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Background: The Kerlan-Jobe Orthopedic Clinic (KJOC) questionnaire is a self-reported performance and functional assessment tool with good reliability and validity for overhead athletes with shoulder and elbow injuries. This study aimed to develop a Japanese version of the KJOC (J-KJOC) to clarify its reproducibility and validity for use by Japanese university baseball players., Methods: The J-KJOC was translated according to the guidelines for cross-cultural adaptation. A total of 88 university baseball players completed the J-KJOC and the Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaires. Thirty players completed the J-KJOC two times after a median interval of two weeks. We assessed the absolute reliability, construct validity, internal consistency, and test-retest reliability., Results: Cronbach's alpha coefficients ranged from 0.88 and the intraclass correlation coefficient for the total score was 0.91. A fixed bias was absent in the J-KJOC scores (mean difference: -2.2, 95% CI: -4.8 to 0.5). Furthermore, the J-KJOC score was correlated with the Q-DASH-disability/symptom (r = -0.60, p<0.01) and Q-DASH-sports/music (r = -0.63, p<0.01) scores but not correlated with the Q-DASH-work score (r = -0.11, p = 0.316)., Conclusions: The J-KJOC questionnaire demonstrated good reproducibility and validity for assessing upper arm performance in Japanese university baseball players. The results of this study support the use of the J-KJOC for Japanese-speaking baseball players. Further research using this instrument on other types of overhead athletes is needed to determine its wider utility in sports medicine applications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Sasagawa et al.)

Background: The lower trapezius (LT) muscle, which stabilizes the scapula posteriorly during arm elevation, has been interesting to both clinicians and researchers for its importance in throwing-related shoulder rehabilitation and injury prevention., Purpose: The purpose of this study was to investigate the electromyographic activity of the LT and other relevant muscles during scapular and shoulder activities in the side-lying position., Methods: Twenty collegiate baseball players volunteered to participate in this study. Electromyographic (EMG) output of the lower trapezius, infraspinatus, posterior deltoid, middle deltoid, serratus anterior, and upper trapezius muscles were collected. All the subjects performed isometric resistance exercises in four arm positions: 0° horizontal abduction from the coronal plane (NEUT) with protraction (NEUT-PRO), 15° horizontal adduction from the coronal plane (HADD) with protraction (HADD-PRO), and NEUT with retraction (NEUT-RET), and HADD-RET in a side-lying isometric abduction exercise with two external loads: a 9.1 kg dumbbell and 40% of the manual muscle test (MMT). The subjects also performed two more isometric resistance exercises: supine protraction and side-lying external rotation (ER) of the glenohumeral (GH) joint in GH adduction at 90° of GH ER or with as much ER as possible. All raw EMG data were normalized to maximal voluntary isometric contraction (% MVIC) of the corresponding muscle., Results: LT activity was significantly greater in HADD-RET with 9.1 kg than that of HADD-PRO (p < 0.001) (55 vs 21% MVIC) while middle deltoid muscle activity was significantly decreased in both NEUT and HADD-RET compared to that of NEUT and HADD-PRO (p < 0.001). In contrast, IS muscle activity was significantly increased in HADD-RET with 9.1 kg compared with that 40% MMT (p < 0.001) (41 vs 22% MVIC)., Conclusion: LT activity was modulated by changes in scapulothoracic and glenohumeral joint positioning during a side-lying isometric abduction exercise. These findings may help clinicians to select exercises to improve scapular muscle balance ratios during rehabilitation of the shoulder complex., Level of Evidence: Level 3b, Controlled laboratory study., Competing Interests: The authors have no conflicts of interest to declare that are relevant to the content of this study.

Background: Elite tennis athletes experience injuries throughout the entire body. Impairments in trunk stability, lower limb flexibility, and hip range of motion (ROM) are modifiable risk factors that can impact injuries and performance. Information on nonmodifiable risk factors such as age and gender is limited. The purpose of this investigation was to provide information on risk factors to direct clinical decision-making and injury prevention and rehab programming in this population., Hypothesis: Prevalence and location of injuries will differ by age group and gender. Trunk stability, lower limb flexibility, and hip ROM will differ by age group and gender., Study Design: Cross-sectional study., Level of Evidence: Level 3., Methods: A de-identified database (n = 237; females = 126) from the United States Tennis Association High Performance Profile (HPP) 2014-2015 was used for the analysis. Subjects were elite junior and professional tennis players (mean age 14.6 [range, 9-27] years). The HPP is a tennis-specific assessment and questionnaire that includes retrospective information on injury history. Subjects were categorized by injury, gender, and age. Injury locations were classified by region. Trunk stability measures included drop vertical jump (DVJ), single-leg squat, and prone and side planks. Lower limb measures included hamstring, quadriceps and hip flexor flexibility, and hip rotation ROM., Results: A total of 46% of athletes reported an injury. Significant differences were found for injury prevalence and location by age group. Adolescent athletes (age 13-17 years) had more trunk injuries, while adult athletes (age ≥18 years) had more lower limb injuries. Adolescent athletes performed worse on DVJ, dominant side plank, and hamstring flexibility compared with young (age ≤12 years) and adult athletes. Significant gender differences in hip ROM included internal rotation on both the dominant and nondominant sides., Conclusion: Impairments in trunk stability, lower limb flexibility, and hip rotation ROM may affect both health and performance outcomes in this population. Elite tennis athletes may benefit from additional off court programming to address trunk and lower limb impairments., Clinical Relevance: Adolescent elite tennis athletes may be at higher risk of trunk injuries. Age, gender, injury history, and impairments should be considered with all assessments and programming.

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., Competing Interests: The authors report no conflicts of interest.

