Comparison of Windup and Stretch Pitching Biomechanics in Baseball With Implications for Safety and Performance.

BACKGROUND: Historically, it was assumed by some that high leg lift with windup pitching generated more ball velocity whereas pitching from the stretch was quicker to reduce the risk of base stealing but also more stressful on the arm. However, many now believe that velocity and stress do not differ between windup and stretch and always pitching from the stretch is simpler than mastering 2 techniques. PURPOSE/HYPOTHESIS: The purpose of this study was to compare windup and stretch fastball pitching biomechanics. It was hypothesized that there would be statistically significant and clinically important differences in ball velocity, timing of angular velocities, joint kinetics, and pitching kinematics. STUDY DESIGN: Controlled laboratory study. METHODS: Fastball pitching biomechanics previously captured for 221 healthy baseball pitchers (105 professional, 52 collegiate, and 64 high school level) were analyzed. For each pitcher, data for 3 to 10 windup trials and 3 to 10 stretch trials were available. Ball velocity was recorded using a radar gun. A 12-camera, 240-Hz automated motion capture system was used to track 39 reflective markers attached to the pitcher. A total of 24 kinematic parameters, 4 temporal parameters, and 5 kinetic parameters were calculated. Data for each parameter were compared across the 2 techniques and 3 competition levels using 2-way repeated-measures analysis of variance (P < .01). Based on previous studies and the expertise of the investigators, the minimal clinically important difference (MCID) was set as 2° for angle measurements, 20 deg/s for angular velocities, 0.5 m/s for fastball velocity, and 0.3% body height × weight for normalized joint torque. RESULTS: Fastball velocity was statistically greater from the windup than stretch for the collegiate subgroup but not for the other 2 levels. The collegiate level difference was below the MCID. Pitching from the windup generated greater front knee height and required more time from initiation of leg lift to front foot contact. From foot contact to ball release, there were 11 additional small, statistically significant differences between windup and stretch; however, each of these was well below the MCID. CONCLUSION: Pitching from the stretch was quicker and should be used with runners on base to prevent stealing. Pitching from the windup and stretch produced similar ball velocity, joint kinetics, and kinematics. Thus, pitchers may choose to use both techniques or stretch only based on comfort and personal preference. CLINICAL RELEVANCE: The decision to pitch from both the windup and stretch or only from the stretch should not affect a pitcher's performance or joint stress (and injury risk).

Comparison of glenohumeral and scapulothoracic kinematics between fastballs and curveballs during baseball pitching.

Shoulder injuries are common in baseball pitchers and primarily involve the glenohumeral joint. Past analyses have examined shoulder biomechanics during different pitch types simply as the motion of the upper arm relative to the thorax. In this study, glenohumeral and scapulothoracic kinematics were compared between fastballs and curveballs at key timepoints throughout a pitch. Upper extremity kinematics of thirteen collegiate pitchers were collected during fastball and curveball pitches with motion capture. A linear model approach was utilised to estimate scapular kinematics based on measurable humerothoracic motion. Glenohumeral kinematics were computed from the scapular and humeral motion data. Comparisons of scapulothoracic and glenohumeral kinematic variables at times of maximum glenohumeral external rotation, ball release, and maximum glenohumeral internal rotation between pitch types were made using paired t-tests with Benjamini-Hochberg corrections. There were no significant differences in glenohumeral kinematics. Fastballs elicited significantly less scapulothoracic internal rotation and more posterior tilt at maximum glenohumeral external rotation. Fastballs produced significantly less scapulothoracic internal rotation and anterior tilt at maximum glenohumeral internal rotation. This study provides further evidence that risk of injury to the glenohumeral joint may be consistent between fastballs and curveballs and offers insights into subtle differences in scapular kinematics between pitch types.

An Interval Throwing Program for Baseball Pitchers Based upon Workload Data.

