Ulnar-Sided Wrist Pain in the Athlete: Sport-Specific Demands, Clinical Presentation, and Management Options.

ABSTRACT: Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.

Categorizing 10 Sports According to Bone and Soft Tissue Profiles in Adolescents.

PURPOSE: Considering the different loading and training characteristics of the sports practiced during growth, it is important to specify and categorize the bone and soft tissue adaptations in adolescent athletes. This study aimed to categorize 10 different loading sports and a nonsport group and identify the differences in bone density and soft tissues. METHODS: The sample included 625 adolescents (10 to 17 yr of age) of 10 sports (soccer, basketball, volleyball, track and field, judo, karate, kung fu, gymnastics, baseball, and swimming) and a nonsport group. Dual-energy x-ray absorptiometry assessed areal bone mineral density (aBMD), bone mineral apparent density (BMAD), and soft tissues (lean soft tissue and fat mass). The results were adjusted for sex, peak height velocity status, lean soft tissue, fat mass, and weekly training volume. RESULTS: The comparisons among groups showed that soccer had the highest whole-body aBMD (mean ± SEM: 1.082 ± 0.007 g·cm) and lower limb aBMD (1.302 ± 0.010 g·cm). Gymnastics presented the highest upper limb aBMD (0.868 ± 0.012 g·cm) and whole-body BMAD (0.094 ± 0.001 g·cm). Swimming presented the lowest aBMD values in all skeletal sites (except at the upper limbs) and whole-body BMAD. The soft tissue comparisons showed that soccer players had the highest lean soft tissue (43.8 ± 0.7 kg). The lowest fat mass was found in gymnasts (8.04 ± 1.0 kg). CONCLUSION: The present study investigated and categorized for the first time 10 different sports according to bone density and soft tissue profiles. Soccer and gymnastics sport groups were found to have the highest bone density in most body segments, and both sports were among the groups with the lowest fat mass.

Humeral Retroversion and Participation Age in Professional Baseball Pitchers by Geographic Region.

CONTEXT: Baseball is played around the world, including in North America and Latin America. The repetitive and stressful act of throwing can lead to adaptations such as increased humeral retroversion (HR) in the throwing arm. This adaptation is often considered beneficial as it allows more glenohumeral external rotation during the cocking phase of pitching without soft tissue stretching. Therefore, it is speculated that throwing should be started at a young age to capitalize on this adaptation. Interestingly, athletes in different geographic regions of the world often begin organized baseball at different ages. However, range of motion (ROM), HR, and the starting age of baseball have never been examined based on geographic region. OBJECTIVE: To determine if ROM, HR, and the starting age of baseball players differed between professional baseball pitchers from North America and Latin America. DESIGN: Cross-sectional study. SETTING: Clinical setting. PATIENTS OR OTHER PARTICIPANTS: Thirty professional pitchers (North American = 19, Latin American = 11) with no current injury or surgery in the previous 6 months. MAIN OUTCOME MEASURE(S): Both ROM and HR were measured in the dominant and nondominant shoulder of each participant. The starting age for baseball was self-reported. RESULTS: The Latin American group had more dominant-arm HR (8.7°; P = .034), more nondominant-arm external rotation (5.3°; P = .049), and a trend toward more nondominant-arm HR (6.5°; P = .058), yet they started playing baseball at a later age (by 3.7 years; P = .021) compared with the North American group. CONCLUSIONS: Latin American players had greater HR but started playing baseball at an older age. These findings contradict current thinking that HR would be more pronounced if baseball was started at a younger age. Additional research is required to better understand HR and the genetic, environmental, and nutritional factors that contribute to its development.

Avaliação radiográfica das alterações no terço proximal do úmero de 21 jovens jogadores de beisebol / X-ray evaluation of the presence of proximal humerus growth plate changes in 21 young baseball pitchers

Objetivo: Avaliar a prevalência de alterações radiográficas no terço proximal do úmero de 21 jovens arremessadores de beisebol e correlacioná-las aos achados clínicos. Desenho do estudo: Série de casos. Local: Estudo realizado pelo Grupo de Cirurgia do Ombro e Cotovelo da Disciplina do Estudo das Afecções Ortopédicas da Faculdade de Medicina do ABC. Santo André, São Paulo, Brasil. Instituição terciária. Pacientes: Foram estudados 21 adolescentes do sexo masculino arremessadores de beisebol, com idade média de 14,5 anos da Seleção Brasileira de Beisebol. Intervenção: Os pacientes foram submetidos a avaliações radiográficas dos ombros. Resultados: Dos atletas, 14 (66%) apresentaram alterações radiográficas na placa de crescimento do terço proximal do úmero. Destes, em nove atletas (64%) nos quais os observadores encontraram alterações radiográficas não apresentavam queixa de dor. Também se observou que em apenas 11 pacientes havia correlação entre os achados clínicos e radiográficos. Conclusão: Concluímos que alterações radiográficas na placa de crescimento do terço proximal de úmero foram encontradas em 66% dos atletas avaliados e não foi encontrada correlação com a avaliação clínica. A presença de alargamento da placa de crescimento do terço proximal do úmero no ombro dominante de jovens arremessadores de beisebol pode acontecer em atletas assintomáticos. Provavelmente, esse alargamento representará, no futuro, uma maior retroversão do ombro dominante do arremessador.

