Major League Baseball Organizations Research Articles

Dynamic Stress Ultrasound Assessment of Professional Baseball Players’ Elbows After Ulnar Collateral Ligament Reconstruction

Background: There is a paucity of data analyzing dynamic stress ultrasound (SUS) findings in elite pitchers who have undergone ulnar collateral ligament (UCL) reconstruction (UCLR) and returned to sport. Purpose: To identify longitudinal, perioperative changes in the elbows of professional baseball pitchers who have undergone UCLR and to compare these findings with a matched cohort of healthy pitchers. Study Design: Cohort study; Level of evidence, 3. Methods: This study used prospectively collected data from dynamic elbow SUS analyses of professional baseball pitchers within a single Major League Baseball organization. Pitchers were divided into 2 cohorts: a UCLR cohort and healthy cohort. The UCLR cohort eligibility included availability of (1) SUS from preseason of injury/UCLR and (2) SUS from ≥2 years after surgery. These players were 1:1 matched to players with no history of upper extremity injury to form the healthy cohort. Ligament thickness and ulnohumeral joint space at rest and under stress were directly measured. Joint laxity was calculated by subtracting joint space at rest from joint space under stress. The term “relative” was used to describe calculated differences where nondominant measurements were subtracted from dominant-side measurements. Results: Eight pitchers were included in the UCLR group and matched to 8 healthy pitchers (mean age at initial SUS examination, 19.6 years). At a minimum follow-up of 2 years, there were no significant differences between groups in terms of relative or dominant arm rest space, stress space, or laxity. Longitudinally (final measurements – baseline measurements), the mean relative ulnohumeral rest space decreased in the UCLR group and increased in the healthy group (–0.36 mm vs +0.50 mm; P = .032). The finding of increased UCL thickness in the UCLR group was expected, as UCL grafts are typically thicker than native ligaments. Conclusion: Ulnhohumeral joint stability was achieved after UCLR as indicated by similar rest space, stress space, and joint laxity in dominant arms compared with a matched healthy cohort. A significant decrease in relative rest space after UCLR may represent the achievement of stability in surgery patients. Alternatively, the increase in ulnohumeral rest space seen in the healthy cohort may represent adaptive changes from pitching at a professional level.

Paper 22: Ulnar Collateral Ligament Tear in Elite Baseball Pitchers: Do High School Showcase Exposures Predict Injury™

Paper 22: Ulnar Collateral Ligament Tear in Elite Baseball Pitchers: Do High School Showcase Exposures Predict Injury™

Case Study of a Professional Development Support Group of Sport Psychology Practitioners Working in Major League Baseball Organizations in the United States and Canada

A case study is presented about sport psychology practitioners working in Major League Baseball organizations in the United States and Canada who collaborated as a professional development support group. The practitioners ranged from entry-level mental skills coaches to midcareer providers to veteran sport psychologists. The professional development support group is described in relation to its professional development goals, membership criteria, and relevant context. The case study offers a perspective on the evolution of the group and provides evaluative information about implementation of its activities relative to its professional developmental goals. The case includes reflections about the meaning of the group and suggestions for how sport psychology practitioners can collaborate to foster their professional development in sport settings. In addition, lessons learned from the case study are considered for continued improvement of professional development support in sport psychology. Finally, guidelines are provided for designing and implementing professional development groups in sport psychology at professional and collegiate levels of sport.

Dental Screening Examinations for Professional Baseball Players: Preventing Potential Loss of Athlete Playing Time

