Upper extremity blood flow in collegiate and high school baseball pitchers A preliminary report

Venous Thromboembolism Within Professional American Sport Leagues

Background

Numerous reports have described players in professional American sports leagues who have been sidelined with a deep vein thrombosis (DVT) or a pulmonary embolism (PE), but little is known about the clinical implications of these events in professional athletes.

Purpose

To conduct a retrospective review of injury reports from the National Hockey League (NHL), Major League Baseball (MLB), the National Basketball Association (NBA), and the National Football League (NFL) to take a closer look at the incidence of DVT/PE, current treatment approaches, and estimated time to return to play in professional athletes.

Study Design

Descriptive epidemiology study.

Methods

An online search of all team injury and media reports of DVT/PE in NHL, MLB, NBA, and NFL players available for public record was conducted by use of Google, PubMed, and SPORTDiscus. Searches were conducted using the professional team name combined with blood clot, pulmonary embolism, and deep vein thrombosis.

Results

A total of 55 venous thromboembolism (VTE) events were identified from 1999 through 2016 (NHL, n = 22; MLB, n = 16; NFL, n = 12; NBA, n = 5). Nineteen athletes were reported to have an upper extremity DVT, 15 had a lower extremity DVT, 15 had a PE, and 6 had DVT with PE. Six athletes sustained more than 1 VTE. The mean age at time of VTE was 29.3 years (range, 19-42 years). Mean (±SD) time lost from play was 6.7 ± 4.9 months (range, 3 days to career end). Seven athletes did not return to play. Players with upper extremity DVT had a faster return to play (mean ± SD, 4.3 ± 2.7 months) than those with lower extremity DVT (5.9 ± 3.8 months), PE (10.8 ± 6.8 months), or DVT with PE (8.2 ± 2.6 months) (F = 5.69, P = .002). No significant difference was found regarding time of return to play between sports.

Conclusion

VTE in professional athletes led to an average of 6.7 months lost from play. The majority of athletes were able to return to play after a period of anticoagulation or surgery. Those with an upper extremity DVT returned to play faster than those with other types of VTE. Further study is needed to look into modifiable risk factors for these events and to establish treatment and return-to-play guidelines to ensure the safety of these athletes.

Upper extremity blood flow changes in professional baseball pitchers between two consecutive seasons

BACKGROUND

Because of the tremendous forces produced and the repetitive nature of baseball, players have shown various shoulder adaptations in strength and range of motion. However, no research has identified whether alterations occur in the blood flow to the dominant arm among competitive baseball players.

METHODS

Twenty professional baseball pitchers and 16 position players participated. Measurements were taken on day 1 of 2 consecutive spring training seasons. Diagnostic ultrasound was used to measure blood flow of the throwing arm brachial artery. These measurements were taken in a standing position with the test arm resting at the participant's side and again with the test arm in a provocative shoulder position. Separate 1-way analyses of variance were conducted to compare blood flow between seasons (P < .05).

RESULTS

In a resting position, the blood flow of the pitchers did not change from 1 year to the next (P = .48). However, blood flow of the pitchers in the provocative position significantly decreased after the first year (P = .009). The position players did not have any significant changes in blood flow for either arm position (P > .11).

CONCLUSIONS

In a provocative shoulder position, the blood flow of pitchers significantly decreased after 1 competitive baseball season. These results indicate that after a competitive season, the blood flow to the upper extremity of pitchers may be compromised.

Decreased blood flow in the throwing arm of professional baseball pitchers

BACKGROUND

As a consequence of the repetitive forces placed on the throwing arm of a baseball player, various bony, capsuloligamentous, and muscular adaptations occur and have been identified. However, no research has identified whether adaptations also exist in the vasculature of the upper extremity in the competitive baseball player.

METHODS

Fifty-one professional baseball pitchers and 34 position players participated. Diagnostic ultrasound was used to measure bilateral blood flow of the brachial artery. These measurements were taken with the participant standing with the test arm resting at the participant's side and again with the test arm in a provocative shoulder position.

