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BACKGROUND AND HYPOTHESIS: Although shoulder and elbow injuries in professional baseball players have been thoroughly studied, little is known about the frequency and impact of pectoralis muscle injuries in this population. The purpose of this study was to use the official league injury surveillance system to describe pectoralis muscle injuries in professional baseball players in Major League Baseball (MLB) and Minor League Baseball (MiLB). Specifically, (1) player demographic characteristics, (2) return to play (RTP), (3) injury mechanism, (4) throwing- and batting-side dominance, and (5) injury rate per athlete exposure (AE) were characterized to guide future injury prevention strategies. METHODS: The MLB Health and Injury Tracking System database was used to compile all pectoralis muscle injuries in MLB and MiLB athletes in the 2011-2017 seasons. Injury-related data including diagnosis (tear or rupture vs. strain), player demographic characteristics, injury timing, need for surgical intervention, RTP, and mechanism of injury were recorded. Subanalyses of throwing- and batting-side dominance, as well as MLB vs. MiLB injury frequency, were performed. RESULTS: A total of 138 pectoralis muscle injuries (32 MLB and 106 MiLB injuries) were reported in the study period (5 tears or ruptures and 133 strains), with 5 of these being recurrent injuries. Operative intervention was performed in 4 athletes (2.9%). Of the 138 injuries, 116 (84.1%) resulted in missed days of play, with a mean time to RTP of 19.5 days. Starting pitchers sustained the greatest proportion of pectoralis injuries (48.1%), with pitching being the most common activity at the time of injury (45.9%). A majority of injuries (86.5%) were sustained during non-contact play. Overall, 87.5% of injuries occurred on the player's dominant throwing side and 81.3% occurred on the player's dominant batting side. There was no significant difference in the rate of pectoralis injuries in the MLB regular season (0.584 per 10,000 AEs) vs. the MiLB regular season (0.425 per 10,000 AEs) (P = .1018). CONCLUSION: Pectoralis muscle injuries are most frequently non-contact injuries, most commonly sustained by pitchers. An understanding of these injuries can guide athletic trainers and management in expectation management and decision making, in addition to directing future efforts at injury prevention.
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Traumatismos do Braço , Traumatismos em Atletas , Beisebol , Atletas , Traumatismos em Atletas/epidemiologia , Beisebol/lesões , Humanos , Músculos Peitorais/lesõesRESUMO
BACKGROUND: Shoulder injuries account for a large portion of all recorded injuries in professional baseball. Much is known about other shoulder pathologies in the overhead athlete, but the incidence and impact of acromioclavicular (AC) joint injuries in this population are unknown. We examined the epidemiology of AC joint injuries in Major League Baseball (MLB) and Minor League Baseball (MiLB) players and determined the impact on time missed. METHODS: The MLB Health and Injury Tracking System was used to compile records of all MLB and MiLB players from 2011 to 2017 with documented AC joint injuries. These injuries were classified as acute (sprain or separation) or chronic (AC joint arthritis or distal clavicular osteolysis), and associated data extracted included laterality, date of injury, player position, activity, mechanism of injury, length of return to play, and need for surgical intervention. RESULTS: A total of 312 AC joint injuries (183 in MiLB players and 129 in MLB players; range, 39-60 per year) were recorded: 201 acute (64.4%) and 111 chronic (35.6%). A total of 81% of acute and 59% of chronic injuries resulted in time missed, with a mean length of return to play of 21 days for both. Of the injuries in outfielders, 79.6% were acute (P < .0001), as were 66.3% of injuries in infielders (P = .004). Pitchers and catchers had more equal proportions of acute and chronic AC injuries (P > .05 for all). Acute AC injuries occurred most often while fielding (n = 100, 84.7%), running (n = 25, 80.6%), and hitting (n = 19, 61.3%), whereas chronic injuries tended to be more common while pitching (n = 26, 68.4%). Of contact injuries, 82.5% were acute (P < .0001), whereas 59.0% of noncontact injuries were chronic (P = .047). MLB players showed consistently higher regular-season rates of both acute and chronic AC injuries than MiLB players (P < .0001 for each). CONCLUSION: Acute AC joint injuries are contact injuries occurring most commonly among infielders and outfielders while fielding that result in 3 weeks missed before return to play, whereas chronic AC joint injuries occur more commonly in pitchers and catchers from noncontact repetitive overhead activity. Knowledge of these data can better guide expectation management in this elite population to better elucidate the prevalence of 2 common injury patterns in the AC joint.
