Considerations of throwing athletes with upper extremity injury when completing the Single Assessment Numeric Evaluation (SANE).

CONTEXT: The Single Assessment Numeric Evaluation (SANE) is a widely used patient-reported outcome (PRO) measure that provides an efficient, but limited view of patient perceptions of health. Knowledge of what throwing athletes with upper extremity injury consider when answering the SANE would inform score interpretation and increase its value for clinical decision-making in this patient population. OBJECTIVE: To investigate the global rating of the SANE and its ability to capture constructs of health reflected in patient-reported outcome measures that are commonly used in throwing athletes with upper extremity sport-related injury. DESIGN: Cross-sectional study. SETTING: Retrospective database review. PATIENTS OR OTHER PARTICIPANTS: De-identified patient records of baseball and softball athletes diagnosed with upper extremity sport-related injury between October 2009 and June 2021 were reviewed. MAIN OUTCOME MEASURES: Primary outcomes were scores on the SANE; Functional Arm Scale for Throwers (FAST) total; Disabilities of the Arm, Shoulder and Hand (DASH) total; and Global Rating of Daily Activities (GRODA). The first administration of all PROs that patients completed post-injury were analyzed as potential predictors of SANE scores. The proportion of variance uniquely accounted for in the SANE by each predictor (R2) variable was estimated. RESULTS: Fifty-five patients completed PRO measures. The FAST total uniquely accounted for 32.9% (P <.001), the GRODA uniquely accounted for 11.6% (P <.001), and the DASH total uniquely accounted for 4.6% (P=.036) of the variance in the SANE score. Overall, the predictors accounted for 49.2% of the variance in the SANE score (P <.001). CONCLUSIONS: Given that the SANE captures multiple constructs of health, it may be useful in gathering a quick, broad view of throwing athletes' perception of their health. When SANE scores suggest diminished health, then multi-item PROs should be considered to further explore constructs of health most impacted.

Man on the Mound: Pictures of a Pitcher in Pain.

Description Atraumatic ball thrower's humerus fracture is an uncommon, and poorly understood injury pattern. The majority of these cases are seen in untrained and younger individuals. A missed diagnosis could severely impact a patient's quality of life, as management is operative in most cases. Here, we present the case of a young patient, suffering an atraumatic "ball thrower's" fracture. We present images of this exceedingly rare injury pattern and showcase original artwork with a proposed mechanism of injury.

Thrower's Fracture With Subsequent Compartment Syndrome Requiring Emergent 2 Compartment Upper Extremity Fasciotomy.

Introduction: A thrower's fracture is a mid-to-distal third humerus fracture that commonly presents as an audible pop with severe arm pain sustained during the throwing motion. Although thrower's fracture has been described previously in the literature, this report is the first to demonstrate compartment syndrome as its potential sequel. Case Presentation: A 25-year-old semi-professional pitcher presented to the emergency department with severe right arm pain following a pitch. He described hearing an audible pop with subsequent severe pain. He was found to have elevated compartment pressures in his upper arm and was rushed to the operating room for a 2 compartment fasciotomy. The thrower's fracture classically presents as an audible pop with subsequent arm pain in male patients aged 20-30 years during the acceleration phase of throwing. A potential well-known sequel is radial nerve palsy, which occurs in roughly 5-11% of patients. A sequel which has not been previously described is the subsequent development of compartment syndrome. Conclusion: Compartment syndrome should be monitored in patients with thrower's fractures, as it is a limb-threatening condition that can subsequently develop.

Pitch-Tracking Metrics as a Predictor of Future Shoulder and Elbow Injuries in Major League Baseball Pitchers: A Machine-Learning and Game-Theory Based Analysis.

