Total Rotational Motion Research Articles

Shoulder External Over Internal Rotation Ratio Is Related to Biomechanics in Collegiate Baseball Pitching.

Altering baseball pitching mechanics affects both performance and the risk of injury. The purpose of this study is to investigate the relationships of shoulder external over internal rotation ratio (SEIR) and other shoulder rotational properties during physical exam and biomechanics of pitching for 177 collegiate baseball pitchers. The shoulder range of motion was quantitatively measured using a custom-made wireless device. Pitching motion data were collected at 240Hz, and a custom program was created to calculate the throwing arm motion and loading during baseball pitching. Linear regression and analysis of variance tests were performed to investigate the relationships between the shoulder physical exam outcomes and throwing arm biomechanics. SEIR had significant correlations with shoulder horizontal adduction angle at foot contact, maximum shoulder external rotation angle, maximum shoulder linear velocity, and elbow angle at ball release. SEIR groups had significant differences in shoulder proximal force, adduction torque, internal rotation torque, and horizontal adduction torque, and in elbow medial force and varus torque. Glenohumeral internal rotation deficit and total rotational motion deficit had no relationships with throwing arm motions or joint loadings. Shoulder health should be monitored to improve understanding of pitching mechanics in collegiate baseball pitchers.

Effectiveness of sleeper’s stretch on proprioception and range of motion in volleyball and basketball athletes with glenohumeral internal rotation deficit

Abstract Glenohumeral internal rotation deficit (GIRD) is a common impairment of neuromuscular origin that affects overhead athletes. The purpose of this study was to investigate the effect of 4-week sleeper stretch program on proprioception and range of motion (ROM) in athletes clinically diagnosed with GIRD. This study was a single group crossover study design (pre-post). The athletes underwent sleeper stretching program (5 sessions/week for 4 weeks) on the affected and non-affected sides. A total of 32 male athletes (15 basketball/17 volleyball were assessed for outcome measures of internal rotation (IR), external rotation (ER), total range of motion (TROM), and proprioception in ER, IR, and TROM (eyes open and eyes closed) at baseline and at the end of intervention. The affected side ROM significantly improved from 54.53±8.90° to 77.56±4.33° and 58.27±3.33° to 81.10±3.67° for volleyball and basketball athletes, respectively (IR ROM); from 114.56±5.88° to 95.77±6.66° and 119.44±4.67° to 104.23±5.05° for volleyball and basketball athletes, respectively (ER ROM); and from 169.90±5.78° to 173.11±5.88° and 177.28±5.88° to 186.89±3.79° for volleyball and basketball athletes, respectively (TROM), after the four-week sleeper stretch exercise. The ROM changes were non-significant on the non-affected side (P>0.05). The ANOVA reading for individual sports was found to be significant: volleyball athlete IR: [P<0.05, effect size (ES)=0.63], basketball athlete IR: [P<0.05, ES=0.74], volleyball athlete ER [P<0.05, ES=0.49), basketball athlete ER [P<0.05, ES=0.38). However, there was no significant improvement in proprioception measured with both eyes open (EO) and eyes closed (EC) for the IR, ER, and TROM. This study establishes the important role of sleeper’s stretching protocol in improvement of internal rotation, external rotation, and total rotational motion of the affected side. These findings may have important clinical implications in the management of GIRD in volleyball and basketball athletes.

Differences in Passive Shoulder Range of Motion Between Baseball Players With Neurogenic Thoracic Outlet Syndrome and Matched Healthy Controls.

Background:Neurogenic thoracic outlet syndrome (nTOS) is becoming more recognized as a diagnosis in the throwing athlete. Currently, there is limited information on the clinical presentation and development of nTOS in baseball players.Purpose:To compare passive shoulder range of motion (ROM) and anatomic humeral retrotorsion (HRT) of baseball players diagnosed with nTOS with a group of healthy, matched controls.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 53 adolescent baseball players diagnosed with nTOS (age, 17.2 ± 2.3 years; height, 180.9 ± 10.1 cm; weight, 80.0 ± 13.3 kg) were compared with 53 healthy baseball players (age, 17.2 ± 2.4 years; height, 183.9 ± 9.0 cm; weight, 83.8 ± 11.5 kg). Participants were measured for shoulder internal rotation (IR) and external rotation (ER) ROM and HRT. All measurements were taken bilaterally, and the differences (throwing to nonthrowing arm) were used to calculate mean values for glenohumeral internal rotation difference, glenohumeral external rotation difference (GERD), total rotational motion difference (TRMdiff), and anatomic humeral retrotorsion difference. Group comparisons were made between the nTOS and control players using multivariate analysis of variance, and descriptive comparisons were made with independent t tests.Results:There were no significant differences between groups in age, height, weight, or years of experience. Players in the nTOS group had significantly less throwing arm ER compared with controls (103.4° ± 10.4° vs 109.6° ± 7.5°, respectively; P = .001) and GERD (3.0° ± 9.2° vs 8.8° ± 9.2°, respectively; P = .002). TRMdiff was significantly greater in nTOS (–11.1° ± 11.1°) than in controls (–3.7° ± 9.4°) (P < .001).Conclusion:In the current study, adolescent baseball players diagnosed with nTOS were evaluated with shoulder ROM differences when compared with a matched healthy cohort. A loss of throwing arm ER appeared to be the main factor behind shoulder ROM changes in the nTOS group.

