1405 Literature suggests that elite baseball pitchers develop acquired laxity as a result of adaptive changes to the shoulder joint capsule from throwing. Capsular laxity has been implicated in the etiology of micro-instability, mechanical impingement, rotator cuff tendinopathy, and scapular dyskinesis. PURPOSE: To quantify and compare glenohumeral (GH) laxity between the throwing and non-throwing shoulder in professional baseball pitchers. METHODS: Force-displacement measures were performed bilaterally in 33 asymptomatic professional baseball pitchers. Shoulders were positioned at 90° of abduction and 60° of external rotation and a 10-daN (100- N) anterior- and posterior-directed force was applied to the humerus. An ultrasound scanner with transducer was used to dynamically track GH motion during joint loading. Static images were captured at baseline (0-daN) and 10-daN force levels. Using selected bony landmarks measurements of bony position were taken directly from the images and the difference in humeral head displacement was recorded in mm. RESULTS: ANOVA revealed no significant differences (p = .14) in laxity between the throwing (global 7.25mm, anterior 2.39mm, posterior 4.87mm) and non-throwing shoulders (global 7.35mm, anterior 2.45mm, posterior 4.91mm). Posterior translation (4.89mm) was found to be significantly greater (p < .01) than anterior translation (2.39mm). CONCLUSION: We conclude that no significant difference in laxity (anterior, posterior or global) exists between throwing and non-throwing shoulders in professional baseball pitchers, however posterior translation was found to be significantly greater than anterior translation in both shoulders of professional baseball pitchers.Figure: No Caption available.
Injuries to the ulnar collateral ligament (UCL), have become increasingly prevalent among overhead-throwing athletes, especially baseball pitchers. From 2011 to 2023, UCL injuries were the most common injury in Major League Baseball (MLB). Contributing factors include high pitching velocity, fatigue, overuse, and year-round pitching. Research indicates that 25% of MLB pitchers and 14% of Minor League pitchers have undergone UCL surgery, with these numbers steadily rising. After traditional UCL reconstruction, 83% of athletes return to the same or higher levels of play. While the success rate for UCL surgery is high, revision surgeries are becoming more frequent, with mixed outcomes. This underscores the need for improved surgical techniques and rehabilitation strategies. The hybrid UCL reconstruction technique presents a reliable and effective solution for treating UCL injuries, combining the benefits of autogenous grafting with internal brace augmentation. Current research, however, lacks focus on the surgical technique and rehabilitation following UCL hybrid surgery. Achieving successful outcomes with this procedure relies on a collaborative approach, from surgery to rehabilitation with adherence to the rehabilitation protocol and throwing program. Full recovery typically requires 12-14 months, depending on the athlete’s level of play. With over 400 successful surgeries to date, this technique has proven to enhance stability and facilitate recovery, particularly in elite-level throwing athletes. The purpose of this paper is to describe this new surgical technique and its associated rehabilitation programs, emphasizing the importance of rehabilitation under the guidance of a rehabilitation professional experienced with overhead athletes. Level of Evidence: 5
Treatment of posterior cruciate ligament (PCL) injuries has changed considerably in recent years. This article discusses current rehabilitation for PCL disruptions in athletes. The treatment of PCL injuries varies somewhat based on the chronicity (acute vs. chronic) of injury and associated pathologies. The authors provide their treatment algorithm for the acute and chronic PCL-injured-knee patient. Nonoperative rehabilitation is discussed with a focus on immediate motion, quadriceps muscle strengthening, and functional rehabilitation. A discussion of the biomechanics of exercise is provided, with a focus on tibiofemoral shear forces and PCL strains. Surgical treatment is also discussed, with the current surgical approach being either the two-tunnel or the one-tunnel patellar tendon autograft procedure. The rehabilitation program after surgery is based on the healing constraints, surgical technique, biomechanics of the PCL during functional activities, and exercise. With the new changes in surgical technique and in the rehabilitation process, the authors believe that the outcome after PCL reconstruction will be enhanced.
Summary: The throwing motion is a complex movement pattern that requires flexibility, muscular strength, coordination, synchronicity of muscular firing, and neuromuscular efficiency. During the act of throwing, excessively high stresses are generated at the shoulder joint because of the unnatural movements frequently performed by the throwing. The thrower's shoulder must be flexible enough to allow the excessive external rotation required to throw a baseball. The overhead throwing motion places tremendous demands on the shoulder joint complex musculature to produce functional stability. The surrounding musculature must be strong enough to assist in arm acceleration but must exhibit neuromuscular efficiency to produce dynamic functional stability. During the act of pitching, the angular velocity at the shoulder joint exceeds 7,000° per second and has been referred to as the fastest human movement. Tremendous forces are generated at the shoulder joint, at times up to one times body weight. Because of these tremendous demands, at incredible angular velocities, various shoulder injuries may occur. An understanding of the biomechanics of throwing will assist the clinician in the recognition of various injuries and their specific treatment approaches. In this paper, we discuss the biomechanics of the overhead throwing motion for baseball as well as football.
Thorough descriptions of specific physical examination tests used to determine glenohumeral instability are lacking in the scientific literature. The purpose of this paper was to discuss the importance of the subjective history and illustrate the physical examination of the glenohumeral joint. Additionally, the authors will illustrate specific stability assessment tests for the glenohumeral joint based on current basic science and clinical research. The physical examination of a patient whose history suggests subtle glenohumeral joint instability may be extremely difficult for the clinician due to the normal amount of capsular laxity commonly present in most individuals. An essential component of the physical examination is a thorough and meticulous subjective history which includes the mechanisms of injury and/or dysfunction, chief complaint, level of disability, and aggravating movements. The physical examination must include an assessment of motion, static stability testing, muscle testing, and a neurologic assessment. A comprehensive understanding of various stability testing maneuvers is important for the clinician to appreciate. The evaluation techniques discussed in this paper should assist the clinician in determining the passive stability of the glenohumeral joint.