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Articulação Acromioclavicular , Traumatismos em Atletas , Beisebol , Atletas , Traumatismos em Atletas/epidemiologia , Humanos , IncidênciaRESUMO
BACKGROUND: A recently introduced classification of medial ulnar collateral ligament (UCL) tears has demonstrated high interobserver and intraobserver reliability, but little is known about its prognostic utility. The purpose of this study was to assess the relationship of the magnetic resonance imaging (MRI)-based classification system and nonoperative vs. operative management. Secondary objectives included subanalysis of baseball players. METHODS: Eighty-five consecutive patients with UCL tears after a standardized treatment paradigm were categorized as operative vs. nonoperative. UCL tears of patients with a minimum of 1-year follow-up were retrospectively classified using the MRI-based classification system. Subanalyses for baseball players included return-to-play and return-to-prior performance. RESULTS: A total of 80 patients (62 baseball players, 54 pitchers) met inclusion criteria. A total of 51 patients underwent surgery, and 29 patients completed nonoperative management. In baseball players, 59% of the proximal tears were treated nonoperatively and 97% of the distal tears were treated operatively; 100% of the proximal partial-thickness tears and 100% of the distal complete tears were treated nonoperatively and operatively, respectively. Patients with distal (odds ratio: 48.4, P < .0001) and complete (odds ratio: 5.0, P = .004) tears were more likely to undergo surgery. Baseball players, regardless of position, were determinants of operative management, and there was no difference in return-to-play clearance and return-to-prior performance between the operative and nonoperative groups. CONCLUSION: A reliable 6-stage MRI-based classification addressing UCL tear grade and location may confer decision making between operative and nonoperative management. Complete and distal tears carry a markedly increased risk of failing nonoperative care compared with proximal, partial tears.
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Traumatismos em Atletas/classificação , Traumatismos em Atletas/diagnóstico por imagem , Beisebol/lesões , Ligamento Colateral Ulnar/diagnóstico por imagem , Ligamento Colateral Ulnar/lesões , Articulação do Cotovelo/diagnóstico por imagem , Imageamento por Ressonância Magnética , Adulto , Traumatismos em Atletas/terapia , Tomada de Decisão Clínica , Ligamento Colateral Ulnar/cirurgia , Tratamento Conservador , Articulação do Cotovelo/cirurgia , Seguimentos , Humanos , Prognóstico , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: This study tested validity and efficiency of Orthopaedic Minimal Data Set (OrthoMiDaS) Episode of Care (OME). METHODS: We analyzed 100 isolated rotator cuff repair cases in the OME database. Surgeons completed a traditional operative note and OME report. A blinded reviewer extracted data from operative notes and implant logs in electronic medical records by manual chart review. OME and electronic medical record data were compared with data counts and agreement between 40 variables of rotator cuff disease and repair procedures. Data counts were assessed using raw percentages and McNemar test (with continuity correction). Agreement of categorical variables was analyzed using Cohen κ (unweighted) and of numerical variables using the concordance correlation coefficient (CCC). Efficiency was assessed by median time to complete. RESULTS: OME database had significantly higher data counts for 25% (10/40) of variables. A high level of proportional and statistical agreement was demonstrated between the data. Among 35 categorical variables, proportional agreement was perfect for 17%, almost perfect (0.81 ≤ κ ≤ 1.00) for 37%, substantial (0.61 ≤ κ ≤ 0.80) for 20%, moderate (0.41 ≤ κ ≤ 0.60) for 14%, fair (0.21 ≤ κ ≤ 0.40) for 6%, and slight (0.0 ≤ κ ≤ 0.20) for 6%. Of 5 numerical variables, agreement was almost perfect (CCC > 0.99) for 20% and poor (CCC < 0.90) for 80%. Median OME completion time was 161.5 seconds (interquartile range, 116-224.5). CONCLUSION: OME is an efficient, valid tool for collecting comprehensive, standardized data on rotator cuff repair.