Background: Understanding interactions between multiple risk factors for shoulder and elbow injuries in Major League Baseball (MLB) pitchers is important to identify potential avenues by which risk can be reduced while minimizing impact on player performance. Purpose: To apply a novel game theory-based approach to develop a machine-learning model predictive of next-season shoulder and elbow injuries in MLB pitchers and use this model to understand interdependencies and interaction effects between the most important risk factors. Study Design: Case-control study; Level of evidence, 3. Methods: Pitcher demographics, workload measures, pitch-tracking metrics, and injury data between 2017 and 2022 were used to construct a database of MLB pitcher-years, where each item in the database corresponded to a pitcher's information and metrics for that year. An extreme gradient boosting machine-learning model was trained to predict next-season shoulder and elbow injuries utilizing Shapley additive explanation values to quantify feature importance as well as interdependencies and interaction effects between predictive variables. Results: A total of 3808 pitcher-years were included in this analysis; 606 (15.9%) of these involved a shoulder or elbow injury resulting in placement on the MLB injured list. Of the >65 candidate features (including workload, demographic, and pitch-tracking metrics), the most important contributors to predicting shoulder/elbow injury were increased: pitch velocity (all pitch types), utilization of sliders (SLs), fastball (FB) spin rate, FB horizontal movement, and player age. The strongest game theory interaction effects were that higher FB velocity did not alter a younger pitcher's predicted risk of shoulder/elbow injury versus older pitchers, risk of shoulder/elbow injury increased with the number of high-velocity pitches thrown (regardless of pitch type and in an additive fashion), and FB velocity <95 mph (<152.9 kph) demonstrated strong negative interaction effects with higher SL percentage, suggesting that the overall predicted risk of injury for pitchers throwing a high number of SLs could be attenuated by lower FB velocity. Conclusion: Pitch-tracking metrics were substantially more predictive of future injury than player demographics and workload metrics. There were many significant game theory interdependencies of injury risk. Notably, the increased risk of injury that was conferred by throwing with a high velocity was even further magnified if the pitchers were also older, threw a high percentage of SLs, and/or threw a greater number of pitches.

The Prevalence of Shoulder and Elbow Pathology in Major League Baseball Prospects From the Dominican Republic.

BACKGROUND: Rates of shoulder and elbow pathology are well documented among competitive baseball players in the United States; however, little is known about the prevalence of these pathologies in the Dominican Republic (DR). PURPOSE: To report the epidemiology of shoulder and elbow pathology among participants at a Major League Baseball scouting event in Santo Domingo, DR. STUDY DESIGN: Retrospective descriptive study. LEVEL OF EVIDENCE: 3. METHODS: All pitchers and position players who attended the 2021 scouting event were reviewed. Those with complete medical history, physical examination, imaging series, and radiology reports were included. All participants underwent shoulder and elbow radiography, while pitchers also underwent magnetic resonance imaging (MRI). All pathologic findings on imaging studies were recorded and compared among position players and pitchers. RESULTS: Seventy-five participants (average age, 17.9 years) were reviewed (42 position players, 33 pitchers); 72% and 32% had ≥1 abnormal finding on elbow and shoulder radiographs, respectively. Position players had significantly higher numbers of elbow radiographic findings compared with pitchers (81% vs 57.6%, P = 0.03) but similar numbers on shoulder radiograph (28.6% vs 33.3%, P = 0.66). Position players had high numbers of acromioclavicular separation (14.3%) and little leaguer's shoulder (14.3%) on shoulder radiograph, with olecranon osteophytes (23.8%) and medial epicondyle nonunions (11.9%) prevalent on elbow radiograph. Pitchers had high numbers of rotator cuff pathology (93.9%), labral tears (75.8%), and Bennett lesions (51.5%). On elbow imaging, pitchers had high numbers of ulnar collateral ligament (UCL) abnormalities (81.8%), olecranon osteophytes (69.7%), osteochondral lesions (18.2%), and medial epicondyle nonunions (12.1%). Two pitchers had complete UCL disruption (6.1%), while 8 had partial tears (24.2%). CONCLUSION: Dominican baseball prospects had high numbers of asymptomatic shoulder and elbow pathology on imaging studies. Knowledge of the prevalence of these pathologies can guide injury prevention programs in Dominican youth baseball.

Management of Shoulder Instability in the Overhead Athletes.

Overhead athletes with anterior, posterior, and multidirectional shoulder instability present with a wide range of symptoms, especially considering the injury mechanism and affected supportive structures. As such, the management of shoulder instability is widely variable and relies on rehabilitation, operative management, and sport-specific considerations, such as positional and seasonal demands on the athlete. Biomechanical analysis may further aid in the recovery process or serve as a predictive tool to identify an increased risk for injury.

Effect of Repetitive Pitching on the Control of Lower Extremity Joints and Center of Mass in Collegiate Baseball Pitchers.

BACKGROUND: Repetitive motion can alter joint angles and subsequently affect the control of the center of mass (CoM). While the CoM has been studied as a fatigue indicator in various sports, the control of the whole-body CoM during repetitive pitching in baseball pitchers has not been examined. This study aimed to investigate changes in lower-extremity joint angles and CoM control in collegiate baseball pitchers after repetitive pitching. HYPOTHESIS: Baseball pitchers would exhibit significant increase in lower-extremity flexion angles, CoM position, and CoM variability after repetitive pitching. STUDY DESIGN: Descriptive laboratory study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 23 pitchers from the Collegiate Baseball League were recruited. A motion analysis system was employed to assess lower-extremity joint angles and CoM position during the simulated game, while pitching accuracy and velocity were also recorded. RESULTS: The results revealed a significant forward and downward shift in CoM position (P < 0.05), along with increased CoM variability in all directions (P < 0.05) after the simulated game. Furthermore, there was a significant increase in flexion angles of the knee and hip (P < 0.05); however, pitching velocity and accuracy did not demonstrate significant changes. CONCLUSION: Repetitive pitching leads to kinematic changes that should be monitored to prevent sports injuries. CLINICAL RELEVANCE: Baseball pitchers have the ability to modify the control of their CoM and angles of their lower-extremity joints to sustain their pitching performance. It is crucial to monitor compensatory strategies closely to avoid shoulder and elbow injuries among these pitchers.