Elbow injuries are frequently seen in throwing and overhead athletes. This review provides a framework for diagnosis, treatment, and particularly rehabilitation of common elbow pathologies, including ulnar collateral ligament injury, valgus extension overload, and medial and lateral epicondylitis. Advanced rehabilitation facilitates complete return to functional sport-specific activity and is based on objective criteria. As diagnostic and therapeutic modalities improve our understanding of elbow pathologies in the athletic patient, continued research will further elucidate objective evidence-based rehabilitation techniques., (© 2022 The Authors.)

Background: The electromyography (EMG) activity of the teres minor (TMi) and infraspinatus (IS) muscle has been demonstrated to vary depending on the arm position, such as in the coronal or scapular position, during intervention exercises. This may be reflected by different EMG activities demonstrated between the TMi and IS muscle during the acceleration and deceleration phases of the pitching motion. Tenderness in the scapular attachment site of the TMi muscle is often seen in baseball pitchers after pitching but not the attachment site of the IS muscle. However, few studies have investigated an interaction between TMi and IS muscle activity across different resistance exercises with different arm positions. The purpose of this study was to identify the feature of TMi and IS muscle activity in the presence of manual resistance applied in the prone position., Methods: Eighteen collegiate baseball players volunteered their participation. Raw EMG amplitudes of the TMi, IS, posterior deltoid, middle deltoid, and upper trapezius muscles on the dominant shoulder were measured during intervention exercises. All subjects performed manual isometric resistance exercises: horizontal abduction (HABD) and external rotation (ER) of the glenohumeral joint with 40% of the manual maximum strength test in prone. The subjects also performed each of the HABD and ER resistance exercises with the arm actively positioned at 0° and 45° of ER of the glenohumeral joint in the coronal and scapular planes., Results: Both TMi and IS muscle activities significantly increased with the arm positioned at 45° of ER compared with 0° of ER regardless of the exercise ( P  < .05). TMi activity was significantly greater with HABD resistance than IS muscle activity regardless of the arm positions, whereas it was significantly less with ER resistance than IS muscle activity., Conclusion: The findings of this study indicated that the TMi and IS muscles were most highly activated during the HABD resistance with the arm actively positioned at 45° of ER in the coronal plane. The results of this study have clinical implications regarding the careful selection of arm position in both exercise and clinical examination for the TMi and IS muscles., (© 2021 The Author(s).)

Background: The teres minor (TMi) muscle exposed relatively high activity during the acceleration and deceleration phases of the throwing motion, compared with the infraspinatus muscle. However, few studies have identified TMi muscle activity in intervention exercises. The purpose of this study was to investigate TMi muscle activities in different horizontal adduction positions in the quadruped horizontal abduction exercise. This study hypothesized that TMi muscle activity would differ in response to resistance application across different horizontal adduction positions., Materials and Methods: Nineteen collegiate baseball players volunteered their participation. Raw electromyography activity of the TMi muscle along with 7 different muscles attached to the scapula on the dominant-side were collected, and normalized by each of the corresponding maximum voluntary isometric contractions. All subjects performed manual isometric resistance horizontal abduction exercises at 90° and 135° of abduction with 3 horizontal adduction angles in the quadruped position: 1) coronal, 2) scapular, and 3) sagittal plane. Electromyography data were also collected from rhythmical concentric contraction of horizontal abduction at 90° of abduction in the quadruped position., Results: TMi muscle activity was significantly greater with the arm positioned in the coronal plane than that of the scapular and sagittal planes (41, 26, and 17% maximum voluntary isometric contraction, respectively) ( P  < .05)., Conclusion: The present study demonstrated that TMi muscle activity varied depending on horizontal adduction positions., (© 2021 The Author(s).)

Background: There are limited studies reporting descriptive strength and range of motion in youth baseball players 12 years of age or younger., Purpose: To establish normative data for external (ER) and internal (IR) rotation range of motion (ROM), total arc range of motion (TROM), and isometric rotator cuff strength in youth baseball players, and to compare between the dominant throwing arm (D) to the non-dominant arm (ND)., Study Design: Cross-sectional., Methods: Patient population included 50 (5 to 12-year-old) uninjured, healthy athletes. ROM measurements were performed preseason using a goniometer for IR and ER in the supine position with the shoulder in 90 degrees of abduction (abd) with scapular stabilization. Isometric strength measurements for IR and ER were collected in both neutral and 90 degrees (deg) of abduction with the use of a hand-held dynamometer and recorded in pounds (lbs) utilizing a "make" test. Descriptive statistics were obtained for all measures., Results: All data were analyzed as a single group (average age: 9.02). No significant difference in average total arc of PROM (ER+IR=Total Arc) on the D side compared to the ND side (136.7 ± 12.7 deg vs. 134.3 ± 12.3 deg). There were statistically significant differences between ER ROM (102.2 ± 7.7 deg vs. 96.8 ± 7.4 deg) and IR ROM (34.4 ± 9.0 deg vs. 37.5 ± 9.5 deg) between D versus ND arms (p= .000, .006 respectively). Mean ER strength in neutral (13.6 ± 3.4 and 12.8 ± 3.6 lbs) and 90 deg abduction (12.3 ± 3.4 and 12.5 ± 4.3 lbs) did were not significantly different between D and ND arms, respectively. Mean IR strength in neutral (18.0 ± 6.0 and 15.7 ± 4.7 lbs) and 90 deg abd (16.4 ± 5.6 and 15.0 ± 5.7 lbs) was significantly greater in the D arm vs ND arm, respectively (p=.000, .001)., Conclusion: These data can provide descriptive information for clinicians who treat very young baseball players. These data show sport specific adaptations occur at very young ages (5-12) and are similar to prior reports on adolescent, high school and professional baseball players regarding upper extremity ROM and rotator cuff strength., Level of Evidence: 3., Competing Interests: The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in this article.

