Physical Examination Versus Ultrasonography for Detection of Ulnar Nerve Subluxation in Professional Baseball Pitchers.

Background: Despite the importance of accurately detecting ulnar nerve subluxation in vulnerable athletes, few studies have compared the performance of physical examination and ultrasound in this population. Purpose/Hypothesis: The purpose of this study was to compare the diagnostic validity of physical examination versus ultrasound in detecting ulnar nerve subluxation at the cubital tunnel of the elbow in professional baseball pitchers. It was hypothesized that ultrasound would more sensitively detect ulnar nerve subluxation. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Physical and sonographic examinations for ulnar nerve subluxation were performed on 186 elbows of 95 consecutive male professional baseball pitchers (age, 17-30 years) as a routine part of their spring training assessments. Provocative maneuvers consisting of the Tinel and elbow flexion-compression tests were evaluated over the cubital tunnel. The validity of physical examination for detecting ulnar nerve subluxation at the elbow was determined using ultrasonographic examination for comparison. Results: Ulnar nerve subluxation was detected by physical examination in 58 (31.2%) elbows and by ultrasonography in 61 (32.8%) elbows. Of the 58 elbows with positive physical examination, 47 were positive on ultrasound. Using a positive ultrasound as a reference, the accuracy of the physical examination was 86.6%, with 77% sensitivity and 91.2% specificity. The positive and negative predictive values of physical examination were 81% and 89.1%, respectively. There was no relationship between nerve instability and positive provocative tests overall, in dominant versus nondominant arms, or in right versus left arms (P > .05 for all). Conclusion: Physical examination had moderate sensitivity and high specificity for detecting ulnar nerve subluxation at the cubital tunnel of the elbow when compared with ultrasound. These findings suggest that when detecting the presence of a subluxating ulnar nerve is most important, it may be advisable to obtain an ultrasound evaluation instead of relying on a physical examination; however, physical examination alone may be appropriate for ruling out subluxation.

Game-Day Pitch and Throw Count Feasibility Using a Single Sensor to Quantify Workload in Youth Baseball Players.

Background: Pitch count recommendations are used to reduce injury risk in youth baseball pitchers and are based chiefly on expert opinion, with limited scientific support. Furthermore, they only account for pitches thrown against a hitter and do not include the total number of throws on the day a player pitched. Currently, counts are recorded manually. Purpose: To provide a method using a wearable sensor to quantify total throws per game that is compliant with Little League Baseball rules and regulations. Study Design: Descriptive laboratory study. Methods: Eleven male baseball players (age, 10-11 years) from an 11U (players 11 years and younger) competitive travel team were evaluated over a single summer season. An inertial sensor was placed above the midhumerus of the throwing arm and was worn during baseball games across the season. A throw identification algorithm capturing all throws and reporting linear acceleration and peak linear acceleration was used to quantify throwing intensity. Pitching charts were collected and used to verify actual pitches thrown against a hitter in a game versus all other throws identified. Results: A total of 2748 pitches and 13,429 throws were captured. On the day a player pitched, he averaged 36 ± 18 pitches (23%) and 158 ± 106 total throws (pitches in game as well as all warm-up pitches and other throws during game). In comparison, on a day a player did not pitch, he averaged 119 ± 102 throws. Across all pitchers, 32% of all throws were low intensity, 54% were medium intensity, and 15% were high intensity. The player with one of the highest percentages of high-intensity throws did not pitch as their primary position, while the 2 players who pitched most often had the lowest percentages. Conclusion: Total throw count can be successfully quantified using a single inertial sensor. Total throws tended to be higher on days a player pitched compared with regular game days without pitching. Clinical Relevance: This study provides a fast, feasible, and reliable method to obtain pitch and throw counts so that more rigorous research on contributing factors to arm injury in the youth athlete can be achieved.

Return to Play After Shoulder Arthroscopy in Major League Baseball Pitchers vs Position Players.

Background: Recovery from shoulder arthroscopy may vary between professional pitchers and position players in Major League Baseball (MLB). The time that it takes to return to play (RTP) and the level of skills to be regained after surgery are important factors for an athlete to consider when making career decisions. Purpose: To identify MLB players who had arthroscopic shoulder surgery and observe their rates of RTP to MLB and the minor league, as well as to compare pre- and postinjury performance statistics and career metrics. Study Design: Descriptive epidemiology study. Methods: Public records (press releases, http://www.prosportstransactions.com, http://www.baseball-reference.com) were searched and analyzed to determine the number of days from shoulder arthroscopy to RTP and pre- and postinjury statistics for pitchers and position players in the MLB and minor league from 1998 to 2018. To meet inclusion criteria, a player must have undergone shoulder arthroscopy after having played at least 1 game in the MLB and had no identifiable concomitant injuries. Results: Of 134 players, 89 (66.4%) returned to MLB. Fifty-four of 89 pitchers (60.7%) and 35 of 45 position players (77.8%) returned to MLB (P = .048). Forty-nine of 54 pitchers (90.7%) and 23 of 35 position players (65.7%) who returned to MLB returned to the minor league first. The mean time to RTP was 469.6 days (range, 100-1079 days) for pitchers and 301.6 days (range, 94-1488) for position players (P = .002). The WAR statistic (wins above replacement) for the pitchers decreased significantly (P = .004) after shoulder arthroscopy. Conclusion: MLB position players returned to play at higher rates and more quickly than did pitchers. The WAR statistic declined in pitchers during the first season of RTP. Players undergoing arthroscopic shoulder surgery should be aware of these possible outcomes in time to RTP and postoperative performance.

Is fantasy baseball score a viable outcome measure for professional baseball pitchers after undergoing Tommy John surgery?