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Bases de Dados Factuais , Registros Eletrônicos de Saúde , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Lesões do Manguito Rotador/cirurgia , Smartphone , Artroplastia , Artroscopia , Humanos , Reprodutibilidade dos TestesRESUMO
Social media provide a unique method of analyzing outcomes and quality in medicine. The purpose of this observational study was to investigate the nature of social media content related to shoulder and elbow (S&E) surgery posted by patients, surgeons, and hospitals. A public search of Instagram for a two-year period yielded 1,177 patient-related posts. A categorical system assessed the perspective, timing, tone, and content of each post. Twitter accounts of 77 S&E specialists from the top five ranked U.S. News & World Report institutions were analyzed for activity and content. 5,246 Twitter and Instagram posts for the institutions were analyzed for frequency and content. Most patient-related posts were by patients (68%), postoperative (82%), positive (87%), and centered on return-to-play for Tommy John (34%), surgical site for shoulder arthroplasty (52%), and activities of daily living for rotator cuff repair (22%). 37% of surgeons had active accounts averaging 46 posts, 87% of which were practice advertisements. Hospitals averaged 273 posts over the 2-year period, focusing on education (38%) and community (18%). S&E patients share outcomes on social media in a positive tone with procedure-dependent emphases. Surgeons on social media use sites for practice augmentation. Hospitals often focused posts towards educating the community.
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Cotovelo/cirurgia , Administração Hospitalar , Satisfação do Paciente , Ombro/cirurgia , Mídias Sociais , Cirurgiões/organização & administração , Publicidade , Artroplastia , Educação em Saúde , Humanos , Pacientes/psicologia , Resultado do TratamentoRESUMO
BACKGROUND: Recent anatomic and clinical studies have shown that the location of the injury to the elbow ulnar collateral ligament (UCL) is an important variable in deciding on surgical intervention; however, no studies have evaluated these findings biomechanically. METHODS: This study tested 16 intact elbow specimens. Valgus torques of 2.5 and 5 Nm were applied to the elbow at various flexion angles, and the resulting valgus angles were measured. The valgus angles were applied to the elbows in their intact states and again after partial and complete cuts were made on the proximal and distal insertions of the UCL. Resulting valgus torques were measured, and stiffness was calculated for each elbow flexion angle. Unpaired t tests were used to evaluate the effects of cut location and flexion angle on joint rotational stability and stiffness. RESULTS: The posterior-distal insertion contributed the most to stability. At valgus angles generated from 2.5 Nm intact torques, the posterior-distal insertions contributed to 51% ± 26% (P < .03) intact rotational stability, and at valgus angles generated from 5 Nm intact torques, the posterior-distal insertions contributed to 41% ± 17% (P < .02) intact rotational stability. For overall stiffness, the posterior-distal insertions contributed to 31% ± 12% (P < .045) intact stiffness. CONCLUSION: Overall, the posterior distal insertion of the UCL contributed most to rotational stability and stiffness of the medial elbow when subjected to valgus stress at 90° and 120° of elbow flexion. At higher elbow flexion angles, the posterior insertions contributed more to stability, whereas the anterior insertions had a greater effect at lower flexion angles.
