1
|
Relationship between shoulder and elbow range of motion and ultrasonographic structural abnormalities in the elbow of Taiwanese high school baseball players. BMC Sports Sci Med Rehabil 2024; 16:44. [PMID: 38347601 PMCID: PMC10860268 DOI: 10.1186/s13102-024-00839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/04/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Ultrasonographic structural abnormalities are regarded as one of the risk factors of elbow injuries. Elbow injuries are commonly associated with decreased shoulder/elbow range of motion (ROM). The purpose of this study is to determine the relationship between shoulder/elbow ROM and elbow ultrasonographic structural abnormalities in Taiwan high school baseball players. METHODS A total of 533 Taiwan high school baseball players were enrolled. Physical examinations including measurements on shoulder/elbow ROM and elbow sonographic examinations were performed and recorded by professional physicians. The analyses were conducted in three subgroups according to their defensive position because the training programs were different. All players pooled, pitchers-only, and fielders-only, due to several demographic differences among these subgroups. In all the subgroups, univariate analyses were conducted separately for participants with and those without elbow ultrasonographic structural abnormalities, and then multivariate analyses were conducted to identify factors significantly related. The odds ratios (ORs) were used to estimate the risk of elbow ultrasonographic structural abnormalities. RESULTS Demographic data showed that pitchers had taller body height (P < 0.001) and greater elbow flexion/extension ROM (P < 0.001). When all players were pooled, significant risk factors included started playing baseball at an younger age (OR = 1.202; 95% CI = 1.064-1.357; P = 0.003), longer experience of official baseball (OR = 1.154; 95% CI = 1.038-1.283; P = 0.008), lower total shoulder rotation angle (OR = 1.007; 95% CI = 1.000-1.014; P = 0.050), and less total elbow arm angle (OR = 1.052; 95% CI = 1.017-1.088; P = 0.003) For pitchers, significant risk factors included longer experience of official baseball (OR = 1.342; 95% CI = 1.098-1.640; P = 0.004), lower total shoulder rotation angle (OR = 1.016; 95% CI = 1.004-1.027; P = 0.006), and lower total elbow arm angle (OR = 1.075; 95% CI = 1.024-1.129; P = 0.004) (Table 5). There were no significant risk factors for elbow structural abnormalities in fielders. CONCLUSION For Taiwan high school pitchers, longer official baseball experience, decreased shoulder total rotational angle, and decreased elbow total flexion/extension angle, were related to ultrasonographic structural abnormalities in elbows.
Collapse
|
2
|
Ultrasonographic appearance of the pronator quadratus muscle in high school baseball pitchers with and without elbow symptoms: a pilot study. J Ultrasound 2023; 26:627-633. [PMID: 35666460 PMCID: PMC10468450 DOI: 10.1007/s40477-022-00685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Earlier reports have described forearm flexor muscles as active stabilizers of the elbow to valgus stress during throwing motion. The pronator quadratus (PQ) muscle acts in coordination with the pronator teres muscle for forearm pronation. This study of high school pitchers was conducted to assess the association between sonographic appearance and a history of elbow symptoms. METHODS We examined 123 high school baseball pitchers, all of whom had completed a self-administered questionnaire, including items related to throwing-related elbow joint pain sustained during the prior year. Ultrasound examination was made of the pitchers with and without valgus stress of the medial aspect of the bilateral elbows. The sonographic appearance of the PQ was assessed on sagittal and axial images on the bilateral side. For participants with and without a history of elbow symptoms, we compared the maximum thickness of the PQ on sagittal and axial images of the throwing side. RESULTS Regarding maximum thickness of the PQ on the sagittal and axial images, a significant difference was found between the throwing and non-throwing sides (throwing side vs non-throwing side mean: sagittal 6.3 mm vs 5.7 mm, axial 8.2 mm vs 7.5 mm, 95% confidence interval: sagittal 0.41-0.70, p < 0.001, axial 0.53-0.82, p < 0.001). The maximum thickness of the PQ on axial images with elbow symptoms was significantly greater than the PQ thickness of those without elbow symptoms. Nevertheless, no association was found between elbow valgus instability and the maximum thickness of the PQ on sagittal and axial images of the throwing side. CONCLUSION Sonographic appearance of the PQ might be associated with elbow joint conditions in high school baseball players.