A Comparison of Throwing Arm Kinetics and Ball Velocity in High School Pitchers With Overall Fast and Overall Slow Cumulative Joint and Segment Velocities.

BACKGROUND: Individual maximum joint and segment angular velocities have shown positive associations with throwing arm kinetics and ball velocity in baseball pitchers. PURPOSE: To observe how cumulative maximum joint and segment angular velocities, irrespective of sequence, affect ball velocity and throwing arm kinetics in high school pitchers. STUDY DESIGN: Descriptive laboratory study. METHODS: High school (n = 55) pitchers threw 8 to 12 fastball pitches while being evaluated with 3-dimensional motion capture (480 Hz). Maximum joint and segment angular velocities (lead knee extension, pelvis rotation, trunk rotation, shoulder internal rotation, and forearm pronation) were calculated for each pitcher. Pitchers were classified as overall fast, overall slow, or high velocity for each joint or segment velocity subcategory, or as population, with any pitcher eligible to be included in multiple subcategories. Kinematic and kinetic parameters were compared among the various subgroups using t tests with post hoc regressions and multivariable regression models created to predict throwing arm kinetics and ball velocity, respectively. RESULTS: The lead knee extension and pelvis rotation velocity subgroups achieved significantly higher normalized elbow varus torque (P = .016) and elbow flexion torque (P = .018) compared with population, with equivalent ball velocity (P = .118). For every 1-SD increase in maximum pelvis rotation velocity (87 deg/s), the normalized elbow distractive force increased by 4.7% body weight (BW) (B = 0.054; ß = 0.290; P = .013). The overall fast group was older (mean ± standard deviation, 16.9 ± 1.4 vs 15.4 ± 0.9 years; P = .007), had 8.9-mph faster ball velocity (32.7 ± 3.1 vs 28.7 ± 2.3 m/s; P = .002), and had significantly higher shoulder internal rotation torque (63.1 ± 17.4 vs 43.6 ± 12.0 Nm; P = .005), elbow varus torque (61.8 ± 16.4 vs 41.6 ± 11.4 Nm; P = .002), and elbow flexion torque (46.4 ± 12.0 vs 29.5 ± 6.8 Nm; P < .001) compared with the overall slow group. A multiregression model for ball velocity based on maximum joint and segment angular velocities and anthropometrics predicted 53.0% of variance. CONCLUSION: High school pitchers with higher maximum joint and segment velocities, irrespective of sequence, demonstrated older age and faster ball velocity at the cost of increased throwing shoulder and elbow kinetics. CLINICAL RELEVANCE: Pitchers and coaching staff should consider this trade-off between faster ball velocity and increasing throwing arm kinetics, an established risk factor for elbow injury.

Prevalence of Abnormal Findings in the Posterosuperior Humeral Head of Asymptomatic Collegiate Baseball Pitchers Using Ultrasonography.

BACKGROUND: The posterosuperior humeral head contacts the glenoid during pitching. While magnetic resonance imaging (MRI) often detects abnormalities in the posterosuperior humeral head of baseball pitchers, ultrasonography may also be effective in identifying these abnormalities. However, studies on such abnormalities in asymptomatic players are limited. Thus, this study aimed to determine the prevalence of abnormal findings in the humeral head using ultrasonography in asymptomatic collegiate baseball pitchers. METHODS: We utilized ultrasonography to assess abnormal findings in the humeral head, defined as a break in continuity or an irregular surface around the infraspinatus insertion, in 33 college baseball pitchers (pitcher group) and 30 college students without experience in overhead sports (control group). For 11 of the 33 pitchers, computed tomography (CT)-like images were used to locate the abnormalities. The location was quantitatively identified in the axial plane using a clock system, with the bicipital groove designated as 12 o'clock, and qualitatively assessed in the sagittal plane. Shoulder internal and external rotation ranges of motion (IR and ER ROMs) and humeral retroversion were measured using an inclinometer. The prevalence of abnormalities among the four subgroups (throwing and non-throwing shoulders of the pitcher group and dominant and non-dominant shoulders of the control group) was compared using the Fisher's exact test. A paired t-test was also performed to compare the IR and ER ROMs, as well as the humeral retroversion between each group's throwing (dominant) and non-throwing (non-dominant) sides. RESULTS: The prevalence of abnormalities was significantly higher (76%) in the throwing shoulder of the pitcher group than in the other shoulder groups (< .001). The mean position of the humeral head abnormalities in the axial plane was 8:32 ± 0:21 in the clock system, with all abnormalities located at the infraspinatus insertion on the greater tuberosity in the sagittal plane according to CT-like image analysis. While ER ROM and humeral retroversion were greater in the throwing shoulder, IR ROM was less than that in the non-throwing shoulder in the pitcher group (< .001). CONCLUSION: Ultrasonographic assessments revealed a higher prevalence of abnormalities in humeral head for asymptomatic collegiate baseball pitchers. Repetitive throwing motions may lead not only to adaptations in the ROM of the shoulder joint but also to abnormalities in the humeral head. Thus, ultrasonography may help identify asymptomatic baseball players with physiological internal impingement.

