All 68 shoulders had an anterior-inferior capsular shift, tailored to the degree of laxity found; in addition, 21 had repair of a Bankart lesion. Forty-two patients were rated excellent (67%), 17 good (27%), 2 fair (3%), and 1 poor (3%). Fifty-eight of 63 (92%) patients returned to their major sports, 47 (75%) at the same competitive levels. Only 5 of 10 elite throwing athletes returned to their prior competitive levels. Loss of external rotation averaged 7 degrees. Two patients (2.9%) re-dislocated postoperatively, after violent falls.

Adult↗
PubMedDate not supplied

Diagnosis of glenoid labral tears. A comparison between magnetic resonance imaging and clinical examinations.

We studied 54 patients with shoulder pain secondary to anterior instability or glenoid labral tears refractory to 6 months of conservative management with no evidence of rotator cuff lesions. All patients had sufficient preoperative clinical data, magnetic resonance imaging, and shoulder arthroscopy results for analysis. The ability to predict the presence of a glenoid labral tear by physical examination was compared with that of magnetic resonance imaging (conventional and arthrogram) and confirmed with arthroscopy. There were 37 men and 17 women (average age, 34 years) in the study group. Of this group, 64% were throwing athletes and 61% recalled specific traumatic events. Clinical assessment included history with specific attention to pain with overhead activities, clicking, and instances of shoulder instability. Physical examination included the apprehension, relocation, load and shift, inferior sulcus sign, and crank tests. Shoulder arthroscopy confirmed labral tears in 41 patients (76%). Magnetic resonance imaging produced a sensitivity of 59% and a specificity of 85%. Physical examination yielded a sensitivity of 90% and a specificity of 85%. Physical examination is more accurate in predicting glenoid labral tears than magnetic resonance imaging. In this era of cost containment, completing the diagnostic workup in the clinic without expensive ancillary studies allows the patient's care to proceed in the most timely and economic fashion. Glenoid labral tears have been associated with overhead throwing activities, trauma, and shoulder instability. Assessment of an athlete with shoulder pain should take into account a careful history of clicking sounds or catching, symptoms with overhead activities, reports of instability, or previous trauma. On physical examination, patients with labral tears often demonstrate objective instability with or without clicking or catching during glenohumeral rotation. Plain radiographs have not been helpful, and radiologists have relied on techniques from arthrogram to arthrotomogram, CT arthrogram, magnetic resonance imaging (MRI), and MR arthrogram to assist in the diagnosis. Various sensitivities and specificities have been reported for these tests. However, a large degree of intra- and interobserver variability has been demonstrated, and the degree to which these studies are helpful in preoperative planning has been questioned. No previous study to our knowledge has involved MRI in a direct comparison of other diagnostic modalities. Therefore, the purpose of this study is to investigate the accuracy of MRI and physical examination in the diagnosis of glenoid labral tears.

Adolescent↗
PubMedDate not supplied

An eccentric- and concentric-strength profile of shoulder external and internal rotator muscles in professional baseball pitchers.

The purpose of this study was to establish a data base on the isokinetic eccentric muscular performance characteristics of external and internal rotator muscles in the shoulders of professional baseball pitchers. Concentric data are also included and compared with previously published concentric studies. Twenty-five professional baseball pitchers were evaluated with a Kin-Com isokinetic dynamometer. The subjects tested had a mean age of 23.5 years and a mean body weight of 199 pounds. Eccentric and concentric isokinetic tests were performed at 60 and 120 deg/sec. The testing protocol was standardized for each subject. Test results indicated no statistically significant difference in mean torque between throwing and nonthrowing shoulders for either external or internal rotator muscle groups. Eccentric strength was significantly greater than concentric strength for all muscle groups tested. The external-to-internal rotator muscle strength ratios were well above those previously published for high school through professional pitchers. Mean torque-to-lean body weight ratios were also included to establish a data base. This study establishes one of the first data bases for eccentric isokinetic muscle strength of shoulder rotator muscles in professional baseball pitchers. The data may help clinicians prevent and rehabilitate shoulder injuries in professional throwing athletes.

Adult↗
PubMedDate not supplied

Shoulder muscle firing patterns during the windmill softball pitch.