Collapse
|
3
|
Glenohumeral Internal Rotation Deficit in the Adolescent Overhead Athlete: A Systematic Review and Meta-Analysis. Clin J Sport Med 2022; 32:546-554. [PMID: 34173779 DOI: 10.1097/jsm.0000000000000945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this review was to investigate the average glenohumeral internal rotation deficit (GIRD) in the dominant arm of adolescent overhead athletes and to examine the association with shoulder and elbow injuries. DESIGN Systematic review and meta-analysis. SETTING MEDLINE, Embase, and PubMed were searched from inception to August 1, 2020. PARTICIPANTS Adolescent overhead athletes with glenohumeral range of motion (ROM) measurements. INTERVENTIONS Nonoperative treatments of GIRD. MAIN OUTCOME MEASURES Glenohumeral ROM measurements comparing the dominant and nondominant extremities were pooled in a meta-analysis. RESULTS Twenty-five studies were included in this review, which involved 2522 overhead athletes. Pooled internal rotation (IR) deficit of the dominant arm was 9.60° (95% confidence interval [CI] 7.87°-11.32°, P < 0.00001), with an external rotation (ER) gain of 6.78° (95% CI 4.97°-8.59°, P < 0.00001) and a total ROM (TROM) deficit of 1.78° (95% CI -0.70° to 4.26°, P = 0.16). The association between GIRD and shoulder or elbow injury was not clearly defined. Two studies reported treatment, and both used nonoperative treatment in the form of physiotherapy and sleeper stretches. CONCLUSIONS The adolescent overhead athlete has roughly 10° of IR deficit in their dominant arm, accompanied by nearly 7° of ER gain, with similar ROM measurements for injured and uninjured athletes. Those with pathological GIRD have a greater degree of IR deficit, but without an accompanying compensatory increase in ER, leading to a TROM deficit of nearly 15°. Surgical treatment in the absence of other indications is rare, whereas physiotherapy and sleeper stretches remain the first-line treatment.
Collapse
|
4
|
Common Upper Extremity Injuries in Pediatric Athletes. Curr Rev Musculoskelet Med 2022; 15:465-473. [PMID: 35913666 PMCID: PMC9789231 DOI: 10.1007/s12178-022-09784-1] [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] [Accepted: 06/21/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW The aim of this study is to review the most recent literature on common upper extremity injuries in pediatric athletes and discuss their diagnosis, management, and outcomes. We also highlight ultrasound as a tool in their evaluation. RECENT FINDINGS Shoulder conditions presented include little league shoulder, glenohumeral rotation deficit, acute traumatic shoulder dislocation, and multidirectional shoulder instability. Elbow conditions include capitellar OCD, medial epicondyle avulsion fracture, and medial epicondylitis. We also review scaphoid fractures and gymnast wrist. Not all physeal injuries lead to long-term growth disruption. Ultrasound has been shown to be useful in the diagnosis of scaphoid fracture, medial epicondyle avulsion fractures, and capitellar OCD. It can also be helpful in assessing risk for shoulder and elbow injuries in overhead athletes. There is a rising burden of upper extremity injuries among pediatric athletes. Knowledge of their sport specific mechanics can be helpful in diagnosis. As long-term outcome data become available for these conditions, it is clear, proper diagnosis and management are critical to preventing adverse outcomes. We highlight many of these injuries, best practice in care, and controversies in care in hopes of improving outcomes and preventing injury for pediatric athletes.
Collapse
|
5
|
Effect of introducing ultrasonography in medical examinations for elbow injuries among young baseball players. J Med Ultrason (2001) 2022; 49:463-469. [PMID: 35633406 DOI: 10.1007/s10396-022-01221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study investigated the usefulness of ultrasonography in medical examinations for detecting elbow injuries, especially capitellar osteochondritis dissecans, among young baseball players. METHODS Players with current or previous elbow joint pain were enrolled. Medical examinations (range of motion, tenderness, and stress tests) were performed with (2012-2016) or without (2007-2011) ultrasonography. Players with abnormal examination results were advised to undergo additional examinations at a local orthopedic clinic. Differences in the rates of capitellar osteochondritis dissecans detection, secondary examination, and elbow injury prevalence were compared between players who did and did not undergo ultrasonography. RESULTS We identified 1045 baseball players, aged 9-12 years, who required medical examinations for elbow injuries. Medical examinations without ultrasonography were performed in 346 players (group A), and examinations with ultrasonography were performed in 556 players (group B). Capitellar osteochondritis dissecans was present in 0.3% (1/346) of group A players and 3.0% (17/556) of group B players (p = 0.003). The secondary examination consultation rates were 51.2% (62/121) and 66.0% (270/409) in groups A and B, respectively (p = 0.004). CONCLUSION Ultrasonography performed as a part of a medical examination can help detect elbow injuries, especially capitellar osteochondritis dissecans, in baseball players. Using ultrasonography in conjunction with medical examinations may contribute to a better understanding of elbow injuries in baseball players and improve consultation rates. Thus, ultrasonography is essential for the evaluation of elbow injuries in young baseball players.
