Shoulder External Rotational Properties During Physical Examination Are Associated With Injury That Requires Surgery and Shoulder Joint Loading During Baseball Pitching

2021 ◽  
pp. 036354652110398
Author(s):  
Hannah Stokes ◽  
Koco Eaton ◽  
Naiquan (Nigel) Zheng
Keyword(s):  
Physical Examination ◽  
Range Of Motion ◽  
Internal Rotation ◽  
Shoulder Joint ◽  
External Rotation ◽  
Joint Loading ◽  
Arm Injuries ◽  
Shoulder External Rotation ◽  
Baseball Pitchers ◽  
Shoulder Flexibility

Background: Throwing arm injuries are common because of the demand on the shoulder. The shoulder is qualitatively checked regularly by team physicians. Excessive instability and joint loading in baseball pitching are risk factors for throwing arm injuries. Knowledge of shoulder flexibility, range of motion, and joint loading may provide new insights for treatments to reduce the likelihood of injury incidence. Purpose: To investigate the relationship among injuries, shoulder external rotational properties, and shoulder joint loading in baseball pitchers. Study Design: Descriptive laboratory study. Methods: Pitching kinetics, shoulder rotational tests, and self-reported injury questionnaires were used to study 177 collegiate baseball pitchers. Pitching motion data were collected at 240 Hz using a motion capture system. A custom program calculated the shoulder joint loading. The shoulder rotational test quantitatively records shoulder range of motion and flexibility using a custom-made wireless device. Self-reported injury questionnaires were filled out during tests and yearly follow-ups. The total length of the study was 5 years. Analysis of variance, chi-square, and regression tests were performed to compare differences among groups and detect correlations with surgery and shoulder joint loadings. Results: There were significant differences in shoulder flexibility among surgery groups. Shoulder external rotational properties during physical examination were significantly associated with shoulder joint loading in baseball pitching. High shoulder external rotation was associated with 14% to 36% lower shoulder posterior force and adduction, internal rotation, and horizontal adduction torque ( P < .05). High shoulder flexibility was associated with 13% higher anterior force ( P < .05). High shoulder external rotation before external rotation torque was applied was associated with 13% to 33% lower shoulder inferior force and adduction, internal rotation, and horizontal adduction torque ( P < .05). There were no significant differences in shoulder joint loading among the surgery groups. Conclusion: Shoulder injuries that require surgery were associated with shoulder external rotation flexibility. High shoulder external rotation may be advantageous because it lowers the force and torque on the shoulder joint. Clinical Relevance: The ability to understand shoulder external rotational properties, joint loading, and injury during baseball pitching helps further our understanding of injury mechanisms. The shoulder rotational test should be used as a screening tool to identify players at risk.

scholarly journals Glenohumeral Rotational Motion and Strength and Baseball Pitching Biomechanics

2012 ◽  
Vol 47 (3) ◽  
pp. 247-256 ◽  
Author(s):  
Wendy J. Hurd ◽  
Kenton R. Kaufman
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Rotational Motion ◽  
Positive Relationship ◽  
External Rotation ◽  
Shoulder Range Of Motion ◽  
Arm Injuries ◽  
Baseball Pitchers ◽  
Clinical Measures ◽  
Insight Into

Context: Addressing loss of shoulder range of motion and rotator cuff weakness in injury-prevention programs might be an effective strategy for preventing throwing arm injuries in baseball pitchers. However, the influence of these clinical measures on pitching biomechanics is unclear. Objective: To evaluate the relationships among clinical measures of shoulder rotational motion and strength and 3-dimensional pitching biomechanics and to evaluate the presence of coupling between the shoulder and the elbow during pitching to provide insight into the influence of clinical shoulder characteristics on elbow biomechanics. Design: Cross-sectional study. Setting: Biomechanics laboratory. Patients or Other Participants: A total of 27 uninjured male high school baseball pitchers (age  =  16 ± 1.1 years, height  =  183 ± 7 cm, mass  =  83 ± 12 kg). Main Outcome Measure(s): Clinical measures included shoulder internal- and external-rotation range of motion and peak isometric internal- and external-rotator strength. Three-dimensional upper extremity biomechanics were assessed as participants threw from an indoor pitching mound to a target at regulation distance. Linear regressions were used to assess the influence of clinical measures on the peak shoulder internal and external rotation moments and the peak elbow-adduction moment. Results: We found a positive relationship between clinically measured internal-rotator strength and shoulder external-rotation moment (R2  =  0.181, P  =  .04) during pitching. We also noted an inverse relationship between clinically measured external-rotation motion and the elbow-adduction moment (R2  =  0.160, P  =  .04) and shoulder internal-rotation moment (R2  =  0.250, P  =  .008) during pitching. We found a positive relationship between peak shoulder internal-rotation moment and the peak elbow-adduction moment (R2  =  0.815, P &lt; .001) during pitching. Conclusions: This study provides insight into the effects of shoulder strength and motion on pitching biomechanics and how these clinical measures might contribute to throwing arm injuries in the baseball pitcher. A relationship also was identified between peak shoulder and elbow moments in the throwing arm during pitching, providing biomechanical support for addressing clinical shoulder characteristics as a potential strategy for preventing elbow injury.