The Impact of Drive Leg Impulse and Slope on Throwing Velocity and Kinematics in the Competitive Throwing Athlete.

BACKGROUND: Multiple studies have analyzed pitching kinematics using motion analysis technology, but lower extremity drive leg impulse (DLI) and drive leg slope (DLS) are not as well characterized. The purpose of this study was to investigate associations between DLI and DLS and pitch velocity as well as angular velocity of the pelvis, trunk, and humerus. HYPOTHESIS: Increased DLI and DLS will be correlated positively with pitch velocity and associated with increased angular velocities in the humerus, trunk, and pelvis. STUDY DESIGN: Retrospective case series. LEVEL OF EVIDENCE: Level 4. METHODS: Three-dimensional motion analyses data from 174 pitchers (age, 17.0 ± 1.0 years; height, 1.82 ± 0.07 m; weight, 80.0 ± 11.3 kg) throwing combined 613 fastball pitches were included. Pitchers threw 2 to 5 pitches, and the variables collected between pitches were averaged and recorded. Statistical analysis was performed using linear regressions to determine the association between DLS as well as DLI and pitch velocity and angular velocities of the pelvis, trunk, and humerus. RESULTS: Pitchers with higher DLI were associated with lower pitch velocities (ß = -22.32; 95% CI, -32.75 to -11.88, P < 0.01). There were no significant associations for DLS and velocity (ß = -0.60; 95% CI, -1.48 to 0.29, P = 0.18) or DLS and DLI with rotational velocities except for DLI and trunk kinematics (ß = -0.60; 95% CI, -1.48 to 0.29, P = 0.18). CONCLUSION: In the combined cohort, DLI correlated negatively with pitch velocity, although this relationship does not exist in the subgroup analysis. Higher DLS was found in pitchers with slower pitch velocities in the elite, high school, and youth groups, although not statistically significant. No associations were found with DLS and any angular velocities between any level of play analyzed in this study, suggesting no consistent association regardless of playing level.

Microscopic Magnetic Resonance Imaging Comparing Asymptomatic and Symptomatic Ulnar Collateral Ligament Injuries in Baseball Players.

BACKGROUND: The relationship between abnormalities of the ulnar collateral ligament (UCL) on magnetic resonance imaging (MRI) and elbow symptoms in baseball players remains unclear. PURPOSE/HYPOTHESIS: This study aimed to compare findings of the UCL on microscopic MRI between asymptomatic and symptomatic elbows in baseball players. We hypothesized that the MRI grade of UCL injuries would exhibit no correlation with medial elbow symptoms in baseball players. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: The study participants were skeletally mature baseball players who underwent high-resolution microscopic MRI of the medial elbow including for medical checkups. Elbows with previous surgical treatment or traumatic UCL injuries were excluded. The patients were divided into symptomatic and asymptomatic groups. The UCL appearance on microscopic MRI was categorized into 4 grades and compared between the groups. Abnormal findings in the medial elbow including bony fragments at the medial epicondyle, osteophytes or bony fragments in the sublime tubercle, and bone marrow edema (BME) in the sublime tubercle were also evaluated. RESULTS: A total of 426 baseball players (426 elbows) with a mean age of 20 years (range, 14-41 years) were included. The asymptomatic and symptomatic groups included 158 and 268 elbows, respectively. In the asymptomatic group, based on MRI grading of the UCL, 46 (29%) elbows were rated as grade I, 64 (41%) as grade II, 40 (25%) as grade III, and 8 (5%) as grade IV. In the symptomatic group, 75 (28%) elbows were rated as grade I, 118 (44%) as grade II, 61 (23%) as grade III, and 14 (5%) as grade IV. There was no significant difference in the MRI grades between the groups (P = .9). BME in the sublime tubercle was more frequently seen in the symptomatic group than in the asymptomatic group (P < .001). CONCLUSION: There was no difference in MRI grades of the UCL between symptomatic and asymptomatic elbows in baseball players; approximately 30% of elbows demonstrated high-grade UCL injuries in both groups. BME in the sublime tubercle was more frequently seen in symptomatic elbows than in asymptomatic elbows. BME in the sublime tubercle was a better indicator of symptoms than was MRI grading of the UCL.

