Navigation-Assisted Micro-Window Excision of Thoracic Ossification of Ligamentum Flavum (Mishima Surgery) in Professional Baseball Pitchers: A Case Report and Technical Note.

Background and Objectives: Thoracic ossification of the ligamentum flavum (OLF) often causes myelopathy and/or radiculopathy. The disease is frequently observed in East Asian populations. Although thoracic OLF in young athletes who have underwent decompression surgery has been reported, the removal of posterior spinal bony elements and ligamentous complex may often cause postoperative thoracolumbar instability. We established a novel surgical technique that preserves the posterior spinal elements, including the spinous processes, facet joints, and supraspinous and interspinous ligaments for thoracic OLF. This is the first case report to describe a navigation-assisted micro-window excision of thoracic OLF. Case: A 32-year-old male right-handed professional baseball pitcher with significant weakness and numbness in the left leg was referred to our hospital. The patient was diagnosed with thoracic OLF at T10-11 based on radiographic and magnetic resonance images in August 2022. After exposure of the left T10-11 laminae via a small unilateral incision, the location of T10-11 OLF was detected over the lamina by O-arm navigation. Then, the micro-window was made directly above the OLF using a navigated air drill, and the OLF was removed on the ipsilateral side. The contralateral side of OLF was also resected through the same micro-window, achieving complete spinal cord decompression. Results: The next day of the surgery, his leg weakness and numbness were significantly improved. Six weeks after the surgery, he started pitching. Three months after surgery, his symptoms had gone completely, and he pitched from the mound. Approximately 6 months after surgery, he successfully pitched in a professional baseball game. Conclusions: A navigation-assisted micro-window excision of thoracic OLF effectively preserved the spinal posterior bony elements and ligamentous complex. However, long-term clinical outcomes should be evaluated in future studies.

Physical functions, to be or not to be a risk factor for osteochondritis dissecans of the humeral capitellum?

Background: Physical risk factors for osteochondritis dissecans (OCD) of the humeral capitellum in young baseball players have not been fully elucidated. We aimed to identify the risk factors for capitellar OCD in baseball players aged 8-14 years. Methods: Between December 2018 and December 2019, young baseball players were recruited from 8 regional baseball leagues. Ultrasonography and physical assessments were performed preseason and at the end of the study period. Bilateral passive ranges of motion (ROM) of horizontal adduction of the shoulders, internal rotation (IR) of the hips, and the thoracic kyphosis angle were measured. 1-year follow-ups were scheduled to determine the occurrence of OCD. Players with OCD were categorized into an OCD group; those without OCD and any elbow pain for one year were categorized into a non-injured group. The players' baseline data (age, sex, position in baseball, and Rohrer's Index) were analyzed using univariate analyses. Their physical parameters were analyzed using two-way analysis of variance with repeated measures to investigate OCD-related risk factors. Results: In total, 3651 baseball players attended the 1-year follow-up. Of these, 71 (1.9%) players had OCD of the humeral capitellum. In the OCD group, a significant association was found at baseline and at the end of the study period between a higher Rohrer index at the baseline and a smaller hip IR ROM on the nondominant side. Conclusions: Loss of hip IR ROM on the nondominant side is a newly discovered risk factor related to physical function in the development of OCD.

Senior Club-Level Rugby Union Player's Positional Movement Performance Using Individualized Velocity Thresholds and Accelerometer-Derived Impacts in Matches.