Shoulder Rotational Laxity is Related to Joint Loading During Throwing

2011 ◽  
Author(s):  
Nigel Zheng ◽  
Hongsheng Wang ◽  
Koco Eaton
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Rotation Velocity ◽  
Joint Loading ◽  
Rotational Laxity ◽  
Physical Assessment ◽  
Arm Injuries ◽  
Shoulder External Rotation

Throwing arm injuries are common and often related to shoulder rotational laxity. Both shoulder external and internal rotational laxity are often checked in a physical assessment. The shoulder external rotation of the throwing arm during physical assessment is reported to be about 10 degree greater than the non-throwing arm [1]. Throwing arm injuries often occur during throwing activities. High forces and torques were generated during throwing activity. Extremely high shoulder external rotation (about 180°) and high internal rotation velocity (over 7000°/s) during baseball pitching are reported [2].

Prevalence of Generalized Ligamentous Laxity in Patients Undergoing Hip Arthroscopy: A Prospective Study of Patients’ Clinical Presentation, Physical Examination, Intraoperative Findings, and Surgical Procedures

2019 ◽  
Vol 47 (4) ◽  
pp. 885-893 ◽  
Author(s):  
Ardavan A. Saadat ◽  
Ajay C. Lall ◽  
Muriel R. Battaglia ◽  
Mitchell R. Mohr ◽  
David R. Maldonado ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Relative Risk ◽  
Physical Examination ◽  
Range Of Motion ◽  
Internal Rotation ◽  
Hip Arthroscopy ◽  
Clinical Presentation ◽  
External Rotation ◽  
Labral Repair ◽  
Ligamentous Laxity

Background: Recent studies identified microinstability in the hip as a pathoetiology of painful hip conditions, and it was proposed that generalized ligamentous laxity conditions may predispose patients to such microinstability. Purpose: To study the relationship of generalized ligamentous laxity with patient characteristics, clinical presentation, intraoperative findings, and surgical treatments in a cohort of patients undergoing hip arthroscopy. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Registry data were prospectively collected and retrospectively reviewed between February 2014 and November 2017 for patients who underwent primary hip arthroscopy and had a documented Beighton score to assess generalized ligamentous laxity. Patients with a history of an ipsilateral hip condition or ipsilateral hip surgery, those with Tönnis grade >1, and those who had simultaneous arthroscopic and open procedures were excluded from the study. Two comparisons were made between patients with low and high Beighton scores: Beighton 0 vs ≥1 (B 0 vs B ≥1) and Beighton 0-3 vs ≥4 (B 0-3 vs B ≥4). Patient demographics, symptomatology, physical examination, and intraoperative findings were compared between these low and high Beighton groups. Results: A total of 1381 patients met our inclusion and exclusion criteria. Within this patient population, there were 882 with B 0, 499 with B ≥1, 1120 with B 0-3, and 261 with B ≥4. B 0 was 54.1% female, compared with 84.2% of B ≥1. Similarly, B 0-3 was 58.5% female, while B ≥4 was 92.7% female. The difference in sex makeup was significant between both sets of groups ( P < .0001). The relative risk of having B ≥1 for women versus men was 2.869, and the relative risk of having B ≥4 for women versus men was 6.873. The patients with higher Beighton scores in B ≥1 and B ≥4 had a younger mean age at onset of symptoms ( P < .0001) and lower mean body mass index ( P < .0001) than those in B 0 and B 0-3, respectively. The B ≥1 group had higher preoperative range of motion with internal rotation ( P = .05), external rotation ( P = .017), and flexion ( P < .0001) than B 0 patients, as well as a lower frequency of Trendelenburg gait pattern ( P = .0268). Similarly, the B ≥4 group had higher range of motion than the B 0-3 group with internal rotation ( P = .030), external rotation ( P = .003), flexion ( P < .0001), and abduction ( P = .002). As compared with the lower-score groups, the higher-score groups also had smaller labral size and tear dimension ( P < .0001), and a higher proportion of these patients underwent labral repair, capsular repair, and iliopsoas fractional lengthening. Conclusion: Patients undergoing hip arthroscopy who have generalized ligamentous laxity are overall younger, have a lower body mass index, and are more often female, as compared with patients who have lesser laxity. Patients with higher preoperative Beighton scores had greater hip range of motion and smaller intraoperative labral size and tear dimensions. Additionally, these patients were more likely to undergo labral repair, capsular plication, and iliopsoas fractional lengthening.