The Difference Between Throwing and Practice Volumes in Youth Softball Athletes With and Without Upper Extremity Pain.

Background: Research indicates that mechanics differ between athletes with and without upper extremity pain; however, it is unclear which modifiable risk factors exist for throwing-related pain in softball athletes. Purpose: To determine whether sport specialization, throwing, practice, and strength and conditioning training volumes vary between youth softball athletes with and without upper extremity pain. It was hypothesized that youth softball athletes with upper extremity pain would participate in softball year-round and have greater throwing, practice, and strength and conditioning volumes compared with those without pain. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 232 youth softball athletes from travel ball, middle school, and high school leagues were invited to complete a survey to assess pain, sport specialization, throwing, practice, and strength and conditioning training volumes. Participants were classified into upper extremity pain and no pain groups based on their survey answers. The responses were compared between groups using Mann-Whitney U and chi-square tests. Results: A total of 101 athletes-with a mean ± SD age of 13.3 ± 2.3 years, height of 161 ± 13.4 cm, and weight of 59.8 ± 14.8 kg-completed the survey and were included for analysis. The response rate was 43.53%, with 22 athletes in the upper extremity pain group and 79 athletes in the no pain group. A significant difference was observed between hours devoted per week to off-season softball practice (U, 626.6; Z =-2; P = .045), where those without upper extremity pain spent 4 fewer median hours (6 hours) practicing softball per week in the off-season compared with those with pain (10 hours). Also, a significant difference was found between the number of throws during an in-season game (U, 457; Z, -2.28; P = .022), where those without upper extremity pain reported 21 fewer median throws (70 throws) during an in-season game compared with those with pain (91 throws). Furthermore, 77% of those who reported upper extremity pain continued to play despite their pain. There were no other significant differences between demographic characteristics, specialization, injury history, and primary position, as well as throwing, practice, and strength and conditioning volumes. Conclusion: Our study demonstrates that youth softball athletes with upper extremity pain had more throws during in-season games and increased hours per week devoted to off-season practice than athletes without upper extremity pain. Our findings support the need for softball stakeholders (eg, coaches, clinicians, parents, and administrators) to engage in further research and recommendations regarding in-season pitch counts and off-season rest.

Chronic Adaptation of the Coracohumeral Space and Subscapularis Tendon in Professional Baseball Pitchers.

BACKGROUND: Pitchers frequently experience anterior shoulder pain, possibly associated with coracohumeral impingement; however, whether the coracohumeral distance (CHD) and/or subscapularis tendon adapt chronically (bilateral difference) due to pitching, and whether clinical measures are associated with CHD and subscapularis tendon organization have not been evaluated in professional pitchers. HYPOTHESIS: The authors hypothesized that dominant arm CHD would be smaller than the nondominant arm, dominant subscapularis tendon would have increased spatial frequency (ie, be more disorganized), and humeral retroversion (HR) would predict CHD and subscapularis tendon organization. LEVEL OF EVIDENCE: Level 4. METHODS: Healthy professional baseball pitchers were recruited during their preseason physical examination. Bilateral diagnostic ultrasound measured CHD, HR, and posterior capsule thickness (PCT), and quantified subscapularis tendon organization. External rotation, neutral, and crossbody CHD was measured. RESULTS: Overall, 52 healthy professional baseball pitchers participated. The dominant arm of pitchers demonstrated a significantly narrower CHD in all 3 positions (P < 0.01), increased scapular protraction (163 vs 156 mm; P < 0.01), and increased spatial frequency of the subscapularis tendon (1.8 vs 1.6 peaks/mm; P < 0.01). HR was associated with CHD in 30° of external rotation (R2 = 0.12; P < 0.01), neutral rotation (R2 = 0.11; P < 0.01), and the crossbody position (R2 = 0.28; P < 0.01). PCT was associated with CHD in 30° of external rotation (R2 = 0.16; P = 0.05). HR and CHD in 30° of external rotation was associated most strongly with subscapularis tendon organization (R2 = 0.11; P = 0.03). CONCLUSION: The dominant shoulder of professional pitchers presents with a smaller CHD, more scapular protraction, and more subscapularis tendon disorganization than the nondominant shoulder. CLINICAL RELEVANCE: Professional pitchers demonstrate chronic CHD and subscapularis tendon adaptations, which may increase their risk for anterior shoulder pain and subscapularis tendon injury.

