Comparison of Biomechanical Factors Before and After UCL Surgery in Baseball Athletes: A Systematic Review With Meta-analysis

Background: Ulnar collateral ligament (UCL) reconstruction (UCLR) and repair (UCLr) are the gold standards in the treatment of UCL injuries. Although return-to-play timelines after UCLR have been established, pitching biomechanical variables are speculated to change after surgical intervention. Purpose/Hypothesis: To synthesize the literature and investigate changes in pitching biomechanics in baseball pitchers after UCLR or UCLr. We hypothesized that differences in pitching biomechanics would be observed for both intra- and interpatient comparisons. Study Design: Systematic review; Level of evidence, 3. Methods: We searched 4 electronic databases (PubMed, Web of Science, SCOPUS, and Sports Medicine & Education Index) from inception to February 2020. Data extracted included author and year of publication, study design, sample size, study population, and primary outcome variables. Meta-analysis was performed to produce random pooled effect sizes (▵). Results: We identified 1010 original articles for inclusion. A total of 5 studies were included in the systematic review; of these, 3 studies were included in the meta-analysis. No differences were found in shoulder range of motion (ROM) between post-UCLR and control pitchers (dominant arm external rotation ▵, 0.13°; 95% CI, –0.15° to 4.02°; P = .36); dominant arm internal rotation ▵, –0.20°; 95% CI, –0.74° to 0.35°; P = .48). Mean fastball velocity as well as pitches thrown decreased after UCLR in professional pitchers. Significant differences in elbow extension, elbow extension velocity, and shoulder internal rotation velocity were found among amateur pitchers. Conclusion: The results of this systematic review and meta-analysis show that limited differences exist in pitchers before and after UCLR as well as in post-UCLR pitchers and healthy, age-matched controls. UCLR may influence throwing velocity, but it had no effect on either the throwing biomechanics or theROM of baseball pitchers. Although trends appear to be forming, further evidence is needed to understand the effect of UCLR on throwing biomechanics.

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Systematic Review and Meta-Analysis on Proximal-to-Distal Sequencing in Team Handball: Prospects for Talent Detection?

Journal of Human Kinetics ◽

10.2478/hukin-2018-0002 ◽

2018 ◽

Vol 63 (1) ◽

pp. 9-21 ◽

Cited By ~ 3

Author(s):

Ben Serrien ◽

Jean-Pierre Baeyens

Keyword(s):

Systematic Review ◽

Internal Rotation ◽

Meta Analysis ◽

Small Sample ◽

Trunk Rotation ◽

Elbow Extension ◽

Trunk Flexion ◽

Team Handball ◽

Angular Velocities ◽

Pelvis Rotation

Abstract The proximal-to-distal sequence has previously been discussed in the light of performance and injury prevention. Sports biomechanics literature in general, and in team handball in specific, has claimed to be of importance to inform coaches on what constitutes a ‘good’ technical performance. However, hitherto no prospective studies exist on how this information may be used and this may in part be due to the general small sample sizes. We therefore performed a systematic review and meta-analysis of proximal-to-distal sequencing in team handball throwing motions. A total of fourteen articles were included in the systematic review. Meta-analyses were performed for the timing of maximal angles and angular velocities as well as initiation of joint angular velocities in the penalty throw, the standing throw with run-up and the jump shot of experienced team handball players. For the initiation of joint angular velocities, the overall sequence was estimated to start with pelvis rotation, followed by trunk rotation, trunk flexion, shoulder internal rotation and elbow extension. For maximal velocities, the sequence started with pelvis rotation, followed by trunk rotation, trunk flexion, elbow extension, and shoulder internal rotation (post ball release). The obtained results were discussed in the light of talent identification purposes. Limitations to individual study methodology and of the present meta-analysis were also discussed. Much more research will be necessary, but at the very least, this review can provide a starting point for evidence-based discussions between movement scientists and team handball coaches to include proximal-to-distal sequencing as a measure of coordination to gauge early onset of talent.

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Glenohumeral Rotational Motion and Strength and Baseball Pitching Biomechanics

Journal of Athletic Training ◽

10.4085/1062-6050-47.3.10 ◽

2012 ◽

Vol 47 (3) ◽

pp. 247-256 ◽

Cited By ~ 22

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 < .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.

