scholarly journals Differences in Shoulder Internal Rotation Strength Between Baseball Players With Ulnar Collateral Ligament Reconstruction and Healthy Controls

2022 ◽  
Vol 10 (1) ◽  
pp. 232596712110650
Author(s):  
Sean M. Kennedy ◽  
Philip Sheedy ◽  
Brooks Klein ◽  
Mason F. Gist ◽  
Joseph P. Hannon ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Ligament Reconstruction ◽  
Ulnar Collateral Ligament ◽  
Healthy Controls ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Healthy Group ◽  
Shoulder Strength ◽  
Rotation Strength ◽  
Ulnar Collateral Ligament Reconstruction

Background: Studies have indicated decreased shoulder internal rotation (IR) and external rotation (ER) strength in the throwing limb of baseball players after ulnar collateral ligament injury. There is limited evidence on the recovery of shoulder rotation strength after primary ulnar collateral ligament reconstruction (UCLR). Hypothesis: At the time of return to throwing, baseball players who underwent UCLR would demonstrate decreased IR and ER shoulder strength in the throwing arm as compared with healthy baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Male competitive high school and collegiate baseball athletes participated in this study. Athletes who underwent UCLR were compared with healthy controls who were matched by age, height, weight, and position. Bilateral isometric shoulder ER and IR strength was measured using a handheld dynamometer for all participants at the time of initial evaluation (UCLR group) and throughout the course of a season (healthy group). Independent t tests were run to calculate mean differences in ER and IR shoulder strength between the groups, with significance set at P < .05. Results: A total of 86 baseball athletes participated in this study (43 UCLR group, 43 healthy group). At the time of return to throwing (mean ± SD, 194 ± 30 days postoperatively), the 2 groups demonstrated no significant differences in nonthrowing arm ER or IR strength ( P = .143 and .994, respectively). No significant difference was found between groups for throwing arm ER strength ( P = .921); however, the UCLR group demonstrated significantly less throwing arm IR strength than the healthy group (144.2 ± 27.8 vs 157.6 ± 27.1 N; P = .023). Conclusion: The results of this study demonstrate that throwing arm rotator cuff strength may not fully recover before the initiation of a return-to-throwing program after UCLR. These data provide a potential framework for clinicians to assist in the management and exercise prescription of the baseball athlete after UCLR and before medical release and the initiation of a return-to-throwing program.

scholarly journals Timing of Return to Batting Milestones Following Ulnar Collateral Ligament Reconstruction in Professional Baseball Players

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0037
Author(s):  
Brandon Erickson ◽  
Peter Chalmers ◽  
D John ◽  
Kevin Ma ◽  
Scott Sheridan ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Ulnar Collateral Ligament ◽  
Professional Baseball ◽  
Collateral Ligament ◽  
Common Procedure ◽  
Baseball Players ◽  
Before And After ◽  
Batting Performance ◽  
The Right ◽  
Ulnar Collateral Ligament Reconstruction

Objectives: Ulnar collateral ligament reconstruction (UCLR) is a common procedure in professional baseball position players. Timing of return to hitting following UCLR is unknown. The purpose of this study was to determine the time to return to batting milestones after UCLR as well as the effect of UCLR upon batting performance in professional baseball players. The authors’ hypothesized that position players would return to batting in an in-season game prior to fielding in an in-season game and hitting performance would remain unchanged following UCLR Methods: All professional position players who underwent UCLR between 2010-2018 were included. Time to batting milestones following UCLR was analyzed. Batting performance before and after UCLR was compared and analyzed. Results: Overall, 141 UCLRs (96% performed on the dominant arm) in 137 position players were included (86% minor leaguers). Four players underwent revision, all within one year of the primary UCLR. With regard to position, catchers and shortstops were over-represented. With regard to batting side, 57% batted from the right and 12% batted as switch-hitters, and thus 76% of surgeries were on the lead arm. While 91% of players were able to return to any throwing at all, there was a progressive gradual decline during the rehabilitation progress such that 77% were able to return to hitting in a real game and 75% were able to return to fielding in a real game. The first dry swing occurred at 150±49 days after surgery, first batting practice occurred at 195±58 days after surgery, and first hitting in a real game occurred at 323±92 days after surgery. However, players generally saw a decrease in their utilization, with fewer at bats (p<0.001) translating into fewer hits (p<0.001) and runs (p<0.001). Conclusion: Professional position players begin swinging at 150 days following UCLR while they do not hit batting practice until 195 days and do not hit in a real game until 323 days following UCLR. Players saw a decrease in hitting utilization following UCLR. [Figure: see text]

scholarly journals Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0008
Author(s):  
Timothy B. Griffith ◽  
Christopher S. Ahmad ◽  
Michael G. Ciccotti ◽  
John D’Angelo ◽  
Joshua S. Dines ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Professional Baseball ◽  
Reconstruction Technique ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Elbow Surgery ◽  
Baseball Pitchers ◽  
Ulnar Collateral Ligament Reconstruction