Background: Previous studies have reported visually observed apparent muscle atrophy in the infraspinous fossa of the dominant arm of overhead athletes. Several mechanisms have been proposed as etiological factors, including eccentric overload, compressive spinoglenoid notch paralabral cysts, and cumulative tensile suprascapular neurapraxia., Purpose: To report the prevalence of apparent infraspinatus atrophy in male professional tennis players and to determine whether the suspected atrophy correlates with objectively measured weakness of external rotation., Study Design: Cross-sectional study; Level of evidence, 3., Methods: A total of 153 male professional tennis players underwent a musculoskeletal screening examination that included visual inspection of the infraspinous fossa. Infraspinatus atrophy was defined as hollowing or loss of soft tissue bulk inferior to the scapular spine in the infraspinous fossa of one extremity that was visibly different from the contralateral extremity. This finding was observed and independently agreed upon by both an orthopaedic surgeon and a physical therapist during the examination. Also assessed were rotator cuff instrument-assisted manual muscle testing, visual observation of scapular kinesis (or motion), and glenohumeral joint range of motion for internal and external rotation and horizontal adduction., Results: In the 153 players, dominant-arm infraspinatus atrophy was observed in 92 players (60.1%), and only 1 player (0.7%) was identified with nondominant infraspinatus atrophy. A Pearson correlation showed a significant relationship between the presence of dominant-arm infraspinatus atrophy and dominant-arm external rotation strength measured in neutral abduction/adduction (at the side) ( P = .001) as well as between the presence of dominant-arm infraspinatus atrophy and bilateral external rotation strength measured at 90° of glenohumeral joint abduction ( P = .009 for dominant arm and .002 for nondominant arm). No significant correlation was found with scapular dyskinesis, glenohumeral range of motion, or instrument-assisted manual muscle testing of the supraspinatus (empty-can test)., Conclusion: Visually observed infraspinatus muscle atrophy is a common finding in the dominant shoulder of asymptomatic male professional tennis players and is significantly correlated with external rotation weakness. This condition is present in uninjured players without known shoulder pathology and is not related to glenohumeral joint internal rotation, total rotation range of motion, or scapular dysfunction. Players with visually observed infraspinatus atrophy should be evaluated for external rotation strength and may require preventive strengthening., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: D.M.D. has received royalties from Zimmer Biomet. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Background: Rehabilitation following shoulder surgery involves the use of resistive exercise but dosing of these -exercises historically employs multiple sets of pre-determined repetitions and few reports document the perceived effort encountered by patients during these exercises for both elastic resistance and free-weights. The OMNI-Resistance Exercise Scale (OMNI-RES) has been tested and applied as a measure of perceived exertion (RPE) for resistive exercise but has not gained widespread acceptance as an optimal method for physical therapists to document RPE during rehabilitation of shoulder surgery., Purpose: To generate descriptive values of RPE encountered during common shoulder exercises of varying resistance in patients following shoulder surgery as well as provide a comparative analysis between perceived exertion ratings of similar exercise movement patterns using elastic and traditional isotonic resistance., Study Design: Descriptive Cross-sectional Cohort., Methods: Sixty-six subjects (mean age 53.3 + 12.8 years) were included in this study following shoulder surgery (RC repair n=22, labral repair n=10, SA n=34). Perceived exertion using the OMNI-RES was recorded during performance of seven rotator cuff and scapular rehabilitation exercises at 6- and 12-weeks following surgery., Results: Mean RPE using OMNI-RES in combined surgical groups ranged between 3.6 and 5.7 (mean = 4.50 + 2.1) across all seven exercises (scale 0 = very easy to 10 = extremely hard). From the external rotation (ER) exercise pair, paired t-tests revealed standing ER w/ Thera-band® (ERB) had a significantly higher OMNI-RES score versus sidelying ER w/ cuff weight (SLERW) (mean: 5.13 vs 4.41, p = 0.001) while the extension exercise pair consisting of standing shoulder extension w/ band (EXTB) and prone extension w/ cuff weight (PEXTW) showed no significant difference in OMNI-RES score (mean: 3.54, 3.67, p = 0.626)., Conclusion: Commonly prescribed resistance exercise in the rehabilitation following shoulder surgery show light-moderate ratings of perceived exertion at both 6 & 12 week post-operative timepoints across three surgical procedures., Level of Evidence: 3b., (© 2020 by the Sports Physical Therapy Section.)

Background: Traditional exercises performed with the shoulder in the position of 90° abduction and external rotation with elbow flexion (90/90) while using a single elastic band showed moderate activity of both the lower trapezius (LT) and infraspinatus (IS) muscle. The purpose of this study was to investigate activity of the teres minor (TMi) and the LT muscles during standing external rotation exercise with the shoulder in the 90/90 position with 2 elastic bands in both the frontal and the scapular plane., Hypothesis: TMi, IS, and LT muscle activities will vary depending on whether the shoulder is positioned in the frontal or scapular plane with the application of 2 elastic bands. Also, the serratus anterior (SA) and teres major (TMa) muscles will produce different muscular activity patterns during exercises performed with 2 elastic bands in the frontal plane compared with the TMi and LT muscles., Study Design: Controlled laboratory study., Level of Evidence: Level 4., Methods: A total of 21 collegiate baseball players volunteered to participate. The electromyography (EMG) activities of the TMi, IS, LT, SA, TMa, middle deltoid (MD), posterior deltoid, and upper trapezius (UT) muscles were measured with the 90/90 arm position during both isometric and oscillation resistance exercises with 2 elastic bands oriented in the frontal and scapular planes., Results: A significant difference was observed in EMG activity of both the TMi and the LT muscles between single and double elastic band applications in the frontal plane ( P < 0.05). In contrast, EMG activity of the IS, SA, and TMa muscles was significantly increased in the scapular plane compared with the frontal plane ( P < 0.05)., Conclusion: The standing 90/90 position effectively increased both TMi and LT muscle EMG activity with the double elastic band in the frontal plane while minimizing UT and MD muscle activity. EMG activity of the IS, SA, and TMa muscles increased with exercise in the scapular plane as compared with the frontal plane., Clinical Relevance: Oscillation movement under double elastic band application differentiated external rotator muscle and scapular muscle activities between the frontal and scapular plane during the 90/90 exercise in the frontal plane compared with the scapular plane. Clinicians can utilize each of the scapular and frontal positions based on their desired focus for muscular activation.