Loss Of Glenohumeral Range Of Motion And Its Effects On Eccentric Strength In Intercollegiate Pitchers

Deficits in glenohumeral joint rotational range of motion (ROM) and strength in baseball pitchers’ shoulders have been linked to increased risk of musculoskeletal injury. Total arc of motion deficit (TAMD) is an objective parameter that involves the comparison of bilateral shoulder internal rotation (IR) and external rotation (ER) ROM values as a measure of soft tissue changes at that joint. PURPOSE: To determine whether TAMD in the throwing shoulder, when compared to the non-throwing shoulder, affected the eccentric strength of IR and ER muscles of the glenohumeral (GH) joints of intercollegiate baseball pitchers. METHODS: 47 male pitchers (age, 19.8+1.2 yrs; hgt, 183.9+5.5 cm; mass, 85.7+10.2 kg; pitching experience, 9.9+2.8 yrs) were recruited to this study and assigned to 1 of 2 groups: 24 pitchers with >10° side-to-side differences in total rotational motion were assigned to the TAMD group, while 23 pitchers with less than 10° side-to-side ROM differences qualified for a non-deficit group (Non-TAMD). We measured eccentric IR and ER peak torques at 300o/sec bilaterally with an isokinetic dynamometer. RESULTS: We observed higher ER/IR strength ratios of the dominant arms when compared to the non-dominant arms of pitchers in both the TAMD (85.2%+24.3% and 45.4%+7.3%) and non-TAMD groups (87.3%+22.8% and 48.5%+8.1%) (p<0.001). There were no significant differences between the normalized TAMD and non-TAMD dominant arm eccentric IR torques (0.497+0.073 Nm/kg BW vs. 0.478+0.062 Nm/kg BW) or eccentric ER torques (0.407+0.082 Nm/kg BW vs. 0.411+0.077 Nm/kg BW) (p>0.05). Dominant arm eccentric ER/IR strength ratio (86.2%±23.3% vs. 47.0%±7.8%) and ER eccentric peak torque (0.410±0.088 Nm/kg BW vs. 0.295±0.049 Nm/kg BW) were both significantly greater than in the non-dominant arm (p<0.05). Internal rotation eccentric peak torque (0.488±0.088 Nm/kg BW vs. 0.636±0.101 Nm/kg BW) was significantly higher in the non-dominant arm (p<0.05). CONCLUSIONS: We found ER/IR ratios that were significantly higher in the dominant arms, but no significant differences in ER or IR eccentric strength between the TAMD and Non-TAMD groups. Loss of shoulder rotation ROM did not have a significant effect on the production of IR and ER eccentric torques at the GH joint in this sample of intercollegiate pitchers.

Glenohumeral rotation deficits in high school, college, and professional baseball pitchers with and without a medial ulnar collateral ligament injury