Hypothesis and Background: Although on-field performance metrics are useful in measuring overall success of ulnar collateral ligament (UCL) reconstruction (UCLR) in professional baseball pitchers, they may not comprehensively quantify athletic performance after returning to playing in the league. To utilize fantasy baseball score (FBS) as a novel and objective outcome to assess the quality of return to play in major league baseball (MLB) pitchers who went back to professional pitching after UCLR. Methods: This is a retrospective observational cohort study of 216 established MLB pitchers who underwent UCLR while in the MLB between the years 1974 and 2018. Pitchers who either started in at least 45 games or pitched 90 relief games in the 3 years leading up to injury were included. FBS was calculated using 3 different scoring methods: ESPN (Entertainment and Sports Programming Network) (FBS-ESPN), Yahoo (FBS-Yahoo), and CBS (Columbia Broadcasting System) (FBS-CBS). Return to play, games played, innings pitched, earned runs, strikeouts, walks, hits allowed, hit batsman, and quality starts were also collected. Performance records were compiled for 3 years prior to and after the return to MLB. Players' pre-injury performance was used as a historic control group. Multivariate linear regression analysis was used to detect trends between seasons, controlling for year of surgery, and number of games. Results: The mean age of the cohort at the time of surgery was 30.0 ± 3.5 years. One hundred seventy-nine of 216 players (83%) returned to MLB play, taking an average of 16.6 ± 5.8 months. One hundred thirty-six of 179 (76%) remained in the league for 3 seasons. After adjusting for year of surgery, pitchers earned significantly fewer points for FBS-CBS (616.45 ± 332.42 vs. 389.12 ± 341.06; P < .001), FBS-Yahoo (801.90 ± 416.88 vs. 492.57 ± 428.40; P < .001), and FBS-ESPN (552.76 ± 275.77 vs. 344.19 ± 300.45; P < .001) after their injury. Also pitchers played in fewer games, pitched fewer innings, and had a decline in all measured on-field performance statistics. Conclusion: FBS may represent a useful outcome measure to objectively assess the quality of return to play in a professional baseball pitcher who returned to play in MLB after UCLR.

Vascular Problems in Elite Throwing Athletes.

There are approximately 880 and 3,600 major league baseball and minor league baseball players who currently are active in their respective leagues, with thousands of players in the collegiate, high school, and little league ranks. Although relatively uncommon, vascular injuries, such as thoracic outlet syndrome, axillary artery compression, quadrilateral space syndrome, and direct vascular trauma, can afflict these players. These career- and limb-threatening injuries can mimic often seen muscular sprains and strains in their early stages with nonspecific symptoms, such as exertional fatigue, which can delay diagnosis with disastrous sequelae, including thrombus propagation, aneurysm rupture, and ischemia from distal embolization. The goal of this review is to discuss the pathophysiology, diagnosis, and treatment of these injuries to increase awareness of sport-related vascular phenomena among the hand and upper-extremity surgery community because these players typically are seen first in the training room or a hand specialist's office.

Glenohumeral Instability and Arm Pain in Overhead Throwing Athletes: A Correlational Study.

Background: The overhead activity of throwing a baseball is arguably the most demanding athletic endeavor placed on the glenohumeral (GH) joint. Previous studies illustrate that 75-80% of baseball players will experience some degree of upper extremity (UE) pain. GH instability is thought to play a role. Purpose: The purpose of this study was to investigate the relationship between GH joint hypermobility and instability with measures of arm pain and performance in overhead throwing athletes. Methods: Actively competing baseball pitchers were recruited and evaluated once with the anterior-posterior Load and Shift examination procedure, the Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Questionnaire (KJOC), and the Functional Arm Scale for Throwers (FAST). Multivariate analysis was performed to identify correlation between severe GH capsular laxity (GH instability), mild capsular laxity (GH hypermobility), no capsular laxity (GH normal), and presence of shoulder pain when pitching. Study Design: Cross-sectional Study. Results: Forty-five pitchers were evaluated, 62.2% of throwing shoulders were classified normal stability, 26.7% were classified hypermobile, and 11.1% were classified unstable. Average KJOC scores for pitchers with the three mobility categories were 66.1 (normal), 59.7 (hypermobile), and 45.0 (unstable). Average FAST scores among the pitchers were 19.9 (normal), 34.2 (hypermobile), and 32.2 (unstable). Pitchers with GH instability and GH hypermobility demonstrated increased arm pain compared to athletes with normal GH joints; KJOC scores of 3.2, 5.5, and 7.4 (p = 0.0007), respectively. Conclusion: Pitchers with GH instability and hypermobility demonstrated significantly increased ratings of arm pain compared to pitchers with no capsular laxity. Level of Evidence: 3b.

Rib Fractures in Professional Baseball Pitchers: Mechanics, Epidemiology, and Management.

Pitching is a complex kinetic chain activity requiring the transfer of energy from the lower body, through the core and trunk, and finally through the arm to generate explosive acceleration of the baseball. As a result, large forces are generated in the trunk musculature and rib attachments from the late cocking phase of pitching through deceleration. The repetitive cumulative load and high pitch velocities put professional pitchers at risk of rib stress fracture. Given the potential for a prolonged recovery course and high rate of recurrence, early recognition of rib bone stress injury is critical to optimize care. Identifying torso strength imbalances, suboptimal pitching biomechanics (such as late or inadequate pelvic rotation), as well as metabolic deficiencies that may adversely affect bone health are essential to expedite safe return to play and prevent future injury. In this review, we discuss risk factors, mechanism of injury, typical clinical presentation, diagnostic imaging findings, and propose treatment and prevention strategies for rib stress fractures in overhand pitchers.

