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At least 1,081 records · Page 60Linked to original sources
PubMed2005

Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement.

BACKGROUND: Alterations in glenohumeral range of motion, including increased posterior shoulder tightness and glenohumeral internal rotation deficit that exceeds the accompanying external rotation gain, are suggested contributors to throwing-related shoulder injuries such as pathologic internal impingement. Yet these contributors have not been identified in throwers with internal impingement. HYPOTHESIS: Throwers with pathologic internal impingement will exhibit significantly increased posterior shoulder tightness and glenohumeral internal rotation deficit without significantly increased external rotation gain. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Eleven throwing athletes with pathologic internal impingement diagnosed using both clinical examination and a magnetic resonance arthrogram were demographically matched with 11 control throwers who had no history of upper extremity injury. Passive glenohumeral internal and external rotation were measured bilaterally with standard goniometry at 90 degrees of humeral abduction and elbow flexion. Bilateral differences in glenohumeral range of motion were used to calculate glenohumeral internal rotation deficit and external rotation gain. Posterior shoulder tightness was quantified as the bilateral difference in passive shoulder horizontal adduction with the scapula retracted and the shoulder at 90 degrees of elevation. Comparisons were made between groups with dependent t tests (P < .05). RESULTS: The throwing athletes with internal impingement demonstrated significantly greater glenohumeral internal rotation deficit (P = .03) and posterior shoulder tightness (P = .03) compared with the control subjects. No significant differences were observed in external rotation gain between groups (P = .16). CLINICAL RELEVANCE: These findings could indicate that a tightening of the posterior elements of the shoulder (capsule, rotator cuff) may contribute to impingement. The results suggest that management should include stretching to restore flexibility to the posterior shoulder.

Adult↗
PubMed2006

Child's play.

Explore the source record for details and available documents.

Baseball↗
PubMed2006

Biomechanical evaluation of 2 techniques for ulnar collateral ligament reconstruction of the elbow.

BACKGROUND: Elbow medial ulnar collateral ligament tears often result in pain and instability that may be career threatening in overhead-throwing athletes. Surgical reconstruction is frequently chosen to treat this injury. Ulnar collateral ligament reconstruction as described by Jobe is the most commonly used technique. Testing of this construct has not demonstrated that the biomechanical parameters of the native ligament are restored. A more recent construct, the docking technique, may more reliably reproduce these factors. HYPOTHESIS: Increasing the number of strands of palmaris longus tendon graft used in ulnar collateral ligament reconstruction and tensioning them using the docking technique result in a construct with improved biomechanical parameters as compared with the Jobe technique. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty-three fresh-frozen human cadaveric elbows were randomized into 3 subgroups: Jobe (11), docking (12), and native (10). The Jobe and docking groups underwent reconstruction using their described palmaris tendon graft constructs. The ulnar collateral ligament was left intact in the native group. Elbows were potted and tested using a servohydraulic materials testing machine to apply a valgus moment at 30 degrees of elbow flexion. Maximal moments to failure, stiffness, and strain at maximal moment and with a 3 N.m force applied were determined using a 2-camera motion analysis system to track reflective markers spanning the site. RESULTS: The docking (14.3 N.m) and native (18.8 N.m) subgroups resulted in higher maximal moment to failure than did the Jobe (8.9 N.m) subgroup (P < .001). There was no significant difference between native and docking groups (P > .05). Native ligaments were stiffer (301.4 N.m) than were Jobe (74.3 N.m) or docking (80.8 N.m; P < .001). Native ligaments demonstrated lower strain at maximal force (0.087 mm/mm) and 3 N.m forces (0.030 mm/mm) than did the Jobe (0.198/0.057 mm/mm) or docking (0.287/0.042 mm/mm) subgroups. There was no difference in stiffness or strain between the Jobe and docking subgroups (P > .05). CONCLUSION: Neither technique reproduced the biomechanical profile of the native ulnar collateral ligament; the findings of this study suggest that the docking construct may offer initial biomechanical advantage over the Jobe construct.

Analysis of Variance↗
PubMed2006

Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes.

BACKGROUND: Medial ulnar collateral ligament insufficiency of the elbow can be a devastating injury in the throwing athlete. Reconstruction of the medial ulnar collateral ligament was initially described by Jobe and associates; good clinical results have been described after this procedure. The authors' experience with this technique raised several concerns, and thus the "docking" procedure was developed as an alternative method for medial ulnar collateral ligament reconstruction of the elbow. The early results of the docking technique were good. The authors wish to investigate the intermediate-term clinical results of this method in a large group of athletes. HYPOTHESIS: The docking technique can return overhead-throwing athletes to sport with minimal perioperative morbidity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: During a 3-year period, 100 consecutive overhead-throwing athletes were treated with surgical reconstruction using the docking technique. The inclusion criteria were as follows: (1) a history of medial elbow pain that prevented throwing, (2) a preoperative standard noncontrast magnetic resonance image demonstrating medial ulnar collateral ligament injury, (3) clinically apparent medial ulnar collateral ligament insufficiency, and (4) an overhead-throwing athlete. At the time of surgery, all patients underwent routine arthroscopic assessment. The ulnar nerve was transposed in 22 cases. The mean follow-up was 36 months (range, 24-60 months). RESULTS: Ninety of 100 (90%) patients were able to compete at the same or a higher level than before medial ulnar collateral ligament injury for more than 12 months as noted at the follow-up interval; 7 patients were able to compete at a lower level. Only 3 patients suffered postoperative complications. CONCLUSION: The docking technique reliably returns athletes to competitive throwing with a low perioperative morbidity.

