Posterior shoulder stiffness was associated with shoulder pain during throwing in college baseball players: assessment of shear wave elastography.

PURPOSE: To investigate shoulder stiffness on the throwing and non-throwing sides in college baseball players using ultrasound shear wave elastography (SWE), and investigate the relationship between stiffness and shoulder pain during throwing. METHODS: Forty-nine college baseball players (98 shoulders) were recruited. Shoulder range of motion was evaluated. SWE was used to measure stiffness of the bilateral supraspinatus tendons, infraspinatus tendons, subscapularis tendons, supraspinatus muscles, infraspinatus muscles (ISPM), and posterior capsules. Participants were divided into pain and no pain groups based on the presence or absence of shoulder pain during throwing within 1 month before measurements on the throwing side. Items were compared between the throwing and non-throwing sides, and between the pain and no pain groups. Factors affecting shoulder pain during throwing were also investigated via multiple logistic regression analysis. RESULTS: Compared with the non-throwing side, the throwing side had significantly greater external rotation at 90° abduction, significantly lesser internal rotation at 0° abduction and internal rotation at 90° abduction (AbdIR), significantly higher SWE values of the infraspinatus tendon, ISPM, and posterior capsule, and significantly lower SWE values of the subscapularis tendon. Compared with the no pain group, the pain group had a significantly higher SWE value of the ISPM, and significantly lesser AbdIR. Increased ISPM SWE values and decreased AbdIR were significantly correlated with shoulder pain during throwing. CONCLUSIONS: The posterior tissue was stiffer than the anterior tissue on the throwing side. Decreased AbdIR and increased ISPM stiffness may be correlated with shoulder pain during throwing.

Assessment of posterior shoulder muscle stiffness related to posterior shoulder tightness in college baseball players using shear wave elastography.

BACKGROUND: Limitations of shoulder range of motion (ROM) have been reported to be at high risk for shoulder disorders in baseball players. In this study, we assessed posterior shoulder muscle stiffness using shear wave elastography in baseball players with and without posterior shoulder tightness. MATERIALS AND METHODS: In total, 21 college baseball players volunteered to participate in this study. Passive ROMs for shoulder abduction and horizontal adduction were measured using a goniometer. Subsequently, we divided all participants into 2 groups based on the differences between bilateral shoulder ROMs: STIFF+ and STIFF- groups. Thickness and elasticity of the posterior and inferior shoulder muscles were assessed using ultrasound. RESULTS: Shoulder abduction ROM on the throwing side was 114.5° ± 5.3° and 131.3° ± 5.7° in the STIFF+ and STIFF- groups, respectively, which was significantly different between the 2 groups (P = .023). Horizontal adduction ROM on the throwing side was 96.6° ± 4.9° and 110.9° ± 4.8° in the STIFF+ and STIFF- groups, respectively, which was also significantly different between the 2 groups (P = .014). The elasticity of infraspinatus and lower trapezius in the STIFF+ group was significantly greater than that in the STIFF- group (P = .018 and .033, respectively). DISCUSSION: In this study, we found that the elasticity of infraspinatus and lower trapezius in stiff shoulders was significantly greater than that in nonstiff shoulders, which indicated that the infraspinatus and lower trapezius could be the key muscles in posterior shoulder tightness.

Assessment of Elbow Torque and Other Parameters During the Pitching Motion: Comparison of Fastball, Curveball, and Change-up.

