Radiographic Predictors of Elbow Injury and Surgery in Major League Baseball Pitchers

Objectives: To evaluate predictive ability of asymptomatic screening MRI’s of Major League Baseball (MLB) pitchers and compare associated findings with future DL placement, pitching statistics, and elbow surgery. Methods: A total of 40 consecutive asymptomatic elbow MRI’s in MLB pitchers at a single organization were analyzed from 2005 - 2017. Asymptomatic MRI was defined as a screening MRI at time of contract signing having been performed at least 6 months prior to DL placement for any elbow-related injury. Publicly available DL data, career innings pitched, career games started, career pitch count, and career max velocity of pitch were obtained. A blinded investigator examined each MRI for pathological signals. Data was analyzed on players that were eventually placed on the DL compared to those with no DL placement. Results: 40 consecutive elbow MRIs of MLB players were reviewed. The average age of the injured cohort was 28.3 ± 3.2 years (16 players) and 28.8 ± 5.5 years (24 players) for the non-injured cohort. There was no statistical difference in age, handedness, height, weight, or pitching stats between the injured and non-injured cohorts. Abnormal radiographic signal intensity in the UCL (p<0.001) and humeral elevation of the UCL (p=0.01) were significantly associated with future DL placement. Those injured spent an average of 200.7 days and 191.7 days in the DL with signal in the UCL and those with humeral elevation of the UCL, respectively. Ulnar elevation/signal of the UCL (p=0.06), and posteromedial impingement (p=0.08) were approaching statistical significance. Of those injured 68.8% (11/16) underwent elbow surgery. Findings of ligament signal intensity (p<0.001), ulnar-sided UCL elevation (p=0.018), humeral-sided UCL elevation (p=0.002), and posteromedial impingement (p=0.042) were all significantly associated with future surgery. There was no significant correlation between injury and radiocapitellar or ulnohumeral chondral lesion, bone edema, loose bodies, or flexor-pronator mass muscle defect. The presence of a flexor-pronator mass muscle defect was associated with a significantly reduced number of innings pitched (53.7 ± 74.3 vs. 304.4 ± 305.5 innings, p=0.0317), games started (5 ± 7.1 vs. 40.1 ± 49.0 games, p=0.004), and pitch count (680.5 ± 919.9 vs. 40.1 ± 49.0 pitches, p=0.022). The presence of ligament signal (26.2 ± 37.1 vs. 51.7 ± 56.5 games, p=0.036) and ulnar elevation (6.3 ± 9.3 vs. 41.2 ± 9.3 games, p=0.003) was associated with significantly fewer games started. The presence of bone edema was associated with significantly decreased pitch count (1451.2 ± 1746.8 vs. 4128.0 ± 4718.0 pitches, p=0.023). There was no association between humeral UCL elevation, flexor-pronator mass tendon, or posteromedial impingement with innings pitched, games started, or pitch count. Conclusion: The heavy demand placed on the elbow joint in professional pitching produces degenerative changes visible on MRI prior to any symptoms, as demonstrated in previous studies. Specific degenerative changes in the UCL Ligament, particularly humeral sided elevation of the UCL, are significantly associated with future injury. [Table: see text]

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Performance and Return to Sport After Hip Arthroscopic Surgery in Major League Baseball Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119825835 ◽

2019 ◽

Vol 7 (2) ◽

pp. 232596711982583 ◽

Cited By ~ 5

Author(s):

Robert A. Jack ◽

Kyle R. Sochacki ◽

Takashi Hirase ◽

Justin Vickery ◽

Patrick C. McCulloch ◽

...

Keyword(s):

Major League Baseball ◽

Statistical Significance ◽

Arthroscopic Surgery ◽

Return To Sport ◽

Control Group ◽

P Value ◽

Postoperative Performance ◽

Significant Difference ◽

Major League ◽

And Performance

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain that may lead to decreased performance in Major League Baseball (MLB) players. Purpose: To determine the (1) return-to-sport (RTS) rate in MLB players after hip arthroscopic surgery for FAI; (2) postoperative career length, innings pitched (IP) (pitchers), and plate appearances (PA) (position players); (3) preoperative and postoperative performance; and (4) postoperative performance compared with control players matched by position, age, years of experience, and performance. Study Design: Cohort study; Level of evidence, 3. Methods: MLB athletes who underwent hip arthroscopic surgery for FAI and matched controls were identified. Demographic and performance data were collected. RTS was defined as playing in at least 1 MLB game after surgery. Continuous variables of each group were compared using a 2-tailed paired-samples Student t test for normally distributed data. The chi-square test was used to analyze categorical data. The Bonferroni correction was used to control for multiple comparisons, with statistical significance defined by a P value of ≤.007. Results: A total of 50 players (57 surgeries) were analyzed (mean age, 30.4 ± 3.9 years; mean MLB experience at the time of surgery, 7.0 ± 4.6 years). Pitchers (31 surgeries; 54.4%) represented the largest proportion of players analyzed. Of these players, 42 (47 surgeries; 82.5%) were able to RTS at a mean of 8.3 ± 4.1 months. The overall 1-year MLB career survival rate of players undergoing FAI surgery was 78.9%. Players in the control group were in MLB a similar number of years (4.0 ± 2.9 years) to players who underwent surgery (3.3 ± 2.4 years) ( P > .007). There was no significant decrease in IP or PA per season after surgery ( P > .007). There was no significant difference in performance for pitchers and nonpitchers compared with matched controls after surgery ( P > .007). Conclusion: The RTS rate for MLB athletes after hip arthroscopic surgery for FAI was high. There were similar IP, PA, and career lengths postoperatively compared with preoperatively and with matched controls. There was no significant difference in performance for pitchers and nonpitchers compared with matched controls after surgery.