Objectives: A major league baseball organization (MLBO) noticed significant player-time loss due to severe dental caries and abscesses. The trend was noted most often in Hispanic players. The administration of the MLBO recruited a dentist to come down to perform dental screening examinations in Spring Training to identify dental problems, specifically among the Hispanic players. Methods: Dental screening examinations were performed in the athletic training room by direct clinical visual examination utilizing high intensity light, mouth mirror and tongue depressors. Caries lesions were classified via the International Caries Detection and Assessment System. Teeth classified as Grade 5/6 were recommended for immediate treatment during spring training. Results: Forty-two Hispanic baseball players were examined. Ten percent exhibited no dental caries; ninety percent exhibited dental caries. Twenty-nine percent of players (N=12) examined required immediate dental treatment during spring training; seventy-one percent (N=30) required dental treatment at a later date. Nine of the twelve players requiring treatment during spring training had severe decay that, if left untreated, would result in a loss of valuable playing time. Thus, for the total sample of nine players with severe decay, the MLBO would incur the loss of sixty-three days of player playing-time loss. Seven of the nine players had a total of fifteen teeth requiring immediate treatment, thus reducing the need and cost for advanced dental treatment. Conclusion: Spring training dental screening examinations and expedited treatment can lead to significant cost savings and minimize potential loss of athlete playing time for the major league baseball organization. Clinical Significance: More than ever, today’s society is sports and fitness oriented. Our research involves identifying the oral health needs of athletes. This study is a prime example of the importance of dental screening exams to be included within pre-season physicals. This information can benefit dentists who manage athletes in their practice.

Hook of Hamate Fractures in Major and Minor League Baseball Players

The purpose of this study was to describe an approach to surgical management of the hook of hamate fractures in professional baseball players. A retrospective chart review was performed on Major and Minor League Baseball players who underwent surgical excision for the hook of hamate fracture between the years 2003 and 2019 by a single surgeon. Patient demographics, the mechanism and timing of the injury, diagnostic and operative details, postoperative complications, and timeline to return to baseball activities were recorded. A total of 145 professional baseball players affiliated with 17 Major League Baseball organizations were studied, with the majority of athletes playing at the Minor League Baseball level (91.7%). Subacute or chronic patterns of injury (81.7%) were found to be more common than acute patterns based on radiographic and intraoperative findings. Two patients reported transient numbness in the fourth and fifth digits after surgery, 6 patients reported pisotriquetral pain when returning to a hitting program, and 1 patient developed heterotopic ossification after surgery. All complications resolved during a strength and conditioning program. On average, players in our cohort began a hitting program at 4.6 weeks after surgery and were released into full baseball activities at 7.1 weeks after surgery. Surgical excision remains an effective method of management, with a low risk of minor complications for both acute and chronic hook of hamate fractures in professional baseball players. Therapeutic Level IV.

Lumbopelvic Control and the Development of Upper Extremity Injury in Professional Baseball Pitchers

Background: The baseball-throwing motion requires a sequential order of motions and forces initiating in the lower limbs and transferring through the trunk and ultimately to the upper extremity. Any disruption in this sequence can increase the forces placed on subsequent segments. No research has examined if baseball pitchers with less lumbopelvic control are more likely to develop upper extremity injury than pitchers with more control. Purpose: To determine if baseball pitchers who sustain a chronic upper extremity injury have less lumbopelvic control before their injury compared with a group of pitchers who do not sustain an injury. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 49 asymptomatic, professional baseball pitchers from a single Major League Baseball organization participated. Lumbopelvic control was measured using an iPod-based digital level secured to a Velcro belt around each player’s waist to measure anteroposterior (AP) and mediolateral (ML) deviations (degrees) during single-leg balance with movement and static bridge maneuvers. During a competitive season, 22 of these pitchers developed upper extremity injuries, while the remaining 27 sustained no injuries. Separate 2-tailed t-tests were run to determine if there were significant differences in lumbopelvic control between groups (P < .05). Results: There were no significant between-group differences for the stride leg (nondominant) during the bridge test in either the AP (P = .79) or the ML (P = .42) directions, or either direction during the drive leg bridge test (P > .68). However, the injured group had significantly less lumbopelvic control than the noninjured group during stride leg balance in both the AP (P = .03) and the ML (P = .001) directions and for drive leg balance in both the AP (P = .01) and the ML (P = .04) directions. Conclusion: These results demonstrate that baseball pitchers with diminished lumbopelvic control, particularly during stride leg and drive leg single-leg balance with movement, had more upper extremity injuries than those with more control. Clinicians should consider evaluating lumbopelvic control in injury prevention protocols and provide appropriate exercises for restoring lumbopelvic control before returning athletes to competition after injury. Specific attention should be given to testing and exercises that mimic a single-limb balance task.

