Cirugía de "Tommy John" en paciente adolescente lanzador de béisbol / Tommy John surgery in adolescent baseball pitcher

La lesión del ligamento colateral cubital (LCC) es una patología debilitante del codo, con alta prevalencia en deportistas. En este trabajo expondremos el caso de una reconstrucción del ligamento colateral cubital realizada en un beisbolista masculino de dieciséis años, mediante un abordaje con la técnica quirúrgica de docking.

Ulnar collateral ligament (UCL) injury is a debilitating pathology of the elbow, with high prevalence in athletes. We describe the case of a UCL reconstruction performed in a 16-year-old male baseball player, using the Docking surgical technique.

Lesiones de cadera relacionadas con la actividad deportiva / Sports-Related Hip Injuries

Introducción: Las lesiones de la cadera relacionadas con las actividades deportivas han sido poco abordadas; sin embargo, han ido en aumento y su diagnóstico suele ser difícil o retardado. Incluyen múltiples afecciones y su recuperación suele ser larga. Objetivo: Actualizar conocimientos sobre algunas de las afecciones deportivas que afectan la cadera. Métodos: Se realiza una revisión bibliográfica sistemática y detallada sobre el tema, para lo cual se emplearon métodos teóricos, analítico-sintético, histórico-lógico e inductivo-deductivo y el análisis documental como método empírico. Se hizo una búsqueda sistemática sobre la temática en las bases de datos PubMed, Medscape y Google Academics desde junio de 2016 hasta la fecha. Se revisaron 500 artículos referentes al tema, de los cuales se seleccionaron 45 artículos para este trabajo. Análisis y síntesis de la información: Las lesiones de la cadera relacionadas con el deporte ocurren entre 5 y 9 por ciento de atletas adultos. Las actividades con movimientos rápidos, aceleraciones, desaceleraciones, y los cambios direccionales son la principal causa de tales lesiones. Provocan daños corporales provocados por una transferencia de energía, que excede la capacidad para mantener la estructura y/o la función íntegra, durante el entrenamiento o competición. Conclusiones: Las lesiones de la cadera relacionadas con el deporte pueden ser múltiples y son responsables de dolor en un gran número de atletas, fundamentalmente en el fútbol, la gimnasia y el beisbol. El diagnóstico precoz es fundamental para evitar la progresión de la lesión. Las mejoras en el diagnóstico radiológico y las posibilidades del uso de la artroscopia han mejorado la evolución y el pronóstico para los atletas(AU)

Introduction: Sports injuries of the hip have been little addressed; however, they have been increasing and their diagnosis is often difficult or delayed. They include multiple conditions and their recovery is usually long. Objective: To bring up to date knowledge on some of the sports conditions that affect the hip, which is particularly important to improve medical care. Methods: A systematic and detailed bibliographic review is carried out on the subject, for which theoretical, analytical-synthetic, historical-logical and inductive-deductive methods were used, as well as documentary analysis as an empirical method. A systematic search on the subject was carried out in PubMed, Medscape and Google Academics databases from June 2016 to date. Five hundred articles referring to the topic were reviewed. Forty-five articles the total were selected for this paper. Analysis and synthesis of the information: Sports-related hip injuries occur between 5 and 9 percent of adult athletes. Activities with rapid movements, accelerations, decelerations, and directional changes are the main cause of such injuries. They cause bodily harm produced by a transfer of energy, which exceeds the capacity to maintain the entire structure and, or function, during training or competition. Conclusions: Sports injuries of the hip can be multiple and are responsible for pain in a large number of athletes, mainly in soccer, gymnastics and baseball. Early diagnosis is essential to avoid progression of the lesion. Improvements in radiological diagnosis and the possibilities of the use of arthroscopy have improved the evolution and prognosis for athletes(AU)

Diferencias en los parámetros lineales del balance autonómico basal entre estudiantes de medicina y atletas juveniles de béisbol / Differences in linear parameters of the basal autonomic balance between medical students and young baseball players

