Does humeral torsion play a role in shoulder and elbow injury profiles of overhead athletes: a systematic review

Background: Superior labrum anterior-posterior (SLAP) lesion is a common shoulder injury, particularly in overhead athletes. While surgical management has traditionally consisted of SLAP repair, high rates of revision and complications have led to alternative techniques, such as biceps tenodesis (BT). While BT is commonly reserved for older nonoverhead athletes, indications for its use have expanded in recent years. Purpose: To determine functional outcomes and return-to-sport rates among overhead athletes after BT for SLAP tear. Study Design: Systematic review. Methods: A systematic review was performed for any articles published before July 2019. The search phrase “labral tear” was used to capture maximum results, followed by keyword inclusion of “SLAP tear” and “biceps tenodesis.” Inclusion criteria included outcome studies of BT for isolated SLAP tear in athletes participating in any overhead sports, not limited to throwing alone. Abstracts and manuscripts were independently reviewed to determine eligibility. When clearly delineated, outcome variables from multiple studies were combined. Results: After full review, 8 articles met inclusion criteria (99 athletes; mean age, 19.8-47 years), with baseball and softball players the most common among them (n = 62). Type II SLAP tear was the most common diagnosis, and 0% to 44% of athletes had a failed previous SLAP repair before undergoing BT. Only 1 study included patients with concomitant rotator cuff repair. Open subpectoral BT was most commonly used, and complication rates ranged from 0% to 14%, with wound erythema, traumatic biceps tendon rupture, brachial plexus neurapraxia, and adhesive capsulitis being reported. Combined reported postoperative functional scores were as follows: American Shoulder and Elbow Surgeons, 81.7 to 97; 12-Item Short Form Health Survey physical, 50 to 54; visual analog scale for pain, 0.8-1.5; Kerlan Jobe Orthopaedic Clinic, 66 to 79; and satisfaction, 80% to 87%. The overall return-to-sports rate for overhead athletes was 70% (60 of 86). For studies that clearly delineated outcomes based on level of play/athlete, the combined return-to-sports rate was 69% (11 of 16) for recreational overhead athletes, 80% (4 of 5) for competitive/collegiate athletes, and 60% (18 of 30) for professionals. Conclusion: BT in the overhead athlete offers encouraging functional outcomes and return-to-sports rates, particularly in the recreational athlete. It can be successfully performed as an index operation rather than SLAP repair, as well as in a younger patient population. Careful consideration should be given to elite overhead athletes, particularly pitchers, who tend to experience poorer outcomes.

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The Relationship Between Humeral Torsion and Arm Injury in Baseball Players: A Systematic Review and Meta-analysis

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738119900799 ◽

2020 ◽

Vol 12 (2) ◽

pp. 132-138

Author(s):

Joshua K. Helmkamp ◽

Garrett S. Bullock ◽

Allison Rao ◽

Ellen Shanley ◽

Charles Thigpen ◽

...

Keyword(s):

High School ◽

Systematic Review ◽

Injury Risk ◽

External Rotation ◽

Level Of Evidence ◽

Baseball Players ◽

Shoulder Range Of Motion ◽

Competition Level ◽

Humeral Torsion ◽

The Relationship

Context: Humeral torsion (HT) has been linked to various injuries and benefits. However, the exact interplay between HT, shoulder range of motion (ROM), competition level differences, and injury risk is unclear. Objective: To determine the relationship between HT, ROM, and injury risk in baseball players. Secondarily, to determine HT based on competition level. Data Sources: PubMed, Embase, Web of Science, CINAHL, and Cochrane databases were searched from inception until November 4, 2018. Study Selection: Inclusion criteria consisted of (1) HT measurements and (2) arm injury or shoulder ROM. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Two reviewers recorded patient demographics, competition level, HT, shoulder ROM, and injury data. Results: A total of 32 studies were included. There was no difference between baseball players with shoulder and elbow injuries and noninjured players (side-to-side HT difference: mean difference [MD], 1.75 [95% CI, –1.83 to 2.18]; dominant arm: MD, 0.17 [95% CI, –1.83 to 2.18]). Meta-regression determined that for every 1° increase in shoulder internal rotation (IR), there was a subsequent increase of 0.65° in HT (95% CI, 0.28 to 1.02). HT did not explain external rotation (ER ROM: 0.19 [95% CI, –0.24 to 0.61]) or horizontal adduction (HA ROM: 0.18 [95% CI, –0.46 to 0.82]). There were no differences between HT at the high school, college, or professional levels. Conclusion: No relationship was found between HT and injury risk. However, HT explained 65% of IR ROM but did not explain ER ROM or HA ROM. There were no differences in HT pertaining to competition level. The majority of IR may be nonmodifiable. Treatment to restore and maintain clinical IR may be important, especially in players with naturally greater torsion. HT adaptation may occur prior to high school, which can assist in decisions regarding adolescent baseball participation.