Pelvis and Trunk Energy Flow in Collegiate Softball Pitchers With and Without Upper Extremity Pain.

BACKGROUND: The softball pitch is a full-body motion, where efficient proximal to distal energy flow through the kinetic chain is said to reduce stress at the upper extremity. Although altered trunk kinematic parameters are associated with upper extremity pain in softball pitchers, further research is needed to determine whether differences exist in proximal energy flow between softball pitchers with and without pain. HYPOTHESIS/PURPOSE: To examine pelvis and trunk energy flow during the acceleration phase of the pitch in collegiate softball pitchers with and without upper extremity pain. It was hypothesized that those with upper extremity pain would have less energy flowing into the proximal ends of the pelvis and trunk as well as less energy flowing out of the distal ends of the pelvis and trunk during the acceleration phase when compared with pitchers who did not have upper extremity pain. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 54 female National Collegiate Athletic Association Division I softball pitchers (age, 20.2 ± 2.0 years; height, 173.5 ± 6.9 cm; weight, 78.5 ± 11.5 kg) were assigned to pain (n = 17) and pain-free (n = 38) groups. Participants pitched 3 maximal effort rise-balls for a strike, and the average of the 3 trials was used for analysis. Kinematic data were collected at 100 Hz using an electromagnetic tracking system. A segment power analysis was performed to quantify energy flow for the pelvis and trunk. The Mann-Whitney U test was used to compare pelvis and trunk energy flow during the acceleration phase of the pitch as well as pitch velocity between collegiate softball pitchers with and without upper extremity pain. RESULTS: No significant differences were found between pelvis and trunk energy flow during the acceleration phase or pitch velocity between collegiate softball pitchers with and without upper extremity pain (all P values >.057). CONCLUSION: Previous research determined that kinematic parameters differ between collegiate pitchers with and without upper extremity pain. However, the current study found no difference in pelvis and trunk energy flow or pitch velocity. Although altered kinematics in collegiate pitchers with upper extremity pain may serve as compensation patterns to maintain pitch velocity and proximal energy flow, future research is needed to confirm this postulation. CLINICAL RELEVANCE: The lack of energy flow differences between upper extremity pain groups suggests that pitchers may adapt their biomechanics to maintain trunk and pelvis energy flow patterns. Coaches, athletes, and clinicians should know that movement adaptations can allow for maintained performance levels but may result in the presence of pain that may manifest in other deleterious and injury-susceptible biomechanics.

Can the Scapular Dyskinesis Test be Associated with Throwing Related Injuries During the Course of Collegiate Baseball Seasons?

Background: A pattern of scapular dyskinesis on the dominant side has been demonstrated to be associated with a decrease in throwing arm conditions identified by a self-report outcome assessment in collegiate baseball pitchers during the course of a single season. However, it is unclear if symptomatic shoulders in baseball pitchers may be associated with the presence of scapular dyskinesis. Purpose: To study the relationship between the presence of scapular dyskinesis and throwing-related injury in collegiate baseball pitchers during each respective course of up to four subsequent seasons. Methods: A single Division 1 National Collegiate Athletic Association team participated in this study over a four-year-period. The scapular dyskinesis test was implemented during the preseason for baseball pitchers. Players were followed throughout each respective season to track the incidence of throwing-related upper extremity injuries. Results: A total of 36 collegiate baseball pitchers (height: 185.3 ± 5.6 cm, weight: 88.8 ± 7.8 kg, age: 20.0 ± 1.5 years) consisting of 57 pitcher seasons were followed in this study, in which 18 pitchers remained with the team for more than one year. Twenty-seven of the 57 pitchers were classified as having scapular dyskinesis demonstrated at around 90° of shoulder flexion on the throwing side. Five injuries (13.2% of a total of 38 injuries) were diagnosed as throwing-related shoulder injuries during the course of the intercollegiate baseball seasons. Four of the five throwing-related shoulder injuries occurred in pitchers who had scapular dyskinesis on their dominant side. Consequently, the odds ratio was 5.04 for the collegiate pitchers with scapular dyskinesis on the throwing arm side associated with a throwing-related shoulder injury compared to those with no scapular dyskinesis (p = 0.16). No relationship was identified between scapular dyskinesis on the throwing arm side and throwing-related elbow injury. Eighty-one percent of the scapular dyskinesis test results were not changed on the throwing side from the previous to the following year for those 18 pitchers who were followed for more than one season, whereas 42.9% of the results remained unchanged on the non-throwing side. Conclusion: The results suggest that collegiate baseball pitchers with dominant arm scapular dyskinesis likely are at increased risk of throwing-related shoulder injury. Level of evidence: Level 2, Prospective Cohort Study.

Anthropometrics, Athletic Abilities and Perceptual-Cognitive Skills Associated With Baseball Pitching Velocity in Young Athletes Aged Between 10 and 22 Years Old.

