Preseason shoulder strength measurements in professional baseball pitchers: identifying players at risk for injury.

BACKGROUND: The ability to identify pitchers at risk for injury could be valuable to a professional baseball organization. To our knowledge, there have been no prior studies examining the predictive value of preseason strength measurements. HYPOTHESIS: Preseason weakness of shoulder external rotators is associated with increased risk of in-season throwing-related injury in professional baseball pitchers. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: Preseason shoulder strength was measured for all pitchers in a professional baseball organization over a 5-year period (2001-2005). Prone internal rotation (IR), prone external rotation (PER), seated external rotation (SER), and supraspinatus (SS) strength were tested during spring training before each season. The players were then prospectively followed throughout the season for incidence of throwing-related injury. Injuries were categorized on an ordinal scale, with no injury, injury treated conservatively, and injury resulting in surgery delineated 0, 1, and 2, respectively. Subset analyses of shoulder injuries and of players with prior surgery were also performed. The association between strength measurements and injury was analyzed using Spearman rank correlation. RESULTS: A statistically significant association was observed for PER strength (P = .003), SER strength (P = .048), and SS strength (P = .006) with throwing-related injury requiring surgical intervention. Supraspinatus strength was also significantly associated with incidence of any shoulder injury (P = .031). There was an association between the ratio of PER/IR strength and incidence of shoulder injury (P = .037) and some evidence for an association with overall incidence of throwing-related injury (P = .051). No associations were noted in the subgroup of players with prior surgery. CONCLUSION: Preseason weakness of external rotation and SS strength is associated with in-season throwing-related injury resulting in surgical intervention in professional baseball pitchers. Thus, preseason strength data may help identify players at risk for injury and formulate strengthening plans for prevention.

Arthroscopic distal clavicle resection in athletes: a prospective comparison of the direct and indirect approach.

BACKGROUND: The clinical success of arthroscopic distal clavicle resection for athletes has been well documented. There are, however, no published studies that prospectively compare the recovery rates in athletes as well as the outcomes of the indirect versus direct approaches. HYPOTHESIS: Both procedures are equally successful; however, the direct approach affords faster return to sports. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 2. METHODS: Thirty-eight consecutive athletes with osteolysis of the distal clavicle or isolated posttraumatic arthrosis of the acromioclavicular joint without instability underwent arthroscopic distal clavicle resection. The patients were randomized into 2 groups: a direct superior approach and an indirect subacromial approach. American Shoulder and Elbow Surgeons and Athletic Shoulder Scoring System scores were measurable outcomes. RESULTS: Thirty-four athletes were available for a minimum 2-year follow-up. The 2 groups were similar, including preoperative American Shoulder and Elbow Surgeons and Athletic Shoulder Scoring System scores. Both groups demonstrated significant improvement in both scores at final follow-up when compared with preoperative scores (P < .001). The direct group demonstrated higher American Shoulder and Elbow Surgeons (82 vs 64) and Athletic Shoulder Scoring System (74 vs 56) scores at week 2 (P < .001) and week 6 (American Shoulder and Elbow Surgeons, 88 vs 77; Athletic Shoulder Scoring System, 87 vs 73) (P < .001). At final follow-up, both groups demonstrated excellent clinical outcomes, even though there was a statistical difference in scores, with the direct group scoring better (American Shoulder and Elbow Surgeons, 95.7 vs 91.2; Athletic Shoulder Scoring System -94.9 vs 88.3). The direct group demonstrated faster return to sports (mean, 21 days) than the indirect group (mean, 42 days) (P < .001). Radiographic analysis demonstrated an equivalent resection. One patient in each group had a clinically insignificant increase in coracoclavicular distance. CONCLUSIONS: Both the direct superior approach and the indirect subacromial approach to the arthroscopic distal clavicle resection result in successful clinical outcome with clinically insignificant difference at final follow-up. Athletes treated with the direct superior approach improved faster clinically and returned to sports earlier.