PURPOSE: To assess the precision of a new wearable device in detecting medial elbow torque during the pitching motion in competitive baseball pitchers and to determine the differences in torque across pitch types and thrower demographic characteristics. METHODS: High school and collegiate baseball pitchers were recruited from August 1, 2016, to January 31, 2017, through direct request by athletic trainers and coaches. Body dimensions and throwing arm measurements of the participants were collected. The sensor was positioned directly over the medial elbow and pitchers were instructed to throw 8 fastballs, 8 curveballs, and 8 change-ups in a standard, randomized sequence. The sensor reported elbow torque, arm speed, arm slot, and shoulder rotation, whereas a radar gun measured peak ball velocity. Precision was calculated by measuring outlier rate, and mixed model regression analysis was performed to detect differences in throwing biomechanics among pitch types. RESULTS: In total, 37 competitive baseball pitchers were included in the study. The device had a precision of 96.9% for fastballs, 96.9% for curveballs, and 97.9% for change-ups. The device was sensitive enough to distinguish pitches according to elbow torque, arm speed, arm slot, and shoulder rotation. Fastballs caused the greatest relative torque across the medial elbow (average = 45.56 N m), compared with change-ups (43.77 N m; P = .006) and curveballs (43.83 N m; P = .01). Ball velocity contributed most to medial elbow torque (P = .003), followed by elbow circumference (P = .021), where smaller elbow circumference predicted greater medial elbow torque. CONCLUSIONS: The sensor is a precise and reproducible device for measuring torque across the medial elbow, as well as additional parameters of arm speed, arm slot, and shoulder rotation. Torque was significantly relatively higher in fastballs than curveballs and change-ups. LEVEL OF EVIDENCE: Level III, comparative study.

Major League Baseball pace-of-play rules and their influence on predicted muscle fatigue during simulated baseball games.

Major League Baseball (MLB) has proposed rule changes to speed up baseball games. Reducing the time between pitches may impair recovery from fatigue. Fatigue is a known precursor to injury and may jeopardise joint stability. This study examined how fatigue accumulated during baseball games and how different pace of play initiatives may influence fatigue. Pitcher data were retrieved from a public database. A predictive model of muscle fatigue estimated muscle fatigue in 8 arm muscles. A self-selected pace (22.7 s), 12 s pace (Rule 8.04 from the MLB) and a 20 s rest (a pitch clock examined in the 2014 Arizona Fall League (AFL)) were examined. Significantly more muscle fatigue existed in both the AFL and Rule 8.04 conditions, when compared to the self-selected pace condition (5.01 ± 1.73%, 3.95 ± 1.20% and 3.70 ± 1.10% MVC force lost, respectively). Elevated levels of muscle fatigue are predicted in the flexor-pronator mass, which is responsible for providing elbow stability. Reduced effectiveness of the flexor-pronator mass may reduce the active contributions to joint rotational stiffness, increasing strain on the ulnar collateral ligament (UCL) and possibly increasing injury risk.

Posterior Shoulder Capsules Are Thicker and Stiffer in the Throwing Shoulders of Healthy College Baseball Players: A Quantitative Assessment Using Shear-Wave Ultrasound Elastography.

BACKGROUND: Posterior and posteroinferior capsules in the shoulder joints of throwing athletes have been reported to be thicker in throwing than nonthrowing shoulders, and this has a relationship to glenohumeral internal rotation deficit (GIRD). However, the stiffness of these thickened capsules has not been reported. Shear-wave ultrasound elastography is a new technology that can measure tissue elasticity quantitatively. HYPOTHESIS: The posterior and posteroinferior capsules are stiffer as well as thicker in the throwing shoulders of baseball players than in their nonthrowing shoulders. The thickness and elasticity of these capsules are inversely correlated with glenohumeral internal rotation. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Forty-five male college baseball players were examined. The thickness and elasticity of the posterior capsule beneath the infraspinatus and the posteroinferior capsule beneath the teres minor were measured using an ultrasonic device equipped with shear-wave elastographic technology. Glenohumeral internal rotation at 90° of shoulder abduction and humeral retrotorsion were also measured. RESULTS: The mean thickness and elasticity of the posterior capsule were significantly greater for the throwing compared with the nonthrowing shoulder (thickness: 1.34 vs 1.04 mm, respectively; elasticity: 40.0 vs 32.2 kPa, respectively; P < .001 for both). The mean thickness and elasticity of the posteroinferior capsule were also significantly greater in the throwing compared with the nonthrowing shoulder (thickness: 1.40 vs 1.04 mm, respectively; elasticity: 39.4 vs 31.6 kPa, respectively; P < .001 for both). After correcting the range of motion for bilateral differences in retrotorsion, correlation coefficients showed that posterior capsule thickness and elasticity (Pearson r = -0.43 and -0.56, respectively; P < .001 for both) and posteroinferior capsule thickness and elasticity (Pearson r = -0.51 and -0.52, respectively; P < .001 for both) were negatively correlated with the corrected glenohumeral internal rotation. Bilateral differences in posterior and posteroinferior capsule elasticity correlated with bilateral differences in the corrected glenohumeral internal rotation (Pearson r = 0.46 [P = .0015] and 0.48 [P < .001], respectively), whereas bilateral differences in posterior and posteroinferior capsule thickness did not (Pearson r = -0.13 [P = .38] and 0.17 [P = .28], respectively). CONCLUSION: The posterior and posteroinferior capsules were stiffer as well as thicker in the throwing shoulder of college baseball players compared with the nonthrowing shoulder. Posterior capsule elasticity appeared to have a greater effect on GIRD than did posterior capsule thickness. This technology could be used as a noninvasive screening method for throwing athletes to identify players at potential risk of shoulder injuries.