Background: Interval throwing programs (ITP) have been used for decades to enable baseball pitchers to return to competition after injury or surgery by gradually applying load to the throwing arm. Past programs have been based on personal experience; however, advances in our understanding of the biomechanics and workloads of throwing allow for a more modern data-based program to be developed. Hypothesis/Purpose: To 1) develop a updated ITP for rehabilitation of modern baseball pitchers based upon biomechanical and throwing workload data, and 2) compare the updated program with a past program to determine differences in chronic workload and acute:chronic workload ratios (ACWR). Study Design: Cross-sectional study. Methods: Workloads (i.e. daily, acute, chronic, and ACWR) for the original ITP were built from the prescribed throwing schedule. Elbow varus torque per throw was calculated based upon a relationship between elbow varus torque and throwing distance. Throw counts, daily/chronic/acute workloads, and ACWR were calculated and plotted over time. A new ITP was built to model current pitcher's throwing schedules and gradually increased ACWR over time. Results: The original ITP had a throwing schedule of 136 days, final chronic workload 15.0, and the ACWR above or below the "safe" range (i.e. 0.7 - 1.3) for 18% of the program with a peak of 1.61. The updated ITP was built to consist of a 217-day schedule, final chronic workload of 10.8, and deviated from the safe range for 9% of the program, with a peak of 1.33. Conclusion: The newly created ITP is more familiar to modern baseball pitchers while exhibiting a more gradual buildup of chronic workload than traditional ITP programs. This ITP may be used to return baseball pitchers back to competition as safely and efficiently as possible, and potentially with less risk of setbacks or reinjury. The ITP may be used following common injuries or surgeries to the throwing shoulder and elbow, such as Tommy John surgery, while also serving as a basis for future development of shorter duration ITPs. Level of Evidence: 2c.

Workload Comparison of Contemporary Interval Throwing Programs and a Novel Optimized Program for Baseball Pitchers.

Background: In the rehabilitation of injured baseball pitchers, there is lack of consensus on how to guide a player back to pitching. It is unknown how different contemporary interval throwing programs (ITPs) progress in the amount of throwing workload. Purposes: To 1) evaluate three prominent ITPs commonly employed in baseball pitcher rehabilitation and assess whether these ITPs produce training loads that increase in a controlled, graduated manner and 2) devise an ITP that produced training loads which increased steadily over time. Study Design: Cross-sectional study. Methods: Three publicly available ITPs from prominent sports medicine institutions were analyzed. Elbow varus torque per throw was calculated from a 2nd order polynomial regression based upon a relationship between recorded torque measurements and throwing distance measured from a database of 111,196 throws. The relative rate of workload increase was measured as an acute:chronic workload ratio (ACWR). For each ITP, throw counts, daily/acute/chronic workloads, and ACWR were calculated and plotted over time. Finally, an original ITP was devised based upon a computational model that gradually increases ACWR over time and finished with an optimal chronic workload. Results: Each ITP exhibited a unique progression of throwing distances, quantities, and days to create different workload profiles. The three ITPs had throwing schedules ranging from 136 days to 187 days, ACWR spiked above or fell below a literature-defined "safe" range (i.e. 0.7 - 1.3) 19, 21, and 23 times. A novel ITP, predicated on a 146-day schedule and with a final chronic workload of 14.2, was designed to have no spikes outside of the safe range. Conclusion: Existing ITPs widely utilized for rehabilitation of baseball pitchers exhibit significantly inconsistent variation in the rate of throwing load progression. Computational modeling may facilitate more incremental workload progression in ITPs, thereby reducing injury during rehabilitation and more efficiently condition a pitcher for return to competition. Level of Evidence: 3b.

Treatment of Chronic Extensor Carpi Ulnaris Stenosing Tenosynovitis Using Ultrasound-Guided Retinaculum Release: A Case Report.

CASE: A 65-year-old man with chronic extensor carpi ulnaris (ECU) stenosing tenosynovitis who had failed treatments for 3 years was successfully treated with an ultrasound-guided retinaculum release of the sixth dorsal compartment. CONCLUSION: There are limited options in the literature for treating chronic, recalcitrant ECU tenosynovitis. We describe a novel technique in which the retinaculum overlying the ECU tendon was successfully incised under ultrasound guidance to release the sixth dorsal compartment stenosis. There was no recurrence of symptoms in the following 2 years of follow-up.

Ulnar Collateral Ligament Repair With Suture Tape Augmentation: Can You Overtighten?

