Maximum External Rotation Research Articles

Assessment of the ulnar nerve stiffness during valgus stress of the elbow using shear wave elastography: an observational cross-sectional study.

Identification of the relationship between valgus stress in the medial elbow and ulnar nerve strain during maximum external rotation of the shoulder is pivotal for the prevention and management of ulnar neuropathies. In this observational cross-sectional study, we aimed to determine the changes in ulnar nerve stiffness under valgus stress at different nerve entrapment sites. Twenty healthy baseball players participated in the study. The stiffness of the ulnar nerve on the throwing side was assessed at two sites, the arcade of Struthers and the Osborne's ligament, at 0°, 60°, and 90° flexion by shear wave elastography using a 10-MHz linear transducer. The arcade of Struthers was defined as the proximal site and the Osborne's ligament as the distal site. Valgus stress was applied to the medial elbow at 0, 30, 50, and 70 N using a Telos stress device, and the stiffness caused by valgus stress was measured. At all elbow flexion angles, the stiffness of the ulnar nerve under 70 N valgus stress was higher than that under 30 N stress. The stiffness of the ulnar nerve at the proximal site was significantly higher than that at the distal site. Valgus stress increases ulnar nerve stiffness. In addition, the stiffness of the proximal site increases.

Limited Total Arc Glenohumeral Rotation and Shoulder Biomechanics During Baseball Pitching.

Upper extremity injuries in baseball pitchers cause significant time loss from competing and decreased quality of life. Although shoulder range of motion (ROM) is reported as a key factor to prevent potential injury, it remains unclear how limited glenohumeral ROM affects pitching biomechanics which may contribute to upper extremity injuries. To investigate how pitchers with decreased total arc glenohumeral ROM of the throwing arm differed in upper extremity pitching kinematics and kinetics as well as ball velocity compared with pitchers with greater levels of glenohumeral ROM. Cross-sectional study. Laboratory. Fifty-seven baseball pitchers (ages 18-24) were divided into either control (≥160° total arc) or lower ROM (<160° total arc) groups. The mean glenohumeral ROM deficits, pitching kinematic and kinetic outcomes, and ball velocity were compared between groups. The control group demonstrated significantly less deficit in total arc ROM between arms than the lower ROM (control: -1.5° ± 10.0°; lower ROM: -12.4° ± 13.9°; P < .001). While the lower ROM group displayed less maximal shoulder external rotation (ER) while pitching, the control group had significantly less difference in ROM between maximal shoulder ER while pitching and clinically measured ER (lower ROM: 64.4° ± 12.1°; control: 55.8° ± 16.6°; P = .025). The control group had significantly faster ball velocity than the lower ROM group (control: 85.0 ± 4.3 mph; lower ROM: 82.4 ± 4.8 mph; P = .024). Pitchers with decreased total arc glenohumeral ROM (<160° total arc) may undergo overstretching toward ER in the shoulder during the late cocking phase. Pitchers with higher total arc ROM can pitch the same or faster ball without increasing loading in the upper extremity. Total arc glenohumeral ROM measurement can be a clinical screening tool to monitor shoulder condition over the time, and pitchers with limited total arc ROM might be at higher risk of shoulder injury.

Literature review of specific techniques in catching and throwing in infield defense in baseball - retrospective article

