Descriptive profile of hip rotation range of motion in elite tennis players and professional baseball pitchers.

BACKGROUND: Repetitive loading to the hip joint in athletes has been reported as a factor in the development of degenerative joint disease and intra-articular injury. Little information is available on the bilateral symmetry of hip rotational measures in unilaterally dominant upper extremity athletes. HYPOTHESIS: Side-to-side differences in hip joint range of motion may be present because of asymmetrical loading in the lower extremities of elite tennis players and professional baseball pitchers. STUDY DESIGN: Cohort (cross-sectional) study (prevalence); Level of evidence, 1. METHODS: Descriptive measures of hip internal and external rotation active range of motion were taken in the prone position of 64 male and 83 female elite tennis players and 101 male professional baseball pitchers using digital photos and computerized angle calculation software. Bilateral differences in active range of motion between the dominant and nondominant hip were compared using paired t tests and Bonferroni correction for hip internal, external, and total rotation range of motion. A Pearson correlation test was used to test the relationship between years of competition and hip rotation active range of motion. RESULTS: No significant bilateral difference (P > .005) was measured for mean hip internal or external rotation for the elite tennis players or the professional baseball pitchers. An analysis of the number of subjects in each group with a bilateral difference in hip rotation greater than 10 degrees identified 17% of the professional baseball pitchers with internal rotation differences and 42% with external rotation differences. Differences in the elite male tennis players occurred in only 15% of the players for internal rotation and 9% in external rotation. Female subjects had differences in 8% and 12% of the players for internal and external rotation, respectively. Statistical differences were found between the mean total arc of hip range of internal and external rotation in the elite tennis players with the dominant side being greater by a clinically insignificant mean value of 2.5 degrees. Significantly less (P < .005) dominant hip internal rotation and less dominant and nondominant hip total rotation range of motion were found in the professional baseball pitchers compared with the elite male tennis players. CONCLUSION: This study established typical range of motion patterns and identified bilaterally symmetric hip active range of motion rotation values in elite tennis players and professional baseball pitchers. Asymmetric hip joint rotational active range of motion encountered during clinical examination and screening may indicate abnormalities and would indicate the application of flexibility training, rehabilitation, and further evaluation.

Ulnar collateral ligament reconstruction in elite throwing athletes.

PURPOSE: Ulnar collateral ligament (UCL) injuries may result in disabling valgus instability in throwing athletes. We evaluated the docking technique for UCL reconstruction and describe a modification to the technique. METHODS: UCL surgery was indicated in 20 high-level baseball players (13 professional and 7 collegiate) based on medial elbow pain preventing effective throwing, clinically apparent medial elbow laxity, and magnetic resonance arthrogram consistent with UCL injury. The mean age was 21.7 years (range, 17.9 to 25.3 years). One patient had previous UCL reconstruction. One had previous arthroscopic elbow debridement. The mean time between injury and treatment was 73 days. Reconstruction was performed via a muscle-splitting approach and the docking technique with palmaris or gracilis graft. For the initial 12 patients, a 2-strand construct was used; however, during the study period, we developed and began using a 3-strand construct with a double anterior bundle and a single posterior bundle, which was used in the next 8 patients. The ulnar nerve was not routinely transposed unless there were preoperative ulnar nerve symptoms (1 patient). Two patients had osteophyte debridement. One had removal of a loose body. RESULTS: Patients were followed up for a mean of 41.9 months (range, 6.4 to 67.1 months). One player was lost to follow-up and could not be identified on a professional roster. Of the remaining 19 patients, 18 returned to their previous level of participation or higher. Two were occasional pitchers who did not wish to return to pitching but continued to play other positions. They were clinically and functionally asymptomatic. The mean time to return to play was 13.1 months (range, 6.3 to 21.3 months). By use of the Timmerman-Andrews 100-point subjective scoring system, the mean preoperative score was 77.0 (range, 65 to 80) and the mean postoperative score was 98.2 (range, 85 to 100). By use of the Conway-Jobe scoring system, the outcome was rated as excellent in 17 patients and good in 2. One patient underwent subsequent ulnar nerve transposition and returned to the previous level of professional play. CONCLUSIONS: UCL reconstruction with the docking technique is a reproducible and safe operation that can reliably return athletes to a high level of participation with limited adverse effects. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Descriptive epidemiology of collegiate men's baseball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004.

OBJECTIVE: To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's baseball and identify potential areas for injury prevention initiatives. BACKGROUND: Prevention and management of collegiate baseball injuries may be facilitated through injury research aimed at defining the nature of injuries inherent in the sport. Through the NCAA Injury Surveillance System, 16 years of collegiate baseball data were collected for the academic years 1988-1989 through 2003-2004. MAIN RESULTS: College baseball has a relatively low rate of injury compared with other NCAA sports, but 25% of injuries are severe and result in 10+ days of time loss from participation. The rate of injury was 3 times higher in a game situation than in practice (5.78 versus 1.85 injuries per 1000 athlete-exposures [A-Es], rate ratio = 3.1, 95% confidence interval = 3.0, 3.3, P < .01). Practice injury rates were almost twice as high in the preseason as in the regular season (2.97 versus 1.58 per 1000 A-Es, rate ratio = 1.9, 95% confidence interval = 1.8, 2.0, P < .01). A total of 10% of all game injuries occurred from impact with a batted ball, an injury rate of 0.56 injuries per 1000 game A-Es. Sliding was involved in 13% of game injuries. RECOMMENDATIONS: Proper preseason conditioning is important to reduce injuries. Athletic trainers covering practices and games should be prepared to deal with serious, life-threatening injuries from batted balls and other injury mechanisms. Further study of batted-ball injuries is warranted, and the use of breakaway bases to prevent sliding injuries should be supported in college baseball.