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Fleisig G.S.,American Sports Medicine Institute
Sports Health | Year: 2012

Context: Although baseball is a relatively safe sport, numerous reports suggest a rapid rise in elbow injury rate among youth baseball pitchers. Evidence Acquisition: PubMed was searched for epidemiologic, biomechanical, and clinical studies of elbow injuries in baseball (keywords: "youth OR adolescent" AND baseball AND pitching AND "ulnar collateral ligament OR elbow"; published January 2000 - April 2012). Studies with relevance to youth baseball pitchers were reviewed. Relevant references from these articles were also retrieved and reviewed. Original data, insight, and recommendations were added. Results: The majority of baseball elbow injuries are noncontact injuries to the dominant arm resulting from repetitive pitching. Five percent of youth pitchers suffer a serious elbow or shoulder injury (requiring surgery or retirement from baseball) within 10 years. The risk factor with the strongest correlation to injury is amount of pitching. Specifically, increased pitches per game, innings pitched per season, and months pitched per year are all associated with increased risk of elbow injury. Pitching while fatigued and pitching for concurrent teams are also associated with increased risk. Pitchers who also play catcher have an increased injury risk, perhaps due to the quantity of throws playing catcher adds to the athlete's arm. Another risk factor is poor pitching biomechanics. Improper biomechanics may increase the torque and force produced about the elbow during each pitch. Although throwing breaking pitches at a young age has been suggested as a risk factor, existing clinical, epidemiologic, and biomechanical data do not support this claim. Conclusions: Some elbow injuries to youth baseball pitchers can be prevented with safety rules, recommendations, education, and common sense. Scientific and medical organizations have published safety rules and recommendations, with emphasis on prevention of overuse and pitching while fatigued. Strength-of-Recommendation Taxonomy (SORT): A. © 2012 The Author(s).

Aune K.T.,American Sports Medicine Institute | Andrews J.R.,American Sports Medicine Institute | Dugas J.R.,American Sports Medicine Institute | Cain E.L.,American Sports Medicine Institute
American Journal of Sports Medicine | Year: 2014

Background: Lateral meniscal injury is a common and possibly career-threatening injury among players in the National Football League (NFL). The rate of return to play (RTP) and factors that affect RTP after lateral meniscal injury in NFL players are currently not defined.Purpose: The aims of this study were to determine the rate of RTP to regular-season NFL game play of NFL players after arthroscopic partial lateral meniscectomy and to identify factors that can predict the ability to return to play.Study Design: Case series; Level of evidence, 4.Methods: Seventy-two patients undergoing 77 arthroscopic lateral partial meniscectomies were followed to determine the rate of RTP (defined as successful RTP in at least 1 egular-eason NFL game after meniscectomy) and factors predicting players ability to return to play. Perioperative variables were recorded using retrospective chart review. Players heights and weights, dates of return, draft rounds, and counts of games, starts, and seasons both before and after meniscectomy were all collected from statistical databases maintained by the NFL. Chi-square and Student t tests were performed to assess differences among covariates with respect to an athletes ability to return to play, and odds ratios were calculated as appropriate. All percentages were calculated as percent of total procedures performed (n=77).Conclusion: The majority of NFL players undergoing arthroscopic lateral meniscectomy are able to return to play. Players selected earlier in the NFL draft and who are listed as starters in more of their games are more likely to return to play, as are linemen and tight ends. It is significantly more difficult for running backs, receivers, linebackers, and defensive backs to return to play.Results: Of the 77 partial lateral meniscectomies performed, 61% (n=47) resulted in the athlete returning to play at his previous level of competition with an average length of time to RTP of 8.5 months; 19 (40%) of those who returned were still active in the NFL at the time of follow-up. Age at time of surgery, games and seasons played before surgery, and individual position were not significantly different between those who did and did not return to play. Undergoing a concomitant procedure did not affect an athletes ability to return to play, nor did concurrent arthroscopic anterior cruciate ligament reconstruction affect a players likelihood to return to play. Players drafted in the first 4 rounds of the NFL draft were 3.7 times more likely to return to play than players drafted after the fourth round, and players who started more than 46.2% of their games played (the mean value for this population) were 2.8 times more likely to return to play. Speed-position players (running backs, receivers, linebackers, and defensive backs) were 4.0 times less likely to return to play than non-speed position players (linemen and tight ends). © 2014 The Author.