ABSTRACT: Takamori, S, Hamlin, MJ, Kieser, DC, King, D, Hume, P, Yamazaki, T, Hachiya, M, and Olsen, PD. Senior club-level rugby union player's positional movement performance using individualized velocity thresholds and accelerometer-derived impacts in matches. J Strength Cond Res 36(3): 710-716, 2022-Game demands of professional rugby union players have been well documented; however, there is minimal game demand information using individualized velocity thresholds and collision loads, particularly for amateurs. This study investigated movement patterns of 20 male amateur rugby players during 16 senior premier division one matches using global positioning system (GPS) devices sampling at 10 Hz. Derived GPS variables included distances, velocities, sprinting, and impacts. Data files from 86 player games (≥60 minutes of play per game) were categorized into broad (forwards and backs) and specific (front row, second row, back row, half back, inside back, and outside back) positional groups for analysis. It was most likely that backs covered more distance in the high-speed running (>60% maximal velocity) zone (502 ± 157 m) compared with forwards (238 ± 147 m) (100/0/0%, chances of positive/trivial/negative differences, effect size [ES] = 1.3), performed more striding (backs 1,116 ± 240, forwards 954 ± 240 m, 96/4/0%, ES = 0.5), and sprinting (backs 121 ± 58, forwards 90 ± 65 m, 93/7/0%, ES = 0.5). However, forwards had higher collision loads (35 ± 12 arbitrary units) compared with backs (20 ± 6, 99.9/0.1/0%, ES = 1.3) with back row forwards completing the highest collision load of any playing position (40 ± 13). Our example match movement performance and impact information is valuable to coaches and support staff in preparing player profiles for similar-level rugby players to help manage their workloads.

Isolated Musculocutaneous Nerve Injury in a Professional Baseball Player: A Case Report.

INTRODUCTION: Musculocutaneous nerve lesion in a throwing athlete is a rare condition. We report the case of a professional baseball pitcher with an isolated musculocutaneous nerve lesion that occurred during a pitching motion. CASE PRESENTATION: The patient had radiating pain in the upper arm and weakness of elbow flexion. Physical examination revealed flaccid paralysis of the biceps brachii muscle and paresthesia in the right lateral forearm. Musculocutaneous nerve injury was suspected. Because some signs of recovery were observed within a few days, the patient received non-operative management. Nerve conduction studies at 2 weeks after the injury showed low-amplitude compound muscle action potential of the right biceps brachii muscle by stimulation of the musculocutaneous nerve. Needle electromyography showed markedly reduced motor unit potential recruitment in the biceps brachii muscle. He was diagnosed as having isolated musculocutaneous nerve injury. At 2 months after the injury, the muscle contraction and strength of the biceps brachii muscle improved. At 7 months after the injury, muscle weakness was fully recovered. His pitching ability returned to that of a competitive player. CONCLUSION: Because the neuroparalysis was incomplete and began to recover within a few days, we considered the pathology of this injury to be incomplete axonotmesis, which was successfully treated conservatively.

Predictors of Failure of Return to Play in Youth Baseball Players After Capitellar Osteochondritis Dissecans: Focus on Elbow Valgus Laxity and Radiocapitellar Congruity.

BACKGROUND: Osteochondritis dissecans of the humeral capitellum (capitellar OCD) is a common injury among youth baseball players, but there are only a few studies that report on return to play with nonoperative treatment. PURPOSE: To evaluate the medial elbow joint laxity under valgus stress and radiocapitellar congruity in patients with capitellar OCD and evaluate their relationship to predicting rehabilitation outcome. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Capitellar OCD was diagnosed in 81 patients included in our study. All patients were elementary school students who initially received rehabilitation treatment after injury. The rates of return to the same level of play or higher (RTSP) were calculated and correlated with the joint gap difference between the dominant and nondominant elbows using ultrasound and radiocapitellar congruity (proximal, lateral, and anterior radial translation length), which was assessed using plain radiographs of the dominant elbow. RESULTS: The overall RTSP rates of patients with nonoperative treatment was 70.4% (57/81). The multivariate logistic regression analysis identified OCD classification (stage I, odds ratio [OR], 4.076; 95% CI, 1.171-14.190) and 1 continuous variable (proximal radial translation length on anteroposterior view, OR, 0.661; 95% CI, 0.479-0.911) as the significant predictive factors for outcome after nonoperative treatment. CONCLUSION: The early stage of capitellar OCD in youth baseball players can be successfully treated nonoperatively in the majority of cases. The presence of proximal radial translation can predict the outcome of nonoperative management of capitellar OCD.

Return-to-play outcomes in high school baseball players after ulnar collateral ligament injuries: dynamic contributions of flexor digitorum superficialis function.