RESUMEN Introducción: La modulación autonómica cardiovascular puede ser considerada como una herramienta útil en la determinación del estado fisiológico de la interacción entre los sistemas nervioso autónomo y cardiovascular. Objetivo: Determinar las diferencias en los parámetros lineales del balance autonómico basal entre estudiantes de medicina y atletas juveniles de béisbol. Método: Se realizó un estudio analítico de tipo transversal en el Laboratorio de Ciencias Básicas Biomédicas de la Facultad Nº. 1 de la Universidad de Ciencias Médicas de Santiago de Cuba. Universo y muestra de 36 individuos (Grupo 1: 18 atletas juveniles de béisbol de alto rendimiento, Grupo 2: 18 estudiantes de medicina). Los datos fueron recolectados mediante de polígrafo PowerLab de 8 canales, y fueron procesados usando el software Kubios® versión 3.0.4 Premium. Resultados: Existieron diferencias significativas en los valores de pNN50 (p=0,009), índice de estrés (stress index [p=0,044]), y en los índices parasimpático (p=0,005) y simpático (p=0,001) entre estudiantes y atletas. La capacidad discriminatoria del índice parasimpático para asociarse con la mejor forma física de los atletas fue buena (área bajo la curva 0,784). El punto de corte óptimo por encima del cual el índice parasimpático se asocia al grupo de los atletas, quedó establecido en 0,57. Conclusiones: El índice parasimpático se asoció con el grupo de atletas, lo que evidencia el predominio vagal en la modulación de la actividad cardíaca en los sujetos de este grupo.

ABSTRACT Introduction: Cardiovascular autonomic modulation can be considered a useful tool in determining the physiological state of the interaction between the autonomic nervous system and the cardiovascular system. Objective: To determine the differences in linear parameters of the basal autonomic balance between medical students and young baseball players. Method: A cross-sectional analytical study was carried out in the Biomedical Basic Sciences Laboratory, Faculty No.1, of the Universidad de Ciencias Médicas in Santiago de Cuba. The population and sample consisted of 36 individuals (Group 1: 18 high-performance young baseball athletes, Group 2: 18 medical students). Data was collected using an 8-channel PowerLab polygraph and it was processed using the Kubios® Software version 3.0.4 Premium. Results: There were significant differences in the values between students and athletes: pNN50 (p=0.009), stress index (p=0.044) and in parasympathetic (p=0.005) and sympathetic (p=0.001) indexes. The discriminatory ability of the parasympathetic index to be associated with the best physical fitness of the athletes was good (area under the curve 0.784). The optimum cut-off point above which the parasympathetic index is associated with the group of athletes was set at 0.57. Conclusions: The parasympathetic index was associated with the group of athletes, showing the vagal predominance in the modulation of cardiac activity in the individuals belonging to this group.

A institucionalização do racismo contra negros(as) e as injúrias raciais no esporte profissional: o contexto internacional / The institutionalization of racism against black people and racial slurs in professional sports: the international context / La institucionalización del racismo contra negros y los insultos raciales en el deporte profesional: el contexto internacional

O racismo é um fenômeno sociocultural que tem notável expressão nos campos esportivos. O objetivo desta pesquisa foi analisar a produção científica internacional sobre o racismo nos esportes profissionais publicada entre 2008 e 2018. A busca foi realizada em duas bases de dados: Portal da Capes e revistas indexadas na área de avaliação "Educação Física" da Plataforma Sucupira. Foram selecionados 65 artigos os quais são analisados a partir das categorias "injúria racial" e "racismo institucional". Vários casos de injúria racial são analisados e ilustram formas como o racismo tem colocado obstáculos às trajetórias de atletas negros em diversas modalidades. No plano institucional, são analisadas campanhas contra o racismo, bem como formas racistas de discriminação presentes em esportes como futebol, basquete, beisebol e futebol americano. Destacam-se a variedade de enfoques, a relevância dos estudos e a importância da temática para o enfrentamento do racismo nos campos esportivos estudados.