&lt;p&gt;目的：內野手可以是整個棒球守備的核心，棒球守備各階段全身上下的協調，有許多值得探討的專項技巧。方法：本研究使用Google scholar，以Baseball infielder、內野、野球守備、內野捕球、守備ゴロ等關鍵字，搜尋台灣、日本、美國三國關於棒球內野守備專項技巧的文獻做歸納，以不同角度探討內野守備的專項技巧：一、內野守備接球，二、內野守備傳球，三、守備的分期與各分期之動作控制。結果：本篇回顧性論文發現，一、移動腳步到好接球的彈跳點是良好守備的關鍵。二、減少軸心腳在接球位置上的變化和較為前面的接球點，對於接球的穩定性至關重要，甚至會影響到後續傳球的動能。三、精簡接傳的動作相較於增加傳球球速可能可以更能有效減少整體守備時間。四、優秀選手在接球的過程中會儘早讓軸心腳著地，並前期和中期將重心保留在軸心腳。五、內野手傳球在前導腳接觸時，軀幹向後扭轉和肘部伸展角度都會比投手小。結論：無論是接球前腳步移動的節奏和精確性，還是接球時的接球點和接短彈跳的能力，甚至是軀幹和骨盆前傾的時機點，對於內野守備過程都產生一定的影響。建議在日常練習時，就能將接短彈跳、腳步移動，納入訓練課表中，並且在動作過程中，加以檢視軀幹的姿勢，方能在比賽時擁有良好的守備表現。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;The standing throw with run-up is the best approach to evaluate the performance of energy transfer and the efficiency of throwing motions for handball players. Purpose: This research aims at analyzing the usage of the standing throw with run-up among the handball players in Taiwan. The roles of body kinematics, strength of core muscles and standing balance of the drive leg played in the standing throw with run-up are also discussed. Methods: Nine Division I handball players from college went through a series of tests. The motions and the speed of the handball throwing were detected by a 3D electromagnetic motion analysis system and a sports radar gun, respectively. The maximum isometric muscle strength of trunks and hips were measured by a torque sensor and a home-made device of strength measurement. The standing balance of the drive leg was measured by a force plate with a mat. Results: The maximal shoulder external rotation angle in the arm cocking phase, the maximal trunk rotation velocity in the arm acceleration phase and the maximal shoulder horizontal adduction velocity showed moderate positive relationships with the ball velocity. The strength of back muscles had a moderate negative relationship with the ball velocity. The correlation between the balance ability of the drive leg and the ball velocity was not observed. Conclusion: The importance of proximal segments to the standing throw with run-up is analyzed by kinematical analysis. It is suggested that the energy of handball throwing is generated by the upper extremities or other limb segments in the processes of the standing throw with run-up. Our findings can serve as a helpful reference for both coaches and players.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

IMPLANT MOVEMENT ANALYSIS: A CT-BASED TECHNIQUE TO DIAGNOSE EARLY LOOSENING IN TOTAL HIP ARTHROPLASTY

The painful hip without obvious clinical or radiographic signs of complications is a well-known scenario for surgeons. The clinical tools we have access to currently lack a dynamic test for detecting early signs of motion between implant and bone.A new software, Sectra IMA, has a potential to facilitate diagnosis of early implant loosening by analysis of paired CT exams. In clinical practise the two scans are acquired by endpoint of a possible motion, “a provocation CT”, for example maximal external and internal rotation in a CT hip examination. 20 years of research by Olivecrona and Weidenhielm is the scientific background for the technique. Early results are presented by Sandberg et al 2022.To further validate and create clinical evidence more extensive clinical studies is needed. A proposal for a multicentric, global clinical study will be presented for further discussion.A new technique for diagnosis of acetabular cup loosening using computed tomography: preliminary experience in 10 patients. Henrik Olivecrona, Lotta Olivecrona, Lars Weidenhielm, Marilyn E Noz, Jocelyn Kardos, Gerald Q Maguire Jr, Michael P Zeleznik, Peter Aspelin. Acta Orthop. 2008 Jun;79(3):346-53. doi: 10.1080/17453670710015247.Inducible displacement CT increases the diagnostic accuracy of aseptic loosening in primary total hip arthroplasty. Sandberg O, Carlsson S, Harbom E, Cappelen V, Tholén S, Olivecrona H, Wretenberg P. Acta Orthop. 2022 Oct 31;93:831-836. doi: 10.2340/17453674.2022.5240.PMID: 36314542

Effect of a semirigid ankle brace on the in vivo kinematics and muscle activity of patients with functional ankle instability during simulated ankle sprain.

Ankle braces can effectively decrease the incidence of recurrent ankle sprain; however, whether the brace can decrease the severity of sprain and its related mechanism during sprain remain unknown. Twenty-two patients with functional ankle instability (FAI) (12 males and 10 females) and 16 healthy subjects (8 males and 8 females) were enrolled in this study. All of the subjects walked on a custom-built tilting platform that offered a 30° inversion (IV) to mimic the IV of ankle sprain. We collected the kinematic and surface electromyography data of patients with FAI with or without ankle brace and normal controls 6 times. The FAI without brace group showed significantly higher maximum IV angles and average IV velocities than the control group (P < .001). The FAI with brace group revealed significantly lower maximum IV angles and average IV velocities than the FAI without brace group (P < .001); this group also showed significantly higher maximum external rotation (ER) angle and average ER velocities than the FAI with brace (P < .001) and control (P < .001) groups. The FAI with brace group indicated significantly lower average EMGPrep (P = .047), EMGTilt (P = .037), and EMGafterTilt (P = .004) of the peroneus longus than the FAI without brace group. The ankle brace could effectively decrease IV angles and their velocities and increase ER angles and their corresponding velocities during ankle sprain in patients with FAI. It could also decrease the activity of the peroneus longus muscle during ankle sprain.