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Ligamento Colateral Ulnar/lesões , Articulação do Cotovelo , Instabilidade Articular/etiologia , Idoso , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Torque , Suporte de CargaRESUMO
BACKGROUND: Mobile technology offers the prospect of delivering high-value care with increased patient access and reduced costs. Advances in mobile health (mHealth) and telemedicine have been inhibited by the lack of interconnectivity between devices and software and inability to process consumer sensor data. The objective of this study was to preliminarily validate a motion-based machine learning software development kit (SDK) for the shoulder compared with a goniometer for 4 arcs of motion: (1) abduction, (2) forward flexion, (3) internal rotation, and (4) external rotation. METHODS: A mobile application for the SDK was developed and "taught" 4 arcs of shoulder motion. Ten subjects without shoulder pain or prior shoulder surgery performed the arcs of motion for 5 repetitions. Each motion was measured by the SDK and compared with a physician-measured manual goniometer measurement. Angular differences between SDK and goniometer measurements were compared with univariate and power analyses. RESULTS: The comparison between the SDK and goniometer measurement detected a mean difference of less than 5° for all arcs of motion (P > .05), with a 94% chance of detecting a large effect size from a priori power analysis. Mean differences for the arcs of motion were: abduction, -3.7° ± 3.2°; forward flexion, -4.9° ± 2.5°; internal rotation, -2.4° ± 3.7°; and external rotation -2.6° ± 3.4°. DISCUSSION: The SDK has the potential to remotely substitute for a shoulder range of motion examination within 5° of goniometer measurements. An open-source motion-based SDK that can learn complex movements, including clinical shoulder range of motion, from consumer sensors offers promise for the future of mHealth, particularly in telemonitoring before and after orthopedic surgery.
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Aprendizado de Máquina , Aplicativos Móveis , Amplitude de Movimento Articular , Rotação , Articulação do Ombro/fisiologia , Adulto , Artrometria Articular , Feminino , Humanos , Masculino , Movimento , Smartphone , TelemedicinaRESUMO
OBJECTIVE: To describe the MR appearance of a series of throwing-related injuries to the subscapularis muscle-tendon complex among baseball players. MATERIALS AND METHODS: A retrospective review of MR scans of the shoulder in players from 1 professional baseball organization over the course of 5 years was performed to identify cases with findings suggestive of subscapularis injury. These findings were graded and the medical record was reviewed to assess clinical findings, treatment, and follow-up. Preinjury baseline measurements of arm external rotation at 90° of abduction were compared to measurements from a noninjured cohort to evaluate whether this measure is a risk factor for injury. RESULTS: A total of 133 MR scans of the shoulder were evaluated. Eleven of the scans demonstrated signal changes suggesting subscapularis injury; 10 of these 11 patients had clinical findings supporting a diagnosis of throwing-related subscapularis strain. There were four grade 1, four grade 2, and two grade 3 injuries. All injuries occurred in the inferior half of the subscapularis at the myotendinous junction. Risk of subscapularis injury increased with lower levels of dominant arm external rotation (odds ratio, 1.12; 95% CI, 1.07-1.21; p < 0.001). A threshold of dominant arm external rotation of <106° demonstrated sensitivity of 0.700 (95% CI, 0.392-0.897) and specificity of 0.951 (95% CI, 0.888-0.982) for subscapularis injury. CONCLUSION: Throwing-related subscapularis injuries occur in the inferior half of the muscle at the myotendinous junction. Our data suggest that there is an increased risk of these injuries with lower levels of dominant arm external rotation.
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Beisebol/lesões , Imageamento por Ressonância Magnética/métodos , Músculo Esquelético/lesões , Lesões do Ombro , Articulação do Ombro/patologia , Traumatismos dos Tendões/patologia , Adulto , Traumatismos do Braço/patologia , Traumatismos em Atletas/patologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Músculo Esquelético/patologia , Estudos Retrospectivos , Adulto JovemRESUMO
Medial epicondylitis, often referred to as "golfer's elbow," is a common pathology. Flexor-pronator tendon degeneration occurs with repetitive forced wrist extension and forearm supination during activities involving wrist flexion and forearm pronation. A staged process of pathologic change in the tendon can result in structural breakdown and irreparable fibrosis or calcification. Patients typically report persistent medial-sided elbow pain that is exacerbated by daily activities. Athletes may be particularly symptomatic during the late cocking or early acceleration phases of the throwing motion. Nonsurgical supportive care includes activity modification, NSAIDs, and corticosteroid injections. Once the acute symptomology is alleviated, focus is turned to flexor-pronator mass rehabilitation and injury prevention. Surgical treatment via open techniques is typically reserved for patients with persistent symptoms.