BACKGROUND: There has been a renewed interest and, recently, wider implementation of ulnar collateral ligament (UCL) repair in throwing athletes because of improvement in ligament repair technology and corresponding outcome data. PURPOSE: To compare the biomechanical parameters and failure mode between 2 brace-tightening techniques for UCL repair. STUDY DESIGN: Controlled laboratory study. METHODS: Eleven matched pairs of cadaveric arms were procured. One limb from each pair underwent UCL repair with suture tape augmentation with either (1) attempted restoration of physiologic ligament tension or (2) maximal tension. Each specimen was subjected to 10 cycles of subfailure valgus torque at 90º of flexion in the intact state after UCL avulsion and then after UCL repair. Specimens were then torqued to failure. Articular contact mechanics, linear gap distance, angular displacement, failure torque, failure stiffness, and suture tape pull-through length were recorded. Two-way analysis of variance and paired t tests were used to test for statistical differences. RESULTS: There was a significant effect (P = .01) of tightening on joint contact area. There was a significant decrease in gap distance (P = .03) and angular displacement (P = .004) from the torn condition to the repaired condition for the maximum tension group, without a significant difference in gap distance from the intact condition. Failure torque and stiffness were not significantly different between groups, although there was a significant difference (P = .001) in the overall suture tape pull-through length. CONCLUSION: Although there are potential physiologic changes at time zero-including significant decreases in contact area, normalized gap distance, and normalized angular displacement with maximal tension repair-examination of failure biomechanics suggests that these effects may be mitigated over time within the construct by suture tape pull-through at the tape-anchor interface. Neither method of UCL repair with suture tape augmentation resulted in overconstraint of the elbow joint compared with the native ligament biomechanics. CLINICAL RELEVANCE: As more long-term outcome data from UCL repair with suture tape augmentation emerge, there will be wider implementation with various techniques to tension the suture tape. Examining the potential biomechanical sequelae of the UCL repair construct applied under maximal tension will help further refine recommendations for surgeons who utilize this technique for UCL repair.

Biomechanical Basis of Interval Throwing Programs for Baseball Pitchers: A Systematic Review.

Background: Interval throwing programs are used in rehabilitation of throwing injuries, especially ulnar collateral ligament injuries. Athletes who are rehabilitating begin by throwing on flat ground progressing through increasing distances, number of throws, and intensity of throwing. If the athlete is a baseball pitcher, the flat-ground throwing phase is followed by pitching on a mound at progressively increased effort. The goal is to build back arm strength and capacity with an emphasis on proper mechanics. Purpose: To determine whether interval throwing progressively builds joint kinetics (specifically, elbow varus torque) to the level required during full-effort baseball pitching. A secondary purpose was to examine the kinematics produced during interval throwing compared to those seen during baseball pitching. Study Design: Systematic Review. Methods: Following PRISMA guidelines, PubMed, Embase, Web of Science, SPORTDiscus, and Google Scholar were systematically searched for biomechanical studies of flat-ground throwing and partial-effort pitching in baseball between 1987 and 2023. Studies that reported the biomechanics of either flat-ground throwing, or partial-effort pitching were included in this review. The AXIS tool was used to assess study quality. Results: Thirteen articles met the inclusion criteria. Ten studies were determined to be of moderate quality, while three studies were deemed high quality. Elbow varus torque during partial-effort pitching was less than during full-effort pitching. Elbow varus torque for most flat-ground throws did not exceed full-effort pitching torque. While most studies showed increased elbow varus torque with increased flat-ground throwing distance, the distance at which elbow varus torque matched or exceeded full-effort pitching elbow varus torque was not consistent.As flat-ground throwing distance increased, shoulder external rotation angle and shoulder internal rotation velocity increased. Arm slot (forearm angle above horizontal) decreased as flat-ground throwing distance increased. For varied effort pitching, shoulder external rotation angle, shoulder internal rotation velocity, elbow extension velocity, and ball velocity increased as effort increased. While the front knee extended slightly from foot contact to ball release in full-effort pitching, the front knee flexed slightly during partial-effort pitching. Conclusions: An interval throwing program progressively builds elbow varus torque up to levels produced in full-effort baseball pitching. While differences exist between interval throwing kinematics and pitching kinematics, the patterns are similar in general. Level of Evidence: 2.

Comparison of a single-view image-based system to a multi-camera marker-based system for human static pose estimation.

