Arm Injuries Research Articles

The curveball as a risk factor for injury: a systematic review.

Context:The curveball is regarded by many as a potential risk factor for injury in youth baseball pitchers.Objective:To critically evaluate the scientific evidence regarding the curveball and its impact on pitching biomechanics and the overall risk of arm injuries in baseball pitchers.Study Type:Systematic review.Level of Evidence:Level 3.Data Sources:Ovid MEDLINE from 1946 to 2012.Study Selection:Ten biomechanical studies on kinematic or electromyographic analysis of pitching a curveball were included, as well as 5 epidemiologic studies that assessed pain or injury incidence in pitchers throwing the curveball.Data Extraction:When possible, demographic, methodology, kinetics, and kinematics variables and pain/injury incidence were compiled.Results:Two biomechanical studies found greater horizontal adduction of the shoulder at ball release and less shoulder internal torque during the curveball pitching motion. Two studies demonstrated less proximal force and less torque at the elbow as the arm accelerated when throwing a curveball compared with a fastball, as well as greater supination of the forearm and less wrist extension. Electromyographic data suggested increased activity of extensor and supinator muscles for curveballs. No studies found increased force or torque about the elbow or shoulder. Three epidemiologic studies showed no significant association between pitching a curveball and upper extremity pain or injury. One retrospective epidemiologic study reported a 52% increase in shoulder pain in pitchers throwing a curveball, although this may have been due to confounders.Conclusion:Despite much debate in the baseball community about the curveball’s safety in youth pitchers, limited biomechanical and most epidemiologic data do not indicate an increased risk of injury when compared with the fastball.

Factors influencing ball-player impact probability in youth baseball.

Background:Altering the weight of baseballs for youth play has been studied out of concern for player safety. Research has shown that decreasing the weight of baseballs may limit the severity of both chronic arm and collision injuries. Unfortunately, reducing the weight of the ball also increases its exit velocity, leaving pitchers and nonpitchers with less time to defend themselves. The purpose of this study was to examine impact probability for pitchers and nonpitchers.Hypothesis:Reducing the available time to respond by 10% (expected from reducing ball weight from 142 g to 113 g) would increase impact probability for pitchers and nonpitchers, and players’ mean simple response time would be a primary predictor of impact probability for all participants.Study Design:Nineteen subjects between the ages of 9 and 13 years performed 3 experiments in a controlled laboratory setting: a simple response time test, an avoidance response time test, and a pitching response time test.Methods:Each subject performed these tests in order. The simple reaction time test tested the subjects’ mean simple response time, the avoidance reaction time test tested the subjects’ ability to avoid a simulated batted ball as a fielder, and the pitching reaction time test tested the subjects’ ability to avoid a simulated batted ball as a pitcher.Results:Reducing the weight of a standard baseball from 142 g to 113 g led to a less than 5% increase in impact probability for nonpitchers. However, the results indicate that the impact probability for pitchers could increase by more than 25%.Conclusion:Pitching may greatly increase the amount of time needed to react and defend oneself from a batted ball.Clinical Relevance:Impact injuries to youth baseball players may increase if a 113-g ball is used.

Core stabilisation reduces compensatory movement patterns in patients with injury to the arm: a randomized controlled trial

Objective: To investigate the effects of adding core stabilisation exercises to traditional rehabilitation in patients with arm injuries. Design: Randomized controlled trial. Setting: Outpatient clinic. Subjects: Twenty-seven patients with elbow and wrist injuries were randomized to a stabilisation or control group. Interventions: The stabilisation group received core stabilisation training and traditional arm rehabilitation and the control group received traditional arm rehabilitation alone for three days/week for six weeks. Main measures: Pre- and post-treatment assessments comprising an analysis of compensatory movement patterns and trunk muscle strength as well as functional measurements of the arm, including pain, range of motion, disabilities of arm, shoulder and hand questionnaire and endurance and fatigue severity were performed. Results: Inter-group comparison revealed significantly greater improvements in the degree of mean change (SD) in total compensation (in degrees) of the head (–14.47 (21.65)) and trunk (–5.56 (5.71)) as well as total compensation (–50.02 (48.62)) for the stabilisation group than for the control group (p < 0.05). Increase in trunk muscle strength (2.43 (3.46)) was statistically significant in the stabilisation group compared with the control group. No significant differences were found for functional measures, including pain, range of motion, disabilities of arm, shoulder and hand or endurance and fatigue severity between the groups, although trends towards greater improvement were observed in the stabilisation group. Conclusions: Adding core stabilisation exercises to traditional arm rehabilitation for patients with traumatic arm injury reduces compensatory movement patterns. Trends towards better functional outcomes in the stabilisation group are worth testing in a large-scale trial.