Background: Little is known about the optimal exercise intensity and the effects of arm position on elastic resistance exercise. The purpose of this study was to investigate scapular muscle activity in different arm positions utilized during standing elastic resistance exercise., Hypothesis: Lower trapezius (LT), serratus anterior (SA), and infraspinatus (IS) muscle activity will vary across arm positions above shoulder level. Also, oscillation resistance exercise will result in increased muscle activity compared with isometric contraction., Study Design: Controlled laboratory study., Level of Evidence: Level 4., Methods: A total of 19 uninjured male collegiate baseball players volunteered to participate in this study. The electromyography (EMG) activity of the LT, upper trapezius (UT), middle deltoid (MD), SA, and IS muscles was determined using surface EMG in 3 arm positions: diagonal pattern 1 (D1), 120° of shoulder abduction (120), and 90° shoulder abduction with external rotation and elbow flexion (90/90) during both isometric contraction and oscillation resistance exercise., Results: No difference in EMG activity of the LT muscle was found between the 120 and 90/90 position. However, the 120 position increased UT and MD muscle activity significantly more than those of the 90/90 position. The D1 arm position significantly increased SA muscle activity more than the 120 and 90/90 positions while the LT muscle activity was nearly silent., Conclusion: The standing 90/90 position effectively generated both LT and IS muscle EMG activity while minimizing both UT and MD muscle activity., Clinical Relevance: The use of oscillation movements under elastic loading can create high muscle activation in the LT muscle without an adverse effect of the humeral head position and scapular rotation.

Background and Purpose: The return to play percentage of baseball pitchers who have undergone isolated superior labrum anterior-posterior (SLAP) repair has been reported to be less than 60%. Scapular dyskinesis (SD), characterized by scapular prominence during dynamic scapulohumeral movements, may be used to assist in diagnosing a baseball pitcher with shoulder pathology including a SLAP lesion. The purpose of this case report was to describe the use of the SD test to assess the scapular muscles and report EMG findings in a college baseball pitcher diagnosed with a Type 2 posterior SLAP lesion., Case Description: The subject was a NCAA-D1 senior collegiate baseball right hand 3/4 slot pitcher (21 years old) with a primary complaint of pain in the anterior portion of the shoulder during the entire fall practice season, which was attributed to labral surgery performed when he was a senior in high school. No positive clinical testing of the patient was found including: the sulcus sign, tests of gross instability, and the load & shift test. A Type II posterior SLAP lesion was identified via magnetic resonance imaging. The subject presented with glenohuemral internal rotation deficit (GIRD). The SD test identified moderate to severe prominence of scapular medial boarder in shoulder flexion/extension (FLX/EXT). Furthermore, surface EMG analyses indicated that the lower trapezius (LT) muscle was abruptly inhibited on the dominant side during the descending phase of FLX, compared with the non-dominant side. Additionally, a remarkably higher ratio of upper trapezius to LT muscle EMG activity on the dominant side compared to that of the non-dominant side was identified during the descending phase from flexion., Discussion: After identification of SD, an off season conservative treatment program allowed him to compete in his last college baseball season, appearing 22 times out of the bullpen in which he was credited four wins with a 3.70 earned run average (ERA) in 41.1 innings in 57 games. The SD test may play a critical role in identifying rehabilitation potential and guide the focus of the rehabilitation program to improve scapulothoracic stability and mobility for unilateral repetitive overhead athletes. Particularly the descending phase during sagittal plane motion (FLX/EXT) may effectively accentuate the scapular prominence during movement, portentially due to LT muscle activity inhibition., Level of Evidence: 5 Case Report., (© 2020 by the Sports Physical Therapy Section.)

Purpose of Review: The purpose of this review will be to provide both a historical and recent review of the role of the kinetic chain for the overhead athlete. The kinetic chain concept will then be applied to clinical exercise modifications and integrations for prevention and treatment of shoulder injury., Recent Findings: The primary conclusion reached through this review is the important role the lower extremity, trunk, and scapular region play in the development of optimal terminal segment acceleration in the overhead throwing and serving motion. Failure of any links in the kinetic chain has implications for shoulder and elbow injury in the overhead athlete. Modifications of traditional shoulder exercises emphasizing activation of the scapular stabilizers and core musculature alongside concomitant rotator cuff activation are recommended and supported in EMG research. Future research is needed to further identify risk factors and rehabilitation and prevention strategies and key clinical tests for the overhead athlete. The goal is to elucidate the important role the kinetic chain plays in both performance enhancement and injury prevention for the overhead athlete. Understanding the key role all segments of the kinetic chain play in the complex biomechanical segmental rotations required for high-level throwing and serving will assist clinicians who work with overhead athletes.