The purpose of this study was to compare human static pose estimation data measured with a single-view image-based system and a multi-camera marker-based system. Thirty participants (20 male/10 female, mean ± standard deviation 29.1 ± 10.0 years old, 1.75 ± 0.10 m tall, 79.1 ± 18.0 kg) performed six repetitions each of static holds of arm-raises and squats, in a different orientation for each repetition. These trials were captured simultaneously with a 120-Hz 12-camera marker-based system and a variable-frequency single-view image-based system. Data for each trial were time-synchronized between the two systems using a near-infrared LED-light that was visible to both systems. Discrete measurements of bilateral shoulder angles during arm-raises and bilateral knee angles during squats were compared between the systems using Bland-Altman plots and descriptive statistics. Pearson correlation coefficients were calculated, comparing the participant trial mean values across systems. Finally, a two-way ANOVA was used to examine whether participant orientation in the capture volume significantly affected either system. Biases for discrete measurements ranged in magnitude from 1.3 to 1.9°, and standard deviations of the differences between systems ranged from 2.4 to 4.7°. Pearson correlation coefficients were all above 0.97, and the ANOVA was unable to find a statistically significant orientation effect for either system. Thus, the marker-based and image-based systems produced similar measurements of static shoulder and knee angles. Future work should examine more complex measurements using volumetric scan-based models and also investigate the ability of single-view image-based systems to measure dynamic movements.

Outcomes of Double-Row Rotator Cuff Repair Using a Novel All-Suture Soft Anchor Medial Row.

Background: Few studies have examined the short-term clinical outcomes of rotator cuff repair (RCR) with all-suture anchors for medial row anchor fixation. Purpose: To evaluate clinical outcomes of double-row suture bridge RCR using a novel all-suture medial row anchor. Study Design: Case series; Level of evidence, 4. Methods: We enrolled 179 patients before double-row suture bridge RCR (mean age at surgery, 60.0 years; 63% male patients) at a single institution. All patients underwent RCR with all-suture anchor fixation for the medial row and solid anchor fixation for the lateral row. Preoperative (baseline) and follow-up (minimum follow-up time of 2 years; mean, 2.5 years) clinical outcomes were compared using the American Shoulder and Elbow Surgeons (ASES) score and a 10-point numeric pain rating scale (NPRS). We calculated the proportions of patients meeting previously published Patient Acceptable Symptom State (PASS) thresholds for the ASES (≥78.0) and NPRS (≤1.7). We further compared baseline and follow-up outcome scores and the proportions of patients meeting PASS thresholds using paired t tests and McNemar tests, respectively, and calculated effect size to quantify the magnitude of change from baseline to follow-up. Results: Values significantly improved from baseline to follow-up for ASES (from 45.3 ± 19.8 to 87.3 ± 17.1) and NPRS (from 5.2 ± 2.5 to 1.4 ± 2.1). The proportion of patients meeting PASS thresholds also significantly improved for the ASES (from 6% to 77%) and the NPRS (from 7% to 72%). The magnitude of baseline to follow-up change for all measures was large (all effect sizes ≥1.5). Conclusion: Our study demonstrated excellent short-term clinical outcomes and substantial improvements for patients undergoing double-row suture bridge RCR with all-suture anchors for medial row fixation.

Primary Deltoid Repair for Ankle Fracture Using All-Suture Anchors.

Primary repair of the deltoid ligament is a common surgical option for unstable ankle fracture. However, controversy exists regarding whether such repair is necessary or provides any benefit to patient outcomes. A retrospective study was performed following acute deltoid repairs using all-suture bone anchors. Patients at 2 surgical centers were included when they were over 18 years old at surgery, had a medial clear space (MCS) greater than 4 mm preoperatively, and had at least 6 months of follow-up. Subjective outcomes were measured with PROMIS, FAAM, and numeric rating scale. Preoperative and follow-up scores were compared with t tests (p < .05). For the 47 patients identified, age at time of surgery was 30.6 ± 14.9 years (range 15.4-65.0 years). Follow-up data were captured for 36 (73%) of the patients at 75 ± 37 weeks (range 18-169 weeks) after surgery. Mean time to weightbearing was 4 ± 1 weeks (range 1-7 weeks). Patients returned to sport 14 ± 5 weeks after surgery (range 8-41 weeks). Various complications consisted of wound infection, superficial dehiscence, and complex regional pain syndrome (CRPS). The PROMIS, FAAM, and NRS patient outcome scores improved significantly from preoperative to postoperative follow-up. Significant reduction in the radiographic MCS postoperatively occurred in all patients. These findings suggest primary deltoid repair when associated with ankle fracture to be a safe procedure and has the potential of allowing early weightbearing and return to sports.