Racism is a sociocultural phenomenon with remarkable expression in sports. This study analyzes scientific works on racism in professional sports published between 2008 and 2018. Searches were performed on two databases: Portal da CAPES and journals indexed on the Sucupira Platform' evaluation area of 'Physical Education.' Sixty-five articles were selected and divided into the categories 'racial slur' and 'institutional racism.' Several cases of racial slurs are analyzed and illustrate how racism has hampered black athletes' careers in several sports. At institutional level, campaigns against racism are analyzed, as well as racist forms of discrimination present in sports such as football, basketball, baseball and American football. We highlight the variety of approaches, the relevance of the studies and the importance of the topic for addressing racism in the studied sports fields.

El racismo es un fenómeno sociocultural que tiene una notable expresión en el deporte. El objetivo de esta investigación fue analizar la producción científica internacional sobre el racismo em los deportes profesionales entre 2008 y 2018. La búsqueda se realizó en dos bases de datos: Portal de la CAPES y revistas indexadas en el área de evaluación "Educación Física" de la Plataforma Sucupira. Fueron seleccionados 65 artículos que son analizados a partir de las categorías "insulto racial" y "racismo institucional". Varios casos de injuria racial son analizados e ilustran las formas en que el racismo ha puesto obstáculos a las trayectorias de los atletas negros en diversas modalidades. A nivel institucional, se analizan campañas contra el racismo, así como formas racistas de discriminación presentes en deportes como fútbol, baloncesto, béisbol y fútbol americano. Destacamos la variedad de enfoques, la relevancia de los estudios y la importancia del tema para enfrentar el racismo en los campos deportivos estudiados.

Is Hyperabduction Arm Position in Early Cocking Phase Really Dangerous for Baseball Pitchers? / 대한스포츠의학회지

PURPOSE: Certain pitching mechanics is thought to lead pitchers in danger of surgical risk and decrease performance. The objective of this study is to analyze the effect of shoulder hyperabduction position during early cocking phase in association with surgical risk and performance in professional baseball players.METHODS: From 2009 to 2013, total of 93 candidates reached minimum inning qualification. After exclusion criteria (overlapped players, foreign players, age over 31 years, proceed to other league and retirement), 19 players were analyzed with slow-motion pitching video for hyperabduction of the shoulder and hyperpronation of forearm in cocking-phase. Also players were analyzed with innings pitched, earned run average (ERA), walks and hits divided by innings pitched (WHIP) and surgical history with database offered by official Korean Baseball Organization website.RESULTS: Out of total 19 players, nine players had hyperabduction arm movement and 10 players did not. Group with hyperabduction had average age of 24.3 years old, average inning/ERA/WHIP for 5 years were 55 innings/yr, 6.52 ERA/yr and 1.33 WHIP/yr, respectively, and seven players (77%) had surgeries eventually. Group without hyperabduction arm movement had average age of 25.4 years old; average inning, ERA/WHIP for 5 years were 127 1/3 innings/yr, 4.84 ERA/yr, and 1.32 WHIP/yr, respectively and five players (50%) went for surgeries. Player performance (ERA, p=0.66; WHIP, p=0.14) was not statistically influenced by the certain arm position at cocking phase but average inning pitched was statistically affected (p<0.01).CONCLUSION: Hyperabduction of shoulder in early cocking phase of throwing motion does not lead to decrease in performance (ERA, WHIP) but will result in tremendous decline of average IP. Also, risk of surgery is not associated to hyperabduction motion of the shoulder.

The impact of major league baseball on the incidence of operative hand and facial trauma at a level 1 trauma center

BACKGROUND: Professional affiliation between medical centers and professional sports teams can be mutually beneficial in the provision of healthcare and marketing strategy. Anecdotal evidence suggests a link between trauma volume and sporting events; however, there is limited data. This study aims to characterize the incidence of operative hand and facial trauma during professional baseball home games. METHODS: A retrospective review of surgical cases for traumatic hand or facial injuries at a level 1 center between 1999 and 2012 was performed. Demographic information including date of injury, admission status, and operative repair were collected. Patients were grouped based on whether their trauma occurred on the date of a home game. RESULTS: Operative hand and facial trauma occurred at a rate of 33.4 injuries per 100 days with home games, compared to 22.2 injuries per 100 days (incidence rate ratios, 1.50; 95% confidence interval, 1.34–1.69). When home games were played, patients were more likely to present as a result of motorcycle accidents (3.1% vs. 1.5%; P=0.04) or bicycle accidents (5.0% vs. 2.6%; P=0.01). Other mechanisms of trauma were not statistically different. There was an increase incidence of injuries during home games in August; weekly variability showed an increased incidence during the weekends. CONCLUSIONS: There was an increased rate of operative hand and facial injuries on dates with professional home games. The incidence of injuries during home games was higher in the late summer and on the weekends. Further analysis may allow improved resource allocation and strategies for injury prevention and treatment.