Descriptive Profile of Hip Rotation Range of Motion in Elite Tennis Players and Professional Baseball Pitchers

2007 ◽  
Vol 35 (8) ◽  
pp. 1371-1376 ◽  
Author(s):  
Todd S. Ellenbecker ◽  
Gail A. Ellenbecker ◽  
E. Paul Roetert ◽  
Rogerio Teixeira Silva ◽  
Greg Keuter ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Hip Joint ◽  
External Rotation ◽  
Professional Baseball ◽  
Tennis Players ◽  
Active Range Of Motion ◽  
Baseball Pitchers ◽  
Hip Rotation ◽  
Bilateral Difference

Background Repetitive loading to the hip joint in athletes has been reported as a factor in the development of degenerative joint disease and intra-articular injury. Little information is available on the bilateral symmetry of hip rotational measures in unilaterally dominant upper extremity athletes. Hypothesis Side-to-side differences in hip joint range of motion may be present because of asymmetrical loading in the lower extremities of elite tennis players and professional baseball pitchers. Study Design Cohort (cross-sectional) study (prevalence); Level of evidence, 1. Methods Descriptive measures of hip internal and external rotation active range of motion were taken in the prone position of 64 male and 83 female elite tennis players and 101 male professional baseball pitchers using digital photos and computerized angle calculation software. Bilateral differences in active range of motion between the dominant and nondominant hip were compared using paired t tests and Bonferroni correction for hip internal, external, and total rotation range of motion. A Pearson correlation test was used to test the relationship between years of competition and hip rotation active range of motion. Results No significant bilateral difference (P > .005) was measured for mean hip internal or external rotation for the elite tennis players or the professional baseball pitchers. An analysis of the number of subjects in each group with a bilateral difference in hip rotation greater than 10° identified 17% of the professional baseball pitchers with internal rotation differences and 42% with external rotation differences. Differences in the elite male tennis players occurred in only 15% of the players for internal rotation and 9% in external rotation. Female subjects had differences in 8% and 12% of the players for internal and external rotation, respectively. Statistical differences were found between the mean total arc of hip range of internal and external rotation in the elite tennis players with the dominant side being greater by a clinically insignificant mean value of 2.5°. Significantly less (P < .005) dominant hip internal rotation and less dominant and nondominant hip total rotation range of motion were found in the professional baseball pitchers compared with the elite male tennis players. Conclusion This study established typical range of motion patterns and identified bilaterally symmetric hip active range of motion rotation values in elite tennis players and professional baseball pitchers. Asymmetric hip joint rotational active range of motion encountered during clinical examination and screening may indicate abnormalities and would indicate the application of flexibility training, rehabilitation, and further evaluation.

scholarly journals The Effect of Straight-Line Long-Toss Versus Ultra-Long-Toss Throwing on Passive Glenohumeral Range of Motion Recovery After Pitching

2021 ◽  
pp. 194173812098001
Author(s):  
T. David Luo ◽  
Aaron D. Sciascia ◽  
Austin V. Stone ◽  
Chukwuweike U. Gwam ◽  
Christopher A. Grimes ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
National Collegiate Athletic Association ◽  
External Rotation ◽  
Level Of Evidence ◽  
Left Hand ◽  
Right Hand ◽  
Straight Line ◽  
Significant Difference ◽  
Baseball Pitchers