It is unclear how a glenohumeral internal rotation (IR) loss (GIRLoss), a glenohumeral external rotation (ER) gain (GERGain), or a total rotational motion (TRM) deficit (TRMD) predict medial ulnar collateral ligament (MUCL) injury risk among high school (HS), college (COLL), and professional (PRO) baseball pitchers with and without MUCL injury. We hypothesized that pitchers with MUCL injury would have more GIRLoss and TRMD compared with pitchers without MUCL injury, with no differences in IR, ER, TRM, GIRLoss, GERGain, and TRMD. The study equally divided 216 male HS, COLL, and PRO pitchers into the MUCL injury group (n = 108) and a control group (n = 108) without MUCL injury. The control group was matched with the MUCL injury group according to number, level of play, and age. Bilateral shoulder passive IR/ER was measured and GIRLoss, GERGain, TRM, and TRMD calculated. A 2-way analysis of variance (P < .05) was used to assess shoulder rotational differences among the 2 groups and 3 pitching levels. Compared with the control group, the MUCL injured group had more GIRLoss (21° ± 14° vs. 13° ± 8°; P < .001), GERGain (14° ± 9° vs. 10° ± 9°; P = .004), and TRMD (7° ± 13° vs. 3° ± 9°; P = .008). For all pitching levels, approximately 60% of pitchers in MUCL injury group had GIRLoss >18° compared with approximately 30% of those in the control group. Approximately 60% of pitchers in the MUCL injury group had TRMD >5° compared with 50% of pitchers in the control group. No differences were observed among HS, COLL, and PRO pitchers for GIRLoss (16° ± 12°, 17° ± 11°, 19° ± 13°, respectively; P = .131), GERGain (11° ± 9°, 11° ± 10°, 13° ± 10°, respectively; P = .171), TRMD (5° ± 11°, 6° ± 11°, 5° ± 14°, respectively; P = .711), and throwing shoulder ER (111° ± 10°, 111° ± 11°, 113° ± 9°, respectively; P = .427), IR (50° ± 11°, 49° ± 11°, 48° ± 10°, respectively; P = .121), and TRM (162° ± 14°, 160° ± 15°, 161° ± 14°, respectively; P = .770). Greater GIRLoss, GERGain, and TRMD in MUCL injured pitchers compared with uninjured pitchers implies these variables may be related to increased MUCL injury risk, especially because GIRLoss >18° and TRMD >5° demonstrate an increased MUCL injury risk. Shoulder rotational motion and deficits do not vary among HS, COLL, and PRO levels of pitchers.

Assessment of ultrasonography as a diagnostic tool in shoulder pain and alterations in glenohumeral range of motion in tennis players.

IntroductionShoulder pain and alterations in the range of motion are common disorders in tennis players. However, the relation between shoulder structures and these conditions is unknown.AimTo evaluate whether, using ultrasonography, one can identify tennis players with shoulder pain and those having specific changes of the range of rotation of the glenohumeral joint.Material and methodsA total of 66 subjects were assessed through examination of the range of rotation of the glenohumeral joint and ultrasonography.ResultsThe study group consisted of 37 people with shoulder pain (24.2 ±8.6 years) and the control group included 29 subjects without shoulder pain (21.9 ±10.8 years). The prevalence of pathologies of the supraspinatus (SSP), infraspinatus (ISP) or subscapularis (SSC) was significantly higher in the study group than in the control group (p = 0.044) but solely for the combined pathologies. The incidence rate of pathological shoulder changes (the SSP, ISP, SSC and the subacromial bursa) was not correlated with the ranges of rotations or intensity of pain. Glenohumeral internal rotation deficit (GIRD), total rotational motion (TROM) deficit and external rotation deficiency (ERD) were independent of pathological shoulder changes, except the significantly higher prevalence of SSP pathologies among subjects with ERD.ConclusionsUltrasonography could be helpful in identifying tennis players with painful shoulder having rotator cuff pathologies. However, the ability of the method to identify players having specific changes of the range of rotation of the glenohumeral joint is limited, with the exception of tennis players with ERD having SSP pathologies.

Factors associated with shoulder deficit in total rotational motion (DTRM) in adolescent athletes

Deficit in Total Rotational Motion (DTRM) is a frequent condition in athletes which is directly associated with risk of shoulder injury. However, the identification of risk factors for DTRM in adolescent athletes is not yet established. Thus, the aim of this study was to identify which factors are associated with shoulder deficit in total rotational motion among adolescent athletes. This is an observational cross-sectional study which recruited 178 male adolescent volleyball, handball, swimming, basketball and judo athletes. Information on age, dominance, training frequency, practice time and duration of each session were recorded. The evaluation was composed of a scapular kinematic analysis according to the observational method in order to identify dyskinesis and external and internal rotation amplitude of the glenohumeral joint to assess the presence of internal rotation deficit (GIRD) and DTRM, both using the passive goniometry method. Data analysis was performed using the STATA software in which binary logistic regression was performed with the outcome DTRM and inputting the independent variables of age, training frequency, duration of each session, practice time, modality, scapular dyskinesis and GIRD to identify possible factors. Results shows that adolescent athletes with a weekly training frequency of more than three times a week and affected by GIRD were 2.68 [1.27;5.63] and 9.28 [3.03;28.15] times more likely to present DTRM, respectively. Based on these results, the presence of DTRM was associated with modifiable factors. Physical fitness strategies are advisable in order to control such factors and prevent injuries associated with DTRM.