Collapse
|
6
|
Successful Nonoperative Treatment of Osteochondritis Dissecans of the Humeral Capitellum in a Young Baseball Player with Advanced Skeletal Maturity. Prog Rehabil Med 2021; 6:20210044. [PMID: 34825100 PMCID: PMC8590945 DOI: 10.2490/prm.20210044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/13/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Osteochondritis dissecans (OCD) of the humeral capitellum presents most typically in adolescent athletes who perform repetitive overhead activities. Earlier studies have demonstrated that conservative treatment of OCD is appropriate for patients with an open capitellar growth plate from the standpoint that spontaneous healing can be expected. Case: A 12-year-old male baseball player with two years of experience with a local team participated in our medical check that included screening for capitellar OCD using ultrasonography. The subject experienced elbow pain when throwing, and ultrasonographic elbow examination indicated OCD of the capitellum, detected as irregularity of the subchondral bone of the capitellum. The initial radiograph, taken with the elbow at 45° of flexion, identified new bone formation in the lateral aspect of the OCD lesion; however the epiphyseal lines of the capitellum and lateral epicondyle were closed. We advised the patient to stop heavy use of the elbow, e.g., throwing and batting, and started conservative treatment in anticipation of spontaneous healing. Physiotherapy focusing on the shoulder girdle, core, and hip and lower limb stretches were performed to resolve general tightness. The OCD lesion had healed completely 12 months after the start of conservative treatment. Discussion: Conservative treatment for young baseball players might be worth considering if lateral new bone formation within the OCD lesion is detected on radiographic findings, even if the epiphyseal lines of the capitellum and lateral epicondyle are closed.
Collapse
|
7
|
Risk Factors for Throwing-Related Shoulder and Elbow Pain in Adolescent Baseball Players: A Prospective Study of Physical and Developmental Factors. Orthop J Sports Med 2021; 9:23259671211017129. [PMID: 34552989 PMCID: PMC8450620 DOI: 10.1177/23259671211017129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Throwing-related shoulder and elbow pain continues to be reported among adolescent baseball players. Few prospective studies have specifically examined the association between throwing-related shoulder and elbow pain and physical and developmental changes. Purpose: To evaluate the changes in physical and developmental characteristics during 1 year with respect to throwing-related shoulder and elbow pain in adolescent baseball players. Study Design: Case-control study; Level of evidence, 3. Methods: This 1-year prospective follow-up study investigated 164 baseball players aged 7 to 13 years. Player data (age, height, weight, field position, and pitch count), lower extremity muscle tightness, and range of motion (ROM) of the shoulder, elbow, and hip joints were assessed during the 2016 and 2017 preseason medical examinations. After the 2016 season, the participants completed questionnaires related to throwing-related shoulder and elbow pain, defined as an inability to play for ≥1 week because of elbow or shoulder difficulties. For study participants with and without throwing-related shoulder or elbow pain during the 2016 season, we conducted univariate and multivariate logistic regression analysis to identify risk factors for throwing-related shoulder or elbow pain. Results: Overall, 21 players (12.8%) reported a shoulder pain episode, 56 players (34.1%) had an elbow pain episode, and 70 players (42.7%) reported having experienced shoulder and/or elbow pain during the 2016 season. In multivariate logistic regression analysis, (1) shoulder pain was associated with 2016 preseason height (odds ratio [OR], 1.06; 95% CI, 1.01-1.11; P = .01) and change in dominant-side elbow extension ROM from 2016 to 2017 (OR, 1.12; 95% CI, 1.02-1.24; P = .02); (2) elbow pain was associated with change in weight from 2016 to 2017 (OR, 1.21; 95% CI, 1.04-1.41; P = .014); and (3) throwing-related shoulder and/or elbow pain was associated with greater 2016 preseason height (OR, 1.04; 95% CI, 1.003-1.68; P = .03) and an increase in height from 2016 to 2017 (OR, 1.17; 95% CI, 1.01-1.35; P = .03). Conclusion: Our results indicated that adolescent baseball players who were taller in the preseason and those with an increase in height over the 1-year study period faced significant risks for developing throwing-related shoulder and/or elbow pain.
Collapse
|
8
|
Risk factor for elbow symptom manifestation in young baseball players with asymptomatic medial elbow abnormalities: a prospective cohort study. Sci Rep 2021; 11:13119. [PMID: 34162960 PMCID: PMC8222278 DOI: 10.1038/s41598-021-92570-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/14/2021] [Indexed: 11/09/2022] Open
Abstract
Asymptomatic elbow abnormalities are relatively common in young baseball players, but the factors responsible are unclear. To prospectively identify risk factors related to symptom manifestation in asymptomatic elbow abnormalities, we recruited 573 baseball players (age: 7-14 years) at a pre-participation medical/physical examination in the preseason who were right-handed and had asymptomatic medial elbow abnormalities on ultrasound (US). Baseline preseason and postseason participant characteristics were assessed. A "symptomatic" elbow was defined as an elbow with medial elbow joint problems that prevented ball throwing for ≥ 8 days. After exclusions, 82 players were enrolled, of whom 22 (26.8%) developed a symptomatic elbow. In univariate analyses, the external and internal rotation strengths of the dominant shoulder were significantly greater in the symptomatic group than in the asymptomatic group (P = 0.021). Multivariate logistic regression analysis showed that the internal rotation strength of the dominant shoulder was a significant independent risk factor (odds ratio = 1.091, P = 0.027) for developing a symptomatic elbow. In young asymptomatic baseball players with abnormalities in the medial elbow region of the dominant arm on US, stronger preseason internal rotation strength of the dominant shoulder was a significant independent risk factor for the development of a "symptomatic" elbow.