Relationship between glenohumeral horizontal abduction angle and scapular internal rotation angle at maximum shoulder external rotation during baseball pitching

BackgroundIncreased scapulothoracic (ST) internal rotation at maximum external rotation (MER) during baseball pitching can decrease glenohumeral (GH) horizontal adduction, leading to excessive GH horizontal abduction. However, few studies have examined this direct relationship, and none have investigated the ST internal rotation angle at stride foot contact (FC) and MER. This study investigated the relationships between GH horizontal adduction and ST internal rotation angles at MER and between ST internal rotation angles at FC and MER. MethodsWe recruited 15 asymptomatic collegiate baseball pitchers and assessed the ST internal rotation angle at FC and MER and GH horizontal adduction angle at MER during pitching using an optical motion tracking system. Pearson’s correlation coefficients determined the relationships between GH horizontal adduction and ST internal rotation angles at MER and between ST internal rotation angles at FC and MER. ResultsThe GH horizontal adduction angle at MER was significantly related to the ST internal rotation angle at MER (r = -0.58, p = 0.022). The ST internal rotation angle at FC was significantly related to the ST internal rotation angle at MER (r = 0.53, p = 0.045). ConclusionsThe GH horizontal adduction angle at MER is associated with the ST internal rotation angle at MER in asymptomatic collegiate baseball pitchers and the ST internal rotation angle at FC is related to the ST internal rotation angle at MER. Thus, the scapula and humerus should be controlled from FC to MER during pitching to reduce internal impingement risk in asymptomatic baseball pitchers.

Kinematic Modeling of Pitch Velocity in High School and Professional Baseball Pitchers: Comparisons With the Literature.

Kinematic parameters predictive of pitch velocity have been evaluated in adolescent and collegiate baseball pitchers; however, they have not been established for high school or professional pitchers. To create multiregression models using anthropometric and kinematics features most predictive for pitch velocity in high school and professional pitchers and compare them with prior multiregression models evaluating other playing levels. Descriptive laboratory study. High school (n = 59) and professional (n = 337) baseball pitchers threw 8 to 12 fastballs while being evaluated with 3-dimensional motion capture (480 Hz). Using anthropometric and kinematic variables, multiregression models for pitch velocity were created for each group. A systematic review was conducted to determine previous studies that established kinematic models for ball velocity in youth, high school, and collegiate pitchers. Leg length was predictive of pitch velocity for high school and professional pitchers (P < .001 for both). When compared with previously established models for pitch velocity, almost all groups were distinct from one another when assessing age (P maximum < .001), weight (P max = .0095), and pitch velocity (P max < .001). Stride length was a significant predictor for the youth/high school pitchers, as well as the current study's high school and professional pitchers (P < .001 for all). Maximal shoulder external rotation (collegiate: P = .001; professional: P < .001) and maximal elbow extension velocity (high school/collegiate: P = .024; collegiate: P < .001; professional: P = .006) were shared predictors for the collegiate and current study's professional group multiregression models. Trunk flexion at ball release was a commonly shared predictor in the youth/high school (P = .04), high school/collegiate (P = .003), collegiate (P < .001), and the current study's professional group (P < .001). Youth, high school, collegiate, and professional pitchers had unique, predictive kinematic and anthropometric features predictive of pitch velocity. Leg length, stride length, trunk flexion at ball release, and maximal shoulder external rotation were predictive features that were shared between playing levels. Coaches, clinicians, scouts, and pitchers can consider both the unique and the shared predictive features at each playing level when attempting to maximize pitch velocity.