Axial Rotation Test for Trapeziometacarpal Joint Hypermobility in the Normal Population.

The objective was to quantify joint laxity in healthy volunteers by measuring the passive axial rotation of the trapeziometacarpal joint using the axial rotation test. Eighty volunteers (34 men and 46 women) were subjected to the axial rotation shear test and the degree of total rotational motion (TRM) was assessed. Volunteers were divided into Group I with a range of 18-50 years old and Group II for 51 years and older. Statistical analysis was performed. The average TRM in Group I was 32.3 mm for women, and 27.4 mm, for men (p = 0.04). The average TRM in women of Groups I and II, was 32.3 and 21.6 mm respectively, (p < 0.001). The average TRM in men of Groups I and II, was 27.4 and 19.4 mm (p < 0.001). In Group II the average TRM of women was 21.6 mm, and for men was 19.4 mm, which was not significantly different. Young women have greater degree of rotational laxity in the TM joint compared to men of the same age group and to older women. The axial rotation test can quantify the degree of rotational laxity of the TM joint.

Glenohumeral internal rotation deficit in throwing athletes: current perspectives

Glenohumeral internal rotation deficit (GIRD) is an adaptive process in which the throwing shoulder experiences a loss of internal rotation (IR). GIRD has most commonly been defined by a loss of >20° of IR compared to the contralateral shoulder. Total rotational motion of the shoulder is the sum of internal and external rotation and may be more important than the absolute value of IR loss. Pathologic GIRD has been defined as a loss of IR combined with a loss of total rotational motion. The leading pathologic process in GIRD is posterior capsular and rotator-cuff tightness, due to the repetitive cocking that occurs with the overhead throwing motion. GIRD has been associated with numerous pathologic conditions, including posterior superior labral tears, partial articular-sided rotator-cuff tears, and superior labral anterior-to-posterior tears. The mainstay of treatment for patients with GIRD is posterior capsular stretching and strengthening to improve scapular mechanics. In patients who fail nonoperative therapy, shoulder arthroscopy can be performed. Arthroscopic surgery in the high-level throwing athlete should be to restore them to their functional baseline with the minimum amount of intervention possible.

Correlation Among Y-Balance Test-Lower Quarter Composite Scores, Hip Musculoskeletal Characteristics, and Pitching Kinematics in NCAA Division I Baseball Pitchers.

Context: Numerous studies have reported kinematic data on baseball pitchers using three-dimensional (3D) motion analysis, but no studies to date have correlated this data with clinical outcome measures. Objective: To examine the relationship among Y-Balance Test-Lower Quarter (YBT-LQ) composite scores, musculoskeletal characteristics of the hip, and pitching kinematics in National Collegiate Athletic Association (NCAA) Division I baseball pitchers. Design: Cross-sectional. Setting: 3D motion analysis laboratory. Participants: Nineteen healthy male college baseball pitchers. Main Outcome Measures: Internal and external hip passive range of motion, hip abduction strength, YBT-LQ composite scores, and kinematic variables of the pitching motion. Results: Stride length demonstrated a moderate positive correlation with dominant limb YBT-LQ composite score (r = .524, P = .02) and nondominant limb YBT-LQ composite score (r = .550, P = .01), and a weak positive correlation with normalized time to maximal humerus velocity (r = .458, P = .04). Stride length had a moderate negative correlation with normalized time to maximal thorax velocity (r = -.522, P = .02) and dominant hip total rotational motion (TRM; r = -.660, P = .002), and had a strong negative correlation with normalized time from stride foot contact to maximal knee flexion (r = -.722, P < .001). Dominant limb YBT-LQ composite score had a weak negative correlation with hip abduction strength difference (r = -.459, P = .04) and normalized time to maximal thorax velocity (r = -.468, P = .04). Nondominant limb YBT-LQ composite score demonstrated a weak negative correlation with normalized time to maximal thorax velocity (r = -.450, P = .05) and had a moderate negative correlation with dominant hip TRM (r = -.668, P = .001). There were no other significant relationships between the remaining variables. Conclusions: YBT-LQ is a clinical measure that can be used to correlate with hip musculoskeletal characteristics and pitching kinematics in NCAA Division I pitchers.