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Serratus Anterior Stretch: A Novel Intervention and Its Effect on the Shoulder Range of Motion

Journal of Sport Rehabilitation ◽

10.1123/jsr.2020-0121 ◽

2020 ◽

pp. 1-4

Author(s):

Keramat Ullah Keramat ◽

Mohammad Naveed Babar

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

External Rotation ◽

Scapular Dyskinesis ◽

Serratus Anterior ◽

Shoulder Dysfunction ◽

Shoulder Range Of Motion ◽

Before And After ◽

Movement Screening ◽

Shoulder Range

Context: Serratus anterior tightness is associated with scapular dyskinesis and overall shoulder dysfunction, which affects the range of motion. The most effective intervention to stretch the serratus anterior is unknown. Objective: To evaluate the effect of a therapist-administered novel serratus anterior stretch (SAS) on shoulder range of motion. Method: This study recruited 30 healthy subjects of age 21.20 (1.69) years, height 1.65 (0.11) m, and weight 60.90 (10.36) kg in equal ratio of males and females who scored 1 or 2 on the shoulder mobility test of functional movement screening. A single intervention of a novel SAS was applied to the shoulder. Outcome variables before and after the SAS included the following: shoulder ROM (flexion, abduction, internal rotation, and external rotation) and functional movements of reaching up behind the back and reaching down behind the neck. Results: A paired t test was used to analyze the data. Following the acute SAS intervention, all shoulder ROM improved significantly (P < .000). The change in internal rotation was 6.00° (7.47°), external rotation was 5.66° (9.35°), abduction was 13.50° (11.82°), flexion was 20° (13.33°), reaching up behind the back was 5.10 (2.21) cm, and reaching down behind the neck was 5.41 (2.89) cm. The most marked improvement was in reaching up behind the back (24.48%) and reaching down behind the neck (22.78%). A very large effect size (>1) was observed across most of the variables. Conclusion: An acute SAS intervention improves shoulder mobility in healthy individuals. It is recommended for the trial on the prevention and rehabilitation of shoulder pathologies with restriction in shoulder mobility.

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Retroversion of the Humerus in the Throwing Shoulder of College Baseball Pitchers

The American Journal of Sports Medicine ◽

10.1177/03635465020300030801 ◽

2002 ◽

Vol 30 (3) ◽

pp. 347-353 ◽

Cited By ~ 217

Author(s):

Daryl C. Osbahr ◽

David L. Cannon ◽

Kevin P. Speer

Keyword(s):

Soft Tissue ◽

Internal Rotation ◽

Study Design ◽

External Rotation ◽

Anatomic Study ◽

Significant Difference ◽

Male College ◽

Overhead Throwing ◽

College Baseball ◽

Baseball Pitchers

Background Increased external rotation and decreased internal rotation have been noted to occur progressively in the throwing shoulder of baseball pitchers. Hypothesis Proximal remodeling of the humerus contributes to the rotational asymmetry between shoulders in pitchers. Study Design Descriptive anatomic study. Methods Both shoulders of 19 male college baseball pitchers were evaluated and retroversion of the humerus calculated by using the technique of Söderlund et al. Measurements were taken of passive glenohumeral external rotation at 0° and 90° of abduction and internal rotation at 90° of abduction under a 3.5-kg load. Subjects completed a questionnaire on the amount and duration of overhead throwing performed during the ages 8 through 16 years. Results All of the subjects had greater external rotation at 0° and 90° of abduction, decreased internal rotation at 90° of abduction, and greater retroversion of the humerus in their dominant compared with nondominant shoulders. A significant difference was found between dominant and nondominant external rotation at 0° and 90° of abduction, internal rotation at 90° of abduction, and retroversion of the humerus. In the dominant arm, there was a significant correlation between retroversion of the humerus and external rotation at 0° and 90° of abduction. There was also a significant correlation between the side-to-side difference in retroversion of the humerus compared with the side-to-side difference in external rotation at 90° of abduction. Conclusions Rotational changes in the throwing shoulder are due to bony as well as soft tissue adaptations.