Objective assessments of players performance and individual characteristics are increasingly used in baseball. However, evidence linking individual characteristics to players' performance are scarce. The purpose of the study was to identify across ages, in younger males and females, and to compare, in younger males, the anthropometrics, athletic abilities and perceptual-cognitive skills associated with baseball pitcher's ball velocity. A cross-sectional design was used to conduct this study. Male and female athletes completed a sociodemographic questionnaire followed by anthropometric, athletic ability, perceptual-cognitive skill and pitching velocity assessments. Athletes were categorized by their age categories (11U, 13U, 15U, 18U, 21U). To evaluate the athletes' anthropometrics, height and weight, BMI, waist circumference, arms segmental length and girth were measured. Athletic abilities were assessed using athletes' grip strength, upper body power, vertical jump height, sprint, change of direction, and dynamic balance. Perceptual-cognitive skills performance was assessed with the Neurotracker platform. Pitching performance assessment was completed using the athletes' average fastball velocity. Kendall Tau's correlation coefficient was used to assess relationships between variables and pitching velocity in male athletes (p < 0.05). A 1-way ANOVA was performed to identify differences between age categories for all variables in male athletes (p < 0.05). In male athletes, without age categories discrimination, all anthropometric, athletic ability and perceptual-cognitive skill factors were associated with pitching velocity with associations ranging from τ = 0.185 for perceptual-cognitive skills to τ = 0.653 for left arm grip strength. The results showed that significant differences exist between age categories for anthropometric, athletic ability and perceptual-cognitive skill assessments. The study showed that associations between anthropometrics and pitching velocity, and athletic abilities and pitching velocity vary across age categories. Descriptive data of female athletes results regarding anthropometrics, athletic abilities, perceptual-cognitive skills and pitching velocity are also presented. Gender differences should be investigated in future studies exploring baseball pitching performance.

Return to play after ulnar collateral ligament reconstruction with concurrent posterior-compartment decompression.

BACKGROUND: Medial ulnar collateral ligament (UCL) injuries and posterior elbow impingement commonly affect throwing athletes. Surgical intervention for each of these pathologies individually has been demonstrated to be successful with high return-to-play (RTP) rates. Our purpose was to report RTP rates for patients treated with concurrent UCL reconstruction (UCLR) and arthroscopic posterior débridement performed by the senior author. MATERIALS AND METHODS: We retrospectively reviewed all elbow medial UCL procedures performed by the senior author from January 2016 through September 2020. The inclusion criteria included an elbow medial UCL operation with arthroscopic posterior-compartment débridement in a throwing athlete. The exclusion criteria included isolated UCLR surgery, non-primary surgery, and revision UCLR with either autograft or allograft. Using a chart review and publicly available information, we were able to determine patients' playing levels after their operations. RESULTS: Twelve patients met the inclusion and exclusion criteria. The average age was 24.27 years (standard deviation, 4.92 years). Of the 12 patients, 10 returned to play at the same level (4 Major League Baseball players and 1 Triple A player) or at a higher level (2 players from Single A to Double A, 1 player from National Collegiate Athletic Association Division I to Single A, 1 player from rookie league to Single A, and 1 player from high school to National Collegiate Athletic Association Division I), 1 did not return to play, and 1 returned to play at a lower level, with an average RTP time of 14.64 months (standard deviation, 2.64 months). Of the 12 patients, 11 were pitchers; of these 11 pitchers, 9 had statistics available both before and after UCLR. Before UCLR, the average statistics for the pitchers were as follows: earned run average, 4.11 ± 0.85; walks and hits per inning pitched, 1.42 ± 0.26; strikeout-to-walk ratio, 3.00 ± 1.83; strikeouts per 9 innings, 8.80 ± 1.14; and innings pitched, 234.88 ± 316.74. After UCLR, their average statistics were as follows: earned run average, 5.24 ± 2.18 (P = .189); walks and hits per inning pitched, 1.55 ± 0.34 (P = .379); strikeout-to-walk ratio, 2.15 ± 0.98 (P = .263); strikeouts per 9 innings, 9.67 ± 1.91 (P = .293); and innings pitched, 138.71 ± 162.97 (P = .487). DISCUSSION AND CONCLUSION: Although surgical intervention to address both posterior impingement and UCL injury is relatively rare (comprising 8.5% of all the senior author's UCLR procedures), our experience demonstrates that primary UCLR with concurrent arthroscopic posterior decompression is a reliable, safe, and successful surgical treatment for patients with UCL injury and posterior impingement and our results show no significant difference in statistical performance in pitchers before surgery vs. after surgery.

Ulnar Neuritis and Its Affect on Outcomes of Elbow Ulnar Collateral Ligament Reconstruction.

BACKGROUND: No study has specifically evaluated how ulnar neuritis and ulnar nerve transposition affect outcomes in baseball players undergoing ulnar collateral ligament (UCL) reconstruction (UCLR). PURPOSE: To evaluate the effects of ulnar neuritis and ulnar nerve transposition in baseball pitchers undergoing UCLR in regard to return to sport, time to return to sport, and need for revision or additional surgery. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: At a single institution, all consecutive baseball pitchers undergoing UCLR between 2002 and 2015 were identified. Ulnar neuritis was diagnosed preoperatively by the following criteria: ulnar nerve symptoms, Tinel sign at the elbow, symptomatic subluxation, and numbness/paresthesia in an ulnar nerve distribution of the hand. The primary outcome of the study was return to sport. The secondary outcomes of the study were time to return to sport, length of playing career, and revision or additional surgery. RESULTS: A total of 578 UCLRs were performed in baseball players; of these, 500 UCLRs were performed in pitchers. Ulnar neuritis was diagnosed in 97 (19.4%) baseball pitchers presenting with UCL injury. There were no significant differences in patient characteristics or surgical techniques performed for reconstruction between baseball pitchers with and without ulnar neuritis. In review of injury characteristics, ulnar neuritis was significantly more likely to be diagnosed in pitchers with an acute onset of UCL injury (P = .03). Transposition of the ulnar nerve was more commonly performed in players with ulnar neuritis (47%) versus those without ulnar neuritis (10%; P = .0001). The players who had ulnar neuritis and underwent UCLR had a significantly lower odds of returning to sport (odds ratio, 0.45; P = .04); however, no significant difference was found for time to return to sport and length of playing career for those with and without ulnar neuritis (P = .38 and .51, respectively). CONCLUSION: The study suggests that ulnar neuritis, when present preoperatively in baseball pitchers undergoing UCLR, may adversely affect their ability to return to sport, whereas ulnar nerve transposition at the time of UCLR does not alter the ability to return to sport.