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Procedimentos Ortopédicos , Cotovelo de Tenista/diagnóstico , Cotovelo de Tenista/terapia , Diagnóstico por Imagem , HumanosRESUMO
PURPOSE: Regarding biceps tenodesis, there are no evidence-based recommendations for the ideal level at which to cut and stabilize the tendon. The purpose of this study is to provide information referencing the tendon for potential clinical applications during biceps tenodesis. METHODS: Forty-three embalmed shoulder specimens were dissected, and markers were placed at four points along each biceps tendon: (1) proximal border of the bicipital groove, (2) distal border of the bicipital groove, (3) proximal edge of the pectoralis major insertion, and (4) musculotendonous junction. Using the origin as the initial point of reference, measurements were made to the four subsequent sites. The humeral length was recorded by measuring the distance between the greater tuberosity and the lateral epicondyle. RESULTS: Measurements were recorded from the origin of the tendon on the supraglenoid tubercle to each established point along its length, and the mean, minimum, and maximum values (cm) were calculated as follows: origin to the proximal bicipital groove [2.8 (1.9, 4.3)], distal bicipital groove [5.2 (3.8, 7.0)], pectoralis major insertion [8.1 (6.3, 10.4)], and musculotendonous junction [13.8 (7.7, 20.3)], and overall humeral length [29.2 (25.2, 32.7)]. An analysis demonstrated a statistically significant overall increase in tendon length at each anatomic site as the overall humeral length increased (p < 0.05). Utilizing the constant and coefficient data from our regression analysis, a predictive formula was calculated based on humeral length. For example, distance from the origin to each anatomic point was determined by a formula [Tendon length at each anatomic landmark, cm = coefficient (humeral length, cm) + constant] for each respective anatomic landmark along the course of the tendon. CONCLUSION: This work will allow surgeons who prefer tenodesis to more accurately re-approximate the appropriate length-tension relationship of the biceps when tenodesing the tendon in a variety of locations. This benefit will potentially result in the most efficient biceps muscle-tendon function and improve the results of biceps surgery. LEVEL OF EVIDENCE: IV.
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Pontos de Referência Anatômicos , Músculo Esquelético/anatomia & histologia , Tendões/cirurgia , Tenodese/métodos , Idoso , Idoso de 80 Anos ou mais , Cadáver , Humanos , Pessoa de Meia-Idade , Músculo Esquelético/cirurgia , Tendões/anatomia & histologiaRESUMO
OBJECTIVES: The purpose of this study was to determine whether the long distal attachment of the medial ulnar collateral ligament (MUCL) can be delineated on sonography. METHODS: We used 12 fresh-frozen cadaveric elbows for this study. We performed sonography of the elbow using a coronal-equivalent long-axis view of the MUCL. All sonographic examinations and measurements were performed by a board-certified, fellowship-trained musculoskeletal radiologist. Measurements were performed from the anteroinferior aspect of the medial epicondyle to the sublime tubercle and then from the sublime tubercle to the terminal fibers of the MUCL long ulnar attachment. We then measured the length of the MUCL from its attachment at the medial epicondyle of the humerus to the sublime tubercle and then from the sublime tubercle to the distal extent of its terminal fibers at the ulnar attachment with digital calipers. RESULTS: On sonography, the average length of the MUCL from its humeral attachment to the sublime tubercle (transarticular) was 19.6 mm. The average length of the ulnar attachment was 27.9 mm. The MUCL was thickest (mediolateral dimension) at its humeral attachment and tapered as it coursed distally along the ulnar attachment. The MUCL was clearly identified on sonography and in all anatomic specimens. On gross measurement, the average lengths of the transarticular portion of the MUCL and its ulnar footprint were 21.5 and 30.2 mm, respectively. CONCLUSIONS: We have successfully shown that the distal ulnar attachment of the MUCL can be visualized on high-resolution sonography. This preliminary work provides a framework for developing protocols for diagnosis of injuries to the distal ulnar collateral ligament.