Patellofemoral Joint Loading during the Performance of the Wall Squat and Ball Squat with Heel-to-Wall-Distance Variations.

INTRODUCTION: Although bodyweight wall and ball squats are commonly used during patellofemoral rehabilitation, patellofemoral loading while performing these exercises is unknown, which makes it difficult for clinicians to know how to use these exercises in progressing a patient with patellofemoral pathology. Therefore, the purpose was to quantify patellofemoral force and stress between two bodyweight squat variations (ball squat vs wall squat) and between two heel-to-wall-distance (HTWD) variations (long HTWD vs short HTWD). METHODS: Sixteen participants performed a dynamic ball squat and wall squat with long HTWD and short HTWD. Ground reaction force and kinematic data were used to measure resultant knee force and torque from inverse dynamics, whereas electromyographic data were used in a knee muscle model to predict resultant knee force and torque, and subsequently, all these data were inputted into a biomechanical computer optimization model to output patellofemoral joint force and stress at select knee angles. A repeated-measures two- and three-way ANOVA ( P < 0.01) was used for statistical analyses. RESULTS: Collapsed across long HTWD and short HTWD, patellofemoral joint force and stress were greater in ball squat than wall squat at 30° ( P = 0.009), 40° ( P = 0.008), 90° ( P = 0.003), and 100° ( P = 0.005) knee angles during the squat descent, and greater in wall squat than ball squat at 100° ( P < 0.001), 90° ( P < 0.001), 80° ( P = 0.004), and 70° ( P = 0.009) knee angles during squat ascent. Collapsed across ball and wall squats, patellofemoral joint force and stress were greater with a short HTWD than a long HTWD at 100° ( P = 0.007) and 90° ( P = 0.008) knee angles during squat ascent. CONCLUSIONS: Patellofemoral joint loading changed according to both squat type and HTWD variations. These differences occurred in part due to differences in forces the wall or ball exerted on the trunk, including friction forces. Overall, patellofemoral force and stress were greater performing the bodyweight wall squat compared with the bodyweight ball squat. Moreover, squatting with short HTWD produced anterior knee displacement beyond the toes at higher knee angles, resulting in greater patellofemoral force and stress compared with squatting with long HTWD.

Clinical outcomes of osteochondritis dissecans lesions of the capitellum treated with arthroscopy with a mean follow-up period of 8.3 years.

BACKGROUND AND HYPOTHESIS: Although numerous studies exist evaluating the short-term clinical outcomes of patients who have undergone elbow arthroscopy for osteochondritis dissecans (OCD) of the capitellum, the literature on minimum 2-year clinical outcomes in a large cohort of patients is limited. We hypothesized that the clinical outcomes of patients treated arthroscopically for OCD of the capitellum would be favorable, with improved postoperative subjective functional and pain scores and with an acceptable return-to-play rate. METHODS: A retrospective analysis of a prospectively collected surgical database was performed to identify all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. The inclusion criteria for this study included a diagnosis of OCD of the capitellum treated arthroscopically with a minimum 2-year follow-up period. The exclusion criteria included any prior surgical treatment on the ipsilateral elbow, missing operative reports, and cases in which any portion of the surgical procedure was performed in an open manner. Follow-up was performed by telephone using multiple patient-reported outcome questionnaires: American Shoulder and Elbow Surgeons-Elbow (ASES-e), Andrews-Carson, and Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC) questionnaires and our institution-specific return-to-play questionnaire. RESULTS: After the inclusion and exclusion criteria were applied to our surgical database, 107 eligible patients were identified. Of these, 90 were successfully contacted, for a follow-up rate of 84%. The mean age was 15.2 years, and the mean follow-up time was 8.3 years. A subsequent revision procedure was performed in 11 patients, for a 12% failure rate in these patients. The ASES-e pain score was an average of 4.0 on a maximum pain scale of 100, the ASES-e function score was an average of 34.5 of a maximum of 36, and the surgical satisfaction score was an average of 9.1 of 10. The average Andrews-Carson score was 87.1 of 100, and the average KJOC score for overhead athletes was 83.5 of 100. Additionally, of the 87 patients evaluated who played sports at the time of their arthroscopy, 81 (93%) returned to play. CONCLUSION: This study demonstrated an excellent return-to-play rate and satisfactory subjective questionnaire scores with a 12% failure rate following arthroscopy for OCD of the capitellum with a minimum 2-year follow-up period.