Collapse
|
9
|
Asymptomatic Medial Elbow Ultrasound Abnormality in Youth Baseball Players Is an Independent Risk Factor for Elbow Injury: A Prospective Cohort Study. Orthop J Sports Med 2021; 9:2325967120986791. [PMID: 33912614 PMCID: PMC8050762 DOI: 10.1177/2325967120986791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 11/15/2022] Open
Abstract
Background Youth baseball players who experience elbow pain during the season frequently exhibit radiographic elbow abnormalities. However, it is unknown whether asymptomatic elbow abnormalities are risk factors for in-season elbow injuries. Purpose To determine whether the preseason presence of asymptomatic medial epicondyle apophysitis is a risk factor for in-season elbow injuries in youth baseball players. Study Design Cohort study; Level of evidence, 2. Methods Youth baseball players (N = 210; age range, 7-12 years) with no pain or history of injury in their throwing arms underwent preseason evaluations that included shoulder and elbow range of motion measurements, shoulder muscle strength testing, and ultrasound elbow scans with a multifrequency 13-MHz linear array transducer. Over 1 year of play, the players and their parents maintained daily elbow pain diaries. Elbow injuries were defined as medial elbow symptoms that prevented ball throwing for ≥8 days. Results The preseason ultrasound evaluation revealed medial epicondyle apophysitis in 59 players. In the year following, elbow injuries occurred in 17 (28.8%) players with preseason medial epicondyle apophysitis and 18 (11.9%) players without apophysitis. Independent predictors of elbow injuries were preseason medial epicondyle apophysitis (odds ratio [OR], 2.488; 95% confidence interval [CI], 1.152-5.376; P = .02) and deficits of abduction (ABD) and external rotation of the dominant shoulder (OR, 0.963; 95% CI, 0.936-0.992; P = .012). Conclusion Asymptomatic medial epicondyle apophysitis and ABD and external rotation deficits in the dominant shoulder were risk factors for elbow injuries in 7- to 12-year-old youth baseball players. These findings may aid in the design of programs to prevent elbow injuries in this population.
Collapse
|
10
|
Relationship between the Lower Limb Function and Shoulder and Elbow Injuries in Elementary School Baseball Pitchers. Prog Rehabil Med 2021; 6:20210015. [PMID: 33728384 PMCID: PMC7952376 DOI: 10.2490/prm.20210015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/03/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives We aimed to examine the relationship between the hip range of motion (ROM) and ankle ROM and throwing-related shoulder and elbow injuries in elementary school baseball pitchers. Methods This retrospective comparative study (Level of evidence: Level III) included 195 baseball pitchers (mean age 10.8±1.0 years, range 8-12 years). All pitchers underwent physical function measurements, including height, weight, shoulder strength, and hip and ankle ROM. Shoulder and elbow injury was defined as shoulder and elbow pain that the pitchers had been aware of in the past or at the time of medical checkups. The results for the injured and non-injured groups were then compared. Results The shoulder ROM and strength in the injured and non-injured groups did not differ to a statistically significant extent. The hip external rotation on the dominant side (injured vs. non-injured: 48.9±11.1° vs. 53.3±9.7°, P<0.01), the hip internal rotation on the non-dominant side (injured vs. non-injured: 36.6±12.0° vs. 40.9±11.0°, P=0.01), and ankle plantar flexion on the non-dominant side (injured vs. non-injured: 52.0±6.8° vs. 54.3±6.7°, P=0.02) were significantly smaller in the injured group than in the non-injured group. Conclusions The hip external rotation ROM on the dominant side and the hip internal rotation and ankle plantar flexion on the non-dominant side were significantly lower in the injured group than in the non-injured group. These results may suggest measures to reduce the incidence of elbow and shoulder injuries in elementary school baseball pitchers.