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Pesos e Medidas Corporais/métodos , Ligamentos Colaterais/diagnóstico por imagem , Articulação do Cotovelo/diagnóstico por imagem , Cadáver , Humanos , UltrassonografiaRESUMO
Batter's shoulder is characterized by posterior shoulder instability in the lead (front) shoulder of a batting athlete. This most commonly occurs as a discrete event, particularly a swing and miss at an outside pitch, which leads to an episode of shoulder subluxation. A thorough history and physical examination is key to diagnosis, with patients feeling pain and instability of the lead shoulder when attempting the baseball swing or during pushing-type activities, as well as positive posterior labral signs in tests such as the Kim, jerk, and modified dynamic labral shear tests. Magnetic resonance imaging can confirm the diagnosis of posterior labral tear and may show concomitant pathologies such as a reverse Hill-Sachs lesion. Nonsurgical treatment is directed at rotator cuff and scapular strengthening; however, arthroscopic posterior labral repair is often required for definitive stabilization. Overall, this is a relatively rare diagnosis, but outcomes of surgical repair are favorable with high satisfaction and rates of return to competition.
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BACKGROUND: Athletes who are well prepared for the physical demands of competition are less susceptible to injury. Defining and then preparing athletes for these in-game demands is critical to athlete health and performance. The injury burden within Major League Baseball (MLB) is significant and differs by position. Despite its importance, the workload demands have not been described for position players in MLB. HYPOTHESIS: That running demands would be significantly higher for outfielders, followed by infielders, and catchers, respectively, while batting and baserunning metrics would be similar across positions. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Total and high-speed running distance (>75% Vmax), high-speed running count, hard accelerations (>2.78 m/s/s), defensive and baserunning minutes, total and hard throws (>75% max), and bat swing counts were calculated from Statcast data. Players with 100 games or more in the 2018 season (n = 126) were included for analysis. RESULTS: All offensive and baserunning metrics were similar across positions; however, significant positional differences were observed for defensive and overall workload metrics. High-speed running was highest among outfielders (F1,7 = 27.1, P < 0.01), followed by infielders, then catchers. Hard accelerations (F1,7 = 12.9, P < 0.01) were highest among first basemen, then outfielders, remaining infielders, and catchers. Total throws (F1,7 = 17.7, P < 0.01) were highest among middle infielders. Hard throws (P < 0.01) were highest among shortstops and third basemen. CONCLUSION: In-game workloads differ significantly by defensive position in MLB. These differences in running, throwing, and hitting volumes have significant implications for physical preparation and injury return-to-play progressions to optimize performance and minimize injury and reinjury risk for these athletes. CLINICAL RELEVANCE: These data provide insight into how best to prepare athletes of different positions for the demands of the game both in terms of preseason preparation as well as return-to-play benchmarks following injury. These data should also serve as a platform for future research into the relationship between workload and injury among professional baseball players.
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PURPOSE: This study was conducted to evaluate reports of clinical outcomes of isolated capitellar fractures. MATERIALS AND METHODS: We conducted a systematic review of medical databases reporting clinical outcomes of patients undergoing nonoperative and operative management of isolated capitellar fractures. RESULTS: We identified 28 studies for inclusion comprising 174 patients. All included studies were level IV evidence. Capitellar fractures were more common among women than men and were more likely to involve the nondominant arm. Type I fractures (84%) were more common than type II (14%) and III fractures (2%). Operative and nonoperative management both led to satisfactory clinical outcomes. No significant difference in outcomes was observed in those undergoing operative management compared with those undergoing closed reduction and immobilization. CONCLUSIONS: Nonoperative and operative management of isolated capitellar fractures leads to satisfactory clinical outcomes as determined by postoperative range of motion, improvement in pain, and a return to previous levels of function. No statistical difference in outcomes was observed between those undergoing operative management compared with those treated with closed reduction and immobilization.