The purpose of this study was to describe the activity of eight shoulder muscles during the windmill fast-pitch softball throw. Ten collegiate female pitchers were analyzed with intramuscular electromyography, high-speed cinematography, and motion analysis. The supraspinatus muscle fired maximally during arm elevation from the 6 to 3 o'clock position phase, centralizing the humeral head within the glenoid. The posterior deltoid and teres minor muscles acted maximally from the 3 to 12 o'clock position phase to continue arm elevation and externally rotate the humerus. The pectoralis major muscle accelerated the arm from the 12 o'clock position to ball release phase. The serratus anterior muscle characteristically acted to position the scapula for optimal glenohumeral congruency, and the subscapularis muscle functioned as an internal rotator and to protect the anterior capsule. Although the windmill softball pitch is overtly different from the baseball pitch, several surprising similarities were revealed. The serratus anterior and pectoralis major muscles work in synchrony and seem to have similar functions in both pitches. Although the infraspinatus and teres minor muscles are both posterior cuff muscles, they are characteristically uncoupled during the 6 to 3 o'clock position phase, with the infraspinatus muscle acting more independently below 90 degrees. Subscapularis muscle activity seems important in dynamic anterior glenohumeral stabilization and as an internal rotator in both the baseball and softball throws.

Adolescent↗
PubMedDate not supplied

Shoulder motion and laxity in the professional baseball player.

We studied 148 professional baseball players with no history of shoulder problems to assess range of motion and laxity of their dominant and nondominant shoulders. There were 72 pitchers and 76 position players. Average external rotation with the arm in 90 degrees of abduction was statistically greater and average internal rotation was statistically less in the dominant shoulders than in the nondominant shoulders, both in pitchers and position players. There was no statistical difference in forward elevation of external rotation with the arm at the side of the body in either group. Both dominant and nondominant shoulders of pitchers had greater average range of motion in forward elevation and external rotation (both at the side and at 90 degrees of abduction) and less average internal rotation than those of position players. Regarding laxity testing, 61% of dominant shoulders in pitchers had a sulcus sign, as compared with 47% in position players. Also, this degree of inferior laxity was significantly greater in pitchers than in position players. Differences in range of motion and laxity exist in the throwing shoulder of athletes involved in overhead throwing motions and should be considered in rehabilitation protocols and surgical repair.

Adolescent↗
PubMedDate not supplied

Results of derotational humeral osteotomy in posterosuperior glenoid impingement.

We identified 20 throwing athletes who continued to have pain after articular debridement for posterosuperior impingement syndrome. These patients were unable to resume sports, and we subsequently performed a derotational humeral osteotomy with a myorraphy of the subscapularis muscle. Patients were observed for an average of 46 months (range, 12 to 69). Eleven patients were able to resume the same sport at the same level, five resumed the same sport at a lower level, three changed sport secondary to persistent pain, and the last patient did not resume any sport and was worse after surgery. Patients returned to sports at an average of 6 months postoperatively (range, 4 to 44) and to their previous level of sports at an average of 12 months (range, 8 to 18). The mean increase in humeral retroversion was 29 degrees (range, 18 degrees to 44 degrees) Three women with preoperative multidirectional hyperlaxity were considered to have failed results. Derotational humeral osteotomy can be considered in the throwing athlete with posterosuperior impingement after failure of all other means of treatment. Careful patient selection and preoperative evaluation of humeral retroversion is important. Best results can be achieved in a motivated patient with low retroversion (< 10 degrees). If retroversion is normal (20 degrees to 30 degrees), the surgical indication is unclear. We do not recommend this surgery for patients with hyperlaxity.

Adult↗
PubMed1984

Current concepts in the diagnosis and treatment of shoulder instability in athletes.

Glenohumeral joint instability is a fairly common clinical disorder in athletes, especially in sports that involve the throwing motion. The direction of shoulder instability can be anterior, inferior, posterior, or multidirectional. The cause can be trauma, congenital laxity, or voluntary muscle action. Normal shoulders that have been disrupted by injury respond well to surgical correction. Shoulders that have inherently lax supporting structures, as found in patients with atraumatic and voluntary dislocation, have less consistent success with surgical repair. A common condition encountered in the shoulder of a throwing arm is anterior subluxation, which can be diagnosed by the positive apprehension sign and confirmed by arthroscopy. A torn glenoid labrum is a common injury also. Improvement in the diagnosis and treatment of shoulder disorders has been made recently by arthroscopy which allows direct visualization of the joint; many conditions can now be corrected by means of arthroscopic surgery. Radiographic techniques have also been improved.

Arthroscopy↗
PubMed2003

Special twin environments, genetic influences and their effects on the handedness of twins and their siblings.

It has been suggested that twinning may influence handedness through the effects of birth order, intra-uterine crowding and mirror imaging. The influence of these effects on handedness (for writing and throwing) was examined in 3657 Monozygotic (MZ) and 3762 Dizygotic (DZ) twin pairs (born 1893-1992). Maximum likelihood analyses revealed no effects of birth order on the incidence of left-handedness. Twins were no more likely to be left-handed than their singleton siblings (n = 1757), and there were no differences between the DZ co-twin and sibling-twin covariances, suggesting that neither intra-uterine crowding nor the experience of being a twin affects handedness. There was no evidence of mirror imaging; the co-twin correlations of monochorionic and dichorionic MZ twins did not differ. Univariate genetic analyses revealed common environmental factors to be the most parsimonious explanation of familial aggregation for the writing-hand measure, while additive genetic influences provided a better interpretation of the throwing hand data.