Background: Repetitive throwing in baseball pitchers can lead to pathologic changes in shoulder anatomy, range of motion (notably glenohumeral internal rotation deficit), and subsequent injury; however, the ideal strengthening, recovery, and maintenance protocol of the throwing shoulder in baseball remains unclear. Two strategies for throwing shoulder recovery from pitching are straight-line long-toss (SLT) throwing and ultra-long-toss (ULT) throwing, although neither is preferentially supported by empirical data. Hypothesis: ULT will be more effective in returning baseline internal rotation as compared with SLT in collegiate pitchers after a pitching session. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A total of 24 National Collegiate Athletic Association Division I baseball pitchers with mean age 20.0 ± 1.1 years were randomized to either the ULT group (n = 13; 9 right-hand dominant, 4 left-hand dominant) or SLT group (n = 11; 10 right-hand dominant, 1 left-hand dominant). Measurements (dominant and nondominant, 90° abducted external rotation [ER], internal rotation [IR], and total range of motion [TROM]) were taken at 5 time points across 3 days: before and immediately after a standardized bullpen session on day 1; before and immediately after a randomized standardized ULT or SLT session on day 2; and before practice on Day 3. Results: ULT demonstrated significantly greater final ER compared with baseline (+10°; P = 0.05), but did not demonstrate significant IR changes. Similarly, SLT demonstrated significantly greater post-SLT ER (+12°; P = 0.02) and TROM (+12°; P = 0.01) compared with baseline, but no significant IR changes. Final ER measurements were similar between ULT (135° ± 14°) and SLT (138° ± 10°) ( P = 0.59). There was also no statistically significant difference in final IR between ULT (51° ± 14°) and SLT (56° ± 8°) ( P = 0.27). Conclusion: The routine use of postperformance, ULT throwing to recover from range of motion alterations, specifically IR loss, after a pitching session is not superior to standard, SLT throwing. Based on these findings, the choice of postpitching recovery throwing could be player specific based on experience and comfort. Clinical Relevance: The most effective throwing regimens for enhancing performance and reducing residual impairment are unclear, and ideal recovery and maintenance protocols are frequently debated with little supporting data. Two strategies for throwing shoulder recovery from pitching are SLT and ULT throwing. These are employed to help maintain range of motion and limit IR loss in pitchers. The routine use of ULT throwing for recovery and to limit range of motion alterations after a pitching session is not superior to SLT throwing.

scholarly journals The relationship between range of motion and muscle strength of the shoulder joint in professional baseball pitchers

2021 ◽  
Keyword(s):  
Body Weight ◽  
Range Of Motion ◽  
Shoulder Joint ◽  
External Rotation ◽  
Linear Regression Analysis ◽  
Isometric Strength ◽  
Professional Baseball ◽  
Baseball Pitchers ◽  
Baseball Team ◽  
The Relationship

Background and objective: This study aimed to assess the relationship between range of motion (ROM) and isometric strength of the shoulder joint, adjusted for humeral head retroversion angle (HHRA), in professional baseball pitchers. Material and Methods: A total of 18 pitchers from a professional baseball team were included in this study. The isometric strength of internal rotation (IR) and external rotation (ER) were measured using an isokinetic device at 85◦ and 30◦ ER, and at 25◦ IR. A linear regression analysis was then performed. Results: The HHRA of the dominant arm was approximately 7◦ greater than that of the non-dominant arm (P < 0.001). As the IR ROM increased by 1◦, the IR isometric strength at 25◦ IR was significantly increased by 0.448% body weight (P < 0.05). However, as the ROM of IR increased, the IR isometric strength at 85◦ and 30◦ ER was not significant (P > 0.05), and as the ROM of ER increased, the IR and ER isometric strength were not significant (P > 0.05). Conclusions: Thus, the increase of IR ROM in professional baseball pitchers was associated with an increase in isometric strength at 25◦ IR, after adjustments were made for HHRA.

Increased Shoulder Distraction Force and Shoulder Horizontal Abduction in Professional Baseball Pitchers With Discordant Torso Rotation Order

2021 ◽  
pp. 036354652110413
Author(s):  
Joseph E. Manzi ◽  
Brittany Dowling ◽  
Joshua S. Dines ◽  
Alexander Richardson ◽  
Kathryn L. McElheny ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Internal Rotation ◽  
External Rotation ◽  
Rotation Velocity ◽  
Mean Difference ◽  
Professional Baseball ◽  
Pelvic Rotation ◽  
Shoulder External Rotation ◽  
Baseball Pitchers ◽  
Distraction Force

