American Sports Medicine Institute

Birmingham, AL, United States

American Sports Medicine Institute

Birmingham, AL, United States
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Cain E.L.,American Sports Medicine Institute
American journal of orthopedics (Belle Mead, N.J.) | Year: 2016

The ulnar collateral ligament (UCL) is the primary static restraint to valgus stress at the elbow. Since Jobe pioneered reconstruction in 1974, thousands of throwers have undergone UCL reconstruction, and good results have been achieved. The high-profile nature of the elite pitcher has brought this technique into the spotlight, and extensive research has been performed with new techniques emerging. The standard reconstruction, modified only slightly since Jobe's original description, remains the gold standard for treatment of UCL insufficiency. Throwers are able to return to the same or even higher levels of competition in the majority of cases. In this article, we present our standard technique and results and discuss emerging techniques for treatment of UCL injuries.

Osbahr D.C.,Orlando Health Orthopedic Institute | Cain Jr. E.L.,American Sports Medicine Institute | Raines B.T.,University of Alabama at Birmingham | Fortenbaugh D.,American Sports Medicine Institute | And 2 more authors.
American Journal of Sports Medicine | Year: 2014

Background: Ulnar collateral ligament reconstruction (UCLR) has afforded baseball players with excellent results; however, previous studies have described only short-term outcomes. Purpose: To evaluate long-term outcomes after UCLR in baseball players. Study Design: Case series; Level of evidence, 4. Methods: All UCLRs performed on competitive baseball players with a minimum 10-year follow-up were identified. Surgical data were collected prospectively and patients were surveyed by telephone follow-up, during which scoring systems were used to assess baseball career and post-baseball career outcomes. Results: Of 313 patients, 256 (82%) were contacted at an average of 12.6 years; 83% of these baseball players (90% pitchers) were able to return to the same or higher level of competition in less than 1 year, but results varied according to preoperative level of play. Baseball career longevity was 3.6 years in general and 2.9 years at the same or higher level of play, but major and minor league players returned for longer than did collegiate and high school players after surgery (P <.001). Baseball retirement typically occurred for reasons other than elbow problems (86%). Many players had shoulder problems (34%) or surgery (25%) during their baseball career, and these occurrences most often resulted in retirement attributable to shoulder problems (P < .001). For post-baseball career outcomes, 92% of patients were able to throw without pain, and 98% were still able to participate in throwing at least on a recreational level. The 10-year minimum follow-up scores (mean ± standard deviation) for the Disabilities of the Arm, Shoulder and Hand (DASH), DASH work module, and DASH sports module were 0.80 ± 4.43, 1.10 ± 6.90, and 2.88 ± 11.91, respectively. Overall, 93% of patients were satisfied, with few reports of persistent elbow pain (3%) or limitation of function (5%). Conclusion: Long-term follow-up of UCLRs in baseball players indicates that most patients were satisfied, with few reports of persistent elbow pain or limitation of function. During their baseball career, most of these athletes were able to return to the same or higher level of competition in less than 1 year, with acceptable career longevity and retirement typically for reasons other than the elbow. According to a standardized disability and outcome scale, patients also had excellent results after UCLR during daily, work, and sporting activities. © 2014 The Author(s).

News Article | February 16, 2017

Now available after years of development by top engineers and clinicians ​​​First tested with elite athletes and pro sports teams, the patented Protonics® T2 Exoskeleton is now available to everyone for preorder beginning today on the crowdfunding site, Protonics® T2 is an intelligent exoskeleton that everyone can use on their left leg prior to sports, fitness training, or everyday activities, minimizing right-side dominance and putting you in a balanced biomechanical state. This helps you to feel healthier, makes your activities more effective, and lets you use 100% of your available strength, speed, & agility. This highly advanced system uses the Protonics® resistance approach, state of the art sensors, wireless communication, embedded processors, haptic/visual alerts, and an onboard power supply, allowing for progression through a training program without the need for supervision. Individuals power-up the Protonics® T2 Exoskeleton, set the resistance level, and then start the T2 Software App on their mobile device to do the following: 1. Provide guidance through the different exercises and the setting of resistance levels. 2. Monitor body position and provide live haptic / visual feedback as to the correct position and other variables while performing exercises. 3. Record the individual's performance including good reps versus bad reps and other variables. Ron Hruska MPA, PT, Director of the Postural Restoration Institute, stated in regards to Protonics T2 that, "this will allow the novice athlete to the professional athlete, to appreciate how to experience alternating function for any type of activity they are going to engage in that requires two legs, whether they run with it, walk with it, or workout with it, its a great way to keep the body in a balanced state." According to world renowned orthopedic surgeon, Dr. James Andrews, who as co-founder of the American Sports Medicine Institute, helped support testing of Protonics® technology, "The youth injury rate is at an all-time high due in part to sports specific training year round which can result in severe muscle imbalances." The excitement in the Protonics® T2 Exoskeleton lies in its ability to help offset these muscle imbalances, preventing muscle tightness and pain, and allowing the individual to perform better in all functional activities.