RESULTS

The throwing arm of the pitchers had significantly less blood flow volume when in the provocative shoulder position compared with their nonthrowing arm (P = .01). Pitchers did not have any bilateral difference while in the resting position (P = .19). There were no bilateral differences among the position players while in the resting (P = .64) or provocative positions (P = .63). Pitchers had significantly less blood flow of the throwing shoulder while in the provocative position compared with position players (P = .02). There were no other between-group differences.

CONCLUSIONS

While in a provocative shoulder position, pitchers have significantly less blood flow in their throwing arm compared with their nonthrowing arm and with the throwing arm of position players. These results provide a descriptive profile of blood flow volume among baseball players, which may be used in the evaluation and treatment of such athletes with vascular disorders.

Axillary artery thrombosis in a major league baseball pitcher: a case report and rehabilitation guide

This case study describes a Major League Baseball player who was diagnosed with an axillary artery thrombosis due to arterial compression from throwing. The purpose of this article is to create awareness as to the signs and symptoms associated with arterial positional compression and the rehabilitative implications to surgical intervention.

Sling exercise and traditional warm-up have similar effects on the velocity and accuracy of throwing

Throwing is a complex motion that involves the entire body and often puts an inordinate amount of stress on the shoulder and the arm. Warm-up prepares the body for work and can enhance performance. Sling-based exercise (SE) has been theorized to activate muscles, particularly the stabilizers, in a manner beneficial for preactivity warm-up, yet this hypothesis has not been tested. Our purpose was to determine if a warm-up using SE would increase throwing velocity and accuracy compared to a traditional, thrower's 10 warm-up program. Division I baseball players (nonpitchers) (16 men, age: 19.6 ± 1.3, height: 184.2 ± 6.2 cm, mass: 76.9 ± 19.2 kg) volunteered to participate in this crossover study. All subjects underwent both a warm-up routine using a traditional method (Thrower's 10 exercises) and a warm-up routine using closed kinetic chain SE methods (RedCord) on different days separated by 72 hours. Ball velocity and accuracy measures were obtained on 10 throws after either the traditional and SE warm-up regimens. Velocity was recorded using a standard Juggs radar gun (JUGS; Tualatin, OR, USA). Accuracy was recorded using a custom accuracy target. An Analysis of covariance was performed, with the number of throws recorded before the testing was used as a covariate and p < 0.05 was set a priori. There were no statistical differences between the SE warm-up and Thrower's 10 warm-up for throwing velocity (SE: 74.7 ± 7.5 mph, Thrower's 10: 74.6 ± 7.3 mph p = 0.874) or accuracy (SE: 115.6 ± 53.7 cm, Thrower's 10: 91.8 ± 55 cm, p = 0.136). Warming up with SE produced equivalent throwing velocity and accuracy compared to the Thrower's 10 warm-up method. Thus, SE provides an alternative to traditional warm-up.

The effects of shoulder laxity on upper extremity blood flow in professional baseball pitchers

BACKGROUND

The repetitive overhand throwing can potentially cause physiologic or pathologic changes in musculoskeletal and vascular structures. The purpose of this study was to investigate the effects of throwing on upper extremity arterial blood flow before and after a controlled pitching session. The hypothesis is that pitchers with physical signs of shoulder laxity would demonstrate differential changes in upper extremity blood flow as compared to those without laxity.

METHODS

Eighteen professional male pitchers underwent a detailed shoulder physical evaluation, followed by a wrist/brachial index (WBI) vascular exam and a vascular ultrasound examination before and after a controlled throwing session.

RESULTS

Following a 50-pitch workout, the WBI was significantly lower (0.79-0.86) in pitchers with laxity on exam versus no laxity (P < .05). For all pitchers, the average arterial volume flow increased from 234 ml/min to 482 ml/min after 50 pitches. Pitchers without physical signs of laxity had an average arterial volume flow increase of 115%, while the pitchers with laxity signs increased 35%.

CONCLUSION

This study demonstrated a statistically significant decrease in arterial blood flow in the laxity group compared to the nonlaxity throwers.