Costs and outcome for serious hand and arm injuries during the first year after trauma – a prospective study

BackgroundTo study costs and outcome for serious hand and arm injuries during the first year after the trauma.MethodsIn patients with a Hand Injury Severity Score (HISS) > 50, DASH and EQ-5D scores as well as factors related to costs within the health care sector, costs due to lost production and total costs were evaluated. Cox-regression analysis stratifying for mechanism of injury was used to analyse return to work.ResultsThe majority of the 45 included patients (median 42 years 16–64) were men with severe (n = 9) or major (n = 36) injuries with different type of injuries (amputations n = 13; complex injuries n = 18; major nerve injuries/full house n = 13; burn injury n = 1). DASH and EQ-5D decreased and increased, respectively, significantly over time during one year. Total costs (+34%) and costs of lost production were highest for persons injured at work. Factors associated with higher health care costs were age >50 years (+52%), injury at work (+40%) and partial labour market activity (+66%). Costs of lost production had a significant role in total costs of injury. Patients with major injuries had longer duration of sick leave. Patients with severe injuries were more likely to return to work [(RR 3.76 (95% CI 1.38-10.22) from Cox regression, controlling for age, gender and presence of nerve injury].ConclusionsDespite the fact that work environments have constantly improved over the last decades, we found that hand injuries at work were most costly both in terms of health care and costs of lost production, although the severity, i.e. HISS, did not differ from injuries occurring at home or during leisure.

Factors Affecting Supination Strength Following a Distal Biceps Rupture

14 FACTORS AFFECTING SUPINATION STRENGTH FOLLOWING A DISTAL BICEPS RUPTURE Christopher C. Schmidt, MD, Brandon Brown, Prasad J. Sawardeker, MD, Martin deGravelle, Mark C. Miller, PhD, Allegheny General Hospital, Pittsburgh and the University of Pittsburgh, Pittsburgh, Pennsylvania, USA Introduction:Advocates for the non-operative treatment of distal biceps ruptures emphasize the limited functional loss. Isometric supination loss of 26%-40% has been reported in a neutral forearm testing position. The amount of strength loss in other forearm positions, i.e. pronation and/or supination, has not been published to date. Biomechanical studies have demonstrated that the native biceps moment arm, the ability of the biceps to generate a torque, changes significantly with forearm position. The purpose of this study is to quantify the effects of a complete distal biceps rupture compared to the uninjured limb in 60 of supination, (0 ) neutral and 60 of pronation. We hypothesize that supination strength loss will be significant, vary with forearm position, and be independent of arm dominance. Furthermore, strength will positively correlate with time from injury and negatively correlate with high perception of pain and low reported disability. Methods: Twentythree consecutive adult males with an average age of 50 6 11 years suffered a complete distal biceps avulsion. There were 12 dominant and 11 non-dominant arm injuries. The patients underwent prospective isometric supination strength testing using a custom-made torque-measuring device and a previously published protocol. The average time of injury to evaluation was 518 days (median of 24), ranging from 4 days to 30 years. Peak torque was recorded for each arm at three forearm positions: 60 of supination, (0 ) neutral and 60 of pronation. Strength loss was expressed as the ratio of the injured side to the uninjured side. Pain level was assessed using a numeric visual analog pain scale (VAPS), ranging from 0-10. Functional outcomes were measured using the DASH questionnaire. Strength data was compared to arm dominance, test angle, and biceps injury using a 3-way ANOVA, while relationships to strength were analyzed using linear regression (significance set at p1⁄40.05). Results: Peak torque values in the injured arm were statistically less than the uninjured arm (p 0.002), but not in supination (p1⁄40.157). The average VAPS score was 5 6 2 and DASH score was 38 6 21. Strength was not related to VAPS or DASH scores at any test angle (p>0.105). Time from injury and the VAPS score were negatively correlated (p1⁄40.029), while time from injury and DASH were not (p1⁄40.244). Discussion: The study clearly shows that a patient can expect to lose 60% of their supination strength in neutral. The loss of supination strength is independent of forearm position. However, patients were strongest in pronation and weakest in supination with or without an intact distal biceps. This finding maybe due in part to the co-contraction of the brachioradialis muscle; which acts as a supinator of a pronated forearm, and a pronator of a supinated forearm. Surprisingly, perceived disability and pain associated with the injury were not indicative of reduced strength. However the strength improved over time in pronation and neutral, but not in supination. We speculate that supination strength from pronation to neutral can improve as one strengthens the brachioradialis, but that strength deficits from neutral to supination will be more difficult to overcome.