Yang J.,Kent State University | Mann B.J.,American Orthopaedic Society for Sports Medicine | Guettler J.H.,Performance Orthopedics | Dugas J.R.,American Sports Medicine Institute | And 3 more authors.
American Journal of Sports Medicine | Year: 2014

Background: There are relatively few published epidemiological studies that have correlated pitching-related risk factors with increased pitching-related arm problems as well as injuries. Hypothesis: High pitching volume and limited recovery will lead to arm fatigue, thus placing young pitchers at a greater risk for elbow and shoulder problems and, subsequently, an increased risk for arm injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A national survey was conducted among 754 youth pitchers (ages 9 to 18 years) who had pitched in organized baseball leagues during the 12 months before the survey. Self-reported risk-prone pitching activities were identified and compared with recommendations by the American Sports Medicine Institute. Relationships between self-reported pitching activities, shoulder and elbow problems, and injuries were assessed using multivariable logistic regression. Results: Of the 754 participating pitchers, 43.4% pitched on consecutive days, 30.7% pitched on multiple teams with overlapping seasons, and 19.0% pitched multiple games a day during the 12 months before the study. Pitchers who engaged in these activities had increased risk of pitching-related arm pain (odds ratio [OR] = 2.53, 95% confidence interval [CI] = 1.14-5.60; OR = 1.85, 95% CI = 1.02-3.38; OR = 1.89, 95% CI = 1.03-3.49, respectively). Nearly 70% of the sample reported throwing curveballs, which was associated with 1.66 (95% CI = 1.09-2.53) greater odds of experiencing arm pain while throwing. Pitching-related arm tiredness and arm pain were associated with increased risk of pitching-related injuries. Specifically, those who often pitched with arm tiredness and arm pain had 7.88 (95% CI = 3.88-15.99) and 7.50 (95% CI = 3.47-16.21) greater odds of pitching-related injury, respectively. However, pitching on a travel baseball club, playing baseball exclusively, or playing catcher were not associated with arm problems. Conclusion: The results of this study, along with those of others, reinforce the importance of avoiding risk-prone pitching activities to prevent pitching-related injuries among youth pitchers. © 2014 The Author(s).

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).

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.

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.

Shah V.M.,The Texas Institute | Andrews J.R.,American Sports Medicine Institute | Fleisig G.S.,American Sports Medicine Institute | McMichael C.S.,American Sports Medicine Institute | Lemak L.J.,American Sports Medicine Institute
American Journal of Sports Medicine | Year: 2010

Background: Rupture of the anterior cruciate ligament (ACL) is a common and potentially career-threatening injury in the National Football League (NFL). The return to play (RTP) percentage and the factors affecting RTP after ACL reconstruction in NFL players are not well defined. Purpose: To determine the actual rate of return to professional football play in the NFL after ACL reconstruction surgery and to determine what factors can predict ability to RTP. We hypothesize that the RTP percentage in this unique patient population will differ from previously reported populations. Study Design: Case series; Level of evidence, 4. Methods: Forty-nine NFL athletes who had undergone primary ACL reconstruction at our institution were followed to determine their RTP percentages and factors predicting RTP. Results: Sixty-three percent (31 of 49) of NFL athletes returned to NFL game play at an average of 10.8 months after surgery. Age at time of surgery, position, and the type and number of procedures were not significantly different between those who did and did not return to play. The average number of games before surgery was 51 for those who did return to play and 28 for those who did not (P =.039). The odds ratio favoring RTP was 5.5 (P =.016) for those players who had more than 4 years of NFL experience before surgery. The average NFL draft round was 3.4 for the group who returned to play and 6.4 for those who did not (P <.001). The odds ratio favoring RTP was 12.2 (P <.001) for those players drafted in the first 4 rounds of the NFL draft compared with those drafted after the fourth round. Conclusions: The RTP rates after ACL reconstruction in NFL football players are lower than previously perceived. More experienced and established athletes are more likely to return to competition at the same level after this procedure than those with less professional experience. Being selected in the first 4 rounds of the NFL draft was highly predictive of RTP. © 2010 The Author(s).

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).

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.

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