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Preseason shoulder range of motion screening and in-season risk of shoulder and elbow injuries in overhead athletes: systematic review and meta-analysis

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-100698 ◽

2020 ◽

Vol 54 (17) ◽

pp. 1019-1027 ◽

Cited By ~ 1

Author(s):

Federico Pozzi ◽

Hillary A Plummer ◽

Ellen Shanley ◽

Charles A Thigpen ◽

Chase Bauer ◽

...

Keyword(s):

Systematic Review ◽

Range Of Motion ◽

External Rotation ◽

Meta Analysis ◽

Professional Baseball ◽

Overhead Athletes ◽

Shoulder Range Of Motion ◽

Elbow Injuries ◽

Shoulder External Rotation ◽

Shoulder Range

ObjectiveTo characterise whether preseason screening of shoulder range of motion (ROM) is associated with the risk of shoulder and elbow injuries in overhead athletes.DesignSystematic review and meta-analysis.Data sourcesSix electronic databases up to 22 September 2018.Eligibility criteriaInclusion criteria were (1) overhead athletes from Olympic or college sports, (2) preseason measures of shoulder ROM, (3) tracked in-season injuries at the shoulder and elbow, and (4) prospective cohort design. Exclusion criteria were (1) included contact injuries, (2) lower extremity, spine and hand injuries, and (3) full report not published in English.ResultsFifteen studies were identified, and they included 3314 overhead athletes (baseball (74.6%), softball (3.1%), handball (16.1%), tennis (2.0%), volleyball (2.0%) and swimming (2.2%)). Female athletes are unrepresented (12% of the overall sample). Study quality ranged from 11 to 18 points on a modified Downs and Black checklist (maximum score 21, better quality). In one study, swimmers with low (<93°) or high (>100°) shoulder external rotation were at higher risk of injuries. Using data pooled from three studies of professional baseball pitchers, we showed in the meta-analysis that shoulder external rotation insufficiency (throwing arm <5° greater than the non-throwing arm) was associated with injury (odds ratio=1.90, 95% confidence interval 1.24 to 2.92, p<0.01).ConclusionPreseason screening of shoulder external rotation ROM may identify professional baseball pitchers and swimmers at risk of injury. Shoulder ROM screening may not be effective to identify handball, softball, volleyball and tennis players at risk of injuries. The results of this systematic review and meta-analysis should be interpreted with caution due to the limited number of studies and their high degree of heterogeneity.PROSPERO registration numberCRD42017072895.

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Effectiveness of arthroscopic management of idiopathic shoulder stiffness: A meta-analysis

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200267 ◽

2021 ◽

pp. 1-8

Author(s):

Ya-Dong Wang ◽

Yu-Xiang Ming ◽

Yong-Hua Pang ◽

Wei-Nan Chen ◽

Xu-Hua Zong ◽

...

Keyword(s):

Range Of Motion ◽

External Rotation ◽

Meta Analysis ◽

Eligibility Criteria ◽

Shoulder Stiffness ◽

Capsular Release ◽

Shoulder Range Of Motion ◽

Arthroscopic Capsular Release ◽

Shoulder Range

BACKGROUND: Persisting shoulder stiffness adversely affects quality of life by causing pain and motion restrictions especially in patients with diabetes. OBJECTIVE: The aim of this study was to evaluate the outcomes of arthroscopic capsular release in patients with idiopathic shoulder stiffness. METHOD: A literature search was conducted in electronic databases and studies were selected by following precise eligibility criteria. Random-effects meta-analyses were performed to estimate the changes at latest follow-up in scores of the Constant, American Shoulder and Elbow Surgeons (ASES), and University of California at Los Angelis (UCLA) scales, Visual Analogue Scale (VAS), and shoulder range of motion. RESULTS: Nineteen studies were included. The follow-up duration was 42 months [95% confidence interval (CI): 32, 51]. Improvements in scores of the Constant, ASES, UCLA scales, and VAS were 48.3 [95% CI: 38.0, 58.6], 44.6 [95% CI: 24.6, 64.6], 19.3 [95% CI: 16.6, 22.0], and -6.1 [95% CI: -6.9, -5.4] respectively (P< 0.05 all). Improvements in the shoulder range of motion were: abduction 82.0 [95% CI: 65.0, 98.9]; forward flexion 75.9 [95% CI: 59.7, 92.1]; external rotation 43.2 [95% CI: 37.5, 49.0]; and internal rotation 25.4 [95% CI: 15.2, 35.5] degrees; P< 0.05 all). CONCLUSION: Arthroscopic capsular release effectively improves shoulder function in patients with idiopathic shoulder stiffness.