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Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738120931764 ◽

2020 ◽

Vol 12 (5) ◽

pp. 478-487 ◽

Cited By ~ 1

Author(s):

Camille Tooth ◽

Amandine Gofflot ◽

Cédric Schwartz ◽

Jean-Louis Croisier ◽

Charlotte Beaudart ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Rotator Cuff ◽

Range Of Motion ◽

Training Load ◽

Shoulder Injuries ◽

Shoulder Injury ◽

Overhead Athletes ◽

Modifiable Factors ◽

And Training

Context: Shoulder injuries are highly prevalent in sports involving the upper extremity. Some risk factors have been identified in the literature, but consensus is still lacking. Objectives: To identify risk factors of overuse shoulder injury in overhead athletes, as described in the literature. Data Sources: A systematic review of the literature from the years 1970 to 2018 was performed using 2 electronic databases: PubMed and Scopus. Study Selection: Prospective studies, written in English, that described at least 1 risk factor associated with overuse shoulder injuries in overhead sports (volleyball, handball, basketball, swimming, water polo, badminton, baseball, and tennis) were considered for analysis. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Data were extracted from 25 studies. Study methodology quality was evaluated using the Modified Coleman Methodology Score. Results: Intrinsic factors, previous injury, range of motion (lack or excess), and rotator cuff weakness (isometric and isokinetic) highly increase the risk of future injuries. Additionally, years of athletic practice, body mass index, sex, age, and level of play seem to have modest influence. As for the effect of scapular dysfunction on shoulder injuries, it is still controversial, though these are typically linked. Extrinsic factors, field position, condition of practice (match/training), time of season, and training load also have influence on the occurrence of shoulder injuries. Conclusion: Range of motion, rotator cuff muscle weakness, and training load are important modifiable factors associated with shoulder injuries. Scapular dysfunction may also have influence. The preventive approach for shoulder injury should focus on these factors.

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Effect of Plyometric Training on Sport Performance in Adolescent Overhead Athletes: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738120938007 ◽

2020 ◽

Vol 13 (1) ◽

pp. 37-44

Author(s):

Leyla Eraslan ◽

Birgit Castelein ◽

Valentien Spanhove ◽

Ceren Orhan ◽

Irem Duzgun ◽

...

Keyword(s):

Systematic Review ◽

Sport Performance ◽

Sprint Performance ◽

Current Evidence ◽

Training Intervention ◽

Control Group ◽

Plyometric Training ◽

Inclusion Criteria ◽

Overhead Athletes ◽

Mesh Terms

Context: Plyometric training has been shown to be beneficial in adolescent overhead athletes. However, existing research on the effects of plyometrics on sport performance has been limited. Objective: To systematically review the current literature to investigate whether plyometric training intervention improves upper- and lower-body sport performance. Data Sources: Two electronic databases (MEDLINE and Web of Science) were searched using specific Medical Subject Headings (MeSH) terms up to February 2019, and hand-searching was performed by looking to relevant studies that were cited in other studies. Study Selection: A total of 932 items were identified and were further assessed for the eligibility in the systematic review. For a study to be eligible, each of the following inclusion criteria had to be met: (1) participants were aged 13 to 18 years and selected from a sports or athletic population and the study (2) involved the evaluation of a plyometric training intervention with an aim to improve sports performance; (3) must have included a control intervention and/or control group; (4) included a quantitative objective measure of sport performance variables concerning throwing, jumping, running, and sprinting; and (5) was published in English. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: A first screening was conducted based on title and abstract of the articles. In the second screening, the full text of the remaining articles was evaluated for the fulfillment of the inclusion criteria. Results: A total of 14 studies were included in this review. The methodological quality of the included studies ranged from low to moderate. There is moderate evidence that plyometric training intervention improves throwing and jumping performances. There is also preliminary evidence that plyometric training intervention improves sprint performance. Conclusion: The current evidence suggests that sport performance consisting of throwing capacity, jumping ability, and sprint performance significantly improved due to plyometric training interventions in adolescent overhead athletes.

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Influence of Humeral Torsion on Interpretation of Posterior Shoulder Tightness Measures in Overhead Athletes

Clinical Journal of Sport Medicine ◽

10.1097/jsm.0b013e3181b544f6 ◽

2009 ◽

Vol 19 (5) ◽

pp. 366-371 ◽

Cited By ~ 58

Author(s):

Joseph B Myers ◽

Sakiko Oyama ◽

Benjamin M Goerger ◽

Terri Jo Rucinski ◽

J Troy Blackburn ◽

...