White Paper: functionality and efficacy of wrist protectors in snowboarding—towards a harmonized international standard

The wrist is the most frequently injured body region among snowboarders. Studies have shown that the risk of sustaining a wrist injury can be reduced by wearing wrist protection. Currently, there are a wide variety of wrist protection products for snowboarding on the market that offer a range of protective features. However, there are no minimum performance standards for snowboarding wrist protectors worldwide. The International Society for Skiing Safety convened a task force to develop a White Paper to evaluate the importance and necessity of a minimum performance for all wrist protectors used in snowboarding. The White Paper outlines the need for a general framework for a harmonized international standard and reviews the existing evidence. Therefore, this White Paper may serve as a common base for future discussions. The broader goal of developing and implementing such a standard is to reduce the incidence and the severity of wrist injuries in snowboarding without increasing the risk of adverse events, such as upper arm or shoulder injury. The European standard for inline skating wrist protectors (EN 14120) can serve as a starting point for efforts related to a standard for snowboard wrist protectors, but certain modifications to the standard would be required. It is hypothesized that implementation of a snowboarding wrist protector standard would result in fewer and less severe wrist injuries in the sport and could translate into more riding days for healthy snowboarders and significant health-care costs savings.

Professional Pitchers with GIRD Display Greater Dominant Humeral Retrotorsion than Pitchers with Normal ROM

Objectives:Glenohumeral internal rotation deficit (GIRD) in the dominant shoulder of a throwing athlete is a previously recognized phenomenon which has been associated with upper extremity injury. The relationship between GIRD and humeral torsion has not clearly been elucidated. The purpose of this study was to compare humeral torsion between professional pitchers presenting with GIRD and those with normal ROM.Methods:Humeral torsion and shoulder range of motion (ROM) was measured in 128 professional pitchers prior to spring training from 2009-2012. Shoulder external (ER) and internal (IR) ROM was assessed in 90º of abduction with the scapula stabilized. Humeral torsion was measured via ultrasound using previously described and validated methods. GIRD was defined as the loss of internal rotation > 15º with a concomitant loss of 10º total arc of motion. The side-to-side difference in HT was calculated by subtracting the dominant arm (D) HT from the non-dominant (ND) HT. A mixed model ANOVA(side X GIRD) were used to compare pitchers dominant and non-dominant HT between pitchers with GIRD to those without GIRD. Independent t-tests were used to compare the side to side difference in HT between pitchers with GIRD and those without (α=0.05).Results:Pitchers with GIRD displayed alterations in ROM (ER=131.8±14.3, IR= 29.1±10.1, Total Arc=160.9±15.5 ) compared with those with normal ROM (ER=132.0±14.2 , IR= 40.5±11.3 , Total Arc= 172.5 ±16.2 ). Pitchers with GIRD displayed significantly less humeral torsion (i.e. greater retro torsion) in their dominant arm compared to those without (GIRD=4.4±12.0º, Normal=10.4±11.6º, P=0.002). Pitchers with GIRD also displayed a greater side to side difference in humeral retro torsion (GIRD=19.5±11.9 compared with 12.4±12.4º, P=0.001). There was no difference in non-dominant humeral torsion in pitchers with and without GIRD (P>0.05).Conclusion:Professional pitchers who display deficits in total arc of motion on the internal rotation side greater than 15º tend to also have greater dominant humeral retro torsion and greater side to side differences. An adaptive increase in humeral retro torsion in the dominant arm due to repetitive throwing may limit internal rotation in the follow through phase of the throwing motion. This, in turn, may increases forces on the posterior soft tissues of the glenohumeral joint leading to the development of GIRD. Given that deficits in total arc of motion and internal rotation are associated with increased arm injury risk future studies should examine the amount of humeral torsion that predisposes a shoulder to develop GIRD.