Effects of a Short-Duration Stretching Drill After Pitching on Elbow and Shoulder Range of Motion in Professional Baseball Pitchers

Background: A glenohumeral internal rotation (IR) deficit or a total rotational motion (IR plus external rotation [ER]) deficit in the throwing shoulder compared with the nonthrowing shoulder has been shown to increase the risk of shoulder and elbow injuries. After a pitching session, both IR and total rotational motion deficits have been shown to occur naturally for an extended period of time in asymptomatic pitchers, but it is unclear how to best control these deficits between pitching sessions. Purpose/Hypothesis: The purpose of this study was to determine whether performing a short-duration stretching/calisthenics drill after pitching will result in an increase in IR, ER, total rotational motion, and elbow extension in professional baseball pitchers. It was hypothesized that these shoulder and elbow passive range of motion (PROM) measurements would all decrease after pitching but would subsequently return to prepitching values after the short-duration stretching/calisthenics drill. Study Design: Controlled laboratory study. Methods: A convenience sample of 20 male professional baseball pitchers served as study participants. The following sequence of activities was performed for all participants: (1) a 5- to 10-minute dynamic warm-up consisting of running and light throwing, (2) elbow extension and IR and ER PROM measurements taken before pitching, (3) 40 full-effort pitches off the pitching mound, (4) 8 minutes of rest, (5) elbow extension and IR and ER PROM measurements taken after pitching, (6) a short-duration stretching/calisthenics drill (two-out drill), and (7) elbow extension and IR and ER PROM measurements taken after the two-out drill. A 1-way repeated-measures analysis of variance (P < .05) was employed to assess differences in elbow extension, IR, ER, and total rotational motion in the 3 measurement conditions (prepitching, postpitching, and postdrill). To assess intrarater and interrater reliability, intraclass correlation coefficients (ICCs) were calculated, and the measurement error was calculated using the standard error of measurement (SEM). Results: Significant differences were observed among the 3 conditions for ER (P = .002), IR (P = .027), and total rotational motion (P < .001), but there was no significant difference in elbow extension (P = .117). Bonferroni post hoc analyses revealed (1) significantly greater ER during prepitching and postdrill versus the postpitching condition (94° ± 7° [prepitching] and 94° ± 8° [postdrill] vs 88° ± 8°; P = .010 and .005, respectively), (2) significantly greater IR during prepitching and postdrill versus the postpitching condition (36° ± 10° [prepitching] and 35° ± 9° [postdrill] vs 30° ± 10°; P = .034 and .043, respectively), and (3) significantly greater total rotational motion during prepitching and postdrill versus the postpitching condition (129° ± 13° [prepitching] and 129° ± 13° [postdrill] vs 119° ± 13°; P = .034 and .004, respectively). There were no significant differences in ER, IR, or total rotational motion between the prepitching and postdrill conditions (P > .999 for all). The intrarater reliability (ICC3,1) was 0.91 for ER (SEM, 1.3°) and 0.90 for IR (SEM, 1.9°), and the interrater reliability (ICC2,1) was 0.81 for ER (SEM, 3.3°) and 0.77 for IR (SEM, 4.3°). Conclusion: After a 40-pitch bullpen session, IR and ER PROM as well as total rotational motion were significantly lower than prepitching values; however, these deficits were restored back to their prepitching levels after the players performed the two-out drill, which may increase pitching performance and decrease the risk of shoulder and elbow injuries. More research is needed to test these hypotheses and assess the clinical efficacy of the two-out drill. Clinical Relevance: The findings from the current study will assist clinicians better understand the positive effects of performing a short duration stretching/calisthenics drill on shoulder internal and external rotation range of motion between innings while pitching during a baseball game.

The Relationship Between Humeral Retrotorsion and Shoulder Range of Motion in Baseball Players With an Ulnar Collateral Ligament Tear.

