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Hannah DC, Scibek JS, Carcia CR, Phelps AL. Junior and Collegiate Tennis Players Display Similar Bilateral Asymmetries of Humeral Retroversion. J Athl Train 2021; 56:464022. [PMID: 33848357 PMCID: PMC8675307 DOI: 10.4085/1062-6050-0686.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Overhead throwing athletes consistently display significant bilateral differences in humeral retroversion (HRV). However, there is limited evidence regarding HRV asymmetries in tennis players despite similarities between the overhead throw and tennis serve. OBJECTIVE To determine if junior and collegiate tennis players demonstrate bilateral differences in HRV, and whether the magnitude of the side-to-side difference (HRVΔ) was similar across different age groups. DESIGN Cross-Sectional Study Setting: Field-Based Patients or Other Participants: Thirty-nine healthy tennis players were stratified into three age groups: Younger Juniors (n = 11; age = 14.5 ± 0.5 years), Older Juniors (n = 12; age = 17.1 ± 0.9 years), and Collegiate (n = 16; age = 19.6 ± 1.2 years). MAIN OUTCOME MEASURES Three-trial means were calculated for HRV for the dominant and nondominant limbs, and HRVΔ was calculated by subtracting the mean of the nondominant side from the dominant side. Paired-sample t-tests were utilized to determine bilateral differences in HRV, while a one-way ANOVA was used to compare HRVΔ between groups. RESULTS For all three groups, HRV was significantly greater in the dominant arm compared to the nondominant arm (Younger Juniors: dominant = 62.8° ± 9.1° vs nondominant = 56.3° ± 6.8°, P = .039; Older Juniors: dominant = 75.5° ± 11.2° vs nondominant = 68.6° ± 14.2°, P = .043; Collegiate: dominant = 71.7° ± 8.5° vs nondominant = 61.2° ± 6.9°, P = .001). However, no significant differences were detected in HRVΔ when compared across age groups (P = .511). CONCLUSIONS Consistent with studies involving overhead throwing athletes, tennis players demonstrated significantly greater measures of HRV in the dominant limb. Further, the development of HRV asymmetries appear to have occurred prior to the teenage years as no changes were observed in HRVΔ between age groups.
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Affiliation(s)
- Daniel C Hannah
- aInstructor, Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Jason S Scibek
- bAssociate Professor, Department of Athletic Training, Duquesne University, Pittsburgh, PA, USA
| | - Christopher R Carcia
- cAssociate Professor, Department of Kinesiology, Colorado Mesa University, Grand Junction, CO, USA
| | - Amy L Phelps
- dAssistant Professor, Palumbo Donahue School of Business, Duquesne University, Pittsburgh, PA, USA
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Hasegawa A, Mihata T, Itami Y, Takeda A, Neo M. Relationship between humeral retroversion and baseball positions during elementary and junior-high school. J Shoulder Elbow Surg 2021; 30:290-297. [PMID: 33125322 DOI: 10.1016/j.jse.2020.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Humeral retroversion is greater in the dominant shoulder than in the nondominant shoulder in baseball players. However, the effect of different baseball positions during childhood on humeral retroversion remains unknown. The purpose of this study was to investigate the following: (1) the relationship between humeral retroversion and baseball positions played during elementary and junior-high schools; (2) the association between humeral retroversion and the prevalence of pain during the medical checkup and self-reported history of injuries in the dominant shoulder or elbow. METHODS We enrolled 149 male high-school baseball players who started playing baseball in elementary school. The subjects were classified into 3 groups according to their baseball positions in elementary and junior-high schools. All participants completed questionnaires regarding their current and past positions, current incidence and history of injuries in their shoulder or elbow joints, and the age they started playing baseball. Shoulder range of motion, humeral retroversion on ultrasonographic-assisted measurement, and the association between humeral retroversion and shoulder and elbow pain were evaluated. RESULTS Humeral retroversion was significantly greater in the dominant shoulder than in the nondominant shoulder in all groups (P < .001). In addition, humeral retroversion in the dominant shoulder was significantly greater in players who were pitchers in both elementary and junior-high schools than in those who were fielders during both periods (96.2° and 89.4°, respectively; P = .02). Humeral retroversion in the dominant shoulder was positively correlated (P = .005, r = 0.23) with the length of career as a pitcher during elementary and junior-high schools. Humeral retroversion was not correlated with the prevalence of pain during the medical checkup or self-reported history of injuries in the dominant shoulder or elbow (P values ranging from 0.09-0.99). CONCLUSION These results suggest that playing baseball as a pitcher during elementary school and junior-high school affects the increase in humeral retroversion in the dominant shoulder. Increased humeral retroversion in the dominant shoulder by repetitive throwing motion is an adaptive change, rather than a pathologic change.