Clinical assessment of scapula and hip joint function in preadolescent and adolescent baseball players.

BACKGROUND: Proper scapulothoracic and hip mechanics are essential aspects of the throwing kinetic chain. Little is known regarding these entities in preadolescent and adolescent baseball players. HYPOTHESIS: Scapular malposition and dyskinesis as well as hip dysfunction are highly prevalent in preadolescent and adolescent baseball players and may be identified by simple clinical testing. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 112 baseball players aged 7 to 18 years were recruited from local Little Leagues, traveling teams, and high schools. Participants were divided into 2 groups: preadolescents (players aged 7-12 years) and adolescents (players aged 13-18 years). Scapular symmetry was tested with the yes/no method of Kibler and by measuring forward shoulder posture via the "coracoid distance." Hip abductor strength was measured by use of a handheld digital dynamometer. Functional gluteal and core strength was assessed by video analysis of the subjects performing the single-legged squat test. Hip range of motion was measured in the prone position by use of a handheld goniometer. RESULTS: Compared with the preadolescent group, the adolescent group had a significantly higher prevalence of scapular dyskinesis in the throwing shoulder (50% vs 25.9%, P = .011). The adolescents had significantly higher normalized hip abduction strength in both the stride (17.41 vs 12.62 N/kg, P < .001) and stance (17.82 vs 12.61 N/kg, P < .001) legs. The preadolescent group was unable to perform the single-legged squat test correctly in either the stance (0% preadolescent vs 13% adolescent, P = .0127) or stride (0% preadolescent vs 9.3% adolescent, P = .0567) leg. The mean coracoid distance was elevated in the dominant (throwing) shoulder after controlling for scapular dyskinesis (P < .0001). Presence of scapular dyskinesis was associated with a higher mean coracoid distance (P = .0067). CONCLUSION: There was a high prevalence of dominant shoulder scapular dyskinesis in the adolescent compared with the preadolescent group, as well as universally poor single-legged squat test performance. The mean coracoid distance was higher in the dominant or throwing side compared with the nondominant side independent of scapular dyskinesis. Presence of scapular dyskinesis was associated with higher mean coracoid distance. CLINICAL RELEVANCE: Identification of players thought to be at increased risk for throwing injuries and initiation of targeted rehabilitation programs may decrease injury rates in preadolescent and adolescent baseball players.

Assessment of professional baseball players aerobic exercise performance depending on their positions.