Collapse
|
11
|
Relationship between tightness of the hip joint and shoulder/elbow injury in high school baseball pitchers: a prospective study. Sci Rep 2020; 10:19979. [PMID: 33203930 PMCID: PMC7673013 DOI: 10.1038/s41598-020-76894-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 11/03/2020] [Indexed: 11/22/2022] Open
Abstract
Some studies have reported that upper limb tightness is a risk factor for shoulder/elbow pain in high school baseball pitchers; but there has been insufficient research on the relationship between lower limb tightness and shoulder and elbow pain in pitchers. This study aimed to clarify the correlation among pre-season hip range of motion (ROM) and shoulder and elbow disorders in high school baseball pitchers. We surveyed 125 high school pitchers. Hip ROM was measured in the supine and prone positions. After the season, based on their answers to the self-recorded questionnaire, a “shoulder or elbow injury” was defined as any condition resulting in the pitcher being considered disabled for ≥ 8 days. An independent t-test and logistic regression analysis were used for statistical analysis. Eleven disabled pitchers (9%) were identified during the season. In the injured group, the ROM of the plant side hip with 90° flexed external rotation was smaller than that in the non-injured group. Preseason limited ROM in the plant side hip with 90° flexed external rotation was a risk factor for the occurrence of shoulder/elbow pain in the season.
Collapse
|
12
|
Satisfaction With Elbow Function and Return Status After Autologous Osteochondral Transplant for Capitellar Osteochondritis Dissecans in High School Baseball Players. Am J Sports Med 2020; 48:3057-3065. [PMID: 32941055 DOI: 10.1177/0363546520952782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondral autograft transplant (OAT), a surgical treatment for capitellar osteochondritis dissecans (OCD), has favorable rates of elbow recovery and return to sports in adolescents. However, few reports have investigated how long patients continue to play baseball after OAT and their satisfaction with their treatment outcome. PURPOSE To evaluate the rate of boys who played baseball and received OAT for OCD in junior high school or earlier (age <15 years) and continued to play baseball in high school and the players' satisfaction with their elbow function during play. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 32 elbows of boys who played baseball and received OAT at age ≤15 years (mean, 14.1 years) were examined and divided into pitcher (n = 11) and nonpitcher (n = 21) groups according to their player position before surgery. The clinical Timmerman-Andrews score at the end of their high school baseball, participation percentage of players who continued to play baseball, and satisfaction level during play (on a scale of 0-10 during pitching and batting and in a 4-choice format) were compared between the 2 groups. RESULTS The Timmerman-Andrews scores significantly improved after surgery in both groups, with no significant difference between the groups. Of the 32 players, 30 (93.8%) continued to play baseball throughout high school, including all players in the pitcher group and 19 (90.5%) of those in the nonpitcher group. The percentage of players who continued to pitch was 55.6% (6/11) in the pitcher group. Satisfaction with elbow joint function at the time of pitching was significantly lower in the pitcher group. Further, 5 players reported being "a little unsatisfied" because of elbow pain during pitching. All of the players indicated satisfaction with elbow function during batting. CONCLUSION The percentage of players who received OAT for OCD in junior high school and continued to play baseball in high school was favorable. However, satisfaction with elbow function during throwing was lower in pitchers than in nonpitchers. CLINICAL RELEVANCE Before surgery, consent should be obtained from patients who are pitchers after it is explained that satisfaction with elbow joint function during pitching could be decreased after OAT.
Collapse
|
13
|
Relation between grip and pinch strength and pitch type in high school pitchers with and without elbow symptoms. J Orthop Surg (Hong Kong) 2020; 28:2309499019890743. [PMID: 31986969 DOI: 10.1177/2309499019890743] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Gripping and pinching a ball is a fundamentally important part of the kinetic chain for throwing baseball pitches of various types. This study of high school pitchers was conducted to assess the association between grip and pinch strength, the pitch type, and the history of elbow symptoms. METHODS We examined 133 high school baseball pitchers, all of whom had completed a self-administered questionnaire including items related to pitch type throwing ratios, the age at starting each pitch type, and throwing-related elbow joint pain sustained during the prior 3 years. We measured grip strength and the bilateral side tip, key, and palmar pinch strengths. Comparisons were made between the participants with and without an elbow symptom history to assess the grip and each pinch strength, throwing ratio of pitch type, and the age at starting to throw each pitch type. RESULTS Pitchers with an elbow symptom history exhibited less difference between the grip strength on the throwing side than those with no elbow symptom history (p = 0.04). No difference was found between participants with and without an elbow symptom history in terms of pinch strength, the throwing ratios of pitch types, or the age at starting to throw pitches of each type. Positive significant association was found between pinch strength on the pitching side and the forkball and screwball throwing ratio (r = 0.27, p = 0.002). CONCLUSION Grip strength might influence high school baseball pitcher elbow conditions. The frequency of certain pitch types might develop pinch strength in high school baseball pitchers.
