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Swinging injuries in competitive baseball players. Skeletal Radiol 2022; 52:1277-1292. [PMID: 36542131 DOI: 10.1007/s00256-022-04261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
Injuries are common in competitive baseball players and can occur in all facets of the game. The majority of the existing literature on injuries in baseball players has focused on injuries secondary to the overhead throw with very little attention given to injuries sustained while batting. The baseball swing is a complex, often violent, motion that predisposes batters to a variety of injuries affecting the spine, trunk, pelvis, and extremities. Knowledge of injury patterns that commonly occur during the baseball swing and radiologic findings important to the treating physician can help radiologists provide accurate imaging interpretations that appropriately guide patient management.
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McCarron L, Bindra R, Coombes BK, Bisset L. Wrist and forearm range of motion commencement time following primary triangular fibrocartilage complex foveal repair surgery: A scoping review. J Hand Ther 2021; 36:179-195. [PMID: 34972604 DOI: 10.1016/j.jht.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/08/2021] [Accepted: 10/02/2021] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Scoping review. BACKGROUND Rehabilitation guidelines following triangular fibrocartilage complex (TFCC) foveal repair surgery have been inconsistently reported in the published literature, with no consensus regarding wrist or forearm range of motion (ROM) commencement time. PURPOSE OF THE STUDY To scope the available literature to identify the extent and strength of the evidence supporting the clinical guidelines for wrist and forearm ROM commencement time following primary TFCC foveal repair surgery. METHODS A systematic search produced 26 studies (3 retrospective cohort studies, 1 prospective cohort study, 1 retrospective comparative study, and 21 retrospective case series) that described specific rehabilitation protocols following TFCC foveal repair surgery. RESULTS No supporting evidence was identified regarding rehabilitation protocol recommendations across all the included studies. Postsurgery wrist ROM commencement ranged from 2 to 8 weeks; forearm ROM commencement ranged from 2 to 12 weeks. ROM commencement times did not appear to systematically influence the rate of adverse events, although adverse events were poorly reported. CONCLUSIONS TFCC rehabilitation protocols were poorly reported and varied widely between the included studies. Additional research is recommended to comprehensively evaluate the association between wrist and/or forearm ROM and the rate of adverse events for this complex and multifaceted condition.
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Affiliation(s)
- Luke McCarron
- School of Medicine and Dentistry, Griffith University, Queensland, Australia; Occupational Therapy Department, Bond University, Queensland, Australia; Orthopaedic and Trauma Department, Gold Coast Hospital and Health Service, Queensland, Australia.
| | - Randy Bindra
- School of Medicine, Griffith University, Queensland, Australia; Orthopaedic and Trauma Department, Gold Coast Hospital and Health Service, Queensland, Australia
| | - Brooke K Coombes
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Leanne Bisset
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
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Abstract
The triangular fibrocartilage complex (TFCC) is an intricate structure that plays an important role in providing distal radioulnar joint stability and load transmission at the ulnar wrist. Understanding this structure is critical for creating treatment plans based on patient history, physical examination, and imaging. Arthroscopic, arthroscopic-assisted, and open surgical treatment options exist for tears meeting distinct surgical criteria that are discussed in this article. Although long-term comparative outcomes studies are limited, long-term retrospective outcome studies of TFCC repair and reconstructive techniques demonstrate improvement in pain, stability, range of motion, and disability.
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Rios-Russo JL, Lozada-Bado LS, de Mel S, Frontera W, Micheo W. Ulnar-Sided Wrist Pain in the Athlete: Sport-Specific Demands, Clinical Presentation, and Management Options. Curr Sports Med Rep 2021; 20:312-318. [PMID: 34099609 DOI: 10.1249/jsr.0000000000000853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.
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Affiliation(s)
- Jose L Rios-Russo
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, San Juan, PUERTO RICO
| | - Lianette S Lozada-Bado
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, San Juan, PUERTO RICO
| | - Sandra de Mel
- Ponce Health Sciences School of Medicine, Ponce Health Sciences University, Ponce, PUERTO RICO
| | - Walter Frontera
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, San Juan, PUERTO RICO
| | - William Micheo
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, San Juan, PUERTO RICO
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Rhee PC, Camp CL, D’Angelo J, Desai VS, Shin SS, Sheridan D, Conte S. Epidemiology and Impact of Hand and Wrist Injuries in Major and Minor League Baseball. Hand (N Y) 2021; 16:498-504. [PMID: 31331206 PMCID: PMC8283117 DOI: 10.1177/1558944719864450] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Professional baseball players are at risk of acute and chronic injuries to their upper extremities. Methods: Major League Baseball's Health and Injury Tracking System, a prospective injury surveillance system, was used to identify and characterize all hand and wrist injuries sustained by all Major League Baseball (MLB) and Minor League Baseball (MiLB) players during the pre-, regular, and postseason throughout 2011-2016. Injuries were included if they resulted in at least 1 day out of play and were sustained during standard baseball activities. Days missed were defined as the time between injury and the first time in which a player was cleared to return to play. Results: During the study period, there were 4478 hand and 1748 wrist injuries throughout MLB and MiLB, which resulted in a total of 105 246 days out of play. This was equivalent to the length of 575 individual MLB player seasons, and the mean days missed per injury was 17 days. Most injuries were traumatic in nature, with 43% (n = 2672) of players injured after being hit by a baseball that mainly occurred during batting (n = 2521; 40%). Injuries that most frequently required surgical intervention were hook of hamate fractures (72%) and scaphoid fractures (60%). Conclusions: Understanding the epidemiology and impact of hand and wrist injuries in MLB and MiLB players may lead to improved management of these injuries and reduce time away from play. Most importantly, preventive measures and/or enhanced protective gear may be developed to minimize these types of injuries in MLB and MiLB.