Active range of motion of the shoulder: a cross-sectional study of 6635 subjects.

Background: Normative data for passive range of motion are well established, but daily living is comprised of active motion. The purpose of this study was to establish normative values for active range of motion of the shoulder across age, sex, and arm. Our hypotheses were that active range of motion of the shoulder (1) decreases with age group, (2) differs between males and females, and (3) differs between the right arm and left arm. Methods: Shoulder active range of motion was captured with an eight-camera markerless motion capture system. Data were collected for a heterogenous sample of 6635 males and females of all ages. For each subject, 6 shoulder motions were collected with maximum values measured: external rotation, internal rotation, flexion, extension, abduction, and horizontal abduction. Three-way repeated measures analyses were performed, with 2 between-subject factors (age group and sex) and 1 within-subject factor (arm). The unadjusted threshold for statistical significance was α = 0.05. Results: External rotation decreased with age (approximately 10° decrease from below 30 years to above 60 years). External rotation was approximately 5° greater in the right arm, whereas internal rotation was approximately 5° greater in the left arm. Flexion decreased with age (approximately 15° decrease from below 20 years to above 60 years). For age groups from 10 to 59 years, extension and horizontal abduction were approximately 5° to 10° greater in females than males. Abduction was greater for females than males. Abduction was also greater in younger people (aged 10-29 years) than older people. Conclusion: In general, active range of motion of the shoulder decreases with age. Sex (male/female) and arm side (right/left) also influence shoulder range of motion.

Effects of Contralateral Trunk Tilt on Shoulder and Elbow Injury Risk and Pitching Biomechanics in Professional Baseball Pitchers.

BACKGROUND: Baseball pitchers employ various contralateral trunk tilt (CTT) positions when pitching depending on if they have an overhand, three-quarter, or sidearm delivery. There are no known studies that have examined how pitching biomechanics are significantly different in professional pitchers with varying amounts of CTT, which may provide insight into shoulder and elbow injury risk among pitchers with different CTT. PURPOSE: To assess differences in shoulder and elbow forces and torques and baseball pitching biomechanics in professional pitchers with maximum 30° to 40° CTT (MaxCTT), moderate 15° to 25° CTT (ModCTT), and minimum 0° to 10° CTT (MinCTT). STUDY DESIGN: Controlled laboratory study. METHODS: In total, 215 pitchers were examined, including 46 pitchers with MaxCTT, 126 pitchers with ModCTT, and 43 pitchers with MinCTT. All pitchers were tested using a 240-Hz, 10-camera motion analysis system, and 37 kinematic and kinetic parameters were calculated. Differences in kinematic and kinetic variables among the 3 CTT groups were assessed with a 1-way analysis of variance (P < .01). RESULTS: Maximum shoulder anterior force and maximum elbow proximal force were significantly greater in ModCTT (403 ± 79 N) than MaxCTT (369 ± 75 N) and MinCTT (364 ± 70 N), while maximum elbow flexion torque and shoulder proximal force, respectively, were significantly greater in ModCTT (69 ± 11 N·m and 1176 ± 152 N, respectively) than MaxCTT (62 ± 12 N·m and 1085 ± 119 N, respectively). During arm cocking, maximum pelvis angular velocity was greater in MinCTT than MaxCTT and ModCTT, and maximum upper trunk angular velocity was greater in MaxCTT and ModCTT than MinCTT. At ball release, trunk forward tilt was greater in MaxCTT and ModCTT than MinCTT and greater in MaxCTT than ModCTT, while arm slot angle was less in MaxCTT and ModCTT than MinCTT and less in MaxCTT than ModCTT. CONCLUSION: The greatest shoulder and elbow peak forces occurred in ModCTT, which occurs in pitchers who throw with a three-quarter arm slot. More research is needed to assess if pitchers with ModCTT are at a higher risk of shoulder and elbow injury compared with pitchers with MaxCTT (overhand arm slot) and MinCTT (sidearm arm slot), although in the pitching literature, excessive elbow and shoulder forces and torques have been shown to correlate with elbow and shoulder injuries. CLINICAL RELEVANCE: The results from the current study will help clinicians better understand if differences in kinematic and kinetic measures differ with pitching, or if differences in force, torque, and arm position occur at different arm slots.