Fastball Quality After Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers.

BACKGROUND: The ulnar collateral ligament (UCL) is essential for elbow stability during pitching. In professional baseball, the fastball (FB) is the most commonly used pitch, making postrecovery FB performance after UCL reconstruction (UCLR) a crucial aspect to consider. HYPOTHESES: (1) Pitchers undergoing UCLR would show no significant changes in performance metrics compared with nonoperated pitchers with similar FB velocity and spin rate, and (2) no significant variance would be found in these metrics within the operated pitchers concerning their preinjury anthropometric characteristics and pitching performance metrics. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The study included 91 Major League Baseball (MLB) pitchers who underwent primary UCLR between January 1, 2015, and December 31, 2021. A matched 1:1 control group of MLB pitchers without UCLR injuries was established. Publicly available pitch metrics and anthropometric data were compared between the study and control groups. RESULTS: Disparities in several performance metrics emerged during the first postreturn year (PRY1), including FB use percentage (P = .029), fielder independent pitching (FIP) (P = .021), and standardized FB runs above average per 100 pitches (wFB/C) (P < .001). Subgroup analysis within the UCLR group revealed a negative correlation between presurgery mean FB velocity and its subsequent change (P < .001) and a positive correlation with changes in FIP (P = .025) from the index year to PRY1. A negative correlation was observed between FB use percentage in the index year and its change by PRY1 (P = .002). By the second postreturn year, no significant differences were found in these performance metrics. No factors were significantly related to prolonged recovery time. CONCLUSION: Although FB velocity and spin rate remained consistent, significant differences were observed in FB use percentage, FIP, and wFB/C in PRY1. However, by second postreturn year, these differences were no longer significant. No specific risk factors were identified concerning prolonged recovery time between pre-UCLR FB pitching metrics and the physical anthropometric data. These results suggest that although the short-term postsurgery period may affect more specialized pitching metrics, the basic pitching performance metrics, as hypothesized, remain largely unaffected by UCLR.

Fresh Osteochondral Allograft Transplantation of the Capitellum for the Treatment of Osteochondritis Dissecans.

BACKGROUND: Osteochondritis dissecans (OCD) of the humeral capitellum is a rare and challenging condition to treat. Several surgical options exist, but in the last few years, the pendulum has swung from debridement and microfracture to restoration of the articular surface. Osteochondral autografts from the rib and knee have been described, but donor-site morbidity is a concern. PURPOSE: To expand the results of fresh osteochondral allograft transplantation (FOCAT) in a previously published report with inclusion of additional patients and a longer follow-up period. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: After institutional review board approval, the charts of patients who underwent FOCAT for OCD of the capitellum between 2006 and 2022 by a single surgeon were reviewed. The majority of cases (94%) had unstable lesions (Minami grades 2 and 3). A trial of nonoperative treatment had failed in all. All patients underwent diagnostic arthroscopy, followed by a mini-open, ligament-sparing approach with grafting using commercially available guides and instruments. RESULTS: A total of 35 patients were identified, of whom 25 were male. The mean age was 16 ± 3.9 years (range, 11-32 years). There were 24 baseball players (19 pitchers and 5 position players), 5 gymnasts, 3 cheerleaders/tumblers, 1 tennis player, 1 student (who did not participate in athletics), and 1 patient with avascular necrosis from chemotherapy. Eighteen patients had a mean flexion contracture of 14.1°± 11.9°. A single osteochondral allograft plug was used in 23 patients (mean diameter, 11.3 ± 2.8 mm), and 12 patients required 2 plugs (Mastercard technique). The mean follow-up was 92.6 ± 54.5 months (range, 24-204 months). There was significant improvement in Oxford (from 25.5 ± 4.9 to 46.7 ± 3.5; P < .00001) and visual analog scale for pain (from 7.5 ± 2 to 0.3 ± 1.0; P < .0001) scores. The mean Single Assessment Numeric Evaluation score at the time of follow-up was 90.6 ± 10.8 (range, 60-100). In overhead athletes, there was significant improvement in the Kerlan-Jobe Orthopaedic Clinic score (from 40.8 ± 11.8 to 90.6 ± 10.8; P < .00001). A postoperative magnetic resonance imaging scan was obtained in 16 (46%) patients at a mean of 32.6 months. In all cases, the graft was incorporated. All overhead athletes were able to return to their sport and perform at the same level or higher for >2 years. Two elbows required a subsequent arthroscopy for loose-body removal; otherwise, there were no other complications. CONCLUSION: FOCAT is an excellent option for treating OCD lesions of the humeral capitellum. Excellent outcomes and high return-to-sport rates were observed, with midterm follow-up showing no graft failures. FOCAT eliminates donor-site morbidity.