Sports-related skin conditions

Skin diseases associated with athletic activities can be classified as skin infections, inflammatory reactions, trauma, and abnormal proliferation, depending on the cause of the condition. Athlete's nodule is a generic term for reactive nodules that occur in athletes. It is particularly common in the foot due to tight sneakers, repetitive pressure or friction, and inappropriate choice of shoes or other sports equipment. The diagnosis of black heel (calcaneal petechiae) should be considered when numerous black spots occur on the soles in patients who frequently engage in abrupt movements, such as starts, stops, or leaps. Palmoplantar eccrine hidradenitis may occur in athletes who play baseball, dance, and climb, activities in which repetitive and strong stimuli are applied to the floor of the hands and feet. Painful fat herniation should be suspected in cases of painful skin-colored firm nodules on the feet of athletes who place a large amount of weight on their feet when moving. Itching, urticaria, angioedema, chest tightness, and syncope occurring within 5 minutes after starting exercise should be suspected to be exercise-induced angioedema/anaphylaxis. Excessive force can cause deformation of nails, as in tennis toe and jogger's toenail. For the diagnosis and treatment of sports-related skin diseases, it is essential to pay attention to patients' hobbies and exercise habits, including sports, and to consider the relationship of those habits with the presumed mechanisms of the skin disease. In addition, thorough pre-exercise warm-ups, increasing strength gradually, and wearing proper equipment will help prevent the occurrence of sports-related skin diseases.

Upper Extremity Injuries in Youth Baseball Players / 대한정형외과학회잡지

The elbow and shoulder in young baseball players are prone to injuries. The internal factors of sports injuries are the fragility of the bones and joints of growing children and adolescents. The main external factors of injuries are the competition and eagerness of adolescent players and the motivation of hard-work. Baseball injuries have many causes, including fast rotation and movement of a load from the trunk to arm, repetitive incorrect placement of the arm in the throwing position, too-many throwing practices, etc. Orthopedic surgeons have generally focused on surgical procedure to cure, but it is time to consider and share the methods of injury prevention.

Early Lateral Compartment Physeal Closure of the Elbow in Osteochondritis Dissecans of the Adolescent Baseball Players / 대한스포츠의학회지

PURPOSE: The purpose of this study is to identify bilateral differences of physeal closure of the lateral compartment of the elbow in osteochondritis dissecans (OCD) and related factors with premature physeal closure. METHODS: Initial radiographs of the bilateral elbows in 40 baseball players with OCD (group I) were reviewed for the status of physeal closure of the lateral compartment; capitellum, radial head, lateral epicondyle. Forty baseball players with medial epicondylar apophysitis (group II) were enrolled as a control. Relative status of physeal closure of dominant elbow was defined as early, same, and delayed. Bilateral differences of the status of physeal closure were analyzed between groups, and according to the radiographic stages, extent of the lesions and demographic factors in group I. RESULTS: Significant early physeal closures of dominant elbows were identified in group I in capitellum (group I, 55%; group II, 3%), radial head (group I, 53%; group II, 3%), and lateral epicondyle (group I 37%; group II, 5%). In group I, advanced stage and extended lesion showed early lateral compartment physeal closure especially in capitellum and radial head, and players with longer career length and limitation of motion showed early closure. CONCLUSION: Over the half of the adolescent baseball players with OCD demonstrated early radiocapitellar physeal closures of dominant elbow in initial presentation. Because premature physeal closure contributes to the development of arthritis without appropriate radiocapitellar remodeling, early detection of OCD is essential for prevention of arthritis and successful conservative management.