Adolescent↗
PubMedDate not supplied

Little League survey: the Houston study.

1. In a study of 595 Little League pitchers, approximately 17% had a history of elbow symptoms: only 1% had elbow symptoms which had ever excluded them from pitching. There was no correlation between the presence of symptoms and years of pitching experience. 2. Some limitation of active extension of the elbow was seen in 12% of the pitchers; however, there was no correlation between elbow flexion contractures and years of pitching experience, symptoms, or roentgenographic pathology. No normal child had an elbow flexion contracture greater than 15 degrees. 3. A slight valgus carrying angle is considered a normal anatomic variant in the dominant arm. There was no correlation between valgus carrying angle and years of pitching experience or symptoms or roentgenographic pathology. 4. No roentgenographic evidence of avascular necrosis of the capitellum, radial head, or both was seen in this population. 5. Roentgenographic findings such as bony hypertrophy, enlargement of the medial epicondyle, and secondary ossification centers are normal anatomic variants not related to symptoms. Undisplaced stress fractures of the medial epicondyle respond well to conservative treatment, with no functional residual.

Adolescent↗
PubMedDate not supplied

Little League survey: the Eugene study.

In a clinical and radiographic survey of the elbows of 120 pitchers ages 11 and 12, 20% were found to have symptoms, 10% flexion contractures, and 23% roentgenographic changes related to traction stresses on the medial side of the elbow. Five per cent had more serious lateral compression findings related to the radial head or capitellum, but none of these had symptoms. Although this represents a definite incidence of abnormal occurrence, there were no statistically significant correlations or interrelations found relating to pitching experience, valgus elbow deformities, symptoms, flexion contractures, or x-ray findings.

Age Factors↗
PubMedDate not supplied

Chronic rotator cuff impingement in the throwing athlete.

Compromise of the space between the humeral head and the coracoacromial arch may be a source of chronic shoulder pain associated with rotator cuff impingement in the athlete participating in throwing sports. In certain carefully selected individuals, surgical decompression may alleviate these symptoms. The surgical procedure can be done under local anesthesia and may enable the athlete to return to his previous level of performance without disability.

Adolescent↗
PubMedDate not supplied

Acute peroneal compartment syndrome in a well conditioned athlete: report of a case.

A case report of acute peroneal compartment syndrome occurring in a 25-year-old male softball player is presented, in which neuropraxia of the common peroneal nerve occurred within 8 hr after onset and in which complete recovery occurred after fasciotomy was done 13 hr after onset of symptoms. A plea is made for early diagnosis and complete fasciotomy carried out as a surgical emergency. This must be accomplished if results previously reported, indicating permanent disability in 80%, are to be improved.

Acute Disease↗
PubMedDate not supplied

The throw: biomechanics and acute injury.

The throw and its modifications are integral components of many sports. This study correlates case histories of acute injuries in throwing with a biomechanical analysis of the throwing mechanism. Comparisons are made with a similar analysis of the kick analyzed by the same film technique and computer program. Just prior to ball release, the pitching arm extends through an arc of about 73 degress in 40 msec, beginning with the elbow flexed at 80 degrees. This produces an axial load on the humerus and coincides with a pulse of external torque at the shoulder. This acts as stress protection to the humerus which is developing an internal torque of 14,000 inch-lb prior to ball release. The change in angular velocity, or the angular acceleration, during the throw is acquired in a much shorter time than in the kick. Torque is directly proportional to angular acceleration. This necessitates the development of substantially higher torques in the humerus during the throw than about the knee during a kick. The kinetic energy in the arm is 27,000 inch-lb during the throw. This is much higher than the kinetic energy in the kicking leg because the kinetic energy varies proportionally with the square of the angular velocity of the extremity. The angular velocity of the arm is about twice that of the leg. Thus, the pitching arm contains about four times as much kinetic energy as the kicking leg. These severe overloading conditions predispose the upper extremity to injury in the throwing mechanism.

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

Acute medial elbow ruptures.

Disruption of the ulnar collateral ligament, flexor muscles, and anterior elbow capsule may result from valgus vector forces and subsequently cause difficulty in throwing, pulling, pushing and catching. Complete medial elbow tears were diagnosed acutely in four elbows by abduction stress tests at 15 degrees of flexion. Three elbows had associated ulnar nerve compression. We repaired torn medial structures by direct suture without ligamentous reconstruction. We also decompressed ulnar nerves and performed one anterior transposition. Full range of motion, strength, and return to previous functional level was attained without infection, neurovascular compression, or myositis ossificans.

Adult↗