Clinical outcomes and return to play in softball players following SLAP repair or biceps tenodesis.

BACKGROUND: Shoulder pain due to labral tears and biceps tendonitis is commonly found in softball players. Surgical options include labral repair and biceps tenodesis. Although past studies are limited by heterogeneous study groups from multiple sports, this is the first study that assesses clinical outcomes and return to play rates for fast-pitch softball players. PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate the clinical outcomes and return to play for fast-pitch softball players treated for a superior labrum anterior posterior (SLAP) tear and recalcitrant biceps tendonitis with a biceps tenodesis compared with a traditional SLAP repair. We hypothesized that the biceps tenodesis would have comparable outcomes with a faster return to play compared with SLAP repair. METHODS: We performed a retrospective analysis on fast-pitch softball players treated surgically for SLAP tear, recalcitrant biceps tendonitis, or a combination between 2001 and 2019 at our institution. Inclusion criteria were fast-pitch softball players who underwent biceps tenodesis or a SLAP repair with greater than 2-year follow-up. Exclusion criteria involved slow-pitch softball players, patients with less than 2-year follow-up, and patients who had undergone concomitant procedures on the ipsilateral shoulder at the time of SLAP repair or biceps tenodesis. Follow-up was either self-reported through OBERD, a patient-reported outcomes (PRO)-managing software, or achieved over the phone. Follow-up data included American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Andrews Carson Score, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score, Numeric Rating Scale for Pain, and our institution-specific return-to-play questionnaire. We statistically compared players who underwent biceps tenodesis or a SLAP repair, and compared pitchers with position players using Student t tests and Fisher exact test with statistical significance determined to be P < .05. RESULTS: From 60 eligible patients identified, follow-up outcome data were successfully captured for 47 (78%). Of the 18 SLAP repair patients, 17 (94%) returned to full competition at an average of 7.9 months. Of the 29 patients who underwent biceps tenodesis, 27 (93%) returned to full competition at an average of 7.1 months. Statistical analysis of PRO scores for each group found no significant differences between any of the measures used to evaluate patient outcomes, including no statistical difference in pitchers compared with position players. CONCLUSION: In conclusion, this study demonstrated comparable outcomes between SLAP repairs and biceps tenodesis procedures among our study group of fast-pitch softball players. There was no significant difference between RTP times between the 2 groups.

A Retrospective Case Series Study on a Minimally Invasive Ultrasound-Guided First Dorsal Compartment Release Technique for Refractory De Quervain Tenosynovitis.

OBJECTIVE: The aim of this study was to evaluate the outcomes of patients treated with a novel minimally invasive complete release of the first dorsal compartment percutaneously under ultrasound guidance using an 18-gauge needle with an 18 blade at the tip. DESIGN: This was a retrospective case series. Nine adults (ten wrists) were included in the study of this technique. All patients had failed conservative care and had tenderness to palpation over the first dorsal compartment, a positive Finklestein test, and confirmed tenosynovitis with ultrasound imaging before the procedure. The main outcome measures were reduction in pain as determined by the numeric rating scale and improvement of function determined by the Nirschl Phase scale at both short- and long-term follow-up. RESULTS: There was 100% follow-up, with mean (SD) follow-up occurring at 23.1 (9.8) mos (range, 9-42 mos). From preprocedure to follow-up, numeric rating scale pain decreased from 4.1 (SD, 2.5) to 0.0 (SD, 0.0) ( P < 0.001), and Nirschl phase improved from 2.5 (SD, 1.9) to 0.2 (SD, 0.4) ( P = 0.03). No patients required revision open-release surgery or suffered neurovascular complications. CONCLUSION: This technique resulted in significant improvement of pain and function for all patients and no short- or long-term neurovascular complications were seen.

The Clinician's Guide to Baseball Pitching Biomechanics.