Changes in Shoulder Rotation Based on Elevation in Children With Brachial Plexus Birth Injury

Lack of shoulder external rotation is common in children with brachial plexus birth injuries. Development of glenohumeral (GH) dysplasia is associated with progressive loss of passive external rotation. Some authors recommend measuring external rotation with the arm adducted, whereas others recommend measurement with the arm in 90° of abduction. The purpose of this study was to compare active and passive external rotation and internal rotation measured in adduction versus abduction. Fifteen children with brachial plexus birth injuries held their affected arms in maximal external and internal rotation with the arm adducted and the arm at approximately 90° of abduction. Active and passive rotations were measured with three-dimensional motion capture. Scapulothoracic (ST) internal/external rotation and GH internal/external rotation joint angles were calculated and compared using multivariable, one-way repeated measures analyses of variance. There were no significant differences for active or passive ST rotation in external rotation in adduction versus abduction. Glenohumeral external rotation was significantly increased with the arm in abduction compared with adduction both actively and passively. There were no differences in ST rotation in active versus passive conditions, but all GH rotations were significantly greater passively. Shoulder internal/external rotation in abduction and adduction is not interchangeable. Comprehensive assessment of shoulder external and internal rotation should include both adduction and abduction. For children with brachial plexus birth injuries, both active and passive GH external rotations were greater in abduction. Therefore, early GH joint dysplasia may be missed if GH external rotation is measured in abduction. Additionally, consistency in arm position is important for comparison over time. The entire ST rotation capacity was used to perform maximal internal and external rotation, but the entire passive GH range of motion was not actively used. This highlights an area for potential surgical intervention to improve motion.

Effect of two quadriceps strengthening protocols on morphological characteristics of knee vastus muscles in patients with lateral patellar compression syndrome

IntroductionThe purpose of this study is to compare the effect of two types of quadriceps strengthening protocols on morphological characteristics of the knee vastus muscles in patients with lateral patellar compression syndrome. Methods48 female patients were randomly divided into 3 groups: selective (16), general (17) and control (15). The selective group participated in an isokinetic knee extension training protocol at the last 30° knee extension arc with maximum leg external rotation at high speed with the aim of selectively strengthening the vastus medialis muscle. The general group participated in an exercise protocol aimed at strengthening the entire quadriceps muscle. Both these protocols lasted 8 weeks. The control group did not receive any intervention. The vastus medialis and lateralis muscles cross-sections and fibers angles were measured using an ultrasound device. The data were analyzed using repeated-measures ANOVA and dependent t tests. ResultsAt pre-intervention, there were no differences between groups in muscles cross-sections and fiber angles (P > 0.05), but after interventions, in selective group, the vastus medialis cross-section and fiber angle, as well as vastus medialis to vastus lateralis cross-section ratio, were significantly higher than other groups (P < 0.01). Also, compared to pre-intervention, the vastus medialis cross-section and fiber angle increased only in selective group (P = 0.001), and the vastus lateralis cross-section increased only in general group (P = 0.001). Discussion and conclusionUse of isokinetic extension exercises targeting selectively strengthening the vastus medialis can improve the activity and involvement of this muscle-which is impaired in chronic patellofemoral joint disorders - by changing its morphology.

Using preoperative planning software to assess the effect of head length on prosthetic range of motion in a high-risk population: a three-dimensional modeling study.

Concurrent use of minus heads with tapered stems in total hip arthroplasty (THA) decreases the prosthetic range of motion (pROM). Three-dimensional preoperative templating can simulate the location of the impingement by taking the hip through a virtual pROM. This enables surgeons to simulate how modifying the type of implant, orientation, and position influences impingement. We hypothesized that CT-based modeling would result in a decrease in the pROM, thereby increasing the risk of impingement when minus heads are used. Forty-three patients who underwent robotic-assisted primary THAs were included. Prosthetic head diameter (32/36-mm) and head length (minus/zero/plus) were the predictors. Maximum external rotation at full hip extension and internal rotation at 90° and 100° of flexion prior to prosthetic impingement were the outcome variables. A CT-based preoperative planning software was used for pROM estimation and impingement detection. Significant decreases in pROM were found for both head diameters as the head length decreased and was more pronounced in external rotation during full hip extension (changes of 2.8-3.4° for the 32-mm head and 1.6-2.8° for the 36-mm head (p = 0.00011)). The magnitude of loss in pROM when using a minus head was larger than the gain provided by a plus head in tapered stems (p < 0.0001). Head length affects the offset and pROM. When the use of minus heads or smaller heads is indicated, 3D preoperative templating for assessing postoperative pROM and impingement provides surgeons with options to consider alternate surgical plans offering additional assurance and protection from dislocation.