Urbin M.A.,Auburn University | Fleisig G.S.,American Sports Medicine Institute | Abebe A.,American Sports Medicine Institute | Andrews J.R.,Auburn University
American Journal of Sports Medicine | Year: 2013

Background: A baseball pitchers ability to maximize ball speed while avoiding shoulder and elbow injuries is an important determinant of a successful career. Pitching injuries are attributed to microtrauma brought about by the repetitive stress of highmagnitude shoulder and elbow kinetics. Hypothesis: Over a number of pitches, variations in timing peak angular velocities of trunk segment rotations will be significantly associated with ball speed and upper extremity kinetic parameters. Study Design: Descriptive laboratory study. Methods: Kinematic and kinetic data were derived from 9 to 15 fastball pitches performed by 16 active, healthy collegiate (n = 8) and professional (n = 8) pitchers via 3-dimensional motion capture (240 Hz). Each pitch was decomposed into 4 phases corresponding to the time between peak angular velocities of sequential body segment rotations. Four mixed models were used to evaluate which phases varied significantly in relation to ball speed, peak shoulder proximal force, peak shoulder internal rotation torque, and peak elbow varus torque. Mixed-model parameter coefficient estimates were used to quantify the influence of these variations in timing on ball speed and upper extremity kinetics. Results: All 4 mixed models were significant (P>.05). The time from stride-foot contact to peak pelvis angular velocity varied significantly in relation to all upper extremity kinetic parameters and ball speed. Increased time in this phase correlated with decreases in all parameters. Decreased ball speed also correlated with increased time between peak upper torso and elbow extension angular velocities. Decreased shoulder proximal force also correlated with increased time between peak pelvis and upper torso angular velocities. Conclusion: There are specific phases that vary in relation to ball speed and upper extremity kinetic parameters, reinforcing the importance of effectively and consistently timing segmental interactions. For the specific interactions that varied significantly, increased phase times were associated with decreased kinetics and ball speed. Clinical Relevance: Although increased time within specific phases correlates with decreases in the magnitude of upper extremity kinetics linked to overuse injuries, it also correlates with decreased ball speed. Based on these findings, it may appear that minimizing the risk of injury (ie, decreased kinetics) and maximizing performance quality (ie, increased ball speed) are incompatible with one another. However, there may be an optimal balance in timing that is effective for satisfying both outcomes. © 2012 The Author(s).

Dugas J.R.,American Sports Medicine Institute
Clinics in Sports Medicine | Year: 2010

Valgus extension overload (VEO) is a constellation of symptoms and pathology commonly seen in the overhead athlete. Athletes in many sports may experience VEO and other common pathologies related to the high repetitive stresses generated by the overhead throwing motion. VEO is characterized by reproducible pain that is elicited by repeatedly forcing the elbow into terminal extension while applying a valgus stress to the elbow. Pain at the posteromedial tip of the olecranon process is pathognomonic of the condition. Olecranon stress fractures are rare, but can cause significant discomfort and, if unrecognized or untreated, can lead to significant pain and dysfunction. Both of these conditions are treated initially with rest from throwing, followed by gradual return to throwing through an interval throwing program. When conservative measures fail, minimally invasive or arthroscopic surgical procedures can be used to address the problem. Successful return to competitive overhead sports is expected at all levels of competition with these conditions. © 2010 Elsevier Inc.

Wilk K.E.,Champion Sports Medicine | Wilk K.E.,American Sports Medicine Institute | MacRina L.C.,Champion Sports Medicine | MacRina L.C.,American Sports Medicine Institute | Arrigo C.,Advanced Rehabilitation
Clinical Orthopaedics and Related Research | Year: 2012

Background Repetitive overhead throwing motion causes motion adaptations at the glenohumeral joint that cause injury, decrease performance, and affect throwing mechanics. It is essential to define the typical range of motion (ROM) exhibited at the glenohumeral joint in the overhead thrower. Questions/purposes We (1) assessed the glenohumeral joint passive range of motion (PROM) characteristics in professional baseball pitchers; and (2) applied these findings clinically in a treatment program to restore normal PROM and assist in injury prevention. Methods From 2005 to 2010, we evaluated 369 professional baseball pitchers to assess ROM parameters, including bilateral passive shoulder external rotation (ER) at 45° of abduction, external and internal rotation (IR) at 90° abduction while in the scapular plane, and supine horizontal adduction. Results The mean ER was greater for the throwing and nonthrowing shoulders at 45° of abduction, 102° and 98°, respectively. The throwing shoulder ER at 90° of abduction was 132° compared with 127° on the nonthrowing shoulder. Also, the pitcher's dominant IR PROM was 52° compared with 63° on the nondominant side. We found no statistically significant differences in total rotational motion between the sides. Conclusions Although we found side-to-side differences for rotational ROM and horizontal adduction, the total rotational ROM was similar. Clinical Relevance The clinician can use these PROM values, assessment techniques, and treatment guidelines to accurately examine and develop a treatment program for the overhead-throwing athlete. © The Association of Bone and Joint Surgeons® 2012.

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