Synovial Osteochondromatosis of the Subtalar Joint in an Adolescent Baseball Player / 대한스포츠의학회지

Synovial chondromatosis is an uncommon disorder characterized by cartilaginous proliferation within the synovial membrane of the articular joint. Smaller joints are rarely affected and it may be progressed to osteochondromatosis after ossification or calcification of metaplastic cartilage. It is commonly presented in the third to fourth decade of life, but rarely presented in adolescence. We report a unique case of synovial osteochondromatosis of the subtalar joint in 14-year-old baseball player. Arthroscopic removal of loose body and complete excision of the osteochondral mass with concomitant synovectomy resulted in satisfactory outcome without recurrence at final follow-up.

Little Leaguer's Shoulder Can Cause Severe Three-Dimensional Humeral Deformity

We analyzed three-dimensional (3D) humeral deformity (valgus–varus, flexion–extension, and rotational deformation) after little leaguer's shoulder using 3D computed tomography in a 15-year-old male baseball player. Humeral retroversion was increased by 27.1° on the dominant side compared with the nondominant side. Compared with the nondominant shaft, the dominant humeral shaft was deformed in the varus direction (9.4°), resulting in a decreased neck–shaft angle (dominant side, 127.5°; nondominant side, 135.1°), and it was also deformed in the extension direction (21.0°). This case demonstrates that little leaguer's shoulder can cause markedly greater humeral retroversion than has been reported previously and can result in varus and extension deformation of the humerus. These findings suggest that humeral deformity in overhead throwing athletes may not always solely reflect adaptation to throwing.

Malar Relocation with Reverse-L Osteotomy and Autogenous Bone Graft

The zygomaticomaxillary complex (ZMC) functions as a buttress for the face and is the cornerstone to a person's aesthetic appearance, by both setting the midfacial width and providing prominence to the cheek. Malar deficiency is often acquired by blunt injury incurred in a traumatic accident, resulting in ZMC fracture. A 48-year-old male patient presented a right ZMC fracture after contusion injury by a baseball. He only received conservative management and later he suffered discomfort during mouth opening at the moment of mastication, due to trismus involving the temporomandibular joint. In the current case, we describe a surgical technique, by which the malar body is shifted anteriorly and laterally after combined oblique-vertical osteotomy. The technique presented, eventually restored the former aesthetic position of the malar complex and symmetry, and, moreover, improved mastication function.

Femoral Shaft Fracture of a Middle-aged Male Adult during Playing Baseball / 대한스포츠의학회지

In general, femur fractures in the younger patient population are the result of high energy trauma, such as motorcycle accidents or traffic accidents. A 43-year-old healthy man presented with painful swelling of his right thigh. Plane radiographs showed short oblique fracture of the femur shaft with comminution. He had no medical history such as osteoporosis or any metabolic bone disorder. He was a healthy man with no smoking and no alcohol drinking, enjoying sports activity such as baseball and football. He was injured during defense time of a baseball game by rapid turning motion to catch a ball. We performed intramedullary interlocking nailing for the femur shaft fracture and the fracture was uneventually healed with no complication. To our knowledge, femur shaft fracture which occurred during playing baseball in a healthy middle-aged man has not been reported in our country. So we report this case with a review of the literature.

Posterior Glenoid Lesions on Magnetic Resonance Imaging in Adolescent Baseball Players / 대한스포츠의학회지

