Common peripheral nerve injuries in sport: diagnosis and management.

Peripheral nerve injuries are unusual in sport but impact an athlete's safe return to play. Nerve injuries result from either acute trauma (most commonly in contact/collision sports) or from repetitive microtrauma and overuse. Diagnosis of overuse nerve injuries includes nerve localization and surrounding soft-tissue anatomy, and must account for possible causes of repetitive microtrauma, including biomechanics, equipment, training schedule, and recovery. Prognosis is related to the type of nerve injury. Management should not simply be rest and gradual return to sport but should address biomechanical and training predispositions to injury. Understanding the type of injury and the tissues involved will guide appropriate rehabilitation decisions. Recognizing acute care considerations and implementing appropriate strategies can help minimize secondary trauma to an area following acute injury.

Hip and glenohumeral rotational range of motion in healthy professional baseball pitchers and position players.

BACKGROUND: Research suggests that limitations in the hip motion of baseball players may lead to altered motion at the glenohumeral joint to maintain throwing velocity, thereby predisposing the upper extremity to injury. PURPOSE: To measure and evaluate the correlation between hip and shoulder rotational range of motion (ROM) in healthy professional baseball players. STUDY DESIGN: Descriptive laboratory study. METHODS: Ninety-nine professional baseball players (50 pitchers and 49 position players; mean age ± standard deviation [SD], 22 ± 2.8 years; mean height ± SD, 187 ± 5.4 cm; mean weight ± SD, 81.6 ± 7.7 kg) with no history of hip or shoulder injury were tested. Dominant and nondominant hip and glenohumeral joints were measured for the following passive ROM variables: (1) hip internal rotation (IR), (2) hip external rotation (ER), (3) total hip rotational ROM (IR + ER), (4) isolated glenohumeral IR, (5) isolated glenohumeral ER, and (6) total glenohumeral rotational ROM (IR + ER). RESULTS: Statistically, hip ER and total hip rotational ROM were greater in position players than in pitchers and less in the lead leg compared with the stance leg hip with groups combined; however, differences are not clinically meaningful. Pitchers had more glenohumeral rotational ROM than did position players. For all players, glenohumeral motion had less IR and greater ER in the throwing arm than the nonthrowing arm, but total glenohumeral rotational ROM was equivalent between sides. The correlations between hip and glenohumeral ROM were little, if any, and ranged from r = -0.19 to 0.11 (P = .006-.94) for all players and r = -0.29 to 0.23 (P = .04-.97) for pitchers only. CONCLUSION: These data suggest no clinically meaningful differences in hip ROM between pitchers and position players and between lead leg and stance legs of all players. There is little or no relationship between hip and glenohumeral ROM in healthy professional baseball players. CLINICAL RELEVANCE: The study findings add to the growing body of evidence that suggests an absence of chronic hip ROM adaptations. It is therefore suggested that in the hip, unlike the glenohumeral joint, symmetry in ROM between player positions and dominant and nondominant sides should be expected in healthy professional baseball pitchers and position players.

Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: American football.

Returning an American football player to sport after an anterior cruciate ligament reconstruction is challenging on several fronts. First, there are approximately 15 different positions a football player could play, depending on how specifically you define the positions on the field. Each of these positions has specific demands for optimal size, strength, power, body composition, cardiovascular fitness, and movement. Understanding all of these factors is paramount to returning a football player not only to his sport but also to his specific position. Second, the chaotic, contact-rich nature of the sport requires that heavy demands be placed on the lower extremities to attenuate external contact forces from other players and from ground reaction forces associated with accelerating, decelerating, quick stops and starts, and changing direction. Finally, return to a competitive level of performance is further influenced by playing surface, shoe selection, the equipment the player wears, and various potential psychosocial factors. It is the responsibility of the clinician to provide a progressive and systematic rehabilitation program by first introducing preprogrammed movements that, once mastered, are progressed with elements of more reactive and random movement patterns. The precise nature of this systematic progression of advanced rehabilitation is key in developing return-to-play criteria and, ultimately, in readying an American football player for eventual return to sport and a particular position.

One-arm hop test: reliability and effects of arm dominance.

STUDY DESIGN: Test-retest reliability analysis and 2-factor ANOVA contrast of athletic group and limb dominance. OBJECTIVES: To determine the reliability of the one-arm hop test and the effects of upper-extremity dominance on test scores for 2 athletic groups. BACKGROUND: Limited information is available regarding functional performance tests of the upper extremity that involve axial loading. METHODS AND MEASURES: Thirteen male collegiate wrestlers (mean age, 20.3 +/- 1.6 years) and 13 male collegiate football players (mean age, 20.0 +/-1.7 years) without upper-extremity pathology participated in the study. Subjects were trained to perform the one-arm hop test, starting from a one-arm push-up position and then hopping as quickly as possible onto and off of a 10.2-cm platform 5 times. Subjects returned to the test site 1 to 2 days later and were timed for 2 trials of the one-arm hop test for each upper extremity. RESULTS: Within-session ICC2,1 reliability values were 0.78 for the football players and 0.81 for the wrestlers. Mean absolute differences between trials were 0.64 seconds for the football players and 0.47 seconds for the wrestlers. Trial 2 performance times were significantly faster than trial 1 times for the wrestlers. Although performance time for the nondominant side was on average 4.4% slower than that of the dominant side, performance times for the dominant side were not significantly different from those of the nondominant upper extremities. CONCLUSIONS: The results provide preliminary evidence that the one-arm hop test may be a reliable upper-extremity functional performance test with sufficient training of the subject. Uninjured upper-extremity performance for the one-arm hop test may be useful as a basis for comparing performance of an injured contralateral upper extremity.