An Autopsy Based Study of Pattern of Firearm Injuries in Karachi, Pakistan

To assess the pattern of fire arm injuries in Karachi amongst medico legal deaths autopsied at all the three mortuaries of Karachi that is, Civil Hospital, Abbasi Shaheed Hospital and Jinnah Post Graduate Medical Centre. It is a descriptive form of study which involves deaths due to firearm injuries and underwent autopsy in three major medico legal centers of Karachi that is Civil Hospital, Abbasi Shaheed Hospital and Jinnah Post Graduate Medical Centre from 1st January 2011 to 31st December 2012. Variables include basic demographics, site and frequency of firearm injuries and also the manner of death. In our study out of 2006 autopsies performed 47.05% (n=944) medico legal deaths were due to fire arms. Out of them 98.62% (n=931) were homicidal and v1.37% (n=13) were suicidal. The age group most affected was of 16-30 years 50.52% (n=477). 65.78% (n=621) had unknown identity. Male to female ratio was 18:1 (M=896 and F=48). The most commonly targeted parts of the body in order of frequency were head 44.17% (n=417), chest 28.49% (n=269), abdomen 7.83% (n=74), head and chest in 3.49% (n=33) (and head chest and abdomen in 4.66% (n=44) cases. The study concluded that homicidal firearm injuries contributed as one of the foremost cause of death. Majority of the victims were identified and were males. The age group of 16-30 years was most affected. The most commonly targeted body part was head.

Direct and collateral effects of staff-worn protective equipment on injury prevention from child aggression

Objective: The present study measured arm and other body injuries to classroom staff that were caused by a student who had developmental disabilities and treatment-resistant aggression.Methods: Following a baseline (no equipment) phase, staff wore protective equipment on their arms but not on other areas of their body.Results: The frequency of self-reported arm injuries increased with protective equipment, but injury severity decreased. Wearing the protective equipment was also associated with more injuries to other areas of the body.Conclusions: Staff-worn protective equipment may reduce the severity but not the frequency of staff injuries from aggression; as well, the presence of protective equipment may set the occasion for increased injuries to non-protected areas of the body.

Regional rural injury study III: the roles of injury type and injured body part in determining short- and long-term consequences of injuries among children on agricultural operations

BackgroundChildren living on agricultural operations are at high risk of work-related injury.Aims/Objectives/PurposeEvaluate the effects of anatomical location of and type of injury on short- and long-term consequences among children (<20...

Falls in children birth to 5 years

Falls are the most common cause of injury-related hospitalization in children younger than 5 years old. Most anticipatory guidance surrounding falls is around falls from windows or stairs; however, falls from furniture also are important causes of morbidity. The purpose of this study was to compare the number of children injured, ages of injured children, and injuries sustained in falls from furniture and falls from stairs in hospitalized children younger than 5 years. All records of individuals from 0 year through 4 years, hospitalized at our institution for a fall from furniture or stairs between January 1, 1996, and December 31, 2006, were retrospectively reviewed. A standard data set was abstracted from each chart. Frequencies were used to characterize the study population. χ and t tests were used to determine differences between groups. A total of 171 patients were hospitalized for falls from stairs and 318 for falls from furniture. There were no differences between the groups with regard to age, sex, race, type of insurance, length of stay, Injury Severity Score, or total cost. The most common pieces of furniture from which children fell were beds (33.0%), couches (18.9%), and chairs (17.9%). Children who fell from stairs were significantly more likely to have injuries to their head (64.3% vs. 38.1%); those that fell from furniture were more likely to sustain arm injuries (33.3% vs. 9.9%). There were significantly more skull fractures in those that fell from stairs (39.8% vs. 20.1%) and humerus fractures in those that fell from furniture (30.8% vs. 9.4%) (p < 0.001). Falls from furniture increased during the study period, while falls from stairs fell; the difference was not statistically significant, however. Falls from furniture and stairs are important causes of morbidity in children. More children were hospitalized for falls from furniture than from stairs. Falls down stairs are decreasing while falls off furniture are increasing. More anticipatory guidance should be developed and given to families regarding falls from furniture to help prevent these injuries. Prognostic/epidemiologic study, level III.