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Hip and Elbow Surgery in Major League Baseball Pitchers: Letter to the Editor

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119854356 ◽

2019 ◽

Vol 7 (6) ◽

pp. 232596711985435

Author(s):

J.W. Thomas Byrd

Keyword(s):

Major League Baseball ◽

Letter To The Editor ◽

Major League ◽

Elbow Surgery ◽

Baseball Pitchers

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Elbow MRI Findings Do Not Correlate With Future Placement on the Disabled List in Asymptomatic Professional Baseball Pitchers

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738117701769 ◽

2017 ◽

Vol 9 (3) ◽

pp. 222-229 ◽

Cited By ~ 7

Author(s):

Nicholas M. Gutierrez ◽

Christopher Granville ◽

Lee Kaplan ◽

Michael Baraga ◽

Jean Jose

Keyword(s):

Degenerative Changes ◽

Professional Baseball ◽

Mri Findings ◽

Elbow Injury ◽

Minor League ◽

Increased Risk ◽

Major League ◽

The Disabled ◽

The Mean ◽

Near Term

Background: Injury rates among professional baseball players may reach as high as 5.8 per 1000 encounters, with pitchers being most vulnerable on account of the excessive biomechanical load on the upper extremity during the throwing motion. Anatomically, the shoulder is the most common site of pitching-related injury, accounting for 30.7% of injuries, closely followed by the elbow at 26.3%. Characteristic valgus loading imparts a predictable constellation of stresses on the joint, including medial tension, lateral compression, and posterior medial shearing. The degenerative cohort of tissue changes that result are readily detected on magnetic resonance imaging (MRI). It is not yet known whether such findings predict future placement on the disabled list (DL) in asymptomatic Major League pitchers. Hypothesis: Abnormal soft tissue and osseous changes detected on MRI of the throwing elbow in asymptomatic professional pitchers will impart an increased risk of subsequent transfer to the DL in the season after MRI. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: The study aimed to examine a potential association between the total number of innings pitched (approximate lifetime valgus load) and the typical MRI degenerative changes, hypothesizing a rejection of the null hypothesis. A total of 26 asymptomatic professional pitchers from a single Major League Baseball (MLB) organization and its various minor league affiliates underwent MRI of their dominant elbow from 2003 to 2013 as a condition of their contract signing or trade. Twenty-one of those pitchers played at the Major League level while 5 played with the team’s minor league affiliates including both the AA and AAA levels. Asymptomatic was defined as no related stints on the DL due to elbow injury in the 2 seasons prior to MRI. A fellowship-trained musculoskeletal radiologist reevaluated the studies after being blinded to patient name, injury history, and baseball history. A second investigator collected demographic data; this included total career number of innings pitched and any subsequent DL reports for each subject while remaining blinded to the MRI results. Results: The mean age at the time of MRI was 29.6 years (range, 19-39 years). The mean number of innings pitched was 1111.7. Of the 26 pitchers, 13 had scar remodeling of the anterior bundle of the ulnar collateral ligament (UCL). Of those, 4 had partial-thickness tears of the anterior bundle of the UCL, ranging from 10% to 90% of the total thickness. Twelve had articular cartilage loss within the posteromedial margin of the ulnohumeral joint, and 12 had posteromedial olecranon marginal osteophytes. Seven pitchers had degeneration of the common extensor tendon origin, 10 had degeneration of the flexor pronator mass, 9 had insertional triceps tendinosis, 2 had enthesopathic spurs at the sublime tubercle, 3 had osteochondral intra-articular bodies, and 2 subjects had joint effusions. In the year after MRI, 6 pitchers were placed on the DL for elbow-related injuries. There was no robust correlation between any single MRI finding and subsequent transfer to the DL, and no statistically significant correlation between number of innings pitched and MRI findings, although some trends were observed for both. Conclusion: MRI findings in asymptomatic MLB pitchers were not associated with placement on the DL within the subsequent year. While a trend was observed with olecranon osteophytes and subsequent DL placement ( P = 0.07), this finding did not reach statistical significance. Furthermore, there was no robust correlation between the number of innings pitched with the presence of any of the aforementioned degenerative changes on MRI. Clinical Relevance: The characteristic structural transformation that occurs in the throwing elbow of professional pitchers is predictable and readily detectable on MRI. However, this study suggests that these changes are not predictive of near-term placement on the DL in those who are asymptomatic. Abnormal findings on MRI, even high-grade partial UCL tears, do not correlate with near-term placement on the DL, mitigating their potential negative impact on signing decisions.