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Affiliation(s)
- Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan.
| | - Yasuo Itami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Atsushi Takeda
- Department of Rehabilitation, First Towakai Hospital, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Helmkamp JK, Bullock GS, Rao A, Shanley E, Thigpen C, Garrigues GE. The Relationship Between Humeral Torsion and Arm Injury in Baseball Players: A Systematic Review and Meta-analysis. Sports Health 2020; 12:132-138. [PMID: 32027223 DOI: 10.1177/1941738119900799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
CONTEXT Humeral torsion (HT) has been linked to various injuries and benefits. However, the exact interplay between HT, shoulder range of motion (ROM), competition level differences, and injury risk is unclear. OBJECTIVE To determine the relationship between HT, ROM, and injury risk in baseball players. Secondarily, to determine HT based on competition level. DATA SOURCES PubMed, Embase, Web of Science, CINAHL, and Cochrane databases were searched from inception until November 4, 2018. STUDY SELECTION Inclusion criteria consisted of (1) HT measurements and (2) arm injury or shoulder ROM. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 3. DATA EXTRACTION Two reviewers recorded patient demographics, competition level, HT, shoulder ROM, and injury data. RESULTS A total of 32 studies were included. There was no difference between baseball players with shoulder and elbow injuries and noninjured players (side-to-side HT difference: mean difference [MD], 1.75 [95% CI, -1.83 to 2.18]; dominant arm: MD, 0.17 [95% CI, -1.83 to 2.18]). Meta-regression determined that for every 1° increase in shoulder internal rotation (IR), there was a subsequent increase of 0.65° in HT (95% CI, 0.28 to 1.02). HT did not explain external rotation (ER ROM: 0.19 [95% CI, -0.24 to 0.61]) or horizontal adduction (HA ROM: 0.18 [95% CI, -0.46 to 0.82]). There were no differences between HT at the high school, college, or professional levels. CONCLUSION No relationship was found between HT and injury risk. However, HT explained 65% of IR ROM but did not explain ER ROM or HA ROM. There were no differences in HT pertaining to competition level. The majority of IR may be nonmodifiable. Treatment to restore and maintain clinical IR may be important, especially in players with naturally greater torsion. HT adaptation may occur prior to high school, which can assist in decisions regarding adolescent baseball participation.
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Affiliation(s)
| | - Garrett S Bullock
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Allison Rao
- Midwest Orthopaedics at Rush University, Chicago, Illinois
| | - Ellen Shanley
- ATI Physical Therapy, University of South Carolina, Greenville, South Carolina
| | - Charles Thigpen
- ATI Physical Therapy, University of South Carolina, Greenville, South Carolina
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Ito A, Mihata T, Hosokawa Y, Hasegawa A, Neo M, Doi M. Humeral Retroversion and Injury Risk After Proximal Humeral Epiphysiolysis (Little Leaguer's Shoulder). Am J Sports Med 2019; 47:3100-3106. [PMID: 31585046 DOI: 10.1177/0363546519876060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The increased humeral retroversion on the dominant side of throwing athletes is thought to result from repetitive throwing motion. Little Leaguer's shoulder-a rotational stress fracture of the proximal humeral epiphyseal plate-may influence the risk of humeral retroversion and injury of the shoulder or elbow joint. PURPOSE To investigate the effect of Little Leaguer's shoulder on humeral retroversion and the rates of shoulder and elbow injuries. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS 10 high school baseball players (average age, 16.6 years; range, 16-18 years) who had experienced Little Leaguer's shoulder during elementary or junior high school (average age, 12.6 years; range, 11-15 years) were enrolled in the study. As a control group, 22 high school baseball players (average age, 16.9 years; range, 16-18 years) who had never had any shoulder or elbow injury during elementary and junior high school were included. Humeral retroversion on ultrasonographic measurement, shoulder range of motion, and rates of shoulder and elbow injuries were evaluated. RESULTS Humeral retroversion was significantly greater on the dominant side than on the nondominant side in both players with Little Leaguer's shoulder (dominant, 104°± 8°; nondominant, 84°± 12°; P < .001) and controls (dominant, 91°± 13°; nondominant, 81°± 10°; P < .001). In the dominant shoulder, humeral retroversion was greater in the Little Leaguer's shoulder group than in the control group (P = .008). When the effects of humeral retroversion were excluded, maximal external rotation was significantly less in the dominant shoulder than in the nondominant shoulder in the Little Leaguer's shoulder group (by 11°± 12°, P = .02), whereas no significant difference was found between dominant (110°± 11°) and nondominant (111°± 13°) shoulders in the control group (P = .64). The rates of shoulder and elbow pain were significantly higher in the Little Leaguer's shoulder group (shoulder pain 80%, elbow pain 70%) than in the control group (shoulder pain 9%, P < .001; elbow pain 32%, P = .04). CONCLUSION Humeral retroversion was increased in baseball players without any history of shoulder or elbow injury during elementary and junior high school and was further increased in players who had had Little Leaguer's shoulder. Increased humeral retroversion after Little Leaguer's shoulder may be a risk factor for future shoulder or elbow injury.