Background:Humeral retrotorsion has been investigated in relation to shoulder range of motion (ROM) in healthy baseball players. Currently, there is limited information on the osseous anatomy and development of ulnar collateral ligament (UCL) tears.Purpose:To determine the relationship between humeral retrotorsion and shoulder ROM in baseball players with a UCL tear.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Fifty-four baseball players (mean age, 18.5 ± 2.0 years) with a UCL tear volunteered for this study. Participants were measured bilaterally for shoulder internal (IR) and external rotation (ER) ROM and humeral retrotorsion. Differences between sides (involved to uninvolved) were used to calculate the glenohumeral internal rotation deficit (GIRD), external rotation ROM difference (ERDiff), total rotational motion difference (TRM), and humeral retrotorsion difference (HTDiff). A multivariate regression analysis was performed with GIRD, ERDiff, and TRM regressing on HTDiff. Univariate analysis was performed to further evaluate the effect of the predictors on each outcome separately. To control for the effect of age, weight, duration of symptoms, and years of experience, the variables were included as covariates. An a priori level was set at P < .05.Results:There was a statistically significant relationship between the GIRD, ERDiff, and TRM results compared with HTDiff (P = .003). Independent analysis revealed a statistically significant relationship between GIRD and HTDiff (P = .004) and between ERDiff and HTDiff (P = .003) but no significant relationship between TRM and HTDiff (P = .999). After adjusting for age, weight, duration of symptoms, years of experience, dominant arm, and position, a significant relationship was found between GIRD and HTDiff (P = .05) and between ERDiff and HTDiff (P = .01). No significant relationship was found between TRM and HTDiff (P = .54). Adjusted univariate regression analysis determined that HTDiff explains approximately 16% of the variance in GIRD (r 2 = 0.158) and approximately 24% of the variance in ERDiff (r 2 = 0.237).Conclusion:In baseball players with a UCL tear, approximately 16% of the variance in GIRD and 24% of the variance in ERDiff can be attributed to differences found in humeral retrotorsion between sides. This indicates that humeral retroversion contributes significantly to GIRD and increased ER ROM in baseball players. Recognition of differences in humeral retrotorsion between the dominant and nondominant upper extremities may help explain some but not all of the changes in shoulder ROM commonly seen in baseball players.

Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study.

To determine whether rotator cuff strength, glenohumeral joint range of motion and scapular control are associated with shoulder injuries among elite male handball players. A total of 206 players in the Norwegian elite handball league for men were tested prior to the 2011-2012 season. Measures included: (1) glenohumeral internal and external rotation range of motion, (2) isometric internal rotation, external rotation and abduction strength and (3) assessment of scapular dyskinesis. Players were followed prospectively for the entire regular season (30 weeks), with shoulder problems registered bi-weekly using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. A cumulative severity score was calculated for each player based on their questionnaire responses. This was used as the outcome measure in risk factor analyses. The average prevalence of shoulder problems throughout the season was 28% (95% CI 25% to 31%). The prevalence of substantial shoulder problems, defined as those leading to moderate or severe reductions in handball participation or performance, or to time loss, was 12% (95% CI 11% to 13%). Significant associations were found between obvious scapular dyskinesis (OR 8.41, 95% CI 1.47 to 48.1, p<0.05), total rotational motion (OR 0.77 per 5° change, 95% CI 0.56 to 0.995, p<0.05) and external rotation strength (OR 0.71 per 10 Nm change, 95% CI 0.44 to 0.99, p<0.05) and shoulder injury. Injury prevention programmes should incorporate interventions aimed at improving glenohumeral rotational range of motion, external rotation strength and scapular control.

RISK FACTORS FOR OVERUSE SHOULDER INJURIES AMONG MALE PROFESSIONAL HANDBALL PLAYERS

BackgroundOveruse shoulder injuries are common among professional male handball players. However, little is known about risk factors for the development of injury.ObjectiveTo determine whether rotator cuff strength, glenohumeral joint range...

Baseball Players Diagnosed With Ulnar Collateral Ligament Tears Demonstrate Decreased Balance Compared to Healthy Controls

Cross-sectional. To compare lower extremity balance and shoulder range of motion in baseball players with ulnar collateral ligament (UCL) tears to a healthy cohort. Background Throwing is a complex motion that requires balance and coordination to effectively transfer energy through the kinetic chain. In theory, poorer balance could negatively affect throwing mechanics and lead to injury. Thirty baseball players (mean ± SD age, 18.5 ± 1.9 years) with a diagnosis of a UCL tear of their throwing arm were compared to 30 players (age, 19.0 ± 1.1 years) without a UCL tear. All participants were competing at either the high school or collegiate level and reported an average ± SD of 13.5 ± 1.7 years of playing experience. The Y Balance Test composite scores were calculated for the stance and lead lower extremities of all players. Shoulder range of motion was used to calculate glenohumeral internal rotation deficit and side-to-side differences in total rotational motion. Group comparisons were made between participants with and without UCL tears using independent t tests. Baseball players with UCL tears scored significantly lower on the Y Balance Test for both the stance (P<.001) and lead (P<.001) lower extremities compared to the noninjured cohort. No between-group differences were noted in glenohumeral internal rotation deficit (P = .453), whereas the mean ± SD side-to-side difference in total rotational motion was -6.0° ± 9.6° for the injured group, compared to -0.4° ± 9.6° for the control group (P = .028). Participants with a UCL tear demonstrated decreased performance for their stance and lead lower extremities during the Y Balance Test. These data are consistent with a clinical hypothesis of a potential association between impaired balance and UCL tears in high school and collegiate baseball players. The lower total rotational motion of the dominant shoulder in participants with UCL tears needs to be considered in the interpretation of those results.