Long term bicycle related head injury trends for New South Wales, Australia following mandatory helmet legislation

Since the 1991 enactment of mandatory helmet legislation (MHL) for cyclists in New South Wales (NSW), Australia, there has been extensive debate as to its effect on head injury rates at a population level. Many previous studies have focused on the impact of MHL around the time of enactment, while little has been done to examine the ongoing effects. We aimed to extend prior work by investigating long-term trends in cyclist head and arm injuries over the period 1991–2010. The counts of cyclists hospitalised with head or arm injuries were jointly modelled with log-linear regression. The simultaneous modelling of related injury mechanisms avoids the need for actual exposure data and accounts for the effects of changes in the cycling environment, cycling behaviour and general safety improvements. Models were run separately with population counts, bicycle imports, the average weekday counts of cyclists in Sydney CBD and cycling estimates from survey data as proxy exposures. Overall, arm injuries were higher than head injuries throughout the study period, consistent with previous post-MHL observations. The trends in the two injury groups also significantly diverged, such that the gap between rates increased with time. The results suggest that the initial observed benefit of MHL has been maintained over the ensuing decades. There is a notable additional safety benefit after 2006 that is associated with an increase in cycling infrastructure spending. This implies that the effect of MHL is ongoing and progress in cycling safety in NSW has and will continue to benefit from focusing on broader issues such as increasing cycling infrastructure.

Incidence of Disability Among Children 12 Months After Traumatic Brain Injury

We examined the burden of disability resulting from traumatic brain injuries (TBIs) among children younger than 18 years. We derived our data from a cohort study of children residing in King County, Washington, who were treated in an emergency department for a TBI or for an arm injury during 2007-2008. Disabilities 12 months after injury were assessed according to need for specialized educational and community-based services and scores on standardized measures of adaptive functioning and social-community participation. The incidence of children receiving new services at 12 months was about 10-fold higher among those with a mild TBI than among those with a moderate or severe TBI. The population incidence of disability (defined according to scores below the norm means on the outcome measures included) was also consistently much larger (2.8-fold to 28-fold) for mild TBIs than for severe TBIs. The burden of disability caused by TBIs among children is primarily accounted for by mild injuries. Efforts to prevent these injuries as well as to decrease levels of disability following TBIs are warranted.

A systematic review on the pros and cons of using a pushrim-activated power-assisted wheelchair

Objective: To determine the (dis)advantages of transition to a power-assisted wheelchair, and derive the clinical implications for its use or prescription. Data sources: Relevant articles published prior to May 2012 were identified using PubMed, Cochrane Library, REHABDATA, CIRRIE and CINAHL databases. Review methods: Clinical or (randomized) controlled trials, published in a peer-reviewed journal, comparing power-assisted wheelchair use and hand-rim or powered wheelchair use were eligible. Data quality and validity were assessed by two reviewers independently using the Checklist for Measuring Quality developed by Downs and Black. Results: A systematic search yielded 15 cross-over trails with repeated measurement design and one qualitative interview. Methodological quality scored between 9 and 15 points out of the maximum score of 32. Ten studies measuring body function and structure reported reduced strain on the arm and cardiovascular system during power-assisted propulsion compared to hand-rim propulsion. Twelve studies measuring activities and social participation reported precision tasks easier to perform with a hand-rim wheelchair and tasks which require more torque were easier with a power-assisted wheelchair. Social participation was not altered significantly by the use of a hand-rim, powered or power-assisted wheelchair. Conclusion: Power-assisted propulsion might be beneficial for subjects in whom independent hand-rim wheelchair propulsion is endangered by arm injury, insufficient arm strength or low cardiopulmonary reserves. Also, subjects who have difficulty propelling a wheelchair in a challenging environment can benefit from power-assisted wheelchair use. Caution is warranted for the additional width and weight in relation to the usual mode of transportation and access to the home environment.

Persistence of Disability 24 to 36 Months after Pediatric Traumatic Brain Injury: A Cohort Study

This study examined the outcome of 0- to 17-year-old children 36 months after traumatic brain injury (TBI), and ascertained if there was any improvement in function between 24 and 36 months. Controls were children treated in the emergency department for an arm injury. Functional outcome 36 months after injury was measured by the Pediatric Quality of Life Inventory (PedsQL), the self-care and communication subscales of the Adaptive Behavior Assessment Scale-2nd edition (ABAS-II), and the Child and Adolescent Scale of Participation (CASP). At 36 months after TBI, those with moderate or severe TBI continued to have PedsQL scores that were 16.1 and 17.9 points, respectively, lower than at baseline, compared to the change seen among arm injury controls. Compared to the baseline assessment, children with moderate or severe TBI had significantly poorer functioning on the ABAS-II and poorer participation in activities (CASP). There was no significant improvement in any group on any outcomes between 24 and 36 months. Post-injury interventions that decrease the impact of these deficits on function and quality of life, as well as preventive interventions that reduce the likelihood of TBI, should be developed and tested.

