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A 17-year-old right-handed high school pitcher sustained a first-time anterior shoulder dislocation. The patient's imaging revealed a small Hill–Sachs lesion; however, the clinical team's decision was to manage it nonoperatively. In this case, the patient underwent 7 weeks of rehabilitation, which included general upper extremity strengthening exercises, a modified interval throwing program, and a pitching progression adapted specifically for the patient. After rehabilitation, the patient returned to live pitching with improvements in his pitching statistics. The uniqueness of this case is that it is a less common intervention approach posttreatment. [ABSTRACT FROM AUTHOR]

Upper extremity injuries in baseball pitchers cause significant time loss from competing and decreased quality of life. Although shoulder range of motion (ROM) is reported as a key factor to prevent potential injury, it remains unclear how limited glenohumeral ROM affects pitching biomechanics which may contribute to upper extremity injuries. To investigate how pitchers with decreased total arc glenohumeral ROM of the throwing arm differed in upper extremity pitching kinematics and kinetics as well as ball velocity compared with pitchers with greater levels of glenohumeral ROM. Cross-sectional study. Laboratory. Fifty-seven baseball pitchers (ages 18–24) were divided into either control (≥160° total arc) or lower ROM (<160° total arc) groups. The mean glenohumeral ROM deficits, pitching kinematic and kinetic outcomes, and ball velocity were compared between groups. The control group demonstrated significantly less deficit in total arc ROM between arms than the lower ROM (control: −1.5° ± 10.0°; lower ROM: −12.4° ± 13.9°; P <.001). While the lower ROM group displayed less maximal shoulder external rotation (ER) while pitching, the control group had significantly less difference in ROM between maximal shoulder ER while pitching and clinically measured ER (lower ROM: 64.4° ± 12.1°; control: 55.8° ± 16.6°; P =.025). The control group had significantly faster ball velocity than the lower ROM group (control: 85.0 ± 4.3 mph; lower ROM: 82.4 ± 4.8 mph; P =.024). Pitchers with decreased total arc glenohumeral ROM (<160° total arc) may undergo overstretching toward ER in the shoulder during the late cocking phase. Pitchers with higher total arc ROM can pitch the same or faster ball without increasing loading in the upper extremity. Total arc glenohumeral ROM measurement can be a clinical screening tool to monitor shoulder condition over the time, and pitchers with limited total arc ROM might be at higher risk of shoulder injury. [ABSTRACT FROM AUTHOR]

Background: Increases in peak shoulder distraction force and peak elbow valgus torque may influence throwing-arm pain and injury risk in youth pitchers. Purpose/Hypothesis: The purpose of this study was to determine whether shoulder distraction force and elbow valgus torque while accounting for anthropometrics and pitch velocity can predict the presence of pain in youth baseball pitchers. It was hypothesized that throwing-arm pain could be predicted using the concept of biomechanical efficiency, where a pitcher who is less efficient (having higher force or torque with the same pitch velocity) is more likely to experience pain. Study Design: Descriptive laboratory study. Methods: A total of 38 youth baseball pitchers (mean age, 13.3 ± 1.7 years) were divided into a pain group and pain-free group based on presence of throwing-arm pain as reported on a health history questionnaire. Each pitcher threw 3 maximal-effort fastballs to a catcher at regulation distance, and kinematics were measured using an electromagnetic motion-capture system (minimum 100 Hz). Height and weight as well as mean peak shoulder distraction force, peak elbow valgus torque, and pitch velocity across the 3 trials were evaluated. Logistic regression analyses determined whether shoulder distraction force or elbow valgus torque could predict the presence of throwing-arm pain when holding anthropometrics (body weight for shoulder distraction force; body weight and height for elbow valgus torque) and pitch velocity constant. Results: Shoulder distraction force significantly predicted the presence of throwing-arm pain after accounting for body weight and pitch velocity (χ2 = 9.49; P =.023). Specifically, for every 1-N increase in peak shoulder distraction force while holding body weight and pitch velocity constant, there was a 0.6% increased likelihood of experiencing throwing-arm pain. Elbow valgus torque could not predict the presence of pain when holding body weight, height, and pitch velocity constant. Conclusion: The models demonstrated that increases in peak shoulder distraction forces when holding pitch velocity and body weight constant increased a youth baseball pitcher's likelihood of experiencing throwing-arm pain. The study results support the concept of the biomechanical efficiency framework by offering evidence that maintaining pitch velocity with a lower joint load led to a lower likelihood of pain. Clinical Relevance: Results suggest that practicing efficient movement strategies can decrease the likelihood of experiencing throwing-arm pain while maintaining performance. [ABSTRACT FROM AUTHOR]