Glenohumeral Passive Range of Motion and the Correlation to Shoulder Injuries in Professional Baseball Pitchers

Objectives:Glenohumeral internal rotation deficit (GIRD) indicates a 20 degree or greater loss of IR on the throwing shoulder compared to the non-throwing shoulder. The purpose of this study was to determine whether GIRD and/or bilateral difference in total rotational motion (TRM) of the glenohumeral joint (external rotation + internal rotation) correlated with shoulder injuries in professional baseball pitchers.Methods:This study was conducted over eight competitive seasons (2005-2012). Each year during spring training, the same examiners assessed passive range of motion (PROM) of both the dominant and non-dominant shoulders of professional pitchers using a bubble goniometer. In total, 505 examinations were conducted on 296 pitchers. Glenohumeral joint motion was assessed in supine with the arm at 90 degrees of abduction and in the plane of the scapula for ER and IR. During ER and IR ROM assessment, the scapula was stabilized per methods previously established. Shoulder injuries and days missed due to injury were assessed and recorded by the medical staff of the team.Results:Significant differences were noted during side-to-side comparisons (p<0.0001) within subjects. Amongst this cohort, there were 77 shoulder injuries in 52 players accounting for a total of 3131 days missed. GIRD did not correlate to increased risk of shoulder injuries (p=0.8629). Pitchers with a deficit of more than 5 degrees in TRM between shoulders had a 1.9x higher risk of injury (p=0.0290). Players with < 5 more degrees of ER motion in their dominant shoulder at 90 degrees of abduction were 2.2 times as likely to have a shoulder injury (p=0.0112).Conclusion:Based on these results, pitchers with bilateral differences in total rotational motion had a significant impact on the risk of shoulder injuries. Loss of ER PROM in the dominant shoulder compared to the non-dominant side appears to contribute to shoulder injury risk as well. Clinicians need to be aware of these findings and plan a program that addresses these issues.

Glenohumeral Passive Range Of Motion And The Correlation To Elbow Injuries In Professional Baseball Pitchers

Objectives:The purpose of this study was to determine whether GIRD and/or bilateral difference in total rotational motion (TRM) of the glenohumeral joint (external rotation + internal rotation) correlated with elbow injuries in professional baseball pitchers.Methods:This study was conducted over eight competitive seasons (2005-2012). Each year during spring training, the same examiners assessed passive range of motion (PROM) of both the dominant and non-dominant shoulders of professional pitchers using a bubble goniometer. In total, 505 examinations were conducted on 296 pitchers. Glenohumeral joint motion was assessed in supine with the arm at 90 degrees of abduction and in the plane of the scapula for ER and IR. During ER and IR ROM assessment, the scapula was stabilized per methods previously established. Elbow injuries and days missed due to injury were assessed and recorded by the medical staff of the team.Results:Significant differences were noted during side-to-side comparisons (p<0.0001) within subjects. Amongst this cohort, there were 50 shoulder injuries in 38 players accounting for a total of 2294 days missed. GIRD did not correlate to elbow injuries (p= 0.5507). Pitchers with a deficit of more than 5 degrees in TRM between shoulders had a 2.3x higher risk of injury (p = 0.0214).Conclusion:Based on these results, pitchers with bilateral differences in total rotational motion had a significant impact on the risk of elbow injuries. This information can help guide the clinician during the evaluation and progression of the professional baseball pitcher.

Shoulder Range of Motion Deficits in Baseball Players With an Ulnar Collateral Ligament Tear