Objectives: Professional baseball pitchers are at high risk for tears of the ulnar collateral ligament (UCL) of the elbow, often requiring subsequent surgical reconstruction. Despite acceptable published return to play outcomes, multiple techniques and graft types have been described. There is a paucity of clinical data in the current literature comparing UCL reconstruction surgical technique and graft type. Even less is known about the risks for subsequent injury, surgery, or revision UCL reconstruction. Accordingly, this study compares UCL reconstruction outcomes based on tunnel configuration and graft type. Methods: Following approval from our institutional review board and Major League Baseball (MLB), 566 professional baseball pitchers who underwent UCL reconstruction between 2010 and 2014 were identified and included. The following patient demographics were analyzed: age, pitching role (starter vs. reliever), level of play (MLB vs. Minor League Baseball [MiLB]), and throwing side dominance. Surgical factors analyzed included reconstruction technique (Docking vs. Modified Jobe), graft type (palmaris longus autograft vs. gracilis autograft), and concomitant procedures. Primary outcome measures consisted of: the ability to return to play at any level (RTP), to return to the same level of play (RSL), the time to return, subsequent elbow injuries, and the need for subsequent or revision elbow surgery. The impact of the patient and surgical factors on outcomes were analyzed using multivariate linear and logistic regression modeling. Results: The overall RTP was 79.9% and RSL was 71.2%. There were no significant differences in the time to RTP or RSL based on reconstruction technique or graft type. RTP rates were similar for the Docking vs. Modified Jobe techniques (80.1% vs. 82.4%; p=0.537) and for the two primary graft types (83.1% for palmaris vs. 80.7% for gracilis; p=0.596). The risk of subsequent elbow surgery was 10.5% for the Docking Technique vs. 14.8% for the Modified Jobe (p=0.203); and the risk for subsequent UCL revision reconstruction surgery was 2.9% vs. 6.2% for the Docking vs. Modified Jobe Techniques, respectively (p=0.128). Significant trends towards an increasing use of palmaris autograft (p=0.023) and the docking technique (p=0.006) were observed. MLB pitchers were more likely than MiLB pitchers to RTP (p<0.001) and to RSL (p<0.001), but they required a longer time to return (mean difference 35 days; p=0.039), had a higher likelihood of subsequent elbow (OR 3.58; 95% CI 2.055 to 6.231; p<0.001) and forearm injuries (OR 5.695; 95% CI 1.99 to 16.302; p=0.004), but not subsequent elbow surgery. No specific variables were noted to be predictive of subsequent elbow or revision surgery in the multivariate analysis. Conclusion: Surgical outcomes in professional baseball players are not significantly influenced by ulnar collateral ligament reconstruction technique or graft type usage. Major League players are more likely to RTP and RSL, but they have a higher frequency of subsequent elbow and forearm injuries. Both the Docking Technique and palmaris autograft are increasing in popularity amongst surgeons treating professional baseball players.

scholarly journals The impact of distance and the crow hop on medial elbow stress during an interval throwing program

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0034
Author(s):  
Austin Cross ◽  
Grace Smith ◽  
Caleb Gulledge ◽  
Dylan Koolmees ◽  
Vasilios Moutzouros ◽  
...  
Keyword(s):  
High School ◽  
Ligament Reconstruction ◽  
Ulnar Collateral Ligament ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Standard Interval ◽  
Rehabilitation Programs ◽  
Ball Velocity ◽  
The Impact ◽  
Ulnar Collateral Ligament Reconstruction

Objectives: Rehabilitation programs following ulnar collateral ligament reconstruction include an interval throwing program in order to gradually increase stress and prevent excessive elbow valgus loads. These programs often instruct players to use the crow hop, even at short distances, in order to reduce stress on the reconstructed ligament. The purpose of the study was to evaluate the impact of the crow hop on medial elbow stress at various distances of an interval throwing program. Methods: High school and college-aged baseball players were recruited for this study. Players threw at distances of 30, 45, 60, 90, 120, 150, and 180 feet. At each distance, participants made 3 throws while using a crow hop and 3 throws without using a crow hop with the instruction to throw on an arc. A wearable device recorded elbow torque, arm slot, arm speed, and shoulder rotation. Ball velocity was measured using radar gun. Results: A total of 20 players participated in this study. Overall elbow torque at each distance was 12.9, 20.5, 26.3, 31.9, 34.7, 36.1, and 37.1 Nm, respectively. There was no difference in elbow stress for throws with a crow hop compared to throws without a crow hop at any distance of throwing (p > 0.05). There was no difference in elbow torque for throws at 150 feet compared to 120 feet (p = 0.10) or 150 feet compared to 180 feet (p = 0.83); however, there were significant increases in elbow torque between every other throwing distance (p < 0.05). Conclusions: Medial elbow torque significantly increases at greater throwing distances of a standard interval throwing program, although the effect becomes less pronounced at longer distances as players maximize effort. The crow hop does not affect medial elbow torque at any distance of throwing.

Long-term Outcomes After Ulnar Collateral Ligament Reconstruction in Competitive Baseball Players

2014 ◽  
Vol 42 (6) ◽  
pp. 1333-1342 ◽  
Author(s):  
Daryl C. Osbahr ◽  
E. Lyle Cain ◽  
B. Todd Raines ◽  
Dave Fortenbaugh ◽  
Jeffrey R. Dugas ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Ulnar Collateral Ligament ◽  
Long Term Outcomes ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Ulnar Collateral Ligament Reconstruction
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