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Lesões no Cotovelo , Fixação Interna de Fraturas/métodos , Fraturas do Rádio/cirurgia , Feminino , Consolidação da Fratura , Humanos , MasculinoRESUMO
OBJECTIVES: To assess the reporting and representation of ethnic and racial minorities in comparative studies of ulnar collateral ligament (UCL) injuries and treatment in baseball athletes. METHODS: A systematic review of the literature was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. The literature search was conducted by two independent reviewers using the PubMed, Scopus, and Cochrane Library databases. Studies were included if they were UCL of the elbow clinical comparative studies, including randomized clinical trials, cohort studies, case series, and epidemiological studies. Studies were excluded if they were related to ulnar collateral ligament of the thumb, lateral ulnar collateral ligament of the elbow, biomechanical studies, non-surgical studies, non-baseball studies, and systematic reviews and meta-analyses. The Methodological Index for Non-Randomized Studies (MINORS) criterion was used to assess quality of studies included. RESULTS: A total of 108 studies were included for analysis, of which only one reported race and ethnicity in their demographics. Additionally, of the 108 studies included, only four reported Country of Origin, a subset of Race and Ethnicity, in their demographics. CONCLUSION: Race and Ethnicity demographics are scarcely reported in comparative studies evaluating ulnar collateral ligament reconstruction. Future studies evaluating similar populations should strongly consider reporting racial and ethnic demographics as this may provide clarity on any potential effect these might have on post-surgical outcomes, particularly in high-level pitchers.
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BACKGROUND: Elite pitchers have demonstrated significant differences in glenohumeral range of motion and humeral torsion compared with the nonthrowing population. Furthermore, abnormal shoulder range of motion measurements have been associated with different injury risks and challenges in assessing rehabilitation progress. Variations in range of motion and torsion due to handedness in the asymptomatic professional population have yet to be investigated in the literature. HYPOTHESIS: No significant differences in glenohumeral range of motion and humeral torsion would exist between asymptomatic right- and left-handed professional pitchers. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: 217 Major League Baseball pitchers from a single organization were evaluated over a 7-year period between 2013 and 2020. Range of motion was measured with a standard goniometer. Ultrasound scanning was used to determine neutral position of the shoulder, and the degree of humeral torsion was measured with a goniometer. RESULTS: Right-handed pitchers demonstrated significantly greater values of glenohumeral external rotation (118.5° vs 112.7°; P < .001) in their throwing arms compared with their left-handed counterparts. Right-handed pitchers also showed greater values of glenohumeral internal rotation deficit (13.9° vs 4.8°; P < .001) and side-to-side differences in humeral retrotorsion (-23.1° vs -2.2°; P < .001). Left-handed pitchers demonstrated significantly greater flexion deficits in the throwing arm compared with their right-handed counterparts (7.5° vs 0.0°; P < .001). CONCLUSION: In the throwing arm, right-handed pitchers demonstrated significantly greater measures of external rotation, glenohumeral internal rotation deficit, and humeral retrotorsion compared with left-handed counterparts. Furthermore, right-handed pitchers demonstrated a significant side-to-side difference in retrotorsion, whereas left-handed pitchers did not. However, left-handed pitchers demonstrated a side-to-side shoulder flexion deficit that was not present in the cohort of right-handed pitchers. The correlation between humeral retrotorsion and increased external rotation indicates that osseous adaptations may play a role in range of motion differences associated with handedness. Additionally, these findings may explain observed differences in several throwing metrics between right- and left-handed pitchers. Knowledge of these differences can inform rehabilitation programs and shoulder maintenance regimens.