Kinematic Effects of Derotational Osteotomy of the Humerus in Patients with Internal Shoulder Contracture Secondary to Erb's Palsy-A Retrospective Cohort Study.

Background: Internal rotation contractures of the shoulder are common sequelae of conservatively treated obstetric brachial plexus palsy (OBPP) with incomplete spontaneous neurological recovery. Humerus derotation osteotomy has been suggested as a possible treatment option to improve arm positioning. However, consensus as to whether humerus derotation osteotomy can successfully restore limb function is missing. Methods: In the present controlled cohort study, we aimed at analyzing global upper extremity kinematics with a 3D-video analysis system in children with shoulder internal rotation contractures secondary to OBPP before, and one year after, humerus derotation osteotomy. Patients under 18 years of age that presented to our center with conservatively treated internal rotation contractures of the shoulder and subsequently underwent humerus derotation osteotomy were included. The unimpaired arm served as a respective control. Results: Pre-operatively, all patients showed severe internal rotation contractures of the shoulder of almost 60° at rest. At the follow-up, the position of the shoulder at rest was greatly shifted to 9° of internal rotation. The patients showed statistically significant improvement in maximum external rotation and abduction of the shoulder, as well as in maximum flexion of the elbow, and the range of motion of pro/supination. The maximum internal rotation of the shoulder, however, was diminished after the osteotomy. Conclusions: Our data indicated that derotational osteotomy is a promising procedure which can be used to correct for internal rotation contractures secondary to OBPP. Moreover, 3D-video analysis proved to be a useful tool that supplies the surgeon with both precise information about the degree of distortion pre-operatively, thus helping to decide on the amount of correction, and secondly, a measurement of the post-operative gain in upper extremity function.

Effective Stretching Positions of the Piriformis Muscle Evaluated Using Shear Wave Elastography.

Piriformis syndrome is often associated with muscle spasms and shortening of the piriformis muscle (PM). Physical therapy, including static stretching of the PM, is one of the treatments for this syndrome. However, the effective stretching position of the PM is unclear in vivo. This study aimed to determine the effective stretching positions of the PM using ultrasonic shear wave elastography. Observational study. Twenty-one healthy young men (22.7 [2.4]y) participated in this study. The shear elastic modulus of the PM was measured at 12 stretching positions using shear wave elastography. Three of the 12 positions were tested with maximum internal rotation at 0°, 20°, or 40° hip adduction in 90° hip flexion. Nine of the 12 positions were tested with maximum external rotation at positions combined with 3 hip-flexion angles (70°, 90°, and 110°) and 3 hip-adduction angles (0°, 20°, and 40°). The shear elastic modulus of the PM was significantly higher in the order of 40°, 20°, and 0° of adduction and higher in external rotation than in internal rotation. The shear elastic modulus of the PM was significantly greater in combined 110° hip flexion and 40° adduction with maximum external rotation than in all other positions. This study revealed that the position in which the PM was most stretched was maximum external rotation with 110° hip flexion and 40° hip adduction.

Comparison of glenohumeral and scapulothoracic kinematics between fastballs and curveballs during baseball pitching

ABSTRACT Shoulder injuries are common in baseball pitchers and primarily involve the glenohumeral joint. Past analyses have examined shoulder biomechanics during different pitch types simply as the motion of the upper arm relative to the thorax. In this study, glenohumeral and scapulothoracic kinematics were compared between fastballs and curveballs at key timepoints throughout a pitch. Upper extremity kinematics of thirteen collegiate pitchers were collected during fastball and curveball pitches with motion capture. A linear model approach was utilised to estimate scapular kinematics based on measurable humerothoracic motion. Glenohumeral kinematics were computed from the scapular and humeral motion data. Comparisons of scapulothoracic and glenohumeral kinematic variables at times of maximum glenohumeral external rotation, ball release, and maximum glenohumeral internal rotation between pitch types were made using paired t-tests with Benjamini-Hochberg corrections. There were no significant differences in glenohumeral kinematics. Fastballs elicited significantly less scapulothoracic internal rotation and more posterior tilt at maximum glenohumeral external rotation. Fastballs produced significantly less scapulothoracic internal rotation and anterior tilt at maximum glenohumeral internal rotation. This study provides further evidence that risk of injury to the glenohumeral joint may be consistent between fastballs and curveballs and offers insights into subtle differences in scapular kinematics between pitch types.