Collapse
|
14
|
The Influence of Pitch Velocity on Medial Elbow Pain and Medial Epicondyle Abnormality Among Youth Baseball Players. Am J Sports Med 2020; 48:1601-1607. [PMID: 32364755 DOI: 10.1177/0363546520914911] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pitch velocity is associated with elbow injuries among skillful baseball players. However, the relationship between pitch velocity and throwing elbow injuries among youth players has not yet been clarified. PURPOSE To investigate the influence of pitch velocity on medial elbow pain and medial epicondyle abnormality among youth baseball players. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The participants consisted of 256 elementary school players (mean age, 11 ± 1 years; range, 9-12 years). The medial aspect of the elbow was evaluated using ultrasound imaging. A questionnaire was used to investigate past or present pain in the elbow, background of the players (age, height, body mass index, and years of baseball experience), and playing environment (number of days of practice in a week, experience as a pitcher, and cryotherapy of the shoulder and elbow after practice). Positioning of the scapula, range of motion in shoulder internal/external rotations and hip internal rotation, angle of the straight-leg raise, and heel-to-buttock distance were measured. The pitch velocity was recorded using a pitch velocity radar gun. The relationship between these variables and the presence of medial epicondyle abnormality, as well as past or present elbow pain, were statistically analyzed. RESULTS A medial epicondyle abnormality was observed in 130 players (51%), elbow pain in the past in 65 players (25%), and elbow pain during the examination in 14 players (5%). Sixty-nine players (27%) experienced elbow pain either in the past or during examination. Abnormality of the medial epicondyle had a relationship with the pitch velocity (odds ratio [OR], 1.1 for increase of 1 km/h; 95% CI, 1.1-1.2; P < .0001) and the number of practice days in a week (OR, 1.8 for increase of the practice days; 95% CI, 1.4-2.5; P < .0001). Pitch velocity was also significantly related with past pain, present pain, and past and/or present pain of the elbow (OR [km/h], 1.1, 1.1, 1.1; 95% CI, 1.0-1.1, 1.0-1.2, 1.1-1.2; P < .0001, P = .002, P < .0001, respectively). CONCLUSION Pitch velocity was significantly associated with abnormality of the medial epicondyle and elbow pain. A 10-km/h increase in pitch velocity would increase the risk of medial epicondyle abnormality and medial elbow pain by 3 times.
Collapse
|
15
|
Relationship between the elbow joint valgus instability and forearm flexor muscle strength in high school pitchers with and without symptom. J Orthop Surg (Hong Kong) 2020; 27:2309499019832664. [PMID: 30827176 DOI: 10.1177/2309499019832664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Earlier reports describe forearm flexor muscles as active stabilizers of the elbow to valgus stress during throwing motion. Given high school pitchers' history of elbow symptoms, this study assesses its relation to elbow valgus joint instability and forearm flexor muscle strength. METHODS Ultrasound examination was made for 132 high school baseball pitchers with and without valgus stress of the medial aspect of the bilateral elbows. They had completed a self-administered questionnaire related to self-satisfaction score (0-100) for pitching performance and throwing-related elbow joint pain sustained during the prior year. Using a digital manual muscle strength meter, we examined the grip strength and muscle strength of the flexor carpi ulnaris (FCU). For participants with and without a history of elbow symptom, we compared differences of ulnohumeral joint space width with and without valgus stress and grip and FCU muscle strength. RESULTS For ulnohumeral joint width difference with and without valgus stress, pitchers with an elbow symptom and those without elbow symptom history on the throwing side were not significantly different. No difference was found in the grip strength or FCU muscle strength of the throwing side for each group. Positive significant association was found between FCU muscle strength on the pitching side and the self-evaluation score for pitching performance ( r = 0.27, p = 0.002). However, no association was found between the elbow valgus instability and the forearm flexor muscle strength. CONCLUSION FCU muscle strength might influence high school baseball pitching performance.
Collapse
|
16
|
Correlation between playing position, elbow physical findings and elbow pain in elementary school baseball players: Results of a multi-regional study in Japan. J Orthop Sci 2020; 25:122-126. [PMID: 30922534 DOI: 10.1016/j.jos.2019.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/24/2019] [Accepted: 02/27/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Elbow injuries are common in young baseball players and evaluating the characteristics of young baseball players in a large-scale population is necessary. However, few studies have compared playing position, length of baseball experience, physical findings, and elbow pain in young baseball players. This retrospective multi-regional cohort study sought to document the physical findings at the elbow in Japanese elementary school baseball players and to examine the relationship between playing position, length of baseball experience, physical findings at the elbow, and elbow pain. METHODS In 2014, 720 fifth-grade baseball players from four regions in Japan were invited to participate in a questionnaire survey and undergo physical examination to obtain data on position played, length of baseball experience, presence of elbow pain, and physical findings at the elbow, including range of motion, tenderness, and valgus stress test results. Potential risk factors associated with elbow pain and correlations between physical findings and playing position, length of baseball experience, and elbow pain were investigated. RESULTS The 720 subjects had a mean age of 10.4 years and 29.4% reported having experienced elbow pain for ≥1 week. Risk factors for elbow pain included playing pitcher and catcher, playing pitcher and fielder, and length of baseball experience. The most frequent finding was limitation of flexion (21.1%) followed by tenderness of the medial epicondyle (18.3%) and a positive valgus stress test (14.3%). These three findings were also significantly associated with elbow pain. Elbow extension was limited in 14.9% of subjects but there was no correlation with length of baseball experience or elbow pain. CONCLUSIONS Our data show that elementary school baseball players who experienced elbow pain are likely to have valgus stress overload. Elbow pain might be prevented by not playing pitcher and catcher.
