Elbow MRI Findings Do Not Correlate With Future Placement on the Disabled List in Asymptomatic Professional Baseball Pitchers.
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ABSTRACT:
SUBMITTER: Gutierrez NM
PROVIDER: S-EPMC5435154 | biostudies-literature | 2017 May/Jun
REPOSITORIES: biostudies-literature
Publications
Elbow MRI Findings Do Not Correlate With Future Placement on the Disabled List in Asymptomatic Professional Baseball Pitchers.
Gutierrez Nicholas M NM Granville Christopher C Kaplan Lee L Baraga Michael M Jose Jean J
Sports health 20170410 3
<h4>Background</h4>Injury rates among professional baseball players may reach as high as 5.8 per 1000 encounters, with pitchers being most vulnerable on account of the excessive biomechanical load on the upper extremity during the throwing motion. Anatomically, the shoulder is the most common site of pitching-related injury, accounting for 30.7% of injuries, closely followed by the elbow at 26.3%. Characteristic valgus loading imparts a predictable constellation of stresses on the joint, includi ...[more]
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Project description:PurposeTo evaluate preseason shoulder magnetic resonance images (MRIs) obtained from pitchers entering either major or minor league baseball (MLB) and correlate findings with subsequent injury, operative repair, and placement on the injured list (IL).MethodsPreseason-MRI of the throwing shoulders of professional-level baseball pitchers, taken during routine evaluations at a single organization (2004-2017) were retrospectively reviewed. Publicly available databases were queried to exclude pitchers with known injuries prior to pre-signing imaging. Three blinded reviewers reviewed all MRI scans independently to evaluate for the presence of abnormalities in the rotator cuff (RTC), labrum, capsule, long-head of the biceps tendon (LHBT), and humeral head. Binary imaging findings were correlated to future placement on the IL for subsequent shoulder complaints. Bivariate statistics using Student's t-tests and Fisher exact tests (both α = .05) were used in this study.ResultsA total of 38 asymptomatic pitchers with shoulder MRIs were included. Pitchers had a mean (±SD) age of 28.2 ± 4.9 and had pitched an average of 119.6 ± 143.8 career games. Pitchers with partial articular-sided RTC tears (P = .04) or intra-articular BT hyperintensity (P = .04) on preseason MRI demonstrated an association with the need for future surgery. Pitchers with evidence of labral heterogeneity demonstrated greater total career pitch counts (10,034.1 vs 2,465.3; P = .04). Evidence of a posterior-superior humeral cyst was associated with decreased strikeouts per 9 innings (6.1 vs 8.0; P = .039) and total strikeout percentage (16.1% vs 23.2%; P = .04).ConclusionAlthough there was a significant difference in the percent of various radiographic findings between the injured and healthy cohort, no MRI findings were predictive of future IL placement or duration of placement. The presence of a posterior superior humeral cyst was associated with decreased strikeout rates at 2 and 3 years, the presence of a labral tear was associated with decreased earned run average (ERA) at 3 years and decreased career strikeout percentages, and increased capsular signal was associated with decreased 5-year ERA.Level of evidenceLevel IV, retrospective study.
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Project description:Purpose To evaluate and describe the differences in characteristics between the Major League Baseball (MLB) pitchers with greater workload and career longevity in terms of innings pitched (IP) and performance-matched controls who have not experienced similar length careers. Methods Using publicly available data, we identified the top 100 MLB pitchers in terms of career IP. Controls were matched to the top 100 pitchers by draft year and round. Pitchers with fewer than 400 IP were excluded. Demographic information, performance statistics, and injury history were reviewed. Logistic regression analysis and Mann–Whitney U tests were used to compare data. Results Compared with controls, the top 100 pitchers in terms of IP were drafted at a younger age (19.35 vs 19.83, P < .001) and in later rounds (6.16 vs 2.45, P < .001). They made their MLB debut at a younger age (21.77 vs 23.12, P < .001). They also pitched fewer innings before debut (470.59 vs 632.07, P = .007), were older at their first (30.72 vs 27.50 years, P < .001) and second (32.42 vs 29.43 years, P < .001) designations to the injured list (IL), and had a significantly longer time from debut to first (3063.50 vs 1565.59 days, P < .001) and second (3712.10 vs 2202.03 days, P < .001) IL trips. The top 100 pitchers were 7.45 times less likely to have made a trip to the IL within 8 seasons from their debut and were 4.04 times more likely to be younger than 24 years at their major league debut. Conclusions Pitchers with the greatest number of IP in their MLB careers were significantly younger when drafted and when they made their major league debut, although this age difference is likely clinically insignificant. Pitchers who were drafted or debuted at a later age accumulate more pre-debut innings and this may contribute to fewer total IP in the MLB. Similarly, later trips to the injured list and longer duration from debut to first or second trip to the IL, but not total IL trips, are predictive of longer careers compared to age and draft class matched controls. Level of Evidence III, retrospective cohort study.