Stiffness Changes in Shoulder Muscles between Pitchers and Position Players after Throwing Overhead Using Shear Wave Elastography and Throwing Motion Analysis.

Objectives: The objective is to compare stiffness changes around the shoulder muscles between pitchers and position players after throwing overhead using shear wave elastography (SWE) in relation to throwing motion analysis and muscle strength. Methods: A total of 32 male college baseball players (12 pitchers and 20 position players) were observed throwing 20 times, and SWE was performed to evaluate 13 shoulder muscle items-tendons (supraspinatus, infraspinatus, subscapularis, and teres minor), muscles (supraspinatus, infraspinatus [transverse and oblique part], teres minor, lower trapezius, latissimus dorsi, and pectoralis minor), and capsules (posterior and posteroinferior). Motion analysis was used to assess elbow torque, forearm angle, forearm rotation speed, and maximum external rotation angle of the shoulder. Muscle strength was measured using a dynamometer for abduction, internal/external rotation of the shoulder at an abduction of 0°, internal/external rotation of the shoulder at an abduction of 90°, and internal/external rotation of shoulder at a flexion of 90°. Results: In the pitcher group, SWE values for the teres minor muscle and latissimus dorsi muscle increased significantly after throwing. In the position player group, SWE values for the teres minor muscle significantly increased, and SWE values of the pectoralis minor muscle decreased after throwing. In the pitcher group, positive correlations were found between the teres minor muscle and forearm rotation speed and between the latissimus dorsi muscle and forearm angle. No significant difference was found in muscle strength after throwing in any of the groups. Conclusions: Stiffness changes occurred after throwing and were related to the motion analysis, but the regions in which stiffness occurred varied between pitchers and position players.

A cadaveric study of the posterior band of the inferior glenohumeral ligament of the shoulder and its dynamic behaviour in different arm positions.

The inferior glenohumeral ligament (IGHL) is composed of three parts: the anterior branch or band (AB), the axillary pouch and the posterior band (PB). The latter has rarely been studied. We aim to describe the PB of the IGHL and its dynamic behaviour in different arm positions. Twelve fresh cadaveric shoulders were used and the two bands (AB and PB) of the IGHL were dissected and isolated, taking away all muscle, ligaments and capsule. Characteristics of the bands were studied in five positions: maximum external rotation (ER1), abduction (ABD), internal rotation (IR), ABD external rotation (ER2) and anterior elevation-adduction-IR (Hawkins-Kennedy test position). Progressive and randomized sectioning of the bands and capsule with a scalpel was performed to study its impact on mobility and translation of the glenohumeral joint. The bands that tensioned first werein ER1, the AB at 97 ± 9° (80-110); in ER2, the AB at 81 ± 19° (30-100); in IR, the PB at 64 ± 9° (50-80); and in ABD, the PB at 87 ± 10° (70-105). Isolated sectioning of the AB had no effect on ABD, whilst isolated sectioning of the PB allowed greater ABD. In ER2, the AB limited anterior translation. After sectioning the AB, anterior translation remained limited by the PB, which wrapped around the humeral head and locked the joint by pressing the two joint surfaces tightly together. In Hawkins-Kennedy position anterior elevation-adduction-IR, the AB is the first constraint and the posterior translation was limited by the PB alone only in four cases. When the IGHL is isolated, ligament limitation of glenohumeral ABD seems to be uniquely dependent on the PB. In the Hawkins and Kennedy position, the AB is the first constraint. In the case of an isolated lesion to the AB, the PB participates in anterior stabilization of the shoulder by wrapping around the humeral head that cannot dislocate. These findings confirm the role of the PB in glenohumeral joint stability. Level IV.

Effects of repetitive baseball throwing on hip muscle strength and trunk and pelvic motions at the shoulder's maximum external rotation position during the late cocking phase and ball release.