Decreased Shoulder External Rotation and Flexion Are Greater Predictors of Injury Than Internal Rotation Deficits: Analysis of 132 Pitcher-Seasons in Professional Baseball

The primary aims of this work were to (1) describe normal range of motion (ROM) profiles for elite pitchers, (2)describe the characteristics of shoulder and elbow injuries in professional pitchers over a 6-year period in one Major League Baseball organization, and (3) identify ROM measures that were independently associated with a future shoulder or elbow injury. Over 6 seasons (2010-2015), a preseason assessment was performed on all pitchers invited to Major League Baseball Spring Training for a single organization. ROM measures included shoulder flexion, horizontal adduction, external rotation (ER), internal rotation, as well as elbow flexion and extension, were measured for both the dominant and nondominant arm, and total range of motion and deficits were calculated. All noncontact shoulder and elbow injuries were identified. Using multivariate binomial logistic regression analysis to control for age, height, weight, and all other ROM measures, the factors associated with an increased risk of subsequent shoulder or elbow injury were identified. A total of 53 shoulder (n= 25) and elbow (n= 28) injuries occurred during 132 pitcher seasons (n=81 pitchers). The most significant categorical risk factor associated with increased elbow injury rates was the presence of a shoulder flexion deficit >5° (odds ratio [OR] 2.83; P= .042). For continuous variables, the risk of elbow injury increased by 7% for each degree of increased shoulder ER deficit (OR 1.07; P= .030) and 9% for each degree of decreasedshoulder flexion (OR 1.09; P= .017). None of the measures significantly correlated with shoulder injuries. Preseason shoulder ER and flexion deficits are independent risk factors for the development of elbow injuries during the upcoming season. Although prior work has supported the importance of reducing glenohumeral internal rotation deficits in pitchers, this study demonstrates that deficits in shoulder ER and flexion are more significant predictors of subsequent elbow injury. Level III, retrospective comparative study.

Defining the Long-Toss: A Professional Baseball Epidemiological Study.

Background:Despite widespread use of long-toss throwing in baseball as a component of arm conditioning, interval throwing programs, and rehabilitation, long-toss distance and throwing mechanics remain controversial.Purpose:To ascertain the perceived definition of long-toss throwing through a survey of professional pitchers, pitching coaches (PCs), and certified athletic trainers (ATCs) associated with Major League Baseball.Study Design:Descriptive epidemiology study.Methods:Pitchers, PCs, and ATCs associated with 5 Major League Baseball organizations completed an anonymous survey that collected demographic data, personal use of long-toss throwing, and their perception of the distance and throwing mechanics that comprised long-toss.Results:A total of 321 surveys were completed by 271 pitchers, 19 PCs, and 31 ATCs. For all respondents, the mean distance considered as long-toss was 175 ft (95% CI, 170-181 ft). Respondents categorized the throwing mechanics of long-toss, with 36% reporting throwing “on a line” and 70% reporting long-toss as “not on a line.” Of those throwing “on a line,” 28% reported using crow-hop footwork while 60% used crow-hop footwork when throwing “not on a line.” Interpretation of long-toss distance significantly varied by position: pitchers, 177 ft (95% CI, 171-183 ft); PCs, 177 ft (95% CI, 155-200 ft); and ATCs, 157 ft (95% CI, 144-169 ft) (P = .048). When asked when long-toss throwing is used, pitchers reported using it more frequently in preseason (P = .007), during the season (P = .015), and in the off-season (P = .002) compared with that by ATCs. Functional goals for long-toss throwing demonstrated that pitchers and PCs use long-toss for shoulder stretching more frequently than ATCs (P < .001 and P = .026, respectively). ATCs used long-toss more than pitchers for interval throwing programs (P < .001).Conclusion:The definition varies for long-toss throwing distance and throwing mechanics. Pitchers and PCs believe that long-toss comprised longer distances than ATCs and employed long-toss differently for strength conditioning, training, stretching, and rehabilitation. This discrepancy highlights a potential lost opportunity for protecting the shoulder. While long-toss is an important tool, a more scientific definition is warranted to better elucidate its role in enhancing throwing performance and rehabilitation.