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Reasons for Retirement Following Ulnar Collateral Ligament Reconstruction Among Major League Baseball Pitchers

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117745021 ◽

2017 ◽

Vol 5 (12) ◽

pp. 232596711774502 ◽

Cited By ~ 3

Author(s):

Brandon J. Erickson ◽

Junyoung Ahn ◽

Peter N. Chalmers ◽

Christopher S. Ahmad ◽

Bernard R. Bach ◽

...

Keyword(s):

Ligament Reconstruction ◽

Major League Baseball ◽

Ulnar Collateral Ligament ◽

Control Group ◽

Collateral Ligament ◽

Level Of Evidence ◽

Elbow Injury ◽

Major League ◽

History Of ◽

Ulnar Collateral Ligament Reconstruction

Background: Ulnar collateral ligament reconstruction (UCLR) has become an increasingly common procedure among Major League Baseball (MLB) pitchers. The long-term effects of this procedure on the career of an MLB pitcher are largely unknown. Purpose/Hypothesis: The purpose of this study was to determine why and when MLB pitchers who underwent UCLR during their careers retired from baseball as compared with controls. We hypothesized that pitchers who underwent UCLR are no more likely than control pitchers to retire from elbow or shoulder problems. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All MLB pitchers who underwent UCLR were identified through publicly available data. A cohort of pitchers who did not undergo UCLR were matched to pitchers with a history of UCLR, based on sex, age, draft year, and draft round. Of those who were no longer pitching in the MLB, the reason for retirement was determined. Reason for retirement and length of career following UCLR (surgical group) and index year (control group) were determined and compared through prior studies via the MLB HITS database, MLB team websites, and publicly available internet-based injury reports. Results: Overall, 153 MLB pitchers who underwent UCLR between 1974 and 2015 are currently retired. Mean ± SD time to retirement was 4.4 ± 4.7 years (range, 0-26 years) after the index year in the control group and 4.4 ± 3.5 years (range, 0-15 years) after surgery in the UCLR group ( P = .388). Patients who were status post-UCLR were significantly more likely to be released during the season (34 of 144, 23.6%) than were players who were not status post-UCLR (14 of 144, 9.7%) ( P = .002). Shoulder injury as a reason for retirement was more common in the control group than the UCLR group ( P = .011). Elbow injury as a reason for retirement was not more common in either group ( P = .379). Leg injury as a reason for retirement was more common in the control group ( P = .013). Performance as a reason for retirement was more common in the UCLR group than the control group ( P < .001). Conclusion: MLB pitchers who have undergone UCLR are no more likely to retire from shoulder or elbow injuries than are those who have not undergone UCLR. MLB career length was similar between pitchers with and without a history of UCLR.

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Effects of Ulnar Collateral Ligament Reconstruction on Pitch Selection in Major League Baseball Pitchers

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118810003 ◽

2018 ◽

Vol 6 (11) ◽

pp. 232596711881000

Author(s):

Eric E. Peterson ◽

Patrick Handwork ◽

Lonnie Soloff ◽

Mark S. Schickendantz ◽

Salvatore J. Frangiamore

Keyword(s):

Repeated Measures ◽

Performance Metrics ◽

Major League Baseball ◽

Statistical Significance ◽

Ulnar Collateral Ligament ◽

Return To Play ◽

Collateral Ligament ◽

Significant Difference ◽

Major League ◽

Before And After

Background: Ulnar collateral ligament (UCL) injuries represent one of the most common impairments to the throwing arm of professional pitchers. Return to play and postoperative performance metrics have been studied extensively, but pitch selection before and after surgery has not been evaluated. Purpose/Hypothesis: This study aimed to characterize the effects of UCL reconstruction on pitch selection in Major League Baseball (MLB) pitchers. We hypothesized that pitchers will throw fewer fastballs and a greater percentage of off-speed pitches after undergoing UCL reconstruction. Study Design: Retrospective cohort study; Level of evidence, 3. Methods: Using publicly available data, we evaluated MLB pitchers who underwent UCL reconstruction between 2003 and 2014. Pitching data were collected for the 2 seasons before UCL reconstruction as well as the first 2 seasons after reconstruction; the data consisted of the total number of pitches thrown and the percentage of fastballs, curveballs, changeups, and sliders. Repeated-measures analysis of variance was used with post hoc least significant difference pairwise t tests to evaluate for statistical significance at P < .05. Results: Overall, 87 pitchers (mean age, 28.2 ± 3.5 years) met all inclusion and exclusion criteria. There was a statistically significant difference in the total number of pitches thrown before and after surgery ( P < .01) as well as in the percentage of fastballs thrown before and after surgery ( P = .02). There was also a statistically significant increase in the use of curveballs between 1 and 2 years postoperatively (7.5% and 8.8%, respectively; P = .01). No other findings were statistically significant. Conclusion: Pitchers who underwent UCL reconstruction were shown to have a statistically significant decline in the percentage of fastballs thrown postoperatively as compared with before injury, with a compensatory trend toward an increased use of curveballs and sliders.

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