Four-year trend in shoulder and elbow injuries in competitive-level high school baseball pitchers: a repeated cross-sectional survey.

BACKGROUND: Shoulder and elbow injuries are the main cause of throwing disability among high school baseball pitchers. However, longitudinal studies on shoulder and elbow injuries among competitive-level high school baseball pitchers have been insufficient. This study aimed to investigate shoulder and elbow injuries in competitive-level high school baseball pitchers over a four-year period and elucidate the effects of implementing medical checkups on the incidence of shoulder and elbow injuries. METHODS: Five hundred fifty-two high school baseball pitchers, who received preseason medical checkups from February 2012 to February 2015, were enrolled in this study. Shoulder and elbow injuries occurring during the season after medical checkups were prospectively evaluated by a postseason questionnaire. Pitchers who were not able to pitch for >7 days owing to shoulder or elbow pain were defined as having shoulder and elbow injuries during the season. The incidence rates of shoulder and elbow injuries during the seasons were calculated and compared over the 4-year period. RESULTS: Ninety-six percent of medical checkup participants were included in the study. The mean questionnaire collection rate of the prospective study was 71.6% (range: 67.7-78.9%). The incidence of shoulder and elbow injuries significantly decreased from 20.0% in 2012 to 7.7% in 2015 (P = .013). CONCLUSION: The four-year trend in the incidence of shoulder and elbow injuries in competitive-level high school baseball pitchers was evaluated. The incidence of shoulder and elbow injuries during the season significantly decreased with a linear downward trend during the survey period after the implementation of medical checkups.

Relación entre variables psicológicas y lesiones deportivas en lanzadores de béisbol / Relação entre habilidades psicológicas e lesões desportivas em lançadores de beisebol / Relationship between psychological variables and sports injuries in baseball pitchers

RESUMEN Se realizó un estudio transversal, descriptivo y correlacional para determinar la relación entre variables psicológicas y lesiones en 34 lanzadores de béisbol de diferentes niveles competitivos. Se describieron las lesiones mediante análisis de frecuencias y distribución porcentual, así como media, desviación típica, asimetría y curtosis para las variables psicológicas; se realizó además la prueba de normalidad mediante K-S para una muestra. Se compararon las variables psicológicas entre grupos de lanzadores mediante Anova de un factor y se analizó la relación entre ambos grupos de variables mediante el coeficiente de correlación de Pearson. Se compararon las variables psicológicas en relación a las lesiones, empleando la prueba t para muestras independientes y Anova de un factor en cada caso, con un intervalo de confianza del 95 % donde p≤0.05. Fueron empleados el cuestionario de aspectos deportivos y lesiones, inventario de ansiedad rasgo-estado, inventario de ansiedad estado en competencia e inventario psicológico de ejecución deportiva. Se obtuvo una marcada presencia de lesiones y un perfil psicológico donde la ansiedad-rasgo, el control de la atención, la autoconfianza, el nivel motivacional y el control de afrontamiento positivo constituyen los puntos fuertes, existiendo diferencias en la ansiedad, según el nivel competitivo. Excepto el control de la actitud, las habilidades psicológicas mostraron relación con las lesiones. Los lanzadores con mayor cantidad y gravedad de lesiones durante las competencias presentan mayor ansiedad. Se concluye afirmando que la preparación psicológica del lanzador de béisbol debe poseer la finalidad de optimizar su rendimiento deportivo y preservar su estado de salud.

RESUMO Foi realizado um estudo transversal, descritivo e correlacional para determinar a relação entre variáveis psicológicas e lesões em 34 lançadores de beisebol de diferentes níveis competitivos. As lesões foram descritas por análise de frequência e distribuição percentual, assim como média, desvio padrão, enviesamento e curtose para as variáveis psicológicas; o teste de normalidade K-S também foi realizado para a amostra. As variáveis psicológicas foram comparadas entre grupos de pitchers através de um fator único. Anova e a relação entre ambos os grupos de variáveis foi analisada por meio do coeficiente de correlação de Pearson. As variáveis psicológicas foram comparadas em relação às lesões, utilizando o teste t para amostras independentes e um fator Anova em cada caso, com um intervalo de confiança de 95 %, em que p≤0.05. Foi utilizado o questionário de aspectos e lesões desportivas, inventário de ansiedade do estado do traço, inventário de ansiedade do estado na competição e inventário psicológico do desempenho desportivo; uma presença marcada de lesões e um perfil psicológico onde a ansiedade do traço, o controlo da atenção, a autoconfiança, o nível motivacional e o controlo positivo da resposta constituem os pontos fortes obtidos, com diferenças na ansiedade, de acordo com o nível competitivo. Com restrição do controlo de atitude, as capacidades psicológicas mostraram relação com lesões. Os lançadores com maior quantidade e gravidade de lesões durante as competições apresentam maior ansiedade. Conclui-se que a preparação psicológica do lançador de beisebol deve ter o propósito de otimizar o seu desempenho desportivo e preservar a sua saúde.