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Project description:BackgroundNumerous studies have discussed the risk factors for shoulder and elbow injuries in high school baseball players worldwide.PurposeTo determine the risk factors for pitching-related shoulder and elbow injuries in Taiwanese high school pitchers.Study designCross-sectional study; Level of evidence, 3.MethodsIncluded in the study were 144 pitchers from 11 top-ranked Taiwanese high school baseball teams between 2016 and 2017 high school baseball season. The participants answered a 55-item questionnaire concerning physical characteristics, pitching activities, injury history, and off-season activities. Univariate analyses were conducted separately for participants with and those without a pitching-related injury in the 12-month study period. The chi-square test or Fisher exact test was applied to categorical variables, and the F test or t test was applied to continuous variables. A stepwise multivariate logistic regression analysis was used to identify factors related to pitching-related injuries, and those results were calculated as odds ratios (ORs).ResultsHaving a pitching-related injury was significantly related to the number of pitches per week in the past 12 months (OR, 1.01; P = .006), pain over the shoulder and/or elbow in the past 12 months (OR, 3.56; P = .008), pitching competitive baseball for more than 8 of the past 12 months (OR, 2.53; P = .036), throwing sliders (OR, 2.97; P = .026), and lack of participating in other over-the-shoulder activities (0.03-0.11 fewer odds; P ≤ .010).ConclusionFor elite high school pitchers in Taiwan, pitching-related shoulder and elbow injuries were related to the number of pitches per week, pitching competitive baseball for more than 8 of the past 12 months, pain over the shoulder and/or elbow in the past 12 months, throwing sliders, and a lack of participation in other sports with over-the-shoulder activities.
| S-EPMC9134447 | biostudies-literature
Project description:BackgroundKinematic 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.PurposeTo 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.Study designDescriptive laboratory study.MethodsHigh 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.ResultsLeg 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).ConclusionYouth, 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.Clinical relevanceCoaches, clinicians, scouts, and pitchers can consider both the unique and the shared predictive features at each playing level when attempting to maximize pitch velocity.
| S-EPMC11322935 | biostudies-literature
Project description:Baseball players frequently injure their shoulders and elbows. Preseason risk factors for such injuries have been relatively well studied, but in-season risk factors are less known, and the relationship between the number of pitches and the incidence of such injuries in baseball pitchers of any level is unclear. Identifying the risk factors related to the number of daily pitches is particularly important to prevent baseball-related arm injuries among young pitchers. Thus, we prospectively investigated the relationship between the number of daily full-power pitches in high school baseball pitchers and the incidence of shoulder and elbow injuries. We observed that a small number of daily full-power pitches, < 30 pitches per day, in high school baseball pitchers, significantly increased the risk of shoulder and elbow injuries: these players had a 2.3-times greater risk of injuries and a 45-day earlier occurrence of injuries than those pitching ≥ 30 pitches per day. Although unexpected, this was plausible as continuous daily pitching is required to maintain physical condition in growing and maturing high school pitchers. These findings may form the basis for establishing guidelines regarding the appropriate number of daily pitches required to prevent shoulder and elbow injuries in high school baseball pitchers.