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Beisebol , Articulação do Ombro , Beisebol/lesões , Estudos Transversais , Humanos , Úmero/diagnóstico por imagem , Amplitude de Movimento Articular , Articulação do Ombro/diagnóstico por imagemRESUMO
Background: Magnetic resonance imaging (MRI)-based rotator cuff assessment is often qualitative and subjective; few studies have tried to validate such preoperative assessments. This study investigates relationships of preoperative MRI assessments made by conventional approaches to intraoperative findings of tear type, location, and size or MRI-assessed muscle occupation ratio. Methods: Intraoperatively, surgeons assessed tear type, location, anterior-posterior (AP) width, and medial-lateral length in 102 rotator cuff repair patients. Two musculoskeletal radiologists independently assessed the preoperative MRI scans for these same parameters and supraspinatus muscle atrophy by both Warner classification and quantitative occupation ratio. Exact agreement proportions, kappa statistics, and correlation coefficients were used to quantify agreement relationships. Results: Agreement between MRI readers' and surgeons' observations of tear status averaged 93% with κ = 0.38, and that of tear location averaged 77% with κ = 0.50. Concordance correlations of MRI and intraoperative measures of anterior-posterior and medial-lateral tear length averaged 0.59 and 0.56 across readers, respectively. Despite excellent interrater agreement on Warner classification (exact agreement proportion 0.91) and occupation ratio (concordance correlation 0.93) separately, correlations between these 2 measures were -0.54 and -0.64 for the 2 readers, respectively. Patients with Warner grade 0 had occupation ratios ranging from 0.5 to 1.5. Conclusion: Correlations of preoperative MRI tear dimensions and muscle atrophy assessed by conventional approaches with intraoperatively measured tear dimensions and quantitative occupation ratio, respectively, were only fair. Since tear size and muscle atrophy are known strong predictors of outcomes following rotator cuff repair that may influence treatment decisions, surgeons need to be aware of the limitations of MRI methods. Continued development and validation of quantitative preoperative imaging methods to accurately assess these parameters are needed to improve surgical planning and prognosis.
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Given the rising incidence and prevalence of shoulder injuries in throwing athletes, this review aims to evaluate management options and outcomes of common shoulder injuries in overhead throwers. Laxity of the glenohumeral joint is often adaptive for overhead athletes to achieve the velocity necessary to compete in the professional ranks. Surgical repair of the stabilizers of the humeral head-specifically the labrum and rotator cuff-often causes inflammation, scarring, and overtensioning of the glenohumeral joint which lead to poor postoperative performance. Thus, nonsurgical management should be exhausted in this population before considering surgical intervention.
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Impingement of the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain. Because of its relative rarity in isolation and nonspecific presentation, diagnosis and management are often challenging for orthopaedic surgeons and their patients. Stenosis of the subcoracoid space between the lesser tuberosity and the coracoid process <6 mm can lead to anterior shoulder pain and associated rotator cuff and biceps pathology. Multiple imaging modalities are available to assess narrowing of the coracohumeral interval, each with its strengths and limitations. If the patient can be accurately diagnosed with subcoracoid impingement, both conservative and surgical management options are available. Despite earlier case series demonstrating promising results with arthroscopic treatment, comparative studies have yet to support these initial claims.
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Lesões do Manguito Rotador , Síndrome de Colisão do Ombro , Humanos , Imageamento por Ressonância Magnética , Manguito Rotador , Síndrome de Colisão do Ombro/diagnóstico , Síndrome de Colisão do Ombro/cirurgia , Dor de Ombro/diagnóstico , Dor de Ombro/etiologiaRESUMO
OBJECTIVE: Our aim is to review several shoulder abnormalities that are difficult to detect accurately on shoulder MRI, describe the technical reasons that limit their detection, and suggest imaging protocol modifications that may improve radiologists' accuracy. CONCLUSION: Although MRI is an excellent tool for detecting some abormalities, there are a number of subtler abnormalities of clinical significance that give radiologists greater difficulty. By understanding the reasons for limited detection and modifying protocols accordingly, radiologists may be able to improve identification, allowing more accurate clinical decision making.