ABSTRACT A cross-sectional, descriptive and correlational study was carried out to determine the relationship between psychological variables and injuries in 34 baseball pitchers of different competitive levels. Injuries were described by frequency analysis and percentage distribution, as well as mean, standard deviation, asymmetry and kurtosis for psychological variables; the K-S normality test was also performed for the sample. The psychological variables were compared between groups of pitchers by means of a one-factor Anova and the relationship between both groups of variables was analyzed by means of Pearson's correlation coefficient. Psychological variables were compared in relation to injuries, using the t-test for independent samples and one-factor Anova in each case, with a confidence interval of 95 % where p≤0.05. The questionnaire of sports aspects and injuries, trait-state anxiety inventory, state anxiety inventory in competition and psychological inventory of sports performance were used; a marked presence of injuries and a psychological profile where trait-anxiety, attention control, self-confidence, motivational level and positive coping control constitute the strong points were obtained, with differences in anxiety, according to the competitive level. Except for attitude control, psychological skills showed a relationship with injuries. The throwers with greater number and severity of injuries during the competitions present greater anxiety. It is concluded by affirming that the psychological preparation of the baseball pitcher should have the purpose of optimizing his sports performance and preserving his state of health.

Risk factors for throwing elbow injuries during pitching analyzed by simulation using human musculoskeletal model in youth baseball pitchers.

BACKGROUND: Pitching mechanics are believed to be risk factors for throwing elbow injury. Thus, a prospective study of abnormal mechanics in youth baseball players is needed. This study aimed to analyze the ulnar collateral ligament during normal pitching using SIMM (Software for Interactive Musculoskeletal Modeling) for analysis and investigate the risk parameters of throwing elbow injuries in youth baseball players. We hypothesized that excessive ulnar collateral ligament force during pitching would be a risk factor for throwing elbow injuries in this population. METHODS: In this cohort study, youth baseball pitchers (aged 9-11 years) were instructed to throw a ball into a netted target. Using a SIMM musculoskeletal model, we analyzed the force of the anterior band of the anterior oblique ligament, posterior band of the anterior oblique ligament (AOL_PB), and elbow varus moment during pitching (foot contact to ball release). We calculated the integral of each force of the anterior band of the anterior oblique ligament and AOL_PB during pitching and summarized these data to establish an impulse at the medial epicondyle. Each participant was followed up for 12 months to assess the occurrence of throwing elbow injury. RESULTS: During the 12-month follow-up period, 18 pitchers (28.1%) reported throwing elbow injuries in the throwing arm. The results of this study showed that the maximum AOL_PB force and the impulse at the medial epicondyle were risk factors for throwing elbow injuries. The maximum AOL_PB force was significantly higher in the throwing elbow injury group than in the uninjured group (59.4 ± 17.8 N vs. 47.1 ± 17.5 N, P = .014). The impulse at the medial epicondyle was also significantly different (11.1 ± 4.0 N ï½¥ s in the throwing elbow injury group vs. 8.3 ± 4.4 N ï½¥ s in the uninjured group, P = .025). CONCLUSIONS: Increasing the AOL_PB force or the impulse at the medial epicondyle may increase the risk of throwing elbow injuries in youth baseball pitchers. It may be possible to reduce injury risk by focusing on ways to decrease AOL_PB load and cumulative stress on the medial epicondyle throughout the throwing motion while still maintaining high levels of ball velocity.

Outcomes After Ulnar Collateral Ligament Revision Reconstruction in Baseball Players.

BACKGROUND: There is a lack of evidence regarding the success of ulnar collateral ligament (UCL) revision reconstruction. Understanding outcomes after UCL revision reconstruction is important in clinical decision making for overhead athletes. PURPOSE: To evaluate return to play and patient-reported outcomes after UCL revision reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All patients who underwent UCL revision reconstruction, attributed to retear of the ligament or pain, between June 2004 and July 2016 at 2 surgical centers were identified. Charts were reviewed for age, sex, date of primary and revision reconstruction, sport played, level of play, graft type, and complications. Patients were contacted by telephone to determine time to return to play, current level of participation, Conway score, Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, and satisfaction. RESULTS: Of the 65 consecutive baseball players who underwent revision UCL reconstruction, 40 (62%) were contacted at a minimum 22 months after surgery. Of these, 38 (95%) were pitchers and 2 (5%) were position players. Time to return to throwing was 6.2 ± 2.3 months (mean ± SD), and the KJOC score was 74.2 ± 20.7. Based on the Conway score, 50% (20/40) had an excellent result, indicating a return to the previous competition level for at least 1 year, and 30% (12/40) had a good result, indicating a return to a lower level for at least 1 year. For those who were able to return to competition, it took 12.7 ± 3.6 months. In pitchers, 47% (18/38) returned to their previous competition levels for at least 1 year, with a KJOC score of 73.7 ± 21.1. Pitchers were able to return to throwing at 6.3 ± 2.3 months and competition at 12.8 ± 3.7 months. CONCLUSION: Only half of baseball players undergoing UCL revision reconstruction were able to return to their previous levels of competition. Outcomes for revision reconstructions are not as promising as primary procedures. Baseball players should be cautioned that they may not return to their previous levels of play after a revision reconstruction.

Assessment of the reliability of a non-invasive elbow valgus laxity measurement device.