The Role of Humeral Torsion on Glenohumeral Rotation in Injured Baseball Players.

Background: Differences in rotational range of motion (ROM) compared to humeral retrotorsion (HRT)-corrected rotational ROM exist in healthy baseball athletes, but it is unclear whether these differences exist in a pathological population. Purpose/Hypothesis: The purpose of this study was to determine if there are disparities between objectively measured differences in ROM and HRT-corrected deficits in injured baseball players. It was hypothesized that disparities would exist between (1) the side-to-side difference in glenohumeral external rotation (GER) and the HRT-corrected glenohumeral external rotation deficit (GERD) and (2) the side-to-side difference in glenohumeral internal rotation (GIR) and the HRT-corrected glenohumeral internal rotation deficit (GIRD). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Data from 172 baseball players with shoulder or elbow injuries (45 shoulder, 127 elbow) were reviewed in July 2023. GER and GIR were measured on the injured and noninjured sides of all players, and diagnostic ultrasound was used to measure HRT. Dependent t tests were run to compare the side-to side differences in GER and GIR with the HRT-corrected GERD and GIRD, respectively. Results: In the players with a shoulder injury, there was a significant disparity between the side-to-side difference in GER and the HRT-corrected GERD (2°± 14° vs -13°± 15°, respectively) and between the side-to-side difference in GIR and the HRT-corrected GIRD (-14°± 8° vs 2°± 9°, respectively) (P < .001 for both). Similarly, players with an elbow injury had significant disparities between the side-to-side difference in GER and the HRT-corrected GERD (6°± 9° vs -10°± 9°, respectively) and between the side-to-side difference in GIR and the HRT-corrected GIRD (-12°± 8° vs 4°± 10°, respectively) (P < .001 for both). Conclusion: The results supported our hypothesis that there were disparities between objectively measured differences in GER and GIR compared with the HRT-corrected GERD and GIRD in injured baseball players. Consideration must be given to osseous adaptations that occur at the glenohumeral joint when evaluating and treating this population.

Outcomes and return to sport after osteochondral autograft transplantation for osteochondritis dissecans of the capitellum: a systematic review.

Background: Capitellar osteochondritis dissecans (OCD) lesions are common in athletes. Osteochondral autograft transfer (OAT) is one possible treatment option, though outcomes including return to sport (RTS) data are limited to small series. The purpose of this study was to systematically review RTS following OAT for capitellar OCD lesions. Our secondary objectives were to evaluate patient-reported outcomes (PROs), range of motion (ROM), and complications after OAT. Methods: PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature were searched for peer-reviewed articles on "osteochondral autograft transfer" and related terms for capitellar OCD lesions. Articles were included if they reported an RTS rate and had a follow-up time point of at least 12 months. Data on RTS rates, PRO measures, complications, and ROM were extracted. Articles were assessed for methodological quality using the Methodological Index for Non-randomized Studies criteria. Results: Six hundred sixty-six articles were retrieved, and 24 articles (470 patients) met the inclusion criteria. In total, 454/470 patients (97%) returned to sports following OAT for OCD. The RTS rate ranged from 79% to 100%. Return to previous level of performance ranged from 10% to 100%. Timmerman-Andrews postoperative scores (range = 169-193) were most often reported, with 87% of patients showing scores within the excellent range. Disabilities of the Arm, Shoulder, and Hand and Japanese Orthopedic Association scores were also excellent postoperatively for all studies reporting, with higher scores among centralized lesions vs. lateral. Conclusions: Following OAT for capitellar OCD lesions, RTS rates are high; however, athletes should be counseled on the potential of a return to lower performance or the need to change positions. Lateral lesion location may negatively impact outcomes. PRO scores are typically excellent and postoperative ROM consistently improves. This information helps counsel patients regarding expectations and outcomes of OAT for OCD of the capitellum.

Examining the changes in strength and mechanical property of dynamic stabilizers of the medial elbow joint through repetitive pitching.