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How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa230 ◽

2020 ◽

Author(s):

Peter J Gates ◽

Rae-Anne Hardie ◽

Magdalena Z Raban ◽

Ling Li ◽

Johanna I Westbrook

Keyword(s):

Systematic Review ◽

Medication Error ◽

Medication Errors ◽

Meta Analysis ◽

Error Rates ◽

Prescribing Error ◽

Before And After ◽

Actual Harm ◽

Computer Based ◽

Wide Scale

Abstract Objective To conduct a systematic review and meta-analysis to assess: 1) changes in medication error rates and associated patient harm following electronic medication system (EMS) implementation; and 2) evidence of system-related medication errors facilitated by the use of an EMS. Materials and Methods We searched Medline, Scopus, Embase, and CINAHL for studies published between January 2005 and March 2019, comparing medication errors rates with or without assessments of related harm (actual or potential) before and after EMS implementation. EMS was defined as a computer-based system enabling the prescribing, supply, and/or administration of medicines. Study quality was assessed. Results There was substantial heterogeneity in outcomes of the 18 included studies. Only 2 were strong quality. Meta-analysis of 5 studies reporting change in actual harm post-EMS showed no reduced risk (RR: 1.22, 95% CI: 0.18–8.38, P = .8) and meta-analysis of 3 studies reporting change in administration errors found a significant reduction in error rates (RR: 0.77, 95% CI: 0.72–0.83, P = .004). Of 10 studies of prescribing error rates, 9 reported a reduction but variable denominators precluded meta-analysis. Twelve studies provided specific examples of system-related medication errors; 5 quantified their occurrence. Discussion and Conclusion Despite the wide-scale adoption of EMS in hospitals around the world, the quality of evidence about their effectiveness in medication error and associated harm reduction is variable. Some confidence can be placed in the ability of systems to reduce prescribing error rates. However, much is still unknown about mechanisms which may be most effective in improving medication safety and design features which facilitate new error risks.

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SARS-CoV-2 genome and antibodies in breastmilk: a systematic review and meta-analysis

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-321074 ◽

2021 ◽

pp. fetalneonatal-2020-321074

Author(s):

Faith Zhu ◽

Carlos Zozaya ◽

Qi Zhou ◽

Charmaine De Castro ◽

Prakesh S Shah

Keyword(s):

Systematic Review ◽

Outcome Measures ◽

Study Design ◽

Web Of Science ◽

Meta Analysis ◽

Respiratory Support ◽

Common Finding ◽

Rt Pcr

ObjectiveTo systematically review and meta-analyse the rate of SARS-CoV-2 genome identification and the presence of SARS-CoV-2 antibodies in breastmilk of mothers with COVID-19.DesignA systematic review of studies published between January 2019 and October 2020 without study design or language restrictions.SettingData sourced from Ovid Embase Classic+Embase, PubMed, Web of Science, Scopus, relevant bibliographies and the John Hopkins University COVID-19 database.PatientsMothers with confirmed COVID-19 and breastmilk tested for SARS-CoV-2 by RT-PCR or for anti-SARS-CoV-2 antibodies.Main outcome measuresPresence of SARS-CoV-2 genome and antibodies in breastmilk.ResultsWe included 50 articles. Twelve out of 183 women from 48 studies were positive for SARS-CoV-2 genome in their breastmilk (pooled proportion 5% (95% CI 2% to 15%; I2=48%)). Six infants (50%) of these 12 mothers tested positive for SARS-CoV-2, with one requiring respiratory support. Sixty-one out of 89 women from 10 studies had anti-SARS-CoV-2 antibody in their breastmilk (pooled proportion 83% (95% CI 32% to 98%; I2=88%)). The predominant antibody detected was IgA.ConclusionsSARS-CoV-2 genome presence in breastmilk is uncommon and is associated with mild symptoms in infants. Anti-SARS-CoV-2 antibodies may be a more common finding. Considering the low proportion of SARS-CoV-2 genome detected in breastmilk and its lower virulence, mothers with COVID-19 should be supported to breastfeed.

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