Quantification of anterior translation of the humeral head in the throwing shoulder. Manual assessment versus stress radiography.

Clinical evaluation of humeral head translation relies mainly on manual tests to measure laxity in the human shoulder. The purposes of this study were to determine whether side-to-side differences exist in anterior humeral head translation in professional baseball pitchers, to compare manual laxity testing with stress radiography for quantifying humeral head translation, and to test intrarater reliability of the manual humeral head translation and stress radiography tests. Twenty professional baseball pitchers underwent bilateral manual anterior humeral head translation and stress radiographic tests. Stress radiography was performed by imparting a 15-daN anterior load to the shoulder in 90 degrees of abduction with both neutral and 60 degrees of external rotation and recording the glenohumeral joint translation at rest and under stress in each position. Eight subjects were retested to assess the reliability of these methods. Results showed no significant difference between the dominant and nondominant extremity in the amount of anterior humeral head translation measured manually and with stress radiography, nor significant correlation between anterior humeral head translation measured manually and by stress radiography. Test-retest reliability was moderate-to-poor for the manual humeral head translation test and moderate for stress radiography.

Glenohumeral joint range of motion and rotator cuff strength following arthroscopic anterior stabilization with thermal capsulorraphy.

STUDY DESIGN: Single-session, posttest only, descriptive analysis of range of motion (ROM) and strength. OBJECTIVES: To measure ROM and strength approximately 12 weeks following arthroscopic anterior stabilization of the glenohumeral joint with thermal capsulorraphy. BACKGROUND: Treatment of the patient with anterior, unidirectional glenohumeral joint instability often includes surgical stabilization. Current methods focus on arthroscopic stabilization and early ROM and strengthening to restore normal function to the upper extremity. METHODS AND MEASURES: Twenty patients diagnosed with unidirectional shoulder instability (mean age 24.5 years, SD = 8.48) underwent a postoperative rehabilitation program following unilateral arthroscopic shoulder stabilization with thermal capsulorraphy. Objective testing including ROM and isokinetic internal rotation (IR) and external rotation (ER) strength at 90, 210, and 300 degrees/s was performed 12 weeks postoperatively. RESULTS: Ten patients had a complete return of shoulder flexion ROM at 12 weeks. There were deficits compared to the noninjured extremity in postoperative glenohumeral joint mean abduction (9.8 +/- 12.7 degrees), IR (8.4 +/- 15.0 degrees), and ER (13.1 +/- 14.4 degrees). Isokinetic testing showed a complete return of ER strength on the postoperative extremity compared to the uninjured extremity for 12 patients with a 4% (+/- 21.1%) mean deficit measured in IR strength at the slowest testing velocity. No significant difference was found between extremities in the external/internal rotation ratios. CONCLUSION: Postoperative rehabilitation emphasizing progressive ROM and rotator cuff and scapular strengthening has produced favorable results in patients 12 weeks postoperatively with respect to glenohumeral joint ROM and IR and ER strength. Further research and follow-up is required to obtain long-term outcomes with respect to patient satisfaction and stability of the glenohumeral joint following this arthroscopic procedure.

Medial elbow joint laxity in professional baseball pitchers. A bilateral comparison using stress radiography.

Injuries to the ulnar collateral ligament frequently occur in throwing athletes because of large, repetitive valgus stresses to the elbow during the cocking and acceleration phases of throwing. Identification of injury to this ligament is important in evaluating the throwing elbow. The purpose of this study was to determine whether differences in medial elbow laxity exist between the dominant and nondominant extremities in uninjured baseball pitchers. Forty uninjured professional baseball pitchers were tested bilaterally with a Telos GA-IIE stress radiography device. Joint space width between the trochlea of the humerus and the coronoid process of the ulna was measured on anteroposterior radiographs obtained with no stress applied and with a 15-daN valgus stress. Results showed significant differences between the medial joint space opening of the dominant and nondominant elbows with no stress applied. With stress, the dominant elbow opened 1.20 +/- 0.97 mm, while the nondominant elbow opened 0.88 +/- 0.55 mm. A significantly greater difference in medial joint space opening between the stressed and unstressed elbows was measured in the dominant elbow compared with the nondominant elbow (0.32 +/- 0.42 mm). This study identifies increased medial elbow laxity in the dominant arm in uninjured pitchers.

Concentric isokinetic shoulder internal and external rotation strength in professional baseball pitchers.

Objective measurement of shoulder internal and external rotation strength is an important part in the comprehensive evaluation and rehabilitation of athletes who perform predominantly unilateral upper extremity movement patterns. Apparatus- and population-specific descriptive data are needed to enhance the interpretation of results from isokinetic dynamometers. The primary purpose of this study was to measure isokinetically glenohumeral joint internal and external rotator peak torque and work in professional baseball pitchers and determine whether significant differences exist between the dominant (throwing) extremity and nondominant extremity. One hundred twenty-five healthy professional baseball pitchers were tested bilaterally on a Cybex 300 series isokinetic dynamometer at 210 and 300 degrees/sec for concentric internal and external rotation of the glenohumeral joint with the arm in 90 degrees of abduction. A standardized protocol and testing guidelines were strictly followed. A dependent t test was used to test for differences between extremities for peak torque and single repetition work isokinetic parameters. No significant difference between the dominant and nondominant shoulder was found for external rotation peak torque or single repetition work at either testing speed. Significantly greater (p < .001) dominant arm shoulder internal rotation was measured for both peak torque and single repetition work at 210 and 300 degrees/sec compared with the nondominant extremity. The results of this study are important for the application and interpretation of isokinetic data on unilaterally dominant upper extremity athletes. The use of a population-specific, descriptive isokinetic data profile is important in both rehabilitation and prevention of shoulder injuries.

Office evaluation and treatment of lower extremity injuries in the runner.

Lower extremity problems in the runner are common and often perplexing. Although many problems such as acute tendinitis and mild sprains can be treated with short periods of rest and nonsteroidal anti-inflammatory drugs, some will be chronic or recurrent in nature. These persistent problems can cause even a serious runner to reduce his activity greatly or even give up the sport entirely. Chronic recurring ailments should be examined carefully with a high suspicion of a biomechanical imbalance in the foot or lower extremity. With a basic understanding of the biomechanics of the foot and ankle and the stresses incurred during running, most of the problems can be managed conservatively.