PURPOSE: The purpose of this study was to assess the reliability of a new objective measurement tool to measure the valgus stress laxity of the ulnar collateral ligament (UCL) of the elbow, the "Elbow Tester". The anterior oblique portion of the ulnar collateral ligament (UCL) of the elbow is the primary static restraint to valgus stress during the overhead throwing motion. The main research question was if the "Elbow Tester" that we have developed was reliable and reproducible for further use in research and daily practice. METHODS: Three different examiners tested both elbows of 11 volunteers for UCL laxity. Each elbow was tested 5 times using a standard 2 Nm valgus load, and 3 times using a manual maximum valgus load. One examiner tested the volunteers again 1 week later. The outcomes of elbow valgus laxity were compared between examiners. The intraobserver reliability was assessed using an intraclass correlation coefficient (ICC) and interobserver reliability was also assessed with a mixed model repeated ANOVA test. RESULTS: The device demonstrated a high level of intraobserver reliability with both the 2 Nm valgus force and manual maximum valgus force, using a minimum of three trials as determined by an ICC > 0.9 for all examiners. The interobserver reliability was moderate using the 2 Nm valgus load with an ICC value of 0.72 and significant different outcomes of elbow valgus laxity amongst examiners (p < 0.01). A high interobserver reliability (ICC value of 0.90) was observed using manual maximum valgus force and no differences between outcomes (p > 0.53). CONCLUSION: The noninvasive valgus elbow tester demonstrates high interobserver and intraobserver reliability using manual maximum valgus force and can be used for further research and daily practice.

La epicondilitis medial en los lanzadores de la Isla de la Juventud / Epicondilite medial em lançadores da Ilha da Juventude / Medial epicondylitis in pitchers of La Isla de la Juventud

Resumen La tendinopatía es una causa importante de morbilidad musculo-esquelética. Tiene una alta incidencia en el ámbito deportivo de 30 a 50 % de las lesiones, en atletas profesionales y recreativos, que pueden comprometer el rendimiento deportivo y causar discapacidad. En gran medida, es causada por una alteración en los orígenes músculo-tendinosos, en los cóndilos humerales. En la mayoría de los casos, se encuentra en población laboralmente activa, por lo cual tiene alto impacto en la reducción de la productividad por ausencias laborales, que de acuerdo con la severidad pueden ser días o semanas. El objetivo general de la investigación consiste en proponer un complejo de ejercicios físicos que contribuyan a la recuperación de dicha lesión en lanzadores de béisbol. Se emplearon los métodos teóricos, empíricos y se determinaron los fundamentos teóricos que componen la rehabilitación de la epicondilitis medial. Se analizó la información obtenida luego de aplicar una entrevista a los entrenadores, con la finalidad de caracterizar el estado actual del proceso de rehabilitación de esta lesión. A partir de los resultados obtenidos, se diseñó un conjunto de ejercicios físicos para rehabilitar dicha lesión en el área de entrenamiento. Los ejercicios diseñados se clasifican en pasivos, activos asistidos, activos libres, activos resistidos; este último dividido en dos grupos. Para facilitar la labor de los entrenadores, se describen la forma de ejecución de los ejercicios, así como las indicaciones metodológicas, músculos implicados, organización y variantes.

Resumo A Tendinopatia é uma das principais causas de morbidade músculo-esquelética. Tem uma alta incidência no ambiente desportivo de 30-50% das lesões em atletas profissionais e recreativos, o que pode comprometer o desempenho desportivo e causar incapacidade. Em grande medida, é causada por uma alteração na origem músculo-tendão nos côndilos umerais. Na maioria dos casos, encontra-se na população ativa, pelo que tem um elevado impacto na redução da produtividade por faltas ao trabalho, que de acordo com a gravidade pode variar de dias a semanas. O objetivo geral da pesquisa é propor um complexo de exercícios físicos que contribuam para a recuperação desta lesão em arremessadores de beisebol. Os métodos teóricos e empíricos foram utilizados e os fundamentos teóricos que compõem a reabilitação da Epicondilite medial foram determinados. As informações obtidas após a entrevista com os treinadores foram analisadas a fim de caracterizar o estado atual do processo de reabilitação para esta lesão. Com base nos resultados obtidos, um conjunto de exercícios físicos foi concebido para reabilitar esta lesão na área de treino. Os exercícios concebidos são classificados em passivos, ativos assistidos, ativos livres e ativos resistidos; sendo estes últimos divididos em dois grupos. Para facilitar o trabalho dos treinadores, é descrita a forma de execução dos exercícios, assim como as indicações metodológicas, músculos envolvidos, organização e variantes.

Abstract Tendinopathy is a major cause of musculoskeletal morbidity. A high incidence of sports-related injuries of 30-50 % in professional and recreational athletes, which can compromise sports performance and cause disability. Mostly, it is caused by an alteration in the muscle-tendontium origins in the humeral condyles. In most cases, it is in the working population, so it has a high impact on reducing productivity due to absences from work, which, depending on the severity, can range from days to weeks. The general objective of the research is to propose a complex of physical exercises that will contribute to the recovery of such injury in baseball pitchers. Theoretical and empirical methods were used and the theoretical foundations for the rehabilitation of medial epicondylitis were determined. The information obtained after interviewing the coaches was analyzed in order to characterize the current state of the rehabilitation process for this injury. Based on the results obtained, a set of physical exercises was designed to rehabilitate this injury in the training area. The exercises designed are classified into passive, assisted active, free active, and resisted active; the latter being divided into two groups. In order to facilitate the work of the trainers, the form of execution of the exercises is described, as well as the methodological indications, muscles involved, organization and variants.

Instrumento para el control y evaluación del accionar técnico-táctico de los lanzadores de béisbol / Instrumento para o controle e avaliação do desempenho técnico-táctico dos lançadores de beisebol / Instrument for the control and evaluation of the tactical technical performance in the baseball pitchers

Resumen El control y evaluación del accionar técnico-táctico en el entrenamiento, en situaciones de juego, es un aspecto que se dificulta por la no definición de indicadores a tener en cuenta en el béisbol, específicamente en el área de lanzadores. Por ello, el objetivo del presente artículo se centra en proponer un instrumento para el control y evaluación del accionar técnico-táctico de los lanzadores de béisbol, categoría 15-16 años, en situaciones de juego, durante la unidad de entrenamiento, así como en la competición deportiva. Para ello, se trabajó con una muestra primaria de 15 lanzadores de la categoría 15-16 años de la Escuela de Iniciación Deportiva "Ormani Arenado Llonch", de Pinar del Río y nueve entrenadores como muestra secundaria. Se emplearon métodos y técnicas de la investigación científica como el análisis de documentos, la observación, la entrevista estandarizada e individual. Fueron constatadas carencias en el tratamiento del control y evaluación de la preparación técnico-táctica en cuanto al accionar técnico-táctico del lanzador de béisbol en situaciones de juego, a partir de la creación de un instrumento que le aportó información al entrenador sobre el estado del accionar técnico-táctico del lanzador, al propiciar el tratamiento de debilidades que presentaron los atletas de esta área de juego.

