Biomechanical comparison of the interval throwing program and baseball pitching: upper extremity loads in training and rehabilitation.

BACKGROUND: The interval throwing progression has been part of baseball rehabilitation and conditioning for decades, yet little is known about the upper extremity loads an athlete is subjected to during this progression. HYPOTHESIS: A biomechanical comparison of fastball pitching, variable-effort pitching, and throwing various flat-ground distances will show significant torque differences in the throwing shoulder and elbow. STUDY DESIGN: Descriptive laboratory study. METHODS: Twenty-nine healthy college baseball pitchers were analyzed using a quantitative motion analysis system. The participants threw from flat ground at distances of 18, 27, 37, and 55 m, having been instructed to throw hard, on a horizontal line. The participants then threw fastballs 18.4 m from a mound at 3 different effort levels: 60%, 80%, and full effort. The kinetic values for humeral internal rotational torque (HIRT) and elbow valgus load (EVL) were extracted for each throw. Repeated-measures analyses of variance (ANOVAs) were used to compare all 7 throwing conditions within pitchers. The kinetic data were also compared against ball velocity to evaluate throwing efficiency. A separate analysis was conducted using a 3-level repeated-measures ANOVA with post hoc paired t tests comparing just the variable-effort throws from the mound. RESULTS: No statistically significant differences were found in either HIRT or EVL between any of the flat-ground distances and throwing from the mound (P \u3e .05). Despite similar biomechanical loads compared with the mound, throwing from flat ground showed significantly decreased ball velocity (82% of maximum). Statistically significant differences were found in humeral internal rotational torque and elbow valgus load between fastball pitching off the mound at 60% and 100%, as these parameters increased with throwing effort (P \u3c .05). At 60% perceived effort from the mound, pitchers generated forces of 76% and ball speeds approaching 84% of maximum. CONCLUSION: Partial-effort pitching demonstrates significantly lower loads on the shoulder and elbow. Flat-ground throwing at even the shortest distances had similar biomechanical loads compared with pitching from the mound, yet at significantly lower ball velocity. This illustrates the mechanical advantage and increased efficiency of throwing from a mound. No increase in shoulder or elbow loads was seen with increasing distances from flat ground, as pitchers began using a crow hop for the longer distances, facilitating the throw with their lower extremity. The mechanical advantage of throwing from a mound or using the crow hop is likely protective during rehabilitation and training throws. CLINICAL RELEVANCE: The findings of this study may be used to improve rehabilitation programs designed for baseball players returning from shoulder or elbow injury

Ulnar Collateral Ligament Repair With Suture Bridge Augmentation

The gold standard for management of elbow ulnar collateral ligament (UCL) injuries in elite athletes is reconstruction of the UCL with a tendon graft. Over the past several years, UCL repair for acute tears, as well as partial tears, in young athletes has gained increasing popularity, with studies reporting good outcomes and high rates of return to sports. Additionally, there is increased interest in ligament augmentation using the InternalBrace concept. A recent technique paper describes a direct repair of the UCL augmented with a spanning suture bridge. Although clinical outcomes for this method are promising, one possible concern when using this technique is bone loss at the ulnar origin of the UCL should revision reconstruction be required. We propose an alternative augmentation method that allows for stress shielding of the healing native ligament while minimizing bone compromise in the face of UCL reconstruction at a later time point

A Single-Tunnel Technique for Coracoclavicular and Acromioclavicular Ligament Reconstruction

Acromioclavicular (AC) joint separation is a common injury seen in the young adult athletic population. Both the indications for surgical management and the best operative technique remain controversial. One of the most popular reconstruction techniques is the anatomic double-tunnel coracoclavicular (CC) ligament reconstruction. However, there have been several case reports of clavicle fractures with this technique. This article presents a single-tunnel reconstruction technique that aims to restore both the CC and AC ligament function, while minimizing fracture risk

Media perceptions of Tommy John surgery

<div><p></p><p><i>Objectives. </i>The prevalence of medial ulnar collateral ligament (UCL) reconstruction is increasing in professional athletes and the delivery of baseball news by the media exerts a powerful influence on public opinion of the injury and surgery. The purpose of this investigation was to examine the media’s perception regarding the causes of UCL injury as well as the indications, risks, benefits, and rehabilitation related to UCL reconstruction. <i>Study design. </i>Cross-sectional survey study, Level 3. <i>Methods. </i>This study utilized an online thirty-question survey designed to assess an individual’s perception of UCL reconstruction with regard to risk factors for injury, indications, benefits, surgical details, and rehabilitation. Eligible study participants were members of the media including print, internet, radio and/or television directly involved in the coverage of Major League Baseball (MLB). <i>Results. </i>A total of 516 members of the media with a mean age of 43.6 years completed the survey. In nearly half (47.8%), professional baseball represented 76–100% of their total sports coverage responsibility. Indications: although the majority answered correctly, 45% did not know if an athlete needed an elbow injury as a prerequisite for UCL reconstruction and 25% believed the primary indication was performance enhancement. As percentage of baseball coverage increased, media members were less likely to believe that an elbow injury was not required (<i>p</i> = 0.038). Benefits: eighty percent recognized that pitching speed is typically reduced following surgery, but the remaining 20% felt that velocities actually increased compared with pre-injury velocities. Return to play: fifty-two percent overestimated the ability of pitchers to return to back to professional baseball and 51.2% believed return would occur in 12 or less months. Estimates were higher in those of older age (<i>p</i> = 0.032) and increased percentage of baseball coverage (<i>p</i> < 0.001). Overuse injuries: less than half (48.4%) believed the use of pitch counts to be important in the prevention of UCL injury and 33.2% felt that throwing injuries were not preventable in adolescent baseball. <i>Conclusion. </i>Common misconceptions exist regarding UCL reconstruction within the professional baseball media. Efforts for physicians to educate the media on the risks of overuse throwing injuries with emphasis on accurate indications, outcomes, and recovery of Tommy John Surgery are encouraged.</p></div