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Project description:ContextHip strength may influence the energy flow through the kinematic chain during baseball pitching, affecting athlete performance as well as the risk for injury.ObjectiveTo identify associations between hip strength and pitching biomechanics in adolescent baseball pitchers during 3 key events of the pitching cycle.DesignCross-sectional study.SettingBiomechanics laboratory.Patients or other participantsA total of 26 adolescent male baseball pitchers (age = 16.1 ± 0.8 years, height = 184.29 ± 5.5 cm, mass = 77.5 ± 8.5 kg).Main outcome measure(s)The main outcome measure was hip strength (external rotation, internal rotation, flexion, abduction, adduction, and extension). After strength measurements were acquired, motion capture was used to obtain a full-body biomechanical analysis at 3 events during the pitching cycle (foot contact, maximal external rotation, and ball release). We then evaluated these values for associations between hip strength and pitching biomechanics. Scatterplots were examined for linearity to identify an appropriate correlation test. The associations were linear; thus, 2-tailed Pearson correlation coefficients were used to determine correlations between biomechanical metrics. An α level of .01 was chosen.ResultsTen strong correlations were found between pitching biomechanics and hip strength: 8 correlations between hip strength and kinematics at key points during the pitch and 2 correlations of hip strength with peak elbow-varus torque.ConclusionsSeveral correlations were noted between lower extremity strength and pitching biomechanics. This information provides data that may be used to improve performance or reduce injury (or both) in pitchers. Increased hip strength in adolescent pitchers may both improve performance and decrease the risk of injury.
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Project description:ContextInadequate hip active range of motion (AROM) may stifle the energy flow through the kinematic chain and decrease pitching performance while increasing the risk for pitcher injury.ObjectiveTo examine the relationship between hip AROM and pitching biomechanics during a fastball pitch in adolescent baseball pitchers.DesignCross-sectional study.SettingBiomechanics laboratory.Patients or other participantsA sample of 21 adolescent male baseball pitchers (age = 16.1 ± 0.8 years, height = 183.9 ± 5.2 cm, mass = 77.9 ± 8.3 kg).Main outcome measure(s)Bilateral hip external-rotation (ER), internal-rotation, flexion, abduction, and extension AROM were measured. Three-dimensional biomechanics were assessed as participants threw from an indoor pitching mound to a strike-zone net at regulation distance. Pearson product moment correlation coefficients were used to determine relationships between hip AROM and biomechanical metrics.ResultsNegative correlations were found at foot contact between back-hip ER AROM and torso-rotation angle (r = -0.468, P = .03), back-hip ER AROM and back-hip abduction angle (r = -0.474, P = .03), and back-hip abduction AROM and lead-hip abduction angle (r = -0.458, P = .04). Back-hip extension AROM was positively correlated with increased stride length (r = 0.446, P = .043). Lead-hip abduction AROM was also positively correlated with normalized elbow-varus torque (r = 0.464, P = .03).ConclusionsWe observed several relationships between hip AROM and biomechanical variables during the pitching motion. These findings support the influence that hip AROM can have on pitching biomechanics. Overall, greater movement at the hips allows the kinematic chain to work at maximal efficiency, increasing the pitch velocity potential.