This study reports the average and SD of professional baseball players' cardiorespiratory endurance, maximum oxygen consumption, oxygen consumption during anaerobic threshold, maximum oxygen consumption of anaerobic threshold %, maximum heart rate, and heart rate of anaerobic threshold. We also report the comparison between pitchers and fielders. Considering the total number of results, percentile was used and results were classified into 5 grades. One professional baseball players' organization with more than 14 years of experience participated in this study. First, we observed that the average pitchers' V[Combining Dot Above]O2max was 53.64 ml·kg·min, whereas the average fielders' was 52.30 ml·kg·min. These values were lower than other sports players. Second, in case of the V[Combining Dot Above]O2AT, pitchers showed 39.35 ml·kg·min and fielders showed 39.96 ml·kg·min. %V[Combining Dot Above]O2AT showed a significant difference of 71.13% between pitchers and fielders-pitchers, whereas fielders showed 73.89% (p < 0.01). Third, maximal heart rates were measured at 188.69 b·min (pitchers) and 187.79 b·min (fielders). These were lower than college baseball players and higher than other sports players. In conclusion, both professional baseball pitchers and fielders should be aware of the necessity of systematic cardiorespiratory endurance data analysis. Moreover, baseball teams, athletic trainers, and coaches should also be aware of the importance of cardiorespiratory endurance.

Motion analysis assessment of alterations in the scapulo-humeral rhythm after throwing in baseball pitchers.

PURPOSE: Throwing a baseball requires a coordinated sequence of scapula and humerus movements also called scapulo-humeral rhythm (SHR). Fatigue associated with repetitive throwing can lead to scapular dyskinesia, a recognized cause of shoulder disability in pitchers and overhead athletes. We introduce a novel device, the Xbus Kit, which can objectively assess scapular biomechanics and the effect of pitching on SHR. METHODS: SHR was studied using the Xbus Kit (Xsens Technologies B.V., NL). Thirteen collegiate baseball pitchers (aged 20 ± 2.6) were studied, evaluating SHR in forward elevation and abduction in three sessions: before throwing (S1), after 60 pitches (S2) and 24 h after a pitching session (S3). RESULTS: SHR changes were found in 85 % of pitchers (11 cases), and no changes were observed in 2 cases (15 %). We were able to subdivide pitchers into four groups, based on their response to pitching. CONCLUSION: Repetitive movement of pitching leads to SHR changes and sometimes, incomplete restoration of normal shoulder biomechanics.

Abner Doubleday, Marc Bloch, and the cultural significance of baseball in rural America.

In 1907 baseball's promoters decreed that Civil War hero Abner Doubleday created the game in the village of Cooperstown, New York, in 1839. Baseball thus acquired a distinctly rural American origin and a romantic pastoral appeal. Skeptics have since presented irrefutable evidence that America's pastime was neither born in the United States nor was a product of rural life. But in their zeal to debunk the myth of baseball's rural beginnings, historians have fallen prey to what Annales School founder Marc Bloch famously called the "idol of origins," and all but neglected the very real phenomenon of rural baseball itself. The claim that baseball has always been "a city game for city men" does not stand up to empirical scrutiny anymore than the Doubleday myth itself, as this address demonstrates with three case studies -- Cooperstown in the 1830s, Davisville, California, in the 1880s, and Milroy, Minnesota, in the 1950s. Baseball may have been a source of rural nostalgia for city people, but it was the sport of choice for farmers and a powerful cultural agent.

Investigating customer racial discrimination in the secondary baseball card market.

A growing body of literature in a variety of disciplines has appeared over the last 20 years examining customer racial bias in the secondary sports card market; however, consensus on the matter has yet to emerge. In this article, we explore the more subtle ways that a player's race/ethnicity may affect the value of his sports card including a player's skin tone (light- to dark-skinned). Data were obtained for 383 black, Latino, and white baseball players who had received at least one vote for induction into Major League Baseball's Hall of Fame including their career performance statistics, rookie card price, card availability, Hall of Fame status, and skin tone. Findings indicate that card availability is the primary determinant of card value while a player's skin tone has no direct effect. Subsequent analysis demonstrates that a player's race (white/non-white) rather than skin tone did have an effect as it interacts with Hall of Fame status to influence his rookie card price.

Does education matter? Major League Baseball players and longevity.