BACKGROUND: Ulnar collateral ligament (UCL) injuries are common in baseball pitchers. The purpose of this study was to evaluate changes to medial elbow joint laxity under valgus stress, as well as under valgus stress with flexor digitorum superficialis (FDS) contraction, and its ability to predict rehabilitation outcomes. METHODS: Sixty-one UCL injuries were diagnosed. All patients were high school students who initially received rehabilitation treatment. Rates of return to play and return to the same level of play or higher (RTSP) were calculated and correlated with joint gapping under the following conditions: elbow gravity valgus stress and intra-articular ring-down artifact (RDA) at rest, elbow gravity valgus stress, and elbow gravity valgus stress with maximum FDS contraction. RESULTS: The overall RTSP rate in patients receiving nonoperative treatment was 83.6% (51 of 61 patients). The RDA at rest significantly differed between the RTSP and non-RTSP groups, with an odds ratio of 17.5. This result indicated that the RDA could be a predictor of rehabilitation outcomes. Moreover, there were significant differences in the RDA under gravity valgus stress conditions with FDS contraction between the 2 groups, with an odds ratio of 98.0. Multivariate logistic regression analysis identified 1 variable (RDA under valgus stress with FDS contraction) as the most significant predictive factor for successful treatment of UCL elbow injury. CONCLUSIONS: UCL injuries in high school baseball players can be successfully treated nonoperatively in most cases. Stress ultrasound with FDS muscle contraction can help predict the potential for RTSP.

Osteointegration of a Biocomposite Suture Anchor After Arthroscopic Shoulder Labral Repair.

PURPOSE: To evaluate osteoconductivity of a poly-L-lactide co-glycolide (PLG)-calcium sulfate (CS)-ß-tricalcium phosphate (ß-TCP) biocomposite suture anchor after arthroscopic shoulder labral repair. METHODS: The subjects of this study were patients who participated in a clinical trial for acquisition of marketing approval of a PLG-CS-ß-TCP biocomposite anchor in Japan. They underwent arthroscopic labral repair using the anchor, and computed tomographic (CT) images of the glenoid were obtained 2 years after surgery. Osteoconductivity at the anchor sites was evaluated with the CT images using the established ossification quality score. Shoulder function scores including the Rowe score and Japanese Shoulder Society shoulder instability score were also assessed 2 years after surgery. RESULTS: CT images and functional scores were obtained from 37 patients, comprising 29 men and 8 women with a mean age of 29 years (range, 25-33 years) at surgery. A total of 148 anchors were implanted in the 37 shoulders. Osteoconductivity was seen in 133 of 148 anchor sites (90.0%) 2 years after implantation. No significant differences in osteoconductivity were found by anchor diameter or position. The Rowe score significantly improved from 39.9 points (95% confidence interval [CI], 33.8-45.9 points) preoperatively to 96.6 points (95% CI, 95.1-98.1 points) at 2 years postoperatively (P < .001). The Japanese Shoulder Society shoulder instability score also significantly improved, from 63.1 points (95% CI, 58.4-67.7 points) preoperatively to 96.3 points (95% CI, 94.7-97.8 points) at 2 years postoperatively (P < .001). CONCLUSIONS: Biocomposite suture anchors made of PLG, CS, and ß-TCP exhibited some osteoconductivity 2 years after arthroscopic labral repair, as well as good clinical outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Throwing Injuries in Youth Baseball Players: Can a Prevention Program Help? A Randomized Controlled Trial.