Background: The Kerlan-Jobe Orthopaedic Clinic (KJOC) score has been used to describe various parameters of throwing shoulder and elbow function for the return to play after a long period of rehabilitation, such as after ulnar collateral ligament reconstruction. No study has yet to identify how scapular dyskinesis (SD) in baseball players affects the KJOC score. This study investigated the relationship of the KJOC score to SD evaluated in collegiate baseball players with and without upper extremity injury., Materials and Methods: The study participants were 30 male collegiate baseball players (13 pitchers) belonging to the National Collegiate Athletic Association D-I conference. Participants were assessed with the KJOC instrument in the beginning (PRE) and end (POST) of the season. The SD test was conducted (PRE) in shoulder flexion to identify SD RESULTS: The mean value of KJOC score was significantly less in POST than that of PRE for the pitchers with SD (89.3 and 60.5, respectively; P = .001), whereas no difference was found in the KJOC score between PRE and POST for the pitchers without SD. For the position players, no difference in the mean value of KJOC score was found between PRE and POST, regardless of SD., Conclusion: The results of this study provide evidence that collegiate baseball pitchers with mild SD may have lower KJOC scores, particularly setup or relief pitchers., (Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: To review the recent literature regarding the epidemiology of tennis injuries at all levels of play, and to discuss recent findings in injury surveillance by the Association of Tennis Professionals (ATP)., Recent Findings: Following the release of a consensus statement in 2009 calling for standardized documentation and analysis of tennis-related injuries, multiple studies have been published describing longitudinal injury incidences at Grand Slam tournaments and the Davis Cup. Recent efforts by the ATP have further elucidated injury patterns on tour. There have also been recent high-quality studies on injury trends among collegiate and elite junior tennis players, bringing attention to musculoskeletal injuries and systemic illnesses that young tennis players may be susceptible to. Recent efforts in injury surveillance by the ATP and at the collegiate and junior levels have highlighted injury trends that will help guide injury prevention strategies at various levels of play.

Background: The characteristics of scapular muscle activities in elevation and descent exercises have yet to be elucidated to assess scapular dyskinesis. The purpose of this study was to identify the adaptation of electromyograph (EMG) activities of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and anterior deltoid (AD) muscles with different weight loads in flexion (FLX) and abduction (ABD) in collegiate baseball players., Materials and Methods: Twenty eight individuals, including 13 pitchers, were tested. Normalized EMG signals for the UT, LT, SA, AD muscle of the both the dominant (DOM) and nondominant (NON) side were blocked at every 1 second during each of the exercises. A 3-way repeated analysis of variance design was used to identify differences in the mean values between DOM and NON and between FLX and ABD for DOM., Results: The mean EMG value of the UT in the DOM was significantly less than that of the NON for all joint angles (P < .01), whereas the mean EMG value of the LT in the DOM was significantly greater than that of the NON (P < .01). In contrast, no difference in the SA EMG activity was determined between DOM and NON. However, the mean EMG value of SA in FLX was significantly greater than in ABD (P < .01)., Conclusion: This study identified an apparent adaptation of scapular muscle activities in the currently advocated scapular dyskinesis test for healthy active overhead athletes who are vulnerable to shoulder pathologies., (Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Injuries to the adolescent elbow are common because of the repetitive overuse inherent in many overhead sport activities. The management of these patients is greatly facilitated through a greater understanding of the demands placed on the upper extremity kinetic chain during these overhead activities as well as a detailed examination and rehabilitation for the entire upper extremity kinetic chain. Particular emphasis on improving rotator cuff strength and muscular endurance, along with scapular stabilization, is a critical part of elbow rehabilitation in these patients. In addition, the use of a strategic and progressive interval sport return program is necessary to minimize reinjury and return the adolescent overhead athlete to full function., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Rehabilitation of the patient with glenohumeral impingement requires a complete understanding of the structures involved and the underlying mechanism creating the impingement response. A detailed clinical examination and comprehensive treatment programme including specific interventions to address pain, scapular dysfunction and rotator cuff weakness are recommended. The inclusion of objective testing to quantify range of motion and both muscular strength and balance in addition to the manual orthopaedic clinical tests allows clinicians to design evidence-based rehabilitation programmes as well as measure progression and patient improvement.

Background: This article describes the best clinical tests of shoulder function and injury as identified in a recent systematic review published in the British Journal of Sports Medicine., Discussion: A description of the different tests is given, with photographs of the exact test procedure.

Evaluation of the athlete with an elbow injury involves a complete upper extremity approach and a corresponding treatment approach that addresses the identified deficiencies to restore normal function. A significant focus should be placed on the proximal aspect of the upper extremity in addition to the obvious distal injury. A detailed review of the available treatment modalities fails to identify any clear definitive choice to address pain levels; however, a combination of modalities and appropriate exercise can be used in the early rehabilitation phases. The use of a total arm strengthening program along with evaluation of the athlete's sport mechanics is required to successfully return the patient back to their preinjury level of function. A supervised interval sport return program is also a necessary component of the complete rehabilitation program for the athlete with an elbow injury.

Background: The importance of the scapular stabilizing muscles has led to an increased interest in quantitative measurements of their strength. Few studies have measured isometric or concentric isokinetic forces. Additionally, limited reports exist on the reliability of objective measures for testing scapular protraction and retraction muscle strength or scapular testing that does not involve the glenohumeral joint., Objective: To determine the reliability of four new methods of measuring the maximal isometric strength of key scapular stabilizing muscles for the actions of protraction and retraction, both with and without the involvement of the glenohumeral (GH) joint., Methods: The Isobex® stationary tension dynamometer was used to measure the maximal isometric force (kg) on thirty healthy females (ages 22-26 years). Three measures were taken for each method that was sequentially randomized for three separate testing sessions on three nonconsecutive days., Results: Intraclass correlations (ICC2,3) for intrasession reliability and (ICC3,3) for intersession reliability ranged from 0.95 to 0.98, and 0.94 to 0.96 respectively. The standard errors of measurement (95% confidence interval [CI]) were narrow. Scatter grams for both protraction and retraction testing methods demonstrated a significant relationship, 0.92 for protraction (95% CI 0.83 to 0.96) and 0.93 for retraction (95% CI 0.87 to 0.97). Bland-Altman plots indicated good agreement between the two methods for measuring protraction strength but a weaker agreement for the two methods measuring retraction strength., Discussion/conclusion: The four new methods assessed in this study indicate reliable options for measuring scapular protraction or retraction isometric strength with or without involving the GH joint for young healthy females.