The authors used duration analysis to examine the longevity of Major League Baseball players. Using data on players who were born between 1945 and 1964, the authors found that the hazard rate of death for players who only attended high school was almost 2.0 times higher than those players who attended a 4-year university, evidence that the educaton [sic]-health link applies to professional athletes. Another important determinant of longevity was race. In addition, a player's body mass index was positively associated with a higher hazard of death. Compared with the general population, the death rate of baseball players was lower--the observed number of deaths in the dataset was only 31% of the expected number. Findings in this article are likely attributable to education being correlated with other variables that affect longevity, most likely intelligence and time preference.

Reliability, precision, accuracy, and validity of posterior shoulder tightness assessment in overhead athletes.

BACKGROUND: Posterior shoulder tightness with subsequent loss of humeral internal rotation range of motion has been linked to upper extremity lesions in overhead athletes. A valid clinical assessment is necessary to accurately identify posterior shoulder tightness as a contributor to injury. PURPOSE: To describe a modified supine assessment of posterior shoulder tightness by establishing the reliability, precision, clinical accuracy, and validity of the assessment. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Intrasession, intersession, and intertester reliability and precision were established by comparing the commonly used side-lying assessment of posterior shoulder tightness and the described modified supine assessment. Clinical accuracy of both methods was obtained using an electromagnetic tracking device to track humeral and scapular motion. Construct validity was established by identifying posterior shoulder tightness in a group of overhead athletes (baseball pitchers and tennis players) reported in the literature to have limited humeral internal rotation and posterior shoulder tightness. RESULTS: The side-lying intrasession intraclass correlation coeffecient (standard error of measurement), intersession intraclass correlation coeffecient (standard error of measurement), and intertester intraclass correlation coeffecient (standard error of measurement) were 0.83 cm (0.9), 0.42 cm (1.7), and 0.69 cm (1.4), respectively. The supine intrasession intraclass correlation coeffecient (standard error of measurement), intersession intraclass correlation coeffecient (standard error of measurement), and intertester intraclass correlation coeffecient (standard error of measurement) were 0.91 degrees (1.1 degrees ), 0.75 degrees (1.8 degrees ), and 0.94 degrees (1.8 degrees ), respectively. In side-lying, the clinical accuracy expected was 0.9 +/- 0.6 cm of error while, when measured supine, it was 3.5 degrees +/- 2.8 degrees of error. Both assessments resulted in minimal scapular protraction (approximately 3.5 degrees ). Between groups, baseball pitchers and tennis players had significantly less internal rotation range of motion (P < .0001) and greater posterior shoulder tightness (P = .004) when measured in supine, but not in side-lying (P = .312). CONCLUSION: Both methods resulted in good clinician accuracy and precision, suggesting that both can be performed accurately. The supine method can be assessed more reliably than side-lying between both sessions and testers. CLINICAL RELEVANCE: Clinicians may want to consider use of the supine method given the higher reliability, validity, and similar precision and clinical accuracy.

Assessment of softball bat safety performance using mid-compression polyurethane softballs.

There is currently much debate about the safety of the sport of softball. Batted-ball speed and average pitcher reaction time are factors often used to determine safe performance. Batted-ball speed is shown to be the most important factor to consider when determining safe play. Average pitcher reaction time is explained and directly correlated to batted-ball speed. Eleven aluminum multi-wall, three aluminum single-wall and two composite softball bats were tested with mid-compression polyurethane softballs averaging 1721+/-62 N/6.4 mm to represent the relative bat-ball performance for the sport of slowpitch softball. Nine men and six women were chosen for this study out of a test group of over three hundred slowpitch softball players. On average, aluminum bat performance results were within the recommended safety limits established by the national softball associations. However, when composite bats were used, their performance results exceeded the recommended safety limits which can pose a significant safety risk. Using aluminum softball bats, batted-ball speeds ranged from 80 to 145km x h(-1) Using composite softball bats, batted-ball speeds ranged from 146 to 161 km x h(-1). The scientific relevance of this study is to provide performance information that can lead to injury prevention in the sport of softball.

