Nonsurgical Management of Ulnar Collateral Ligament Injuries

Ulnar collateral ligament (UCL) injuries are a common source of pain and disability in the overhead athlete and often result in notable loss of time from competition. Over the past 10 to 15 years, the prevalence of UCL injury and reconstruction has undergone a dramatic increase, making it imperative to determine which patients may benefit from a nonsurgical regimen. Nonsurgical treatment involves a multidisciplinary approach of rehabilitation with tailored physical therapy programs and, in certain cases, biologic adjuncts. Physical therapy protocols should focus on strengthening the periscapular muscles, rotator cuff, core musculature, and flexor pronator mass to help stabilize the injured elbow and prevent injury recurrence before the initiation of a progressive throwing program. The implementation of injury prevention programs has shifted the focus from just the elbow and have included the shoulder, legs, and core in an effort to help decrease the stress on the upper extremity. In addition, biologic therapies such as platelet-rich therapy are promising modalities to augment the conservative treatment of UCL injuries but remain under investigation. The purpose of this study is to review available strategies and outcomes for conservatively treating UCL injuries.

Fastball velocity trends in short-season minor league baseball

Diminishing baseball velocities are objective measures to delineate pitching fatigue. Yet, velocity changes over the course of a competitive season vs. a single game remain unknown. This study examined fastball velocity (FBV) trends of minor league pitchers over an 8-game span. We assumed that accumulation of pitches would cause similar velocity decreases within games to produce velocity decreases between games pitched. Retrospective analysis of major league-affiliated pitching charts indicated mean FBVs, game pitches thrown, game innings pitched, rest days, and pitching work to rest ratios (PWRRs) for 12 pitchers over 8 games. Regression analyses (p < 0.05) were performed using the ordinary least squares method. The FBV was the dependent variable, where the explanatory variable was the game number (representing cumulative workload). Further analyses were performed on ball velocity differences predicted by days rest and PWRRs. The FBV increased linearly for the first 8 games of the season (R = 0.91, F(1,7) = 64.67, p < 0.001). Over the 8 - game period, mean FBVs increased 0.25 m/s (0.56 mph) with the greatest velocity increase occurring between the first and eighth game at 1.97 m/s (4.4 mph). Days rest and PWRRs did not impact FBV differences. When compared with previous research, minor league pitchers at the Class A Short Season level did not show similar exertion responses to cumulative workloads (pitches and innings pitched). Recovery factors (rest days, PWRRs, and training) also did not impact FBVs. Velocity increases may be attributable to biomechanical compensations, skill development, strength and conditioning regimens, multistarter rotations, and other performance-related factors. Strength and conditioning professionals should be aware of ball velocity trends, as apparent changes may infer neuromuscular fatigue and increased injury susceptibility, which require in-season training modifications.