Objective: To compare performance in baseball pitchers before and after revision ulnar collateral ligament (UCL) surgery using performance metrics. Design: Case series. Setting: Public online database. Patients (or Participants): Players who underwent revision UCL surgery between 2015 and 2021 were identified. Players were included if they were Minor League (MiLB) or Major League (Major League baseball [MLB]) pitchers. Players were excluded if they were not pitchers, if they underwent their revision surgery as an amateur, or if there is no record of their primary reconstruction surgery. Interventions: Revision UCL surgery (repair or reconstruction). Main Outcome Measures: Return to sport (RTS) rate, RTS time, pitch velocity, and pitch spin rate. Results: Sixty-five pitchers underwent revision UCL surgery. MiLB pitchers had a shorter RTS time after their primary surgery (15.62 vs 20.77 months, P, 0.01) compared with MLB pitchers but similar RTS times after their revision reconstruction (19.64 vs 18.48 months, P 5 0.44). There was also no difference in return to play (RTP) rate overall after primary versus revision reconstruction (P 5 1.00). Major League baseball pitchers also had decreased RTS time after primary compared with revision reconstruction (15.62 vs 19.64 months, P, 0.01) but similar RTP rates (P 5 0.28). Finally, MLB pitchers had similar pitch breakdowns, velocities, and spin rates before and after their primary and revision repair or reconstruction. Conclusions: Both revision UCL repair and reconstruction can return pitchers to preinjury performance levels. Pitchers and teams should be properly counseled on realistic RTP times and postsurgery performance when discussing revision UCL surgeries. [ABSTRACT FROM AUTHOR]

Intra-player movement pattern variability in baseball pitching has been demonstrated to affect metrics of performance and injury risk. It is currently unknown how many pitches are necessary to properly accommodate for intra-player variability for an appropriately representative analysis of a pitcher's throwing mechanics. The purpose of this study was to establish a standard for how many fastball pitches are necessary to account for within and between-individual pitching variability for fastballs thrown by youth athletes. Motion capture data were collected for seven fastballs thrown by 17 male youth pitchers (age = 13.5 ± 1.07 years) using a 3D motion analysis system, incorporating 10-cameras. Maximum shoulder distraction force (MSDF) and maximum elbow valgus torque (MEVT) were compiled from pitching reports previously generated using Visual 3D and the Qualisys baseball module. Spearman-Brown prophecy formula was used to calculate how many pitches were required to account for within and between subject variability for throwing arm metrics analyzed. Results showed that 2, 4, and 19 fastballs are needed to accurately report MSDF and MEVT metrics with 90%, 95%, and 99% reliability, respectively. The results of this study provide the first methodological guidelines for how to account for the factor of fastball pitch variability in youth baseball biomechanics studies. [ABSTRACT FROM AUTHOR]