Throwing-Related Injuries of the Subscapularis in Professional Baseball Players

Objectives:Injuries to the shoulder are a common cause of missed playing time in professional baseball athletes. These injuries predominately involve the supraspinatus tendon or the glenoid labrum. The purpose of this project is to describe a series of throwing-related injuries to the subscapularis muscle-tendon complex that have been previously unreported amongst baseball players. Additionally, it is the goal to describe a mechanism of injury as well as a treatment program for these athletes.Methods:A retrospective review of shoulder magnetic resonance imaging (MRI) scans of players from 1 Major League Baseball organization over the course of 5 years was performed to identify cases with findings suggestive of a subscapularis injury. The MRIs were graded and the medical records were reviewed to assess clinical findings, treatment plans, and follow-up. In the injured cohort, preinjury baseline measurements of shoulder motion including external rotation at 90° of abduction were compared to measurements from a non-injured baseball athlete cohort to evaluate whether decrease external rotation is a risk factor for this injury.Results:A total of 133 MRI scans of the shoulder were evaluated. Eleven of the 133 MRIs demonstrated signal changes suggesting subscapularis injury. Ten of these 11 patients had clinical findings supporting a diagnosis of throwing-related subscapularis strain. There were 4 grade I, 4 grade II, and 2 grade III injuries. All injuries occurred in the inferior half of the subscapularis at the myotendinous junction. Risk of subscapularis injury increased with lower levels of dominant arm external rotation (odds ratio, 0.89; 95% CI, 0.82-0.94; P < .001). A threshold of dominant arm external rotation of less than 106° demonstrated sensitivity of 0.700 (95% CI, 0.392-0.897) and specificity of 0.951 (95% CI, 0.888-0.982) for subscapularis injury. All players were treated conservatively without surgery; only 1 did not return to play. Of the remaining players, the mean number of days missed because of injury was 27 (range, 11-61 days).Conclusion:Throwing-related subscapularis injuries occur in the inferior half of the muscle at the myotendinous junction. The subscapularis muscle fibers are oriented along a fan shape because of the relatively narrow insertion on the lesser tuberosity of the proximal humerus and a broader origin on the scapula with muscle fiber alignment dependent on arm position. When the thrower's arm is at 90 degrees of abduction and external rotation, the inferior fibers of the subscapularis comes to be aligned in the transverse plane across the glenohumeral joint and are placed on greatest stretch during the late cocking and early acceleration phases of throwing. Our data suggest that there is an increased risk of these injuries with lower levels of dominant arm external rotation as this shorter arc requires greater force production by the subscapularis muscle to achieve the same peak throwing velocity.

Biomechanical Performance of Baseball Pitchers With a History of Ulnar Collateral Ligament Reconstruction

Background: A relatively high number of active professional baseball pitchers have a history of ulnar collateral ligament reconstruction (UCLr) on their throwing elbow. Controversy exists in the literature about whether professional baseball pitchers regain optimal performance after return from UCLr. It has been suggested that pitchers may have different biomechanics after UCLr, but this has not been previously tested. Hypothesis: It was hypothesized that, compared with a control group without a history of UCLr, professional pitchers with a history of UCLr would have (1) significantly different throwing elbow and shoulder biomechanics; (2) a shortened stride, insufficient trunk forward tilt, and excessive shoulder horizontal adduction, characteristics associated with “holding back” or being tentative; (3) late shoulder rotation; and (4) improper shoulder abduction and trunk lateral tilt. Study Design: Controlled laboratory study. Methods: A total of 80 active minor league baseball pitchers (and their 8 Major League Baseball organizations) agreed to participate in this study. Participants included 40 pitchers with a history of UCLr and a matched control group of 40 pitchers with no history of elbow or shoulder surgery. Passive ranges of motion were measured for each pitcher’s elbows and shoulders, and then 23 reflective markers were attached to his body. The pitcher took as many warm-up pitches as desired and then threw 10 full-effort fastballs for data collection. Ball speed was recorded with a radar gun. The reflective markers were tracked with a 10-camera, 240-Hz automated motion analysis system. Eleven biomechanical parameters were computed for each pitch and then averaged for each participant. Demographic, range of motion, and biomechanical parameters were compared between the UCLr group and the control group by use of Student t tests (significance set at P < .05). Results: All hypotheses were rejected, as there were no differences in pitching biomechanics between the UCLr group and the control group. There were also no differences in passive range of motion between the 2 groups. Conclusion: Compared with a control group, active professional pitchers with a history of UCLr displayed no significant differences in shoulder and elbow passive range of motion and no significant differences in elbow and shoulder biomechanics. Clinical Relevance: Clinical studies have previously shown that 10% to 33% of professional pitchers do not return to their preinjury level; however, the current study showed that those pitchers who successfully return to professional baseball after UCLr pitch with biomechanics similar to that of noninjured professionals.