CONTEXT: Improper baseball pitching biomechanics are associated with increased stresses on the throwing elbow and shoulder as well as an increased risk of injury. EVIDENCE ACQUISITION: Previous studies quantifying pitching kinematics and kinetics were reviewed. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 5. RESULTS: At the instant of lead foot contact, the elbow should be flexed approximately 90° with the shoulder at about 90° abduction, 20° horizontal abduction, and 45° external rotation. The stride length should be about 85% of the pitcher's height with the lead foot in a slightly closed position. The pelvis should be rotated slightly open toward home plate with the upper torso in line with the pitching direction. Improper shoulder external rotation at foot contact is associated with increased elbow and shoulder torques and forces and may be corrected by changing the stride length and/or arm path. From foot contact to maximum shoulder external rotation to ball release, the pitcher should demonstrate a kinematic chain of lead knee extension, pelvis rotation, upper trunk rotation, elbow extension, and shoulder internal rotation. The lead knee should be flexed about 45° at foot contact and 30° at ball release. Corrective strategies for insufficient knee extension may involve technical issues (stride length, lead foot position, lead foot orientation) and/or strength and conditioning of the lower body. Improper pelvis and upper trunk rotation often indicate the need for core strength and flexibility. Maximum shoulder external rotation should be about 170°. Insufficient external rotation leads to low shoulder internal rotation velocity and low ball velocity. Deviation from 90° abduction decreases the ability to achieve maximum external rotation, increases elbow torque, and decreases the dynamic stability in the glenohumeral joint. CONCLUSION: Improved pitching biomechanics can increase performance and reduce risk of injury. SORT: Level C.

Training Background and Characteristics of NFL, MLB, and NBA Team Physicians.

Background: An analysis of the demographics and training of head team physicians (HTPs) in professional sports would be valuable for evaluating training programs and as a resource for aspirant HTPs. Purpose: To outline common characteristics among professional sport HTPs. Study Design: Cross-sectional study. Methods: In June 2021, publicly available directories and news articles were used to identify the head orthopaedic HTPs and primary care HTPs for every team in Major League Baseball (MLB), the National Basketball Association (NBA), and the National Football League (NFL). Data regarding HTP characteristics were collected via internet-based sources. Age, sex, years from fellowship completion to current team role, and years in current team role were compared across sports with chi-square analyses and analyses of variance; comparisons between orthopaedic and primary care HTPs were performed with Fisher exact tests and Student t tests. The most frequently attended residency and fellowship training programs were also calculated. The productivity of fellowship programs was calculated as the number of current HTPs from that institution divided by the number of fellowship positions currently offered. Results: We identified 181 HTPs: 171 (94%) men and 10 (6%) women. The mean age was 55.4 years (range, 33-79 years); the mean time from fellowship training completion to first year in current team role was 9.8 years (range, 0-29 years); and the mean time spent in current team role was 14.1 years (range, 0-39 years). There were 94 orthopaedic HTPs and 87 primary care HTPs. The rate of fellowship training was significantly higher in orthopaedic HTPs (95%) than in primary care HTPs (67%; P < .001). The fellowship programs that produced the largest number of current HTPs were the Hospital for Special Surgery (n = 16; productivity = 2.3), the American Sports Medicine Institute (11; 1.8), and the Kerlan-Jobe Orthopaedic Clinic (11; 1.2). The years from fellowship to HTP varied significantly by sport: 7.2 for MLB, 10.0 for the NFL, and 11.7 for the NBA (P = .048). Conclusion: Almost all orthopaedic HTPs were fellowship trained, as compared with two-thirds of primary care HTPs. Of the 94 orthopaedic HTPs, 62% were trained at 6 specific fellowship programs. Men accounted for a majority of HTPs.

Endoscopic Gluteus Medius Repair.

Endoscopic gluteus medius repair is indicated after failed conservative management for debilitating peritrochanteric hip pain. In our experience, most of these surgeries are performed on women, 45 to 75 years old. Often for undersurface high-grade partial-thickness tears and some small full-thickness tears, a single-row repair technique is performed. For larger, full-thickness tears, a double-row repair is often performed. For minimal, superficial, partial-thickness tears with a longitudinal component of tearing through the gluteus medius tendon, a side-to-side repair is performed. Short-term follow-up shows significant improvements in hip outcome score for activities of daily living and in numeric rating scale.