The purpose of this study is to evaluate the characteristics of posterior glenoid lesion (PGL) on magnetic resonance imaging (MRI) in adolescent baseball players. Seventy-two adolescent baseball players (mean age, 15.1 years) who underwent MRI scan for dominant shoulder pain were enrolled and the location and morphologic features of PGLs were assessed on MRI. All players were divided into three groups based on the physeal status of proximal humerus: group I, open; group II, partial closure; and group III, complete closure. Of the 72 players, posterior glenoid rim rounding (69%) and periosteal thickening (88%) were the main PGL on axial imaging. Osteochondritis dissecans (OCD) of glenoid (10%), Bennett lesion (6%), and posterior labral tear (21%) were also identified. On oblique sagittal imaging, bony PGL including OCD involves mid-portion of posterior glenoid consistent with the level of the infraspinatus muscle, but Bennett lesion was located relatively lower than PGL. Posterior glenoid rim rounding was more prevalent in younger players (group I, 86%; group II, 78%; group III, 43%; p=0.015), and posterior labral tears were in older players (group I, 0%; group II, 19%; group III, 38%, p=0.027). Factors related with prevalence of posterior glenoid rim rounding were increased body mass index (p=0.016), pitchers (p=0.024), and players with posterior shoulder tightness (p=0.023), but career length was not statistically significant (p=0.089). Decreasing the rate of posterior glenoid rim rounding with skeletal growth implies that it may be recovered through the remodeling process, and labral tears are increasing internal impingement lesion after physeal closure.

Radiological analysis of the medial epicondyle in the adolescent throwing athlete

<p><b>INTRODUCTION</b>Injuries to the medial structures of the elbow due to overhead throwing games are well documented. However, variations of medial epicondyles are not well described, especially in athletes with fused medial epicondyles. In this study, we evaluated variations in the medial epicondyle of baseball players who were aged 15-17 years and had fused epicondyles.</p><p><b>METHODS</b>In this cross-sectional observational study, 155 skeletally mature baseball players with unilateral medial elbow pain and 310 elbow radiographs were reviewed by two independent reviewers. The medial epicondyles were categorised into three groups: normal, elongated or separated.</p><p><b>RESULTS</b>Among the 155 patients, 65 (41.9%) had normal epicondyles, 41 (26.5%) had elongated epicondyles and 49 (31.6%) had separated epicondyles. The medial epicondyle was larger on the dominant arm for 125 (80.6%) patients; the mean surface area on the dominant arm was 222.50 ± 45.77 mm, while that of the non-dominant arm was 189.14 ± 39.56 mm(p < 0.01). Among the three categories of medial epicondyles, separated epicondyles had the largest surface area, followed by elongated and normal epicondyles.</p><p><b>CONCLUSION</b>Medial epicondyles in adolescent throwing athletes can be categorised into three different groups according to their shape (normal, elongated and separated). We observed a correlation between the shape and the surface area of the medial epicondyle in adolescent throwing athletes, with separated medial epicondyles having the largest surface area. Further studies and follow-up are needed to determine the prognostic value and clinical significance of these morphological variations.</p>

Elbow Impingement Syndrome in Athletes / 대한스포츠의학회지

Overhead athletes often suffer from elbow injuries due to repetitive throwing movements. In particular, in the baseball pitching motion, a high shear torque generated in the late corking and early acceleration stage causes tensile loads on the medial elbow and shear force on the posterior of the elbow. These repetitive movements can lead to valgus extension overload syndrome. The valgus extension overload syndrome mainly occurs in overhead athletes, and is characterized by limited elbow flexion and pain at the end of extension. It is necessary to differentiate from the stress fracture or the avulsion fracture of the olecranon which complain of posterior elbow pain through computed tomography. The treatment is primarily rehabilitation that restricts the elbow motion. If refractory or mechanical symptoms persist, arthroscopic surgery may be an effective treatment modality for the removal of the osteophytes. In the surgical field, it is desirable to reconstruct the medial collateral ligament when it is confirmed that the ligament is ruptured. Patients who underwent arthroscopic removal of olecranon osteophytes had immediate active elbow exercises and for 3 months were prohibited from pitching exercises. During this period, they were rehabilitated with the focus on strengthening muscles around the scapula, rotator cuff and shoulder. After 3 months, the pitching exercise is gradually started. Six months after the operation, the elbow strength should be restored to the level at which the game starts. Patients who underwent a combined ulnar collateral ligament reconstruction, half pitching are allowed at 6 months.