Relationship Between Humeral Torsion and Injury in Professional Baseball Pitchers

Background: High levels of humeral torsion allow baseball pitchers to achieve maximum external rotation in the late cocking phase of pitching with lower twisting and shear forces on the long head of the biceps tendon and rotator cuff tendons. Hypothesis: Humeral torsion is inversely related to the incidence and severity of shoulder injuries and other upper extremity injuries in professional baseball pitchers. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 25 professional pitchers from a single Major League Baseball organization were prospectively recruited into this study. Computed tomography (CT) was performed on dominant and nondominant humeri, and image data were processed with a 3-dimensional volume-rendering postprocessing program. The software program was then modified to model a simplified throwing motion and to measure potential internal impingement distances in a small subset of players. Players were followed for 2 years after CT, and the number of days missed from pitching activities was recorded as a measure of injury severity and incidence. Results: The mean dominant humeral torsion was 38.5° ± 8.9°; the mean nondominant humeral torsion was 27.6° ± 8.0°. The difference between dominant and nondominant torsions was significant (P < .0001). Among the 11 pitchers (44%) injured during follow-up, 5 players had shoulder injuries, 7 had elbow injuries, and 2 had finger injuries. Dominant humeral torsion was a statistically significant predictor of severe injuries (≥30 days; P = .048) but not of milder injuries. Among injured players, higher numbers of days missed because of injury were strongly correlated with lower degrees of dominant humeral torsion (r = −0.78; P = .005) and smaller differences between dominant and nondominant humeral torsions (r = −0.59; P = .055). There was no significant association between the incidence of shoulder injury and minimum glenoid-tuberosity distance in the dominant or nondominant shoulder or degree of dominant glenoid version. Conclusion: A strong relationship was found between lower degrees of dominant humeral torsion and more severe upper extremity injuries as well as a trend relating lower side-to-side differences in torsion with more severe dominant upper extremity injuries. In addition, there was a higher incidence of severe injuries in players with lower degrees of dominant torsion. If future studies confirm these results, humeral torsion measurements could play a role in risk assessment in pitchers.

The bright-side and the dark-side of CEO personality: Examining core self-evaluations, narcissism, transformational leadership, and strategic influence.

This article reports on an examination of the relationships between chief executive officer (CEO) personality, transformational and transactional leadership, and multiple strategic outcomes in a sample of 75 CEOs of Major League Baseball organizations over a 100-year period. CEO bright-side personality characteristics (core self-evaluations) were positively related to transformational leadership, whereas dark-side personality characteristics (narcissism) of CEOs were negatively related to contingent reward leadership. In turn, CEO transformational and contingent reward leadership were related to 4 different strategic outcomes, including manager turnover, team winning percentage, fan attendance, and an independent rating of influence. CEO transformational leadership was positively related to ratings of influence, team winning percentage, and fan attendance, whereas contingent reward leadership was negatively related to manager turnover and ratings of influence.

Effort thrombosis in the elite throwing athlete.

Upper extremity vascular injuries are uncommon in the elite throwing athlete. However, the extreme stresses that are placed on the upper extremity of elite baseball players, especially pitchers, puts them at risk for such injuries. One such injury is upper extremity venous thrombosis or "effort thrombosis." We wanted to review the common initial clinical symptoms and physical examination findings of effort thrombosis in elite baseball players and to review the associated clinical conditions such as hypercoagulable states and pulmonary embolism. Retrospective review of a series of cases. A retrospective review of the medical records of a Major League Baseball organization and a Division I college was performed for the period 1987 to 1997. We located four cases of effort thrombosis involving elite baseball players. Contrast venography was used to confirm the diagnosis in all cases. All patients were successfully treated with transluminal catheter-directed urokinase thrombolysis followed by first rib resection and systemic anticoagulant therapy for up to 3 months. All four players returned to play at or above their previous level of competition with no long-term chronic sequelae. Prompt clinical recognition, diagnosis, and treatment of effort thrombosis in the elite baseball player provides the player with an excellent prognosis for return to the previous level of play.