Hypothesis: Chondrolysis has been observed after shoulder arthroscopy and results in severe glenohumeral complications., Materials and Methods: Twenty three cases of post-arthroscopic glenohumeral chondrolysis, occurring between 2005-2006, are reported following a variety of arthroscopic shoulder procedures. Presenting complaints, signs and symptoms, associated operative findings, and potential etiological factors are reviewed. Management options are summarized., Results: Of the 23 cases of chondrolysis identified in our practice over a two year period, 14 occurred in patients following labral repair using a bioabsorbable device. Seventeen of the 23 patients used a high volume intra-articular pain pump for 48 hours after surgery. Seven of the 23 cases had documented use of a thermal probe. Four cases occurred in shoulders with no reported use of fixation anchors, pain pumps, or thermal probes. All cases had at least a 20 cc intra-articular bolus injection of 0.25% bupivicaine with epinephrine., Discussion: This case series identifies several common factors that could be responsible for post-arthroscopic glenohumeral chondrolysis. No single mechanism can be implicated based on the results of this study. Although strong concerns are raised over the use of intra-articular local anesthetics, glenohumeral chondrolysis appears to be an unfortunate convergence of multiple factors that may initiate rapid dissolution of articular cartilage and degenerative changes., Conclusion: Chondrolysis is a devastating complication of arthroscopic shoulder surgery that can result in long-term disabling consequences. Further research is required to specifically identify causative factors. Until this is a available, we strongly advise against the use of large doses of intra-articular placement of local anesthetics.

Study Design: Case report., Background: Management of glenohumeral joint osteoarthritis in young, active patients is challenging due to the significant functional limitations and progression of the disease, coupled with the limited lifespan of prosthetic implants presently in use. The purpose of this report is to present the detailed rehabilitation program and outcome of a patient who suffered an initial glenohumeral dislocation and, following multiple surgical interventions, required shoulder hemiarthroplasty and biologic glenoid resurfacing to return to function., Case Description: An objectively based rehabilitation protocol was used for this patient following shoulder hemiarthroplasty. Data collected included passive and active range of motion, isometric rotational strength, and functional outcome scores to include the Single Assessment Numeric Evaluation (SANE) and American Shoulder Elbow Surgeons (ASES) outcome measures., Outcomes: Progressive improvements in active and passive range of motion were documented at numerous points during postoperative rehabilitation, including 1 and 2 years postoperatively. The patient's initial functional outcome scores improved from 2/100 to 90/100 in the SANE and from 17/100 to 85/100 for the ASES rating scales. At 2 years postsurgery the SANE score was 60/100 and ASES 68/100., Discussion: Early postoperative range of motion exercises performed in a range protecting the subscapularis, coupled with a progressive program of rotator cuff and scapular strengthening exercises, resulted in decreased pain, improved range of motion, and return to work in a limited capacity following hemiarthroplasty with biologic glenoid resurfacing. Further research in series of patients following this procedure will help to establish optimal treatment guidelines and prognosis for young active patients with severe glenohumeral joint osteoarthritis., Level of Evidence: Therapy, level 4.

Objectives: To measure short-term post surgery glenohumeral internal and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following arthroscopic superior labral (SLAP) repair., Background: Physical therapists provide rehabilitation for patients following arthroscopic repair of the superior labrum. Little research has been published regarding the short-term results of this procedure while the patient is typically under the direct care of the physical therapist., Methods: Charts from 39 patients (7 females and 32 males) with a mean age of 43.4±14.9 years following SLAP repair were reviewed. All patients underwent rehabilitation by the same therapist using a standardized protocol and were operated on and referred by the same orthopaedic surgeon. Retrospective chart review was performed to obtain descriptive profiles of shoulder ROM at 6 and 12 weeks post surgery and isokinetically documented internal and external rotation strength 12 weeks post surgery., Results: At 12 weeks post-surgery, involved shoulder flexion, abduction, and external rotation active ROM values were 2-6 degrees greater than the contralateral, non-involved extremity. Isokinetic internal and external rotation strength deficits of 7-11% were found as compared to the uninjured extremity. Patients completed the self-report section of the Modified American Shoulder Elbow Surgeons Rating Scale and scored a mean of 37/45 points., Conclusion: The results of this study provide objective data for both glenohumeral joint ROM and rotator cuff strength following superior labral repair at time points during which the patient is under the direct care of the physical therapist. These results show a nearly complete return of active ROM and muscular strength following repair of the superior labrum and post-operative physical therapy.