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Affiliation(s)
- Atsushi Ito
- Doi Orthopaedic Clinic, Takatsuki, Osaka, Japan
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | | | - Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
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Hellem A, Shirley M, Schilaty N, Dahm D. Review of Shoulder Range of Motion in the Throwing Athlete: Distinguishing Normal Adaptations from Pathologic Deficits. Curr Rev Musculoskelet Med 2019; 12:346-355. [PMID: 31264172 PMCID: PMC6684718 DOI: 10.1007/s12178-019-09563-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Overhand (OH) throwers demonstrate a unique motion profile of the shoulder joint complex. This manuscript reviews normal adaptations in the OH thrower and contrast findings with pathologic motion deficits. RECENT FINDINGS Multiple adaptations in range of motion have been associated with increased risk for arm injury. The use of a more conservative cutoff value for glenohumeral internal rotation deficit and horizontal adduction in younger throwers may help reduce injury risk. Deficits in glenohumeral internal rotation, total range of motion, shoulder flexion, and external rotation insufficiency have all been proposed as means to identify OH throwers at risk for arm injury, but conflicting evidence exists. Understanding normal adaptation due to repetitive stress of throwing is essential to effective management of these athletes. Adaptive change in bone and soft tissues is normal and contributes to the unique motion profiles expected in throwers. The causative link between normal adaptation and shoulder and elbow injury remains uncertain.
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Affiliation(s)
- Aaron Hellem
- Department of Physical Medicine and Rehabilitation, Sports Medicine Center at Mayo Clinic Square, Mayo Clinic, 600 Hennepin Avenue #310, Minneapolis, MN, 55403, USA.
| | - Matthew Shirley
- Department of Orthopedic Surgery, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
| | - Nathan Schilaty
- Department of Orthopedic Surgery, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Diane Dahm
- Department of Orthopedic Surgery, Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
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Hosokawa Y, Mihata T, Itami Y, Neo M, Doi M. Little Leaguer's Shoulder Can Cause Severe Three-Dimensional Humeral Deformity. Clin Orthop Surg 2017; 9:537-541. [PMID: 29201309 PMCID: PMC5705315 DOI: 10.4055/cios.2017.9.4.537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 05/05/2017] [Indexed: 11/06/2022] Open
Abstract
We analyzed three-dimensional (3D) humeral deformity (valgus–varus, flexion–extension, and rotational deformation) after little leaguer's shoulder using 3D computed tomography in a 15-year-old male baseball player. Humeral retroversion was increased by 27.1° on the dominant side compared with the nondominant side. Compared with the nondominant shaft, the dominant humeral shaft was deformed in the varus direction (9.4°), resulting in a decreased neck–shaft angle (dominant side, 127.5°; nondominant side, 135.1°), and it was also deformed in the extension direction (21.0°). This case demonstrates that little leaguer's shoulder can cause markedly greater humeral retroversion than has been reported previously and can result in varus and extension deformation of the humerus. These findings suggest that humeral deformity in overhead throwing athletes may not always solely reflect adaptation to throwing.
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Affiliation(s)
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan.,First Towakai Hospital, Takatsuki, Japan.,Katsuragi Hospital, Kishiwada, Japan
| | - Yasuo Itami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Differences in humeral retroversion in dominant and nondominant sides of young baseball players. J Shoulder Elbow Surg 2017; 26:1083-1087. [PMID: 28131683 DOI: 10.1016/j.jse.2016.11.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 11/17/2016] [Accepted: 11/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The relationship between the disabled throwing shoulder and humeral retroversion has recently attracted a great deal of attention. However, none of the previous studies clarified when the side-to-side difference of humeral retroversion in young baseball players would start. This study aimed to clarify when the difference of humeral retroversion in the dominant and nondominant sides appeared in baseball players. METHODS The bicipital-forearm angle in bilateral shoulders of 172 elementary school baseball players was measured by ultrasound. The bicipital-forearm angle was defined as an angle between the perpendicular line to the bicipital groove and the ulnar long axis with the elbow flexed at 90°. The correlation between the bicipital-forearm angle and the grade and the difference of the bicipital-forearm angle between the dominant and nondominant sides were analyzed. RESULTS In the nondominant shoulders, the bicipital-forearm angle increased with the grade in school (r = 0.32, P < .0001), but this was not observed in the dominant shoulders. In the fourth to sixth graders, the bicipital-forearm angles were significantly smaller in the dominant shoulders than in the nondominant shoulders. CONCLUSION Our findings indicated that humeral retroversion decreased with age in the nonthrowing side but not in the throwing side and that the side-to-side difference of humeral retroversion in the baseball players became obvious from the fourth grade. We assume that the repetitive throwing motion restricts the physiologic humeral derotation process and the difference became apparent from the fourth grade when the growth spurt begins in boys.
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