Keyword(s):

Overhead Athletes ◽

Posterior Shoulder ◽

Humeral Torsion ◽

Posterior Shoulder Tightness

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Glenohumeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes: A Meta-Analysis and Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738118756577 ◽

2018 ◽

Vol 10 (2) ◽

pp. 125-132 ◽

Cited By ~ 22

Author(s):

Robert A. Keller ◽

Anthony F. De Giacomo ◽

Julie A. Neumann ◽

Orr Limpisvasti ◽

James E. Tibone

Keyword(s):

Systematic Review ◽

Range Of Motion ◽

Upper Extremity ◽

Internal Rotation ◽

Meta Analysis ◽

Mean Difference ◽

Extremity Injury ◽

Overhead Athletes ◽

Glenohumeral Internal Rotation Deficit ◽

Upper Extremity Injury

Context: Current perception dictates that glenohumeral internal rotation deficit (GIRD) is a chronic adaptation that leads to an increased risk of pathologic conditions in the dominant shoulder or elbow of overhead athletes. Objective: To determine whether adaptations in glenohumeral range of motion in overhead athletes lead to injuries of the upper extremity, specifically in the shoulder or elbow. Data Sources: An electronic database search was performed using Medline, Embase, and SportDiscus from 1950 to 2016. The following keywords were used: GIRD, glenohumeral internal rotation deficit, glenohumeral deficit, shoulder, sport, injury, shoulder joint, baseball, football, racquet sports, volleyball, javelin, cricket, athletic injuries, handball, lacrosse, water polo, hammer throw, and throwing injury. Study Selection: Seventeen studies met the inclusion criteria for this systematic review. Of those 17 studies, 10 included specific range of motion measurements required for inclusion in the meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 4. Data Extraction: Data on demographics and methodology as well as shoulder range of motion in various planes were collected when possible. The primary outcome of interest was upper extremity injury, specifically shoulder or elbow injury. Results: The systematic review included 2195 athletes (1889 males, 306 females) with a mean age of 20.8 years. Shoulders with GIRD favored an upper extremity injury, with a mean difference of 3.11° (95% CI, –0.13° to 6.36°; P = 0.06). Shoulder total range of motion suggested increased motion (mean difference, 2.97°) correlated with no injury ( P = 0.11), and less total motion (mean difference, 1.95°) favored injury ( P = 0.14). External rotational gain also favored injury, with a mean difference of 1.93° ( P = 0.07). Conclusion: The pooled results of this systematic review and meta-analysis did not reach statistical significance for any shoulder motion measurement and its correlation to shoulder or elbow injury. Results, though not reaching significance, favored injury in overhead athletes with GIRD, as well as rotational loss and external rotational gain.

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Insights into the epidemiology, aetiology and associations of infraspinatus atrophy in overhead athletes: a systematic review

Sports Biomechanics ◽

10.1080/14763141.2017.1306096 ◽

2017 ◽

Vol 16 (3) ◽

pp. 325-341 ◽

Cited By ~ 7

Author(s):

Dimitrios Challoumas ◽

Georgios Dimitrakakis

Keyword(s):

Systematic Review ◽

Overhead Athletes ◽

Infraspinatus Atrophy

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Regional Interdependence and the Role of the Lower Body in Elbow Injury in Baseball Players: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546520910138 ◽

2020 ◽

Vol 48 (14) ◽

pp. 3652-3660

Author(s):

Matthew Jordan Deal ◽

Bradley P. Richey ◽

Cyrus Anthony Pumilia ◽

Ibrahim Mamdouh Zeini ◽

Charles Wolf ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Lower Extremity ◽

Lower Extremity Injury ◽

Lower Body ◽

Extremity Injury ◽

Baseball Players ◽

Elbow Pain ◽

Elbow Injury

Background: Elbow injuries are exceedingly common in baseball players. Previous studies have identified that upper extremity strength and range of motion deficits pose a risk for these injuries, but few studies have examined the effect of lower extremity deficits. Given the role of the lower extremity in the kinetic chain of the baseball throwing motion, lower body deficits may affect the kinematics of the upper extremity and play a role in the elbow injury of baseball players. Purpose: To systematically review the current literature investigating the association of trunk and lower extremity deficits with elbow pain or injury in baseball players. Study Design: Systematic review. Methods: A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines to identify and analyze all previous studies focused on the association of elbow pain and/or injury with functional deficits of the trunk and lower extremities. Results: A total of 14 studies met inclusion criteria, examining a range of baseball players extending from youth to professional athletes. One of the 14 studies examined other types of overhead throwing athletes alongside baseball players. Lower extremity–related risk factors for elbow pain and injury in these athletes were found and stratified per level of play. Factors included specific hip range of motion, lower extremity injury or pain, balance, and foot arch posture. Associations were also found with lower extremity injury and noncompliance with primary prevention programs. Conclusion: Specific lower extremity deficits were found to be independent risk factors for elbow pain and injury in throwing athletes at certain levels of play. Additionally, prevention programs designed to correct deficits in identified risk factors were effective in reducing the incidence of elbow injury in youth athletes. These results highlight the potential of screening and subsequent intervention to reduce the incidence of elbow injury in certain subsets of baseball players.

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