BACKGROUND: Throwing injuries of the shoulder and elbow are common among youth baseball players. HYPOTHESIS: A prevention program will reduce the incidence of throwing injuries of the shoulder and elbow by 50% among youth baseball players. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: The authors block randomized 16 youth baseball teams consisting of 237 players aged 9 to 11 years into an intervention group (8 teams, 117 players) and a control group (8 teams, 120 players). The intervention program consisted of 5 stretching, 2 dynamic mobility, and 2 balance training exercises performed during warm-up. Both groups were followed up for 12 months, during which the incidence of shoulder and elbow injuries was recorded. In addition, ball speed during pitching as a performance-related factor and variables of physical function (passive range of motion of the elbow, shoulder and hip, dynamic balance, and thoracic kyphosis angle) were assessed during the pre- and postintervention periods. RESULTS: The incidence of shoulder and elbow injuries in the intervention group (1.7 per 1000 athlete-exposures) was significantly lower than that in the control group (3.1 per 1000 athlete-exposures) (hazard ratio, 1.940; 95% CI, 1.175-3.205; P = .010). The factors related to pitching performance, as assessed by ball speed, tended to increase in the intervention group as compared with the control group (P = .010). The program also improved shoulder horizontal adduction deficits on the dominant side, hip internal rotation on the nondominant side, and the thoracic kyphosis angle. CONCLUSION: A prevention program decreases throwing injuries of the shoulder and elbow and enhances the parameter of pitching performance in youth baseball players.

Physicochemical Properties of Starches from Lotus Rhizomes Harvested in Different Months.

We investigated the physicochemical properties of starches extracted from 8 lotus (Nelumbo nucifera Gaertn.) rhizomes harvested in different months (September 2012 to May 2013). The physicochemical properties of the lotus starches depended on the harvest date. The peak viscosity (PV) in the Rapid Visco-Analyser analysis, and the viscosity at 65 °C (V65) in the rotational viscometer analysis were significantly lower in SEP starch (extracted from the September-harvested sample) than in the other lotus starches. The Spearman's rank correlation coefficients of potassium ion (K) content vs. V65 and of K content vs. PV were 0.905 and 0.714, respectively, indicating that potassium ions are important for expressing the pasting properties of lotus starch. Principal component analysis suggested that the potassium, magnesium, calcium, and phosphorus contents are important for displaying both the pasting and gelatinization properties of the lotus starches. Meanwhile, the cluster analysis revealed that physicochemical properties of the SEP starch were different from those of the starches harvested in other months.

Lower shoulder abduction during throwing motion may cause forceful internal impingement and decreased anterior stability.

BACKGROUND: Internal impingement and decreased anterior stability, which result from shoulder capsular loosening, are common shoulder pathologies in throwing athletes. The purpose of this study was to assess the effect of shoulder abduction angle on shoulder internal impingement and anterior shoulder stability during the simulated throwing motion. METHODS: Eight cadaveric shoulders were tested by simulating the late-cocking and acceleration phases of the throwing motion for intact and thrower's shoulder conditions. The maximal glenohumeral external rotation, anterior translation, location of the rotator cuff insertion with respect to the glenoid, length and site of internal impingement, and glenohumeral contact pressure were measured. All data were compared between shoulder abduction angles of 80°, 90°, and 100°. RESULTS: Decreasing shoulder abduction in the simulated late-cocking phase shifted the humeral head posteriorly (P < .03) and superiorly (P < .001), decreasing the total internal impingement area between the greater tuberosity and glenoid (P = .04) and increasing the glenohumeral contact pressure during internal impingement (P = .02). In the simulated acceleration phase, anterior glenohumeral translation significantly increased as the shoulder abduction angle decreased (P < .001). CONCLUSION: Decreasing shoulder abduction significantly increased the contact pressure during internal impingement in the simulated late-cocking phase of the throwing motion. During the simulated acceleration phase of the throwing motion, anterior glenohumeral translation significantly increased as shoulder abduction decreased.

Prevalence of radiological findings related to femoroacetabular impingement in professional baseball players in Japan.