Background: Inefficient energy transfer from the pelvis and trunk has been shown to increase compensation at the level of the shoulder. Kinetic chain sequencing of the core segments is underexamined in professional baseball pitchers, especially as it relates to changes in upper extremity kinetics. Purpose: To evaluate elbow and shoulder kinetics in a cohort of professional pitchers differentiated by instances of discordant pelvic to upper torso sequencing during the pitch. Study Design: Descriptive laboratory study. Methods: 285 professional baseball pitchers were evaluated using 3D motion capture (480 Hz). Pitchers were divided into “chronological” and “discordant” groups based on whether maximum pelvic rotation velocity occurred before (chronological) or after (discordant) maximum upper torso rotation velocity during the pitch motion. Pelvic, upper torso, and shoulder kinematic parameters, shoulder distraction force, shoulder internal rotation torque, and pitch efficiency (PE) were compared between groups. Results: Pitchers with discordant torso sequencing (n = 30; 110 pitches) had greater shoulder horizontal adduction at maximum external rotation (mean difference, 3.6°; 95% CI, −5.2° to −2.0°; t = −4.5; P < .001) and greater maximum shoulder external rotation (mean difference, 3.7°; 95% CI, 5.7° to 1.5°; t = −3.5; P < .001) than chronological pitchers (n = 255; 2974 pitches). PE did not differ between groups ( P = .856), whereas ball velocity was significantly faster in the discordant group (mean difference, 0.6 m/s; 95% CI, −1.1 to −0.3 m/s; t = −3.3; P = .0012). Chronological pitchers had significantly reduced shoulder distraction force (mean difference, −4.7% body weight (BW); 95% CI, −7.9% to −1.5% BW; t = −2.9; P = .004) with no difference in shoulder internal rotation torque ( P = .160). These kinematic and kinetic differences were not observed when accounting for interpitcher variability. Conclusion: Between pitchers, those who had a discordant pelvic to upper torso sequence experienced significantly greater shoulder distraction forces, potentially compensating by increasing maximum shoulder external rotation and horizontal abduction. Achieving maximal pelvic rotation velocity before maximal rotation velocity may be advantageous in preventing compensation at the upper extremity and excessive throwing arm loading. Clinical Relevance: Identifying risk factors for increased upper extremity forces has potential implications in injury prevention. Specifically, mitigating shoulder distraction forces may be beneficial in reducing risk of injury.

Impact of a competition with two consecutive matches in a day on physical performance in young tennis players

2017 ◽  
Vol 42 (7) ◽  
pp. 750-756 ◽  
Author(s):  
Cesar Gallo-Salazar ◽  
Juan Del Coso ◽  
David Barbado ◽  
Alejandro Lopez-Valenciano ◽  
Francisco Javier Santos-Rosa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Physical Performance ◽  
External Rotation ◽  
Isometric Strength ◽  
Tennis Players ◽  
Performance Variables ◽  
Change Of Direction ◽  
Shoulder Range Of Motion ◽  
Shoulder External Rotation

The purpose of this study was to analyze the effects of playing 2 tennis matches on the same day on physical performance in young tennis players. Twelve well-trained young tennis players took part in a simulated tennis competition consisting of 2 tennis matches on the same day (morning and afternoon sessions). Before and the day after the competition, physical performance was measured using a battery of countermovement jumps; a 10 m sprint; the 5–0–5 agility test; hip, grip and shoulder maximal isometric strength; shoulder range of motion; and a serve velocity test. Postcompetition results showed reduced performance in 10 m (–3.3%, effect size (ES) = small), dominant and nondominant 5–0–5 agility test (–4.6%, ES = moderate; –4.2%, ES = moderate, respectively), bilateral (–5.2%, ES = small), and unilateral countermovement jumps (dominant leg: –7.2%, ES = small; non-dominant leg: –9.1%, ES = small). Both dominant and nondominant shoulder external rotation range of motion increased (12.2%, ES = moderate; 5.6%, ES = small), whereas internal rotation decreased (–4.2%, ES = small; –3.3%, ES = small) in the postcompetition tests, together with the dominant shoulder external rotation (–10.7%, ES = moderate) and internal rotation (–9.3%, ES = small) strength. Physical impairments occurred in neuromuscular performance variables involving lower (e.g., jumping, sprinting, and change of direction) and upper (e.g., isometric strength and range of motion) limbs the day after playing a competition with 2 consecutive matches on the same day. These alterations in neuromuscular and sport-specific performance need to be taken into consideration when planning tournament schedules for young tennis players, as well as preparing match and recovery strategies.

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