BACKGROUND: The flexor-pronator muscles (FPM) and their common tendon (CT) are essential in protecting the medial ulnar collateral ligament against elbow valgus stress during pitching. This study aimed to investigate the effect of repetitive pitching on FPM strength and CT stiffness. METHODS: Fifteen healthy males (mean age: 21.8 ± 1.3-years-old) with over 5 years of baseball experience performed a series of 100 full-effort fastball pitches. We measured grip and isolated digital flexion strength of the second, third, and fourth digits before and after the pitching task. The decline in muscle strength was determined using the rate of change in muscle strength after pitching relative to that before. CT stiffness was measured using a hand-held myotonometer device at rest and during grip motion at 50% maximum voluntary contraction. The increase in CT stiffness during grip motion relative to rest was calculated as the augmentation rate of CT stiffness. Statistical analyses were performed to compare the changes in grip strength, digital flexion strength, and CT stiffness due to pitching. Additionally, the reduction rate of muscle strength was compared among various strength variables. Correlation coefficients were used to evaluate the relationships between the augmentation rate of CT stiffness after pitching and the reduction rate in any muscle strength. RESULTS: Grip and isolated digital flexion strengths decreased significantly after pitching (P < 0.01). The decline in muscle strength was significantly higher for all isolated digital strengths than that for grip strength (P < 0.05). CT stiffness was augmented with grip motion compared to that at rest pre- and post-pitching (P < 0.001). However, no change in CT stiffness due to pitching was observed, regardless of the grip motion (P > 0.05). Additionally, a lower augmentation rate of CT stiffness after pitching was moderately associated with the greater reduction rate of the second digital flexion strength (r = 0.607, P = 0.016) without other relationships. CONCLUSION: This study found reduced grip and digital flexion strength after pitching; with no change in CT stiffness. However, given the consequences of correlation analyses, individuals with a more prominent reduction in second digital flexion strength due to pitching were impaired in CT stiffness augmentation after pitching. Digital flexion strength represents the strength of the flexor digitorum superficial; therefore, this study suggests that forearm FPM, particularly the second digit of the flexor digitorum superficial, is an important factor for enhancing CT stiffness.

Is There a Relationship Between Grip Strength and Injuries in Professional Baseball Players?

Background: Injuries in professional baseball players have become exceedingly common. Efforts to mitigate injury risk have focused on the kinetic chain, shoulder motion, and so forth. It is unclear whether grip strength is related to injury risk in professional baseball pitchers. Purpose/Hypothesis: The purpose of this study was to determine if grip strength was a risk factor for injury. It was hypothesized that pitchers with weaker grip strength would have a higher likelihood of sustaining a shoulder or elbow injury compared with pitchers with stronger grip strength. Study Design: Case-control study; Level of evidence, 3. Methods: All professional pitchers from a single Major League Baseball organization were included. Dominant and nondominant grip strength were measured after each pitching outing throughout the 2022 season. Injuries over the course of the season were recorded, and data were compared between pitchers who sustained a shoulder or elbow injury and those who did not. Results: Overall, 213 pitchers were included, of whom 53 (24.9%) sustained a shoulder or elbow injury during the season. The mean grip strength for all pitchers was 144.0 ± 20.8 lb (65.3 ± 9.4 kg). The mean dominant-arm grip strength was 142.6 ± 20.8 lb (64.7 ± 9.4 kg) for pitchers who did not sustain a shoulder or elbow injury and 148.2 ± 20.9 lb (67.2 ± 9.5 kg) for pitchers who did sustain an injury, with no significant group difference in grip strength (P > .05). Furthermore, there were no significant differences in change in grip strength over the course of the season between the groups. Conclusion: There was no significant difference in mean grip strength or change in grip strength over the course of a single season between professional baseball pitchers who sustained a shoulder or elbow injury and those who did not.

Ulnar collateral ligament repair in professional baseball players.

BACKGROUND: While initial reports of surgical repair of ulnar collateral ligament tears are promising, studies detailing post-repair outcomes are lacking. This study explores the effectiveness of ulnar collateral ligament (UCL) repair in returning professional baseball players to their pre-injury level of play. Our hypothesis is that professional baseball players undergoing UCL repair will have successful outcomes and high return to sport rates after surgery. METHODS: Publicly available databases were utilized to search for data on professional baseball players who underwent UCL repair from 2016 to 2021. Players undergoing primary UCL repair with an internal brace were included. Amateur players were excluded as were those undergoing revision UCL repair or UCL reconstruction. RESULTS: Of the 11 pitchers who underwent UCL repair, minor league baseball (MiLB) pitchers returned to the sport at an average of 17.5 months. MiLB pitchers had similar earned run averages (ERAs), games played, innings pitched, and walks plus hits per inning pitched ratios (WHIPs) before and after surgery. Four major league baseball (MLB) pitchers (80%) returned to the sport at 9.55 months. MLB pitchers played fewer games and pitched fewer innings than before the surgery, but their ERAs and WHIPs were similar before and after surgery. Pitch velocity and spin rates after surgery varied based on pitch type. The seven positional players who underwent UCL repair showed no differences in batting or fielding performance before and after surgery. CONCLUSIONS: UCL repair can successfully return both pitchers and positional players at both the MiLB and MLB levels to play at pre-injury performance levels. Repair can be considered as an option for qualifying injuries in players hoping to maximize performance after surgery with minimal recovery time. Level of Evidence: IV.