[Purpose] This study aimed to investigate the changes in the trunk and pelvic lateral tilt angles at the shoulder's maximum external rotation during the late cocking phase (MER) and ball release (BR) and hip muscle strength during repetitive throwing. [Participants and Methods] In this study, 12 male baseball players participated. During the throwing, which was filmed using a high-speed video camera, the trunk and pelvic lateral tilt angles toward the nonthrowing side were measured at the MER and BR. Hip muscle strength during abduction, adduction, and external internal rotations were measured on the throwing and nonthrowing sides. Repetitive throwing was performed for nine innings, with 15 pitches per inning. Throwing motion was compared during innings 1, 7, 8, and 9. Hip muscle strength was measured before and after repetitive throwing. [Results] Compared with the trunk lateral tilt angle toward the nonthrowing side at BR in inning 1, the angle in innings 8 and 9 increased. The strength of hip abduction, adduction, and external and internal rotations on the throwing and nonthrowing sides decreased after repetitive throwing. [Conclusion] Hip muscle strength decreases after 135 pitches, and throwing >120 pitches changes the trunk lateral tilt angle at BR.

Biomechanical comparison of open Bankart repair vs. conjoint tendon transfer in a 10% anterior glenoid bone loss shoulder instability model

The treatment of shoulder instability in patients with subcritical glenoid bone loss poses a difficult problem for surgeons as new evidence supports a higher failure rate when a standard arthroscopic Bankart repair is used. The purpose of this study was to compare a conjoint tendon transfer (soft-tissue Bristow) to an open Bankart repair in a cadaveric instability model of 10% glenoid bone loss. Eight cadaveric shoulders were tested using a custom testing system that allows for a 6-degree-of-freedom positioning of the glenohumeral joint. The rotator cuff muscles were loaded to simulate physiologic muscle conditions. Four conditions were tested: (1) intact, (2) Bankart lesion with 10% bone loss, (3) conjoint tendon transfer, and (4) open Bankart repair. Range of motion, glenohumeral kinematics, and anterior-inferior translation at 60° of external rotation with 20 N, 30 N, and 40 N were measured in the scapular and coronal planes. Glenohumeral joint translational stiffness was calculated as the linear fit of the translational force-displacement curve. Force to anterior-inferior dislocation was also measured in the coronal plane. Repeated measures analysis of variance with a Bonferroni correction was used for statistical analysis. A Bankart lesion with 10% bone loss increased the range of motion in both the scapular (P=.001) and coronal planes (P=.001). The conjoint tendon transfer had a minimal effect on the range of motion (vs. intact P=.019, .002), but the Bankart repair decreased the range of motion to intact (P=.9, .4). There was a significant decrease in glenohumeral joint translational stiffness for the Bankart lesion compared with intact in the coronal plane (P=.021). The conjoint tendon transfer significantly increased stiffness in the scapular plane (P=.034), and the Bankart repair increased stiffness in the coronal plane (P=.037) compared with the Bankart lesion. The conjoint tendon transfer shifted the humeral head posteriorly at 60° and 90° of external rotation in the scapular plane. The Bankart repair shifted the head posteriorly in maximum external rotation in the coronal plane. There was no significant difference in force to dislocation between the Bankart repair (75.8±6.6 N) and the conjoint tendon transfer (66.5±4.4 N) (P=.151). In the setting of subcritical bone loss, both the open Bankart repair and conjoint tendon transfer are biomechanically viable options for the treatment of anterior shoulder instability; further studies are needed to extrapolate these data to the clinical setting.

Kinematic analysis of damaged capsulolabral structure in patients with anterior shoulder instability using cine-magnetic resonance imaging

We assessed damaged anterior capsulolabral motion during axial shoulder rotation in patients with anterior shoulder instability. Twenty-nine shoulders of 28 patients with anterior shoulder instability who underwent cine-magnetic resonance imaging during axial rotation of the adducted arm were included. The motion was captured after an intra-articular injection of saline solution (10-20 mL). During imaging, the shoulder was rotated passively from maximum internal rotation to maximum external rotation in the first 10 s and then back to maximum internal rotation in the subsequent 10 s. We assessed the rotational angles of the damaged labrum during compressing and pulling the humeral head against the glenoid. Evaluation of the rotational angles was performed on a series of axial images through the humeral head center. The mean angles that damaged labrum compressed and pulled off against the glenoid were 12.0±19.1° and 2.8±21.2°, respectively. Additionally, seven of the 29 shoulders showed that the damaged labrum compressed on the glenoid rim before the rotational angle exceeded 0° during external rotation. In 13 shoulders, the damaged labrum could remain repositioned on the glenoid rim over the neutral position during internal rotation. In two shoulders, the damaged labrum was not compressed against the glenoid at the maximum external rotation. The injected saline moved from the posterior to the anterior side of the glenohumeral joint during internal rotation in each shoulder. The damaged labrum could be positioned on the glenoid when the arm was in a traditional internal immobilization.