Background and Purpose: The prevalence of arm pain in youth baseball players is high with approximately half reporting arm pain during the season, and the number of ulnar collateral ligament reconstructions in youth baseball players is increasing. Few studies have examined the relationship between shoulder strength and passive range of motion (ROM) with arm pain (either shoulder or elbow pain) during throwing, especially in athletes in early adolescence. The purpose of this study was to determine the relationship between shoulder ROM and strength and the presence of arm pain during throwing in youth baseball players. It was hypothesized that less internal rotation (IR) ROM, less total rotational ROM, and lower IR and external rotation (ER) strength would be associated with arm pain. Study Design: Observational cohort study Methods: Sixty-five youth male baseball players between the ages of 12-15 were enrolled. Shoulder strength (ER, IR, ER/IR strength ratio, scaption) and passive ROM (ER, IR, flexion, horizontal adduction) were collected prior to the start of the spring 2021 baseball season. Players self-reported their arm pain frequency during throwing as never, rarely, sometimes, often, or always. The relationship between reported arm pain frequency during throwing and shoulder ROM and strength measurements was examined. Results: ER (ρ= -0.289, p=0.020) and IR strength (ρ= -0.262, p=0.035) were weakly and negatively correlated with reports of arm pain during throwing. No other clinical variables were associated with reports of arm pain (p ≥ 0.124) Conclusion: In youth baseball players, greater IR and ER strength were associated with less arm pain frequency during throwing, while ROM was not associated with arm pain frequency. Future research should explore these variables prospectively to determine if changes in ROM and strength are related to the development of arm pain in youth baseball players. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background: The ulnar collateral ligament (UCL) is essential for elbow stability during pitching. In professional baseball, the fastball (FB) is the most commonly used pitch, making postrecovery FB performance after UCL reconstruction (UCLR) a crucial aspect to consider. Hypotheses: (1) Pitchers undergoing UCLR would show no significant changes in performance metrics compared with nonoperated pitchers with similar FB velocity and spin rate, and (2) no significant variance would be found in these metrics within the operated pitchers concerning their preinjury anthropometric characteristics and pitching performance metrics. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 91 Major League Baseball (MLB) pitchers who underwent primary UCLR between January 1, 2015, and December 31, 2021. A matched 1:1 control group of MLB pitchers without UCLR injuries was established. Publicly available pitch metrics and anthropometric data were compared between the study and control groups. Results: Disparities in several performance metrics emerged during the first postreturn year (PRY1), including FB use percentage (P =.029), fielder independent pitching (FIP) (P =.021), and standardized FB runs above average per 100 pitches (wFB/C) (P <.001). Subgroup analysis within the UCLR group revealed a negative correlation between presurgery mean FB velocity and its subsequent change (P <.001) and a positive correlation with changes in FIP (P =.025) from the index year to PRY1. A negative correlation was observed between FB use percentage in the index year and its change by PRY1 (P =.002). By the second postreturn year, no significant differences were found in these performance metrics. No factors were significantly related to prolonged recovery time. Conclusion: Although FB velocity and spin rate remained consistent, significant differences were observed in FB use percentage, FIP, and wFB/C in PRY1. However, by second postreturn year, these differences were no longer significant. No specific risk factors were identified concerning prolonged recovery time between pre-UCLR FB pitching metrics and the physical anthropometric data. These results suggest that although the short-term postsurgery period may affect more specialized pitching metrics, the basic pitching performance metrics, as hypothesized, remain largely unaffected by UCLR. [ABSTRACT FROM AUTHOR]

The fan cooling vest is coming into very common use by Japanese outdoor manual workers. We examined that to what extent using this vest reduces thermal strain and perception during outdoor exercise in the heat on a sunny summer day. Ten male baseball players in high school conducted two baseball training sessions for 2-h with (VEST) or without (CON) a commercially available fan cooling vest on a baseball uniform. These sessions commenced at 10 a.m. on separate days in early August. The fan airflow rate attached the vest was 62 L·s−1. Neither ambient temperature (Mean ± SD: VEST 31.9 ± 0.2°C; CON 31.8 ± 0.7°C), wet-bulb globe temperature (VEST 31.2 ± 0.4°C; CON 31.4 ± 0.5°C) nor solar radiation (VEST 1008 ± 136 W·m−2; CON 1042 ± 66 W·m−2) was different between trials. Mean skin temperature (VEST 34.5 ± 1.1°C; CON 35.1 ± 1.4°C), infrared tympanic temperature (VEST 38.9 ± 0.9°C; CON 39.2 ± 1.2°C), heart rate (VEST 127 ± 31 bpm; CON 139 ± 33 bpm), body heat storage (VEST 140 ± 34 W·m−2; CON 160 ± 22 W·m−2), thermal sensation (− 4–4: VEST 0 ± 2; CON 3 ± 1) and rating of perceived exertion (6–20: VEST 11 ± 2; CON 14 ± 2) were lower in VEST than CON (all P < 0.05). Total distance measured with a global positioning system (VEST 3704 ± 293 m; CON 3936 ± 501 m) and body fluid variables were not different between trials. This study indicates that the fan cooling vest use can reduce thermal strain and perception during outdoor exercise in the heat on a sunny summer day. Cooling with this vest would be effective to mitigate thermal risks and perceptual stress in athletes and sports participants under such settings. [ABSTRACT FROM AUTHOR]