Assessment of shoulder proprioception in the female softball athlete.

BACKGROUND: There have been reports of overhand throwing athletes having decreased joint position sense in their dominant shoulder as compared with the nondominant shoulder. Very little research, however, exists concerning joint position sense in the female athlete. HYPOTHESIS: Female softball athletes have decreased joint position sense in their dominant shoulder as compared with their nondominant shoulder. STUDY DESIGN: Factorial design with investigation of multiple independent variables. METHODS: Joint position sense was assessed in 50 female softball players and 50 nonthrowing female athletes by using an inclinometer during four glenohumeral joint motions. Both the dominant and nondominant shoulders were assessed and error scores were calculated to describe joint position sense. Data were collected during the course of a fall semester and analyzed by using a mixed model analysis of variance with repeated measures on the dependent variable (error scores). RESULTS: A significant group by movement interaction was observed, with the softball athletes demonstrating significantly greater external rotation error scores than the nonthrowing athletes. CONCLUSION: We failed to reject the null hypothesis. Increased error scores (less joint position sense) were observed in both arms of subjects in the softball group. CLINICAL RELEVANCE: This study suggests that there is decreased shoulder proprioception in asymptomatic female athletes involved in overyhand throwing sports, which may predispose them to injury.

Accuracy of qualitative analysis for assessment of skilled baseball pitching technique.

Baseball pitching must be performed with correct technique if injuries are to be avoided and performance maximized. High-speed video analysis is accepted as the most accurate and objective method for evaluation of baseball pitching mechanics. The aim of this research was to develop an equivalent qualitative analysis method for use with standard video equipment. A qualitative analysis protocol (QAP) was developed for 24 kinematic variables identified as important to pitching performance. Twenty male baseball pitchers were videotaped using 60 Hz camcorders, and their technique evaluated using the QAP, by two independent raters. Each pitcher was also assessed using a 6-camera 200 Hz Motion Analysis system (MAS). Four QAP variables (22%) showed significant similarity with MAS results. Inter-rater reliability showed agreement on 33% of QAP variables. It was concluded that a complete and accurate profile of an athlete's pitching mechanics cannot be made using the QAP in its current form, but it is possible such simple forms of biomechanical analysis could yield accurate results before 3-D methods become obligatory.

The later evolution of modern sport in Latin America: the North American influence.

American impact on modern sports in Latin America overlaps geographically and chronologically with the European, especially British, impact. Principally baseball in the Caribbean basin, more recently basketball and volleyball across the hemisphere and occasionally American football in more limited areas illustrate a north-to-south movement executed by businessmen, educators, missionaries, military personnel, returning travelers (often students), sports entrepreneurs and television. Often initially supported by promoters of development within Latin America, this transfer has altered local recreational patterns and attracted Latin athletes to pursue careers in North America, provoking accusations of cultural imperialism and exploitation.

Quantification of anterior translation of the humeral head in the throwing shoulder. Manual assessment versus stress radiography.

Clinical evaluation of humeral head translation relies mainly on manual tests to measure laxity in the human shoulder. The purposes of this study were to determine whether side-to-side differences exist in anterior humeral head translation in professional baseball pitchers, to compare manual laxity testing with stress radiography for quantifying humeral head translation, and to test intrarater reliability of the manual humeral head translation and stress radiography tests. Twenty professional baseball pitchers underwent bilateral manual anterior humeral head translation and stress radiographic tests. Stress radiography was performed by imparting a 15-daN anterior load to the shoulder in 90 degrees of abduction with both neutral and 60 degrees of external rotation and recording the glenohumeral joint translation at rest and under stress in each position. Eight subjects were retested to assess the reliability of these methods. Results showed no significant difference between the dominant and nondominant extremity in the amount of anterior humeral head translation measured manually and with stress radiography, nor significant correlation between anterior humeral head translation measured manually and by stress radiography. Test-retest reliability was moderate-to-poor for the manual humeral head translation test and moderate for stress radiography.