Background: Cementless humeral resurfacing arthroplasty is a bone-conserving arthroplasty option for patients with glenohumeral arthritis. It has been successful in the older patient population. However, data regarding the results of arthroplasty in younger, more active patients are lacking. We report the two-year results of this procedure in active patients who were less than fifty-five years of age., Methods: We reviewed prospectively collected clinical data on a series of thirty-six patients under fifty-five years of age with end-stage glenohumeral arthrosis, but without osteonecrosis, who had undergone a cementless humeral resurfacing hemiarthroplasty performed by a single surgeon. All patients were followed for a minimum of two years. We assessed pain, function, and patient satisfaction and documented all complications. Radiographs were evaluated for implant loosening., Results: The thirty-six patients had a mean age of 42.3 years and were followed for a mean of 38.1 months. Scores measured with a visual analog pain scale, the Single Assessment Numeric Evaluation (SANE) scale, and the American Shoulder and Elbow Surgeons (ASES) scale all improved significantly from preoperatively to two years postoperatively (p < 0.001). Complications included one traumatic subscapularis rupture at six weeks, three cases of arthrofibrosis, and one deep hematoma. No obvious radiographic evidence of loosening was noted at the time of the latest follow-up. One shoulder was converted to a stemmed total shoulder arthroplasty at twenty-four months because of pain, but the implant was not loose at the revision. The remaining thirty-five patients were satisfied with the outcome at the time of the latest follow-up and had returned to their desired activity., Conclusions: Cementless humeral resurfacing arthroplasty is a viable treatment option for younger, active patients. Early results indicate that the desired function and pain relief can be expected. Implant loosening and glenoid wear do not appear to be concerns in the short term despite the high activity levels of many patients. Long-term follow-up is needed to determine if these results persist.

Background: Tennis requires repetitive multidirectional movement patterns that can lead to lower extremity injury. Knowledge of population and age-specific strength parameters can be used during performance enhancement training and rehabilitation of tennis players., Objectives: The purpose of this study was to generate population and age-specific descriptive profiles of concentric isokinetic knee extension and flexion strength in elite junior tennis players, and determine whether bilateral differences exist between extremities and across age ranges., Methods: A total of 103 elite male tennis players (mean (SD) 15.92 (2.14), range 11-21) and 53 female tennis players (mean (SD) 15.0 (2.30, range 11-21) were isokinetically tested on a Cybex 6000 isokinetic dynamometer at 180 and 300 degrees/s to assess bilateral concentric knee extension and flexion strength using a standard bilateral testing protocol., Results: No significant bilateral difference between the dominant (racquet side) lower extremity and the contralateral non-dominant side were measured in lower extremity knee extension or flexion strength normalised to body weight, or in the hamstring quadriceps strength ratios in male and female subjects. Male subjects did show significant (p<0.001) increases in knee extension and flexion strength across the age ranges from 11-15 years of age to 16-21 years. Female subjects did not show any significant change in the normalised knee extension or flexion strength across age ranges. Hamstring/quadriceps strength ratios were bilaterally symmetric and remained clinically and statistically constant across age ranges for the male and female elite tennis players., Conclusions: Population and age-specific isokinetic descriptive data from elite tennis players can provide guidance in the development and monitoring of performance enhancement and rehabilitation programs for elite tennis players. The changes identified in normalised knee extension and flexion strength in elite male tennis players necessitate the use of population and age-specific descriptive data.

Background: Repetitive loading to the hip joint in athletes has been reported as a factor in the development of degenerative joint disease and intra-articular injury. Little information is available on the bilateral symmetry of hip rotational measures in unilaterally dominant upper extremity athletes., Hypothesis: Side-to-side differences in hip joint range of motion may be present because of asymmetrical loading in the lower extremities of elite tennis players and professional baseball pitchers., Study Design: Cohort (cross-sectional) study (prevalence); Level of evidence, 1., Methods: Descriptive measures of hip internal and external rotation active range of motion were taken in the prone position of 64 male and 83 female elite tennis players and 101 male professional baseball pitchers using digital photos and computerized angle calculation software. Bilateral differences in active range of motion between the dominant and nondominant hip were compared using paired t tests and Bonferroni correction for hip internal, external, and total rotation range of motion. A Pearson correlation test was used to test the relationship between years of competition and hip rotation active range of motion., Results: No significant bilateral difference (P > .005) was measured for mean hip internal or external rotation for the elite tennis players or the professional baseball pitchers. An analysis of the number of subjects in each group with a bilateral difference in hip rotation greater than 10 degrees identified 17% of the professional baseball pitchers with internal rotation differences and 42% with external rotation differences. Differences in the elite male tennis players occurred in only 15% of the players for internal rotation and 9% in external rotation. Female subjects had differences in 8% and 12% of the players for internal and external rotation, respectively. Statistical differences were found between the mean total arc of hip range of internal and external rotation in the elite tennis players with the dominant side being greater by a clinically insignificant mean value of 2.5 degrees. Significantly less (P < .005) dominant hip internal rotation and less dominant and nondominant hip total rotation range of motion were found in the professional baseball pitchers compared with the elite male tennis players., Conclusion: This study established typical range of motion patterns and identified bilaterally symmetric hip active range of motion rotation values in elite tennis players and professional baseball pitchers. Asymmetric hip joint rotational active range of motion encountered during clinical examination and screening may indicate abnormalities and would indicate the application of flexibility training, rehabilitation, and further evaluation.

Study Design: Retrospective chart review., Objectives: To measure short-term postsurgery glenohumeral internal rotation and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following mini-open rotator cuff repair of full-thickness rotator cuff tears., Background: Physical therapists provide rehabilitation for patients following mini-open rotator cuff repair. Long-term outcome studies have reported a high percentage of good and excellent results following surgery; however, little has been published regarding the immediate short-term results of this procedure, during which the patient is under the direct care of the physical therapist., Materials and Methods: Charts from 11 female and 26 male patients, with a mean +/- SD age of 57.3 +/- 9.9 years, were reviewed following rotator cuff repair, using an arthroscopically assisted mini-open deltoid-splitting approach. All patients underwent postsurgery rehabilitation by the same therapist using a standard protocol. Retrospective chart review was used to obtain descriptive profiles of shoulder joint ROM at 6 and 12 weeks postsurgery and isokinetically assessed shoulder strength at 12 weeks postsurgery., Results: For the postsurgical shoulder, ROM deficits ranging between 5 degrees to 7 degrees were measured for shoulder abduction and external rotation and internal rotation at 90 degrees of abduction. The postsurgical extremity had greater flexion ROM (9 degrees ) compared to the contralateral side. Isokinetic external rotation strength deficits of 5% to 7% were present at 12 weeks postsurgery, with 2% to 11% greater internal rotation shoulder strength on the operative extremity, when compared to the other side. Patients completed the self-report section of the modified American Shoulder Elbow Surgeons (ASES) Rating Scale at 12 weeks postsurgery and scored a mean of 38.7/45.0 points., Conclusion: The application of early ROM and progressive strengthening following mini-open rotator cuff repair allows for the successful return of ROM and strength 12 weeks postsurgery. The results of this study provide objective data for both shoulder ROM and strength at time points during which patients are traditionally receiving physical therapy following surgery.