Correlation between run-up speed and throwing distance of elite javelin athletes

&lt;p&gt;目的：本研究探討台灣優秀標槍選手助跑速度與投擲距離之相關性。方法：8位國內優秀標槍選手 (身高：176.2 &amp;plusmn; 4.5公分，體重：87.7 &amp;plusmn; 10.7公斤，年齡：21.1 &amp;plusmn; 3.7歲，平均投擲距離：68.8 &amp;plusmn; 6.9公尺)，本研究採用實際比賽進行數據收集，本研究使用高速攝影機 (60Hz) 紀錄投擲標槍助跑過程，透過影像分析獲得助跑距離及時間。本研究採用相依樣本t檢定比較預賽及決賽的助跑速度及投擲表現及使用皮爾森積差相關分析比較助跑速度及投擲表現之相關性，顯著水準訂為 &amp;alpha; = .05。結果：研究結果發現，預賽與決賽的投擲表現顯著大於決賽有顯著差異 (p &lt; .05)，但預賽與決賽的助跑速度無顯著差異 (p &gt; .05)，另外，預賽與決賽的投擲距離與助跑速度相關性沒有顯著差異。結論：當助跑速度越快不會增加投擲距離。選手可能會有個別最佳的助跑速度。&lt;/p&gt;&lt;p&gt;The standing throw with run-up is the best approach to evaluate the performance of energy transfer and the efficiency of throwing motions for handball players. Purpose: This research aims at analyzing the usage of the standing throw with run-up among the handball players in Taiwan. The roles of body kinematics, strength of core muscles and standing balance of the drive leg played in the standing throw with run-up are also discussed. Methods: Nine Division I handball players from college went through a series of tests. The motions and the speed of the handball throwing were detected by a 3D electromagnetic motion analysis system and a sports radar gun, respectively. The maximum isometric muscle strength of trunks and hips were measured by a torque sensor and a home-made device of strength measurement. The standing balance of the drive leg was measured by a force plate with a mat. Results: The maximal shoulder external rotation angle in the arm cocking phase, the maximal trunk rotation velocity in the arm acceleration phase and the maximal shoulder horizontal adduction velocity showed moderate positive relationships with the ball velocity. The strength of back muscles had a moderate negative relationship with the ball velocity. The correlation between the balance ability of the drive leg and the ball velocity was not observed. Conclusion: The importance of proximal segments to the standing throw with run-up is analyzed by kinematical analysis. It is suggested that the energy of handball throwing is generated by the upper extremities or other limb segments in the processes of the standing throw with run-up. Our findings can serve as a helpful reference for both coaches and players.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Some Offset Restoration Options Can Paradoxically Lead to Decreased Range of Motion in Primary Total Hip Arthroplasty: A 3-Dimensional Computer Simulation Study

BackgroundIn total hip arthroplasty (THA), femoral offset restoration results in optimal biomechanics and range of motion (ROM) without bone-bone impingement. We hypothesized that differences in implant design features significantly affect bone-bone impingement risk in primary THA. MethodsThis retrospective computer simulation study included a cohort of 43 primary robotic arm–assisted THA. Considering sagittal pelvic tilt, we measured the maximum external rotation at 0° hip flexion and the maximum internal rotation at both 90° and 100° hip flexion before any bone-bone impingement occurred. To influence the offset, we included neutral or extended polyethylene liners, neutral or plus prosthetic heads, standard or high-offset stems, and stems with 132° or 127° neck angles. ResultsExtended polyethylene liner use resulted in decreased bone-bone impingement for both stems but also decreased prosthetic ROM in hip extension (mean −4.5 to 5°, range −10 to 0°) and hip flexion (mean −3 to 3.7°, range −10 to 0°) due to decreases in head diameter. Using a plus head or different stem offset/neck angle options resulted in either (1) no improvement in ROM (stem 1: 60%; stem 2: 28%) or (2) a paradoxical increase in bone-bone impingement (stem 1 with 127°: 19% and stem 2 with high offset option: 7%). ConclusionCounterintuitively, a subset of patients experience a paradoxical increase in bone-bone impingement when transitioning from standard to high-offset or varus necks due to the pelvic and proximal femoral bone shape. For this group of patients, preoperative personalized 3-dimensional modeling may help guide implant choice for optimizing outcomes.