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Project description:BackgroundWeighted-ball throwing programs are commonly used in training baseball pitchers to increase ball velocity. The purpose of this study was to compare kinematics and kinetics among weighted-ball exercises with values from standard pitching (ie, pitching standard 5-oz baseballs from a mound).HypothesisBall and arm velocities would be greater with lighter balls and joint kinetics would be greater with heavier balls.Study designControlled laboratory study.MethodsTwenty-five high school and collegiate baseball pitchers experienced with weighted-ball throwing were tested with an automated motion capture system. Each participant performed 3 trials of 10 different exercises: pitching 4-, 5-, 6-, and 7-oz baseballs from a mound; flat-ground crow hop throws with 4-, 5-, 6-, and 7-oz baseballs; and flat-ground hold exercises with 14- and 32-oz balls. Twenty-six biomechanical parameters were computed for each trial. Data among the 10 exercises were compared with repeated measures analysis of variance and post hoc paired t tests against the standard pitching data.ResultsBall velocity increased as ball mass decreased. There were no differences in arm and trunk velocities between throwing a standard baseball and an underweight baseball (4 oz), while arm and trunk velocities steadily decreased as ball weight increased from 5 to 32 oz. Compared with values pitching from a mound, velocities of the pelvis, shoulder, and ball were increased for flat-ground throws. In general, as ball mass increased arm torques and forces decreased; the exception was elbow flexion torque, which was significantly greater for the flat-ground holds. There were significant differences in body positions when pitching on the mound, flat-ground throws, and holds.ConclusionsWhile ball velocity was greatest throwing underweight baseballs, results from the study did not support the rest of the hypothesis. Kinematics and kinetics were similar between underweight and standard baseballs, while overweight balls correlated with decreased arm forces, torques, and velocities. Increased ball velocity and joint velocities were produced with crow hop throws, likely because of running forward while throwing.Clinical relevanceAs pitching slightly underweight and overweight baseballs produces variations in kinematics without increased arm kinetics, these exercises seem reasonable for training pitchers. As flat-ground throwing produces increased shoulder internal rotation velocity and elbow varus torque, these exercises may be beneficial but may also be stressful and risky. Flat-ground holds with heavy balls should not be viewed as enhancing pitching biomechanics, but rather as hybrid exercises between throwing and resistance training.
| S-EPMC5435148 | biostudies-literature
Project description:BackgroundFatigue in baseball pitchers is a process linked to lowered physical and mental performance, injury, and changes in kinematics. Numerous studies have associated fatigue with overuse, high ball velocities, lack of rest time, poor mechanics, and degree of self-satisfaction. The aim of this study was to systematically review the literature to identify a theoretical framework for the relationship between outcomes and the manifestation of fatigue on baseball pitching. The synthesized data may identify areas requiring further research.MethodologyThis protocol was registered with PROSPERO (ID: CRD42018114194). SPORTDiscus, Medline, PubMed, Cochrane Database of Systematic Reviews, and Google Scholar were searched, using keywords such as fatigue in pitchers and changes in kinematics (e.g., pitching mechanics, valgus elbow torque), performance (e.g., pitch count, pitch type), and injury (e.g., pain, elbow, and shoulder soreness). Three reviewers independently screened the articles, selected relevant literature based on abstract eligibility, and assessed the methods described therein for final inclusion.ResultsA total of 31,860 articles were screened for eligibility and 25 articles were included for the review. The selected articles included epidemiological, longitudinal, experimental, conference papers, and crossover laboratory studies. Evidence extracted from the 25 studies demonstrates a relationship between fatigue in baseball pitching, and three overarching outcomes: changes in kinematics, a decrease in performance, and an increase in injury risk.ConclusionsFindings show that a co-dependence between changes in kinematics and a decrease in performance, which stems from central and peripheral fatigue, is a contributing factor of injury in baseball pitchers. A large percentage of baseball pitchers exhibit pain or soreness in either their elbow or shoulder, or both at some point in a season. Initially, kinematic changes occur that could maintain performance, but may increase joint and tissue loading. Performance decreased with elevated pitch counts and innings thrown, and pitching further into games or the season. Evidence was found to be consistent across all studies; however, more work is needed in the area of fatigue as an injury mechanism during pitching. With a proof of concept established, the prevention of negative outcomes associated with fatigue must be the focus of future research and performance should not be the only criteria.
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Project description:In our daily lives, we use faces as a major source of information about other people. Recent work has begun to highlight how one's facial width-to-height ratio (fWHR) is linked to a number of behaviours (e.g. deception, aggression and financial performance in firms). fWHR has also been linked to several factors that may be beneficial for sport (e.g. achievement drive, winning mentality and aggression). Despite this, few studies have examined the relationship between fWHR and sports performance, and these have focused on Caucasian sportsmen. Here, we investigated the relationship between fWHR and baseball performance in professional Japanese baseball players. We show that fWHR is positively related with home run performance across two consecutive seasons. The findings provide the first evidence linking fWHR to baseball performance and linking fWHR to behavioural outcomes in Asian participants.
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