Shoulder and Elbow Injury Rates and Patterns in Korean Rookie Professional Baseball Pitchers

BACKGROUND: To investigate how many rookie pitchers suffered from injuries while playing in the amateur league without guidelines for prevention of excessive pitching, we analyzed their amateur pitching patterns based on the pitch count, use of breaking balls, and pitches during winter camp. METHODS: Forty-one rookie pitchers who graduated from high school or university in 2013 and joined professional baseball teams. Participants were interviewed by a trainer using our questionnaire. Injury inclusion criteria were 1) history of shoulder surgery, 2) history of elbow surgery, 3) shoulder pain requiring treatment, and 4) elbow pain requiring treatment. RESULTS: Mean number of pitches per game and warm-up pitches for practice was 84.5 pitches (range, 15 to 130 pitches) and 16.4 pitches (range, 2 to 210 pitches), respectively. Mean number of pitches during the last year was 906.9 (range, 80 to 2,000). Mean number of maximal pitches was 127 pitches (range, 50 to 210 pitches). Fourteen pitchers had pitched over 150 pitches. Twenty-seven pitchers (65.9%) had pitched in spite of enduring pain. During winter training (mean 1.8 months), mean number of pitches per day was 162.5 pitches, and 20 pitchers (48.8%) had practiced pitching excessively despite the cold weather. Twenty-six rookies (63.4%) had shoulder pain or history of shoulder surgery, and 31 pitchers (75.6%) had elbow pain or history of elbow surgery. Only four participants (9.8%) did not have pain and history of surgery. CONCLUSIONS: For young baseball pitchers, guidelines for prevention of excessive pitching and for regulating the winter training program may be needed.

Shoulder and Elbow Injury Rates and Patterns in Korean Rookie Professional Baseball Pitchers

BACKGROUND: To investigate how many rookie pitchers suffered from injuries while playing in the amateur league without guidelines for prevention of excessive pitching, we analyzed their amateur pitching patterns based on the pitch count, use of breaking balls, and pitches during winter camp. METHODS: Forty-one rookie pitchers who graduated from high school or university in 2013 and joined professional baseball teams. Participants were interviewed by a trainer using our questionnaire. Injury inclusion criteria were 1) history of shoulder surgery, 2) history of elbow surgery, 3) shoulder pain requiring treatment, and 4) elbow pain requiring treatment. RESULTS: Mean number of pitches per game and warm-up pitches for practice was 84.5 pitches (range, 15 to 130 pitches) and 16.4 pitches (range, 2 to 210 pitches), respectively. Mean number of pitches during the last year was 906.9 (range, 80 to 2,000). Mean number of maximal pitches was 127 pitches (range, 50 to 210 pitches). Fourteen pitchers had pitched over 150 pitches. Twenty-seven pitchers (65.9%) had pitched in spite of enduring pain. During winter training (mean 1.8 months), mean number of pitches per day was 162.5 pitches, and 20 pitchers (48.8%) had practiced pitching excessively despite the cold weather. Twenty-six rookies (63.4%) had shoulder pain or history of shoulder surgery, and 31 pitchers (75.6%) had elbow pain or history of elbow surgery. Only four participants (9.8%) did not have pain and history of surgery. CONCLUSIONS: For young baseball pitchers, guidelines for prevention of excessive pitching and for regulating the winter training program may be needed.

Clinical Results of Excision of Hamate Hook in the Baseball Players with Hamate Hook Nonunion

PURPOSE: The purpose of this study is to report the clinical results of excision of the hamate hook in baseball players with hamate hook nonunion. MATERIALS AND METHODS: This study included 10 baseball players treated with excision of the hamate hook. Among 10 players, there were 3 professional players and 7 amateur players. The clinical outcomes were evaluated using the visual analog scale (VAS) pain score, exercise performance score, and grip power. We also checked complications and time to return to the game. RESULTS: At final follow-up, the average VAS score was 0.4 points and the average performance score was 9.0 points. The grip power was recovered to 96.7% of the opposite hand at final follow-up. Significant improvement in pain and grip power was observed after surgery. The average time to return to the game was 11.8 weeks. There was one case of postoperative ulnar nerve neuropathy, which was completely resolved within 12 weeks after surgery. CONCLUSION: We think that excision of the hamate hook is an effective treatment to enable early return to the game without loss of grip strength in the baseball player with nonunion of the hamate hook.