Background: Shoulder range of motion (ROM) deficits are associated with elbow injury in baseball players. Purpose: To compare the ROM characteristics of baseball players with a diagnosed ulnar collateral ligament (UCL) tear with those of a group of age-, activity-, and position-matched healthy controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Sixty male competitive high school and collegiate baseball players participated. Thirty athletes (age [mean ± standard deviation], 18.20 ± 1.56 years) with a diagnosed UCL tear were compared with 30 (age, 18.57 ± 0.86 years) age-, activity-, and position-matched players without a UCL injury. Of the 60 participants, there were 44 pitchers, 4 catchers, 5 infielders, and 7 outfielders. Participants were measured for shoulder internal rotation (IR), external rotation (ER), and horizontal adduction (HA) at 90° of shoulder elevation. Participants were also measured for elbow extension in a seated position. Group comparisons were made between participants with and without a UCL injury using independent t tests with an α level set at P < .05. All measurements were taken bilaterally, and the differences (involved to uninvolved) were used to calculate means for all variables, including glenohumeral internal rotation deficit (GIRD), total rotational motion (TRM), HA, and elbow extension. Results: Baseball players with a UCL tear (UCLInj) exhibited significantly greater deficits in TRM compared with the control group of healthy baseball players (NUCLInj) (UCLInj = −6.67° ± 11.82°, NUCLInj = 0.93° ± 9.91°; P = .009). No group differences were present for GIRD (UCLInj = −12.53° ± 5.98°, NUCLInj = −13.63° ± 5.90°; P = .476), HA (UCLInj = −3.00° ± 5.01°, NUCLInj = −3.23° ± 5.15°; P = .860), or elbow extension (UCLInj = −2.63° ± 7.86°, NUCLInj = −1.17° ± 2.76°; P = .339). Pitchers with a UCL tear had significantly greater deficits in TRM (UCLInjPitch = −6.96° ± 11.20°, NUCLInjPitch = 1.29° ± 8.33°; P = .0087) and dominant shoulder ER (UCLInjPitch = 112.04° ± 14.35°, NUCLInjPitch = 121.85° ± 9.46°; P = .011) than pitchers without a UCL tear. Conclusion: A deficit in TRM is associated with a UCL tear in baseball players. Although GIRD may be prevalent in throwers, it may not be associated with a UCL injury. When examining ROM in baseball players, it is important to assess both TRM and GIRD.

Passive Range of Motion Characteristics in the Overhead Baseball Pitcher and Their Implications for Rehabilitation

Repetitive overhead throwing motion causes motion adaptations at the glenohumeral joint that cause injury, decrease performance, and affect throwing mechanics. It is essential to define the typical range of motion (ROM) exhibited at the glenohumeral joint in the overhead thrower. We (1) assessed the glenohumeral joint passive range of motion (PROM) characteristics in professional baseball pitchers; and (2) applied these findings clinically in a treatment program to restore normal PROM and assist in injury prevention. From 2005 to 2010, we evaluated 369 professional baseball pitchers to assess ROM parameters, including bilateral passive shoulder external rotation (ER) at 45° of abduction, external and internal rotation (IR) at 90° abduction while in the scapular plane, and supine horizontal adduction. The mean ER was greater for the throwing and nonthrowing shoulders at 45° of abduction, 102° and 98°, respectively. The throwing shoulder ER at 90° of abduction was 132° compared with 127° on the nonthrowing shoulder. Also, the pitcher's dominant IR PROM was 52° compared with 63° on the nondominant side. We found no statistically significant differences in total rotational motion between the sides. Although we found side-to-side differences for rotational ROM and horizontal adduction, the total rotational ROM was similar. The clinician can use these PROM values, assessment techniques, and treatment guidelines to accurately examine and develop a treatment program for the overhead-throwing athlete.

Correlation of Glenohumeral Internal Rotation Deficit and Total Rotational Motion to Shoulder Injuries in Professional Baseball Pitchers

Background: Glenohumeral internal rotation deficit (GIRD) indicates a 20° or greater loss of internal rotation of the throwing shoulder compared with the nondominant shoulder. Purpose: To determine whether GIRD and a deficit in total rotational motion (external rotation + internal rotation) compared with the nonthrowing shoulder correlate with shoulder injuries in professional baseball pitchers. Study Design: Case series; Level of evidence, 4. Methods: Over 3 competitive seasons (2005 to 2007), passive range of motion measurements were evaluated on the dominant and nondominant shoulders for 170 pitcher-seasons. This included 122 professional pitchers during the 3 seasons of data collection, in which some pitchers were measured during multiple seasons. Ranges of motion were measured with a bubble goniometer during the preseason, by the same examiner each year. External and internal rotation of the glenohumeral joint was assessed with the participant supine and the arm abducted 90° in the plane of the scapula, with the scapula stabilized anteriorly at the coracoid process. The reproducibility of the test methods had an intraclass correlation coefficient of .81. Days in which the player was unable to participate because of injury or surgery were recorded during the season by the medical staff of the team and defined as an injury. Results: Pitchers with GIRD (n = 40) were nearly twice as likely to be injured as those without but without statistical significance (P = .17). Pitchers with total rotational motion deficit greater than 5° had a higher rate of injury. Minor league pitchers were more likely than major league pitchers to be injured. However, when players were injured, major league pitchers missed a significantly greater number of games than minor league pitchers. Conclusion: Compared with pitchers without GIRD, pitchers with GIRD appear to be at a higher risk for injury and shoulder surgery.