BACKGROUND: Femoroacetabular impingement (FAI) is a known patho-mechanism that causes hip pain and osteoarthritis (OA) and is considered uncommon in Japan, while secondary OA due to hip dysplasia is considered common. However, no studies have specifically targeted athletes in Japan and/or Asia. This study aimed to determine FAI prevalence using radiological findings among baseball players playing on a professional, Japanese team. METHODS: We retrospectively assessed 63 plain anteroposterior (AP) hip radiographs (126 hips from 47 [74.6%] Asian players and 16 [25.3%] non-Asian players) obtained for medical evaluations. Radiographs were used to measure lateral center-edge (LCE) angle; acetabular roof obliquity (ARO); and the presence of crossover sign (COS), posterior wall sign (PWS), coxa profunda, pistol grip deformity, herniation pits, and labral ossification. Further, the prevalence of radiographic indicators related to FAI was compared between Asian and non-Asian players. RESULTS: In the 126 hips examined, 10 hips (7.94%) were classified as having hip dysplasia (LCE angles < 20°). Of the remaining 116 hips, eight (6.9%) had LCE angles > 40°, and 24 hips (20.7%) had AROs of <0°, indicating acetabular over-coverage. In Asian players, COS was identified in 47 hips (54.0%), positive PWS in 38 hips (43.7%), positive coxa profunda in 8 hips (9.2%), and pistol grip deformity in 37 hips (42.5%). Further, herniation pits and positive labral ossification were identified in 25 (28.7%) and 11 (12.6%) hips, respectively. A comparative review of COS prevalence (Asians vs. non-Asians) revealed that COS was significantly higher in Asian players. No differences were observed in the mean LCE angle, mean ARO, or other radiographic indicators. CONCLUSIONS: Radiological indicators related to FAI were identified in 76.6% (72/94 hips) of the Asian professional baseball players; this prevalence was considerably higher than that reported for general Asian populations. We consider that elite Asian athletes may frequently show morphological deformities related to FAI.

Physicochemical Properties of Starches from Different Lotus Cultivars in Japan: Shinashirobana cultivar and Kanasumi-line No. 20.

We investigated the physicochemical properties of starches from rhizomes of two lotus (Nelumbo nucifera Gaertn.) cultivars, Shinashirobana cultivar and Kanasumi-line No. 20, harvested at the same farm in Japan. A rapid visco analyser analysis indicated that pasting temperatures of the starches from Shinashirobana cultivar and Kanasumi-line No. 20 were 62.1 and 66.5 °C, respectively, and the peak viscosities of the starch of both lotuses were similar 244 and 240 RVU, respectively. The starch from the Kanasumi-line No. 20 at 60 °C had low viscosity, 16.2 mPa∙s, but the starch from Shinashirobana cultivar had higher viscosity, 2,720 mPa∙s, at 60 °C. The onset and peak temperatures of the differential scanning calorimetry (DSC) curve of the starch from Shinashirobana cultivar were 4-5 °C lower than those of the starch from Kanasumi-line No. 20, although both exhibited similar ΔH values (13.4 and 11.6 J/g). The distribution patterns of the branched chain lengths of amylopectin in the two starches indicated that the rate of low-degree of polymerization (DP 5-12) of all branched chains was higher for the starch from Shinashirobana cultivar than that for the starch from Kanasumi-line No. 20. These results suggest that the increased rate of DP 5-12 in the starch from Shinashirobana cultivar is related to the higher viscosity of the starch.

MALDI-Fourier transform mass spectrometric and theoretical studies of donor-acceptor and donor-bridge-acceptor fullerenes.

Fourier-transform ion cyclotron resonance (FTICR) mass spectrometric studies have been performed on donor-acceptor and donor-bridge acceptor fullerene-based systems. Matrix-assisted laser desorption/ionization (MALDI) was used for ion production; both the positive and negative ion modes were utilized. In addition, collision-induced dissociation (CID) experiments were carried out to study the movement of the charge (electron or hole) upon fragmentation. The experiments are complemented by ab initio theoretical calculations yielding both molecular orbital energies and electron density distributions. It was found that the theoretical electron density map predicted the experimentally observed fragmentation correctly in every case. Both the calculations and the MS experiments may be useful in studying these and related donor-acceptor systems in view of their use for charge separation and eventually, solar energy production.

Synthesis and electrolytic polymerization of the ethylenedioxy-substituted terthiophene-fullerene dyad.

[reaction: see text] Two derivatives of ethylenedioxy-substituted terthiophene-fullerene dyads were newly synthesized as the precursors for polythiophene having fullerene side chains. By electrolytic oxidation of dyad 1, the charm-bracelet type polythiophene, poly-1, was obtained as a purple film, which showed electrochemical activity, electrochromism, and photoelectronic response.