Collapse
|
17
|
Flexor pronator muscles' contribution to elbow joint valgus stability: ultrasonographic analysis in high school pitchers with and without symptoms. JSES Int 2019; 4:9-14. [PMID: 32544928 PMCID: PMC7075757 DOI: 10.1016/j.jses.2019.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Few researchers have examined the different contributions of flexor-pronator muscles to valgus stress in high school baseball pitchers with and without elbow symptoms. This study used ultrasonography to assess these muscles' dynamic contributions to elbow valgus joint stability in high school pitchers. Methods A self-administered questionnaire on throwing-related elbow joint pain sustained during the prior year was completed by 89 high school baseball pitchers. Gravity stress ultrasonographic elbow examinations with 30° of flexion were done before and after isometric contraction of the flexor-pronator muscles. For study participants with and without a history of elbow symptoms, we compared differences of ulnohumeral joint space without gravity stress and isometric contraction of the flexor-pronator muscles and with gravity stress only and with isometric contraction of the flexor-pronator muscles under gravity stress. Results For each pitcher, the ulnohumeral joint space in the condition with valgus stress was significantly larger than in the condition without valgus stress. Also, the ulnohumeral joint space in the condition with valgus stress was significantly larger than in the condition with valgus stress and flexor-pronator isometric muscle contraction. Participants with and without elbow symptom history showed no differences of ulnohumeral joint space in the unloaded and loaded flexor-pronator muscle contracted conditions. Conclusion Ultrasonographic assessment demonstrated that flexor-pronator muscles contribute to elbow valgus stability. No difference was found in the flexor-pronator muscle contribution in high school baseball pitchers with and without elbow symptom history.
Collapse
|
18
|
Shoulder and elbow pain in junior high school baseball players: Results of a nationwide survey. J Orthop Sci 2019; 24:708-714. [PMID: 30638688 DOI: 10.1016/j.jos.2018.12.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 11/14/2018] [Accepted: 12/04/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite proposals and guidelines to prevent baseball injuries in young players by societies and organizations, many shoulder and elbow injuries continue to occur among junior high school baseball players. In order to investigate the training conditions of junior high school baseball players and the risk factors for shoulder and elbow pain in the players, we conducted a questionnaire survey among junior high school baseball players throughout the country. METHODS The questionnaire survey was conducted among junior high school baseball players in September 2016. RESULTS A total of 11,134 junior high school baseball players belonging to 495 teams responded to the survey. Among these, 4004 players trained every day of the week and 1151 players played baseball games every month with no off-season. Among 9752 players who did not have shoulder and/or elbow pain in the spring and summer of 2015, 19.2% of players experienced elbow pain over the course of one year, 13.6% of players experienced shoulder pain, and 28.0% complained of shoulder and/or elbow pain. The frequency of elbow pain was more than that of shoulder pain. At risk for shoulder pain were pitchers and catchers and second-year students, while risk factors for elbow pain were playing pitcher and catcher positions, pitching or throwing ≥300 balls per week, playing ≥10 games on average per month and being left-handed. CONCLUSION Risk factors for shoulder pain were different from those for elbow pain. To prevent elbow pain, coaches should pay attention to pitchers and catchers and left-handed players and not allow players to pitch or throw ≥300 full-power balls per week or participate in ≥10 games per month. They should also pay attention to pitchers and catchers and second-year students to prevent shoulder pain. It is important for coaches to train multiple pitchers and catchers.