Does the presence of proximal humerus growth plate changes in young baseball pitchers happen only in symptomatic athletes? An x ray evaluation of 21 young baseball pitchers.

OBJECTIVE: To evaluate the presence of x ray changes in the proximal humerus growth plate of 21 young pitchers. DESIGN: Case series. SETTING: This study was conducted at the Orthopaedic and Traumatology Department of the ABC College of Medicine, Santo André, São Paulo, Brazil, tertiary institution. PATIENTS: 21 male adolescent baseball pitchers, with a mean age of 14.5 years and selected from the Brazilian National Team, were studied. INTERVENTIONS: The patients underwent x ray examinations of the shoulders. MAIN OUTCOME MEASUREMENTS: The x rays of the pitchers' shoulders were studied to determine any changes in the proximal humeral growth plate and correlate them with clinical findings. RESULTS: Fourteen athletes (66%) had radiographic changes in the humerus growth plate but only 5 (36%) had pain complaints. Nine of these 14 cases (64%) whom the observers found radiographic changes did not complain of pain. It was also observed that there was a correlation in only 11 cases between clinical and radiographic evaluations. CONCLUSION: Radiographic changes in the proximal humerus growth plate were found in 66% of the cases, but 64% were asymptomatic. These changes indicate possible evolution, in the future, to a greater degree of retroversion in pitchers' dominant shoulders.

Kinematic comparisons of 1996 Olympic baseball pitchers.

The aim of this study was to compare and evaluate the kinematics of baseball pitchers who participated in the 1996 XXVI Centennial Olympic Games. Two synchronized video cameras operating at 120 Hz were used to video 48 pitchers from Australia, Japan, the Netherlands, Cuba, Italy, Korea, Nicaragua and the USA. All pitchers were analysed while throwing the fastball pitch. Twenty-one kinematic parameters were measured at lead foot contact, during the arm cocking and arm acceleration phases, and at the instant of ball release. These parameters included stride length, foot angle and foot placement; shoulder abduction, shoulder horizontal adduction and shoulder external rotation; knee and elbow flexion; upper torso, shoulder internal rotation and elbow extension angular velocities; forward and lateral trunk tilt; and ball speed. A one-way analysis of variance (P < 0.01) was used to assess kinematic differences. Shoulder horizontal adduction and shoulder external rotation at lead foot contact and ball speed at the instant of ball release were significantly different among countries. The greater shoulder horizontal abduction observed in Cuban pitchers at lead foot contact is thought to be an important factor in the generation of force throughout the arm cocking and arm acceleration phases, and may in part explain why Cuban pitchers generated the greatest ball release speed. We conclude that pitching kinematics are similar among baseball pitchers from different countries.

[Anthropometric and physiologic profile of Puerto Rican athletes: female softball]. / Perfil antropométrico y fisiológico de atletas puertorriqueños: softbol femenino.

This study was conducted to describe and compare various anthropometric, body composition, cardiorespiratory, metabolic and neuromuscular characteristics of 12 female athletes, members of the Puerto Rico national softball team. The subjects were divided into three categories according to their game specific requirements (game position): infielders (n = 5), outfielders (n = 4), and pitchers (n = 3). The mean and standard deviations of all the variables in each group was calculated. These athletes demonstrated high levels of body fat and below optimal levels of flexibility, cardiorespiratory endurance, and muscular strength and endurance. The results revealed deficiencies in the health related fitness components and in the physical preparation for sports competition. These results also suggest that the subjects are at risk for the development of cardiovascular diseases, sport injuries, and poor sport performance.

Perfil antropométrico y fisiológico de atletas puertorriqueños: softbol femenino / Anthropometric and physiologic profile of Puerto Rican athletes: female softball

This study was conducted to describe and compare various anthropometric, body composition, cardiorespiratory, metabolic and neuromuscular characteristics of 12 female athletes, members of the Puerto Rico national softball team. The subjects were divided into three categories according to their game specific requirements (game position): infielders (n = 5), outfielders (n = 4), and pitchers (n = 3). The mean and standard deviations of all the variables in each group was calculated. These athletes demonstrated high levels of body fat and below optimal levels of flexibility, cardiorespiratory endurance, and muscular strength and endurance. The results revealed deficiencies in the health related fitness components and in the physical preparation for sports competition. These results also suggest that the subjects are at risk for the development of cardiovascular diseases, sport injuries, and poor sport performance