Association between posttraumatic stress, depression, and functional impairments in adolescents 24 months after traumatic brain injury

The degree to which postinjury posttraumatic stress disorder (PTSD) and/or depressive symptoms in adolescents are associated with cognitive and functional impairments at 12 and 24 months after traumatic brain injury (TBI) is not yet known. The current study used a prospective cohort design, with baseline assessment and 3-, 12-, and 24-month followup, and recruited a cohort of 228 adolescents ages 14-17 years who sustained either a TBI (n = 189) or an isolated arm injury (n = 39). Linear mixed-effects regression was used to assess differences in depressive and PTSD symptoms between TBI and arm-injured patients and to assess the association between 3-month PTSD and depressive symptoms and cognitive and functional outcomes. Results indicated that patients who sustained a mild TBI without intracranial hemorrhage reported significantly worse PTSD (Hedges g = 0.49, p = .01; Model R(2) = .38) symptoms across time as compared to the arm injured control group. Greater levels of PTSD symptoms were associated with poorer school (η(2) = .07, p = .03; Model R(2) = .36) and physical (η(2) = .11, p = .01; Model R(2) = .23) functioning, whereas greater depressive symptoms were associated with poorer school (η(2) = .06, p = .05; Model R(2) = .39) functioning.

Glenohumeral Rotational Motion and Strength and Baseball Pitching Biomechanics

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. 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. Cross-sectional study. Biomechanics laboratory. A total of 27 uninjured male high school baseball pitchers (age = 16 ± 1.1 years, height = 183 ± 7 cm, mass = 83 ± 12 kg). 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. We found a positive relationship between clinically measured internal-rotator strength and shoulder external-rotation moment (R(2) = 0.181, P = .04) during pitching. We also noted an inverse relationship between clinically measured external-rotation motion and the elbow-adduction moment (R(2) = 0.160, P = .04) and shoulder internal-rotation moment (R(2) = 0.250, P = .008) during pitching. We found a positive relationship between peak shoulder internal-rotation moment and the peak elbow-adduction moment (R(2) = 0.815, P < .001) during pitching. 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.

Shot Gun Firearm Injury: Reliability of Calculation of Range of Fire by Dispersion of Pellets - A Case Report

Introduction and case report: An interesting case of shot gun injury fired from a near range of 1.0 to 2.0 meter distance as per the eye witnesses is presented here which on examination revealed that the dispersion of pellets on the body indicates that the range of fire has occurred from a distance of 4 meters to 7 meters. Further the presence of wad in the wound adds to the confusion that the firing would have occurred within a distance of 5.0 meters. Conclusion : This case report reiterates the importance of examination of the crime weapon, test firing the similar cartridges with the same weapon and proper analysis of the wound ballistics is a must for a forensic expert to arrive at a proper opinion in fire arm injury cases.

Shoulder Rotational Properties of Throwing Athletes

Throwing arm injuries are common and often related to the shoulder external and internal rotation. Quantitative assessment may provide new insights to physical assessment and options for treatment. After having signed IRB approved consents and filled out injury questionnaires, 96 baseball pitchers were examined on both shoulders using a custom-made wireless device. The resistance onset angle (ROA), end-point angle (EPA), shoulder rotational flexibility (SRF) in both external and internal rotation, and rotational ranges of motion (ROM) of both shoulders were determined. About 34% of subjects had surgeries on their throwing arm. Another 15% of subjects had throwing arm injuries that did not require surgical treatments. The throwing arm had significantly lower internal ROA, EPA and SRF, but significantly higher external ROA, EPA and SRF than the non-throwing arm. There were significant differences in shoulder rotational properties among groups with different surgery locations. Subjects with shoulder surgeries had greater internal rotation flexibility of their throwing arm than those with surgeries on the elbow. Throwers with injury and surgery history had significantly different shoulder rotational properties. Abnormal shoulder rotational properties may be related to throwing arm injuries. A better understanding of their relationship may lead us to effective preventive measures of throwing arm injuries.

A Proposed Method to Reduce Underreporting of Brain Injury in Sports

The topic of brain injury and concussion in helmeted sports, including football, has received significant media attention in recent months, particularly with respect to the potential long-term negative consequences of repeated impacts to the head. Initiatives to reduce brain injuries in helmeted spo