Purpose: The changes in stroke production in the modern game of tennis have increased the demands on trunk rotation in elite tennis players. Unlike the shoulder, where unilateral strength adaptations have been identified, no study to date has objectively quantified side to side rotational trunk strength in elite tennis players., Methods: One hundred nine elite tennis players were tested using a Cybex isokinetic torso rotation unit at 60 and 120 degrees x s(-1) to measure left and right rotation while stabilized in a seated position. A repeated-measures ANOVA was used with post hoc dependent t-tests where main effect differences were identified to determine side to side rotational differences., Results: No significant difference in trunk rotation strength was measured in the elite male players. Peak torque to body weight ratios averaged 63.7 and 57.5% for forehand rotation (left rotation in right-handed player) and 64.4 and 59.2% for backhand rotation at 60 and 120 degrees x s(-1), respectively. In females, slightly greater (P < 0.001) backhand rotation strength (right rotation in a right-handed player) was measured at both testing speeds with peak torque to body weight ratios ranging between 47.7 and 45.1% for left rotation and 50.8 and 48.3% for right rotation at 60 and 120 degrees x s(-1), respectively. Left rotation/right rotation ratios ranged from 95 to 98% for males and from 94 to 96% for females., Conclusions: Elite-level male tennis players have symmetric trunk rotation strength. Elite female tennis players have slightly greater backhand rotation strength (by 4-8%) than forehand rotation. Conditioning programs for elite tennis players should include exercises to facilitate and develop bilateral trunk rotation.

Unlabelled: The amount of glenohumeral joint internal and external rotation used during overhead sport activities has been measured experimentally by sports scientists. Clinical measurement of glenohumeral joint internal and external rotation using goniometry is an integral part of a shoulder evaluation after injury or surgery or during preseason or preventative musculoskeletal screenings., Purpose: This study measured glenohumeral joint internal and external rotation in two groups of unilaterally dominant upper extremity athletes to compare the total arc of rotational range of motion between the dominant and nondominant extremities., Methods: A total of 163 elite athletes (117 male junior tennis players and 46 male baseball pitchers) were measured for glenohumeral joint internal and external rotation at 90 degrees of abduction. Total rotation range of motion was calculated by summing internal and external rotation measures in each extremity., Results: An ANOVA with post hoc testing revealed no significant difference (P > 0.05) between extremities in baseball pitchers for total rotation range of motion (145.7 vs 146.9), whereas significantly less (P < 0.001) dominant arm total rotation range of motion was identified in the elite junior tennis players (149.1 vs 158.2)., Conclusion: This study has identified unique glenohumeral joint rotational patterning in unilaterally dominant upper extremity athletes that has ramifications for rehabilitation after injury and for both injury prevention and performance enhancement.

The purpose of this study was to determine the intrarater and interrater reliability of a manual anterior humeral head translation test. Fifteen subjects were positioned lying in a supine position with their identity shielded from examiners. A standard manual anterior humeral head translation test was performed and repeated with the glenohumeral joint in 90 degrees of elevation in the scapular plane, with use of the grading method proposed by Altchek and Dines in 1993. Reliability was assessed with the coefficient of agreement and kappa statistic. Intrarater reliability was 81.4% comparing grade I and II translation. This decreased to 54% when examiners distinguished between grades I, I+, II, and II+. Interrater reliability for the same comparisons was 70.4%, decreasing to 37.3%. On the basis of these data, the technique of manually assessing anterior humeral head translation studied has poor overall interrater reliability and only fair intrarater reliability. The test-retest accuracy of humeral head translation is enhanced when examiners only determine the relationship of the humeral head relative to the glenoid rim.

Glenohumeral osteoarthritis is a relatively uncommon type of osteoarthritis characterized by loss of anterior or forward flexion. Assessing range of motion, impingement, and strength, combined with radiologic imaging, can help determine the extent of damage. Published studies focus primarily on surgical treatment, but commonly used nonsurgical approaches include anti-inflammatory medications, oral and injectable viscosupplementation, and physical therapy. These conservative measures can be very effective for active patients and also appeal to their physicians who consider shoulder surgery as a last resort.

The purpose of this study was to examine the effects of a 4-month season of collegiate tennis on glenohumeral joint internal and external rotation strength and range of motion in female collegiate tennis players. Eleven female collegiate tennis players were isokinetically tested to assess glenohumeral joint internal and external rotation strength with 90 degrees of abduction on a Cybex 6000 isokinetic dynamometer. Subjects were also measured for internal and external rotation range of motion using a universal goniometer with 90 degrees of abduction. Measurements were taken before and immediately after a 4-month season of competitive collegiate tennis play. A repeated-measures analysis of variance showed no significant difference in internal or external rotation strength or range of motion between pre- and postseason measures. Results from this study show that, despite 4 months of competitive tennis play, changes in rotational strength and range of motion did not occur. These data have implications for clinicians as well as strength and conditioning professionals designing rehabilitation and preventative conditioning programs for athletes in this population.