Resumo O controle e avaliação da ação técnica tática no treinamento em situações de jogo, é um aspecto dificultado pela falta de definição de indicadores a serem levados em conta no beisebol, especificamente na área de lançamento. Portanto, o objetivo deste artigo é propor um instrumento para o controle e avaliação do desempenho técnico tático dos arremessadores de beisebol, categoria 15-16, em situações de jogo, durante a unidade de treinamento, bem como em competições esportivas. Para isso, trabalhamos com uma amostra primária de 15 arremessadores da categoria de 15-16 anos da Escola de Iniciação ao Esporte, "Ormani Arenado Llonch" de Pinar del Río e nove treinadores como amostra secundária. Foram utilizados métodos e técnicas de pesquisa científica, tais como análise documental, observação, entrevistas padronizadas e individuais. Foram encontradas deficiências no tratamento do controlo e avaliação da preparação técnica táctica em termos da ação técnica táctica do lançador de basebol em situações de jogo, com base na criação de um instrumento que forneceu ao treinador informações sobre o estado da ação técnica táctica do lançador, promovendo o tratamento das debilidades apresentadas pelos atletas nesta área de jogo.

Abstract The control and evaluation of the tactical technical action in the training in game situations, is an aspect that is made difficult by the lack of definition of indicators to be taken into account in baseball, specifically in the pitching area. Therefore, the objective of this article focuses on proposing an instrument for the control and evaluation of the tactical technical performance of baseball pitchers, category 15-16, in game situations, during the training unit, as well as in sports competition. For this purpose, we worked with a primary sample of 15 pitchers of the 15-16 years old category of the Sports Initiation School, "Ormani Arenado Llonch" of Pinar del Río and nine coaches as a secondary sample. Scientific research methods and techniques were used, such as document analysis, observation, standardized and individual interviews. Shortcomings were found in the treatment of the control and evaluation of the tactical technical preparation, in terms of the baseball pitcher's tactical technical action in game situations based on the creation of an instrument that provided the coach with information about the state of the pitcher's tactical technical action, by promoting the treatment of weaknesses presented by the athletes in this game area.

Efecto de las lesiones deportivas sobre variables psicológicas en lanzadores de béisbol / Effect of sports injuries on psychological variables in pitchers of baseball

Resumen La presente investigación se enmarca en el campo de las lesiones deportivas, teniendo como objeto de estudio su relación con las variables psicológicas, asociadas a la ejecución deportiva en lanzadores de béisbol. Se trabajó con 24 lanzadores lo que constituye una población heterogénea en cuanto a edad cronológica, edad deportiva, antecedentes y cantidad de lesiones sufridas. Para su evaluación, se utilizaron los siguientes instrumentos: cuestionario sobre aspectos deportivos y lesiones, el inventario del estado de ansiedad en competición y el inventario psicológico de ejecución deportiva. Los resultados obtenidos indican diferencias estadísticamente significativas en el estado de las variables psicológicas entre lanzadores con historial de lesiones y aquellos que no las presentaron en el momento del estudio, lo cual permitió determinar el efecto negativo de las lesiones sobre la autoconfianza, la ansiedad competitiva, el control del afrontamiento negativo, el control de la atención y el control visuoimaginativo. En el grupo de lanzadores con antecedentes de lesiones, se mostraron relaciones estadísticamente significativas en la autoconfianza y el control del afrontamiento negativo, estableciendo relaciones con la cantidad de lesiones sufridas, de manera tal, que, a mayor número de lesiones, mayor es la diferencia en ambas variables. Por otra parte, la motivación, el control de la actitud y el control del afrontamiento positivo no ofrecieron diferencias algunas entre lanzadores que se han lesionado y los que no lo han hecho. El efecto negativo de las lesiones sobre las variables psicológicas estudiadas mostró diferentes niveles de relación y dependencia en estos deportistas estudiados.

Abstract The present research is framed in the field of sports injuries, having as object of study its relation with the psychological variables associated to the sports performance in baseball pitchers. The work was developed with 24 pitchers constituting a heterogeneous population in terms of chronological age, sports age, history and number of injuries suffered. The following instruments were used for its evaluation: Questionnaire on Sports Aspects and Injuries, the Inventory of the State of Anxiety in Competition and the Psychological Inventory of Sports Execution. The results obtained indicate statistically significant differences in the state of the psychological variables between pitchers with a history of injuries and those who did not at the time of the study, which allowed determining the negative effect of the injuries on self-confidence, competitive anxiety, negative coping control, attention control and imaginative visual control. In the group of pitchers with a history of injuries, statistically significant relationships were shown in self-confidence and negative coping control, establishing relationships with the number of injuries suffered in such a way that the greater the number of injuries, the greater the difference in both variables. On the other hand, motivation, attitude control and positive coping control did not offer any differences between injured and uninjured pitchers. The negative effect of the injuries on the psychological variables studied showed different levels of relationship and dependence in these athletes studied.