Birth Order↗
PubMed2003

Contributing factors to performance of a medicine ball explosive power test: a comparison between jump and nonjump athletes.

The present study examined the factors contributing to performance of a backward overhead medicine ball throw (B-MBT) across 2 types of athletes. Twenty male volleyball players (jump athletes) and 20 wrestlers (nonjump athletes) were evaluated on 4 measures of power, including B-MBT, chest medicine ball throw (C-MBT), countermovement vertical jump (CMJ), and power index (PI). The athletes also completed 3 measures of strength: a 1-repetition-maximum (1RM) bench press (BP), a 1RM leg press (LP), and combined BP + LP strength. Jump athletes demonstrated greater absolute scores for CMJ, C-MBT, and B-MBT (p < 0.05), whereas nonjump athletes demonstrated greater strength scores for BP and for BP + LP (p < 0.05). When performances were examined on a relative basis, jump athletes achieved superior scores for C-MBT (p < 0.05), whereas nonjump athletes had greater scores for BP, LP, and BP + LP (p < 0.05). For both groups, B-MBT had strong correlations with PI (r = 0.817 [jump] and 0.917 [nonjump]), whereas for C-MBT, only nonjump athletes demonstrated a strong correlation (r = 0.842). When expressed in relative terms, B-MBT was strongly correlated with C-MBT (r = 0.762 [jump] and 0.835 [nonjump]) and CMJ (r = 0.899 [jump] and 0.945 [nonjump]). Only nonjump athletes demonstrated strong correlations with strength for absolute LP (r = 0.801) and BP + LP (r = 0.810) strength. The interaction of upper- and lower-body strength and power in the performance of a B-MBT appears complex, with the contributing factors differing for athletes with divergent skill sets and performance demands.

Adolescent↗
PubMed2004

Difference in isokinetic torque acceleration energy of the rotator cuff: competitive male pitchers versus male nonathletes.

Rotator cuff function is critical to the overhead athlete. Rotator cuff power is felt to be important in the overhead athlete during the throwing motion. Little research exists regarding torque acceleration energy (TAE) in overhead athletes. Twenty-five males were divided into 2 groups consisting of overhead athletes (pitchers) (n = 12) and nonoverhead athletes (controls) (n = 13). All participants were given a concentric velocity spectrum isokinetic test at speeds of 60 degrees (1.05 r), 180 degrees (3.16 r), and 300 degrees.s(-1) (5.26 r) to both the dominant and nondominant shoulder internal and external rotators. Significant differences were found for all internal rotator TAE scores (p = 0.000-0.016), at each of the 3 velocities, when comparing dominant to nondominant arms of both overhead athletes and nonoverhead athletes. Only 60 degrees.s(-1) (1.05 r) was found to be different during external rotation TAE testing of the overhead athletes (p = 0.027) but was not found in the control subjects. Post hoc analysis revealed no differences between dominant or nondominant TAE scores when comparisons were made between overhead athletes and controls. Results may reveal that power of the rotator cuff muscles may not be a critical component of the overhead throwing motion.

Adolescent↗
PubMed2005

Acute effect on power output of alternating an agonist and antagonist muscle exercise during complex training.

The efficient coordination of agonist and antagonist muscles is one of the important early adaptations in resistance training responsible for large increases in strength. Weak antagonist muscles may limit speed of movement; consequently, strengthening them leads to an increase in agonist muscle movement speed. However, the effect of combining agonist and antagonist muscle exercises into a power training session has been largely unexplored. The purpose of this study was to determine if a training complex consisting of contrasting agonist and antagonist muscle exercises would result in an acute increase in power output in the agonist power exercise. Twenty-four college-aged rugby league players who were experienced in combined strength and power training served as subjects for this study. They were equally assigned to an experimental (Antag) or control (Con) group and were no different in age, height, body mass, strength, or maximal power. Power output was assessed during bench press throws with a 40-kg resistance (BT P40) with the Plyometric Power System training device. After warming up, the Con group performed the BT P40 tests 3 minutes apart to determine if any acute augmentation to power output could occur without intervention. The Antag group also performed the BT P40 tests; however, an intervention strategy of a set of bench pulls, which is an antagonistic action to the bench throw, was performed between tests to determine if this would acutely affect power output during the second BT P40 test. Although the power output for the Con group remained unaltered between test occasions, the significant 4.7% increase for the Antag group indicates that a strategy of alternating agonist and antagonist muscle exercises may acutely increase power output during complex power training. This result may affect power training and specific warm-up strategies used in ballistic sports activities, with increased emphasis placed upon the antagonist muscle groups.

Adult↗