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Affiliation(s)
| | - Christopher L. Camp
- Mayo Clinic, Rochester, MN, USA,Christopher L. Camp, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | | | | | | | | | - Stan Conte
- Conte INJURY Analytics, San Carlos, CA, USA
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DeFroda SF, Staffa SJ, Keeley T, Kriz PK. Home Run Derby Participation in Major League Baseball Players: Is There Associated Injury Risk and Impact on Second-Half Performance? Orthop J Sports Med 2021; 9:2325967120983350. [PMID: 33738309 PMCID: PMC7934056 DOI: 10.1177/2325967120983350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The Major League Baseball (MLB) All-Star Game (ASG) Home Run Derby (HRD) remains a highly anticipated event, during which contestants can take hundreds of maximum-effort swings en route to hitting a multitude of home runs. Critics have openly questioned the risk-benefit of HRD participation as it pertains to injury, alterations in swing mechanics, and timing. Purpose: To determine whether participation in the MLB ASG HRD was associated with both increased injury risk and decline in second-half performance in MLB players. Study Design: Cohort study; Level of evidence, 3. Methods: MLB players who participated in the HRD between 2006 and 2019 were identified through publicly available internet databases. A control group of ASG participants who had the highest home run totals in the first half of the corresponding MLB season were selected as a control group. Multivariable linear regression was used to determine independent associations between HRD participation and batting metrics in the second half of the season. Multivariable logistic regression also assessed the impact of HRD participation on injured list placement during the second half of the concurrent MLB season. Results: A total of 114 HRD participants and 114 ASG participant controls competed during the study period. No statistically significant differences were seen in batting metrics in the second half of the MLB season between HRD participants and ASG controls, although HRD participants had a significantly lower wins-above-replacement statistic for the season compared with controls (4.69 ± 2.06 vs 5.33 ± 2.08; P = .021). HRD participation was not significantly associated with injury during the second half. The number of HRD rounds in which a player participated did not result in a statistically significant increased odds of injury during the second half of the MLB season. Conclusion: HRD participants did not have increased odds of being placed on the injured list during the second half of the MLB season compared with controls, nor did they experience second-half performance declines in offensive production versus controls when multivariable linear regression analysis was performed.
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Affiliation(s)
- Steven F DeFroda
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tim Keeley
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Peter K Kriz
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA.,Division of Sports Medicine, Departments of Orthopedics and Pediatrics, Warren Alpert Medical School, Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island, USA
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Abstract
Triangular fibrocartilage complex tears are a common source of ulnar-sided wrist pain and distal radioulnar joint instability. Symptoms recalcitrant to conservative management or injuries in high-demand athletes may indicate surgical management. Both open and arthroscopic techniques offer improvements in objective measures, patient-centered outcome scores, and return to work, but may be complicated by nerve irritation, persistent wrist instability, and pain. Recently developed knotless arthroscopic techniques are not well studied but may limit morbidity.
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Affiliation(s)
- John C. Dunn
- William Beaumont Army Medical Center, El Paso, TX, USA
| | - Michael M. Polmear
- William Beaumont Army Medical Center, El Paso, TX, USA,Michael M. Polmear, Department of Orthopaedic Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79920-5001, USA.
| | - Leon J. Nesti
- Walter Reed National Military Medical Center, Bethesda, MD, USA,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Abstract
PURPOSE OF REVIEW The goal of this manuscript is to review key historic and recent literature regarding extensor carpi ulnaris (ECU), triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) injuries, particularly in athletes. RECENT FINDINGS Many recent studies examining the ECU focus on clinical and radiographic diagnosis. Several physical exam findings are described in addition to the use of MRI and US. Imaging studies must be clinically correlated due to high incidence of findings in asymptomatic patients. In regard to the TFCC/DRUJ, there are numerous recent studies that support the use of MRA as an adjunctive diagnostic study. There are also a number of repair constructs that are described for the various different kinds of TFCC pathology reviewed here. In summary, there are a number of options for the diagnosis and treatment of ulnar-sided wrist pain. Patient factors, especially in the athletic population, must be taken into account when approaching any patient with these pathologies.
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Recognition and Management of Triangular Fibrocartilage Complex Injury. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY AND TRAINING 2013. [DOI: 10.1123/ijatt.18.3.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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