Collapse
|
19
|
Abstract
BACKGROUND The incidence of shoulder and elbow injuries among adolescent baseball players is on the rise. These injuries may lead to surgery or retirement at a young age. PURPOSE To identify independent risk factors for elbow and shoulder injuries in adolescent baseball players. A secondary aim was to determine whether the literature supports the Major League Baseball and USA Baseball Pitch Smart guidelines. STUDY DESIGN Systematic review. METHODS A systematic review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines utilizing MEDLINE, SPORTDiscus, and Web of Science. Because of study heterogeneity, a quantitative synthesis was not performed. A qualitative review was performed on 19 independent risk factors for elbow and shoulder injuries in adolescent baseball players. Level of evidence was assigned per the Oxford Centre for Evidence-Based Medicine Working Group, and risk of bias was graded per the Newcastle-Ottawa Scale. RESULTS Twenty-two articles met criteria for inclusion. Of the 19 independent variables that were analyzed, age, height, playing for multiple teams, pitch velocity, and arm fatigue were found to be independent risk factors for throwing arm injuries. Pitches per game appears to be a risk factor for shoulder injuries. Seven independent variables (innings pitched per game, showcase participation, games per year, training days per week, pitch type, shoulder external rotation, and shoulder total range of motion) do not appear to be significant risk factors. The data were inconclusive for the remaining 6 variables (weight, months of pitching per year, innings or pitches per year, catching, shoulder horizontal adduction, and glenohumeral internal rotation deficit). CONCLUSION The results from this study demonstrate that age, height, playing for multiple teams, pitch velocity, and arm fatigue are clear risk factors for throwing arm injuries in adolescent baseball players. Pitches per game appears to be a risk factor for shoulder injuries. Other variables are either inconclusive or do not appear to be specific risk factors for injuries.
Collapse
|
20
|
Prospective multifactorial analysis of preseason risk factors for shoulder and elbow injuries in high school baseball pitchers. Knee Surg Sports Traumatol Arthrosc 2017; 25:3303-3310. [PMID: 26239860 DOI: 10.1007/s00167-015-3731-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 07/23/2015] [Indexed: 01/26/2023]
Abstract
PURPOSE To prospectively identify preseason physical factors for shoulder and elbow injuries during the season in high school baseball pitchers. METHODS The study included 105 high school baseball pitchers [median age 16 (15-17) years]. The range of motion of the shoulder (90° abducted external and internal rotation) and elbow (extension/flexion), shoulder muscle strength (abduction and prone internal and external rotation), shoulder and elbow laxity, horizontal flexion, and scapular dyskinesis were assessed. After the season, the participants completed questionnaires regarding shoulder and/or elbow injuries, with injury defined as an inability to play for ≥1 week due to elbow/shoulder problems. The results of two groups (injured and noninjured) were compared using t tests and Chi-square analyses. Stepwise forward logistic regression models were developed to identify risk factors. RESULTS Twenty-one injuries were observed. In univariate analysis, 90° abducted internal rotation and total arc of the dominant shoulder and the ratio of prone external rotation in the dominant to nondominant sides in the injured group were significantly less than those in the noninjured group (P = 0.02, 0.04, and 0.01, respectively). In logistic regression analysis, 90° abducted internal rotation in the dominant shoulder and prone external rotation ratio were significantly associated with injuries (P = 0.02 and 0.03, respectively). CONCLUSION A low prone external rotation ratio and decreased 90° abducted internal rotation in the dominant shoulder in the preseason were significant risk factors for shoulder and elbow injuries in high school baseball pitchers. The results may contribute to reduce the incidence of these injuries. LEVEL OF EVIDENCE II.
Collapse
|
21
|
Shoulder Stretching Intervention Reduces the Incidence of Shoulder and Elbow Injuries in High School Baseball Players: a Time-to-Event Analysis. Sci Rep 2017; 7:45304. [PMID: 28345616 PMCID: PMC5366891 DOI: 10.1038/srep45304] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/22/2017] [Indexed: 11/28/2022] Open
Abstract
We prospectively evaluated the effects of a prevention program on the incidence of shoulder and elbow injuries in high school baseball pitchers. Ninety-two pitchers participated in this study and were taught to perform stretching and strength exercises aimed at improving shoulder external rotation strength in the preseason. The pitchers freely chose to participate in one of four groups [SM-group: performed both exercises, S-group: performed stretching exercise only, M-group: performed strength training only, and N-group: performed neither intervention]. Injury was defined as inability to play for ≥8 days because of shoulder/elbow symptoms. Kaplan-Meier survival curves were generated and hazard ratios (HRs) for injury occurrence were calculated using multivariate Cox regression. Log-rank test was used for between-group comparisons of survival distributions. The injuries occurred in 25, 35, and 57% of participants and median times to injury were 89, 92, and 29.5 days in the S- (n = 32), SM- (n = 46), and N- (n = 14) group, respectively. Nobody chose M-group. HRs were 0.36 and 0.47 for the S- and SM-group, respectively, based on the N-group. The incidence of injury was significantly lower in the S-group than in the N-group (p = 0.04). Daily posterior shoulder stretching may reduce the incidence of the injuries in high school baseball pitchers.
Collapse
|
22
|
Letter to the Editor: A clinical and ultrasonographic study of risk factors for elbow injury in young baseball players. J Orthop Surg (Hong Kong) 2016; 24:279. [PMID: 27574280 DOI: 10.1177/1602400234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|