Background: Understanding interactions between multiple risk factors for shoulder and elbow injuries in Major League Baseball (MLB) pitchers is important to identify potential avenues by which risk can be reduced while minimizing impact on player performance. Purpose: To apply a novel game theory–based approach to develop a machine-learning model predictive of next-season shoulder and elbow injuries in MLB pitchers and use this model to understand interdependencies and interaction effects between the most important risk factors. Study Design: Case-control study; Level of evidence, 3. Methods: Pitcher demographics, workload measures, pitch-tracking metrics, and injury data between 2017 and 2022 were used to construct a database of MLB pitcher-years, where each item in the database corresponded to a pitcher's information and metrics for that year. An extreme gradient boosting machine-learning model was trained to predict next-season shoulder and elbow injuries utilizing Shapley additive explanation values to quantify feature importance as well as interdependencies and interaction effects between predictive variables. Results: A total of 3808 pitcher-years were included in this analysis; 606 (15.9%) of these involved a shoulder or elbow injury resulting in placement on the MLB injured list. Of the >65 candidate features (including workload, demographic, and pitch-tracking metrics), the most important contributors to predicting shoulder/elbow injury were increased: pitch velocity (all pitch types), utilization of sliders (SLs), fastball (FB) spin rate, FB horizontal movement, and player age. The strongest game theory interaction effects were that higher FB velocity did not alter a younger pitcher's predicted risk of shoulder/elbow injury versus older pitchers, risk of shoulder/elbow injury increased with the number of high-velocity pitches thrown (regardless of pitch type and in an additive fashion), and FB velocity <95 mph (<152.9 kph) demonstrated strong negative interaction effects with higher SL percentage, suggesting that the overall predicted risk of injury for pitchers throwing a high number of SLs could be attenuated by lower FB velocity. Conclusion: Pitch-tracking metrics were substantially more predictive of future injury than player demographics and workload metrics. There were many significant game theory interdependencies of injury risk. Notably, the increased risk of injury that was conferred by throwing with a high velocity was even further magnified if the pitchers were also older, threw a high percentage of SLs, and/or threw a greater number of pitches. [ABSTRACT FROM AUTHOR]

Background: Differences in rotational range of motion (ROM) compared to humeral retrotorsion (HRT)–corrected rotational ROM exist in healthy baseball athletes, but it is unclear whether these differences exist in a pathological population. Purpose/Hypothesis: The purpose of this study was to determine if there are disparities between objectively measured differences in ROM and HRT-corrected deficits in injured baseball players. It was hypothesized that disparities would exist between (1) the side-to-side difference in glenohumeral external rotation (GER) and the HRT-corrected glenohumeral external rotation deficit (GERD) and (2) the side-to-side difference in glenohumeral internal rotation (GIR) and the HRT-corrected glenohumeral internal rotation deficit (GIRD). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Data from 172 baseball players with shoulder or elbow injuries (45 shoulder, 127 elbow) were reviewed in July 2023. GER and GIR were measured on the injured and noninjured sides of all players, and diagnostic ultrasound was used to measure HRT. Dependent t tests were run to compare the side-to side differences in GER and GIR with the HRT-corrected GERD and GIRD, respectively. Results: In the players with a shoulder injury, there was a significant disparity between the side-to-side difference in GER and the HRT-corrected GERD (2°± 14° vs −13°± 15°, respectively) and between the side-to-side difference in GIR and the HRT-corrected GIRD (–14°± 8° vs 2°± 9°, respectively) (P <.001 for both). Similarly, players with an elbow injury had significant disparities between the side-to-side difference in GER and the HRT-corrected GERD (6°± 9° vs −10°± 9°, respectively) and between the side-to-side difference in GIR and the HRT-corrected GIRD (–12°± 8° vs 4°± 10°, respectively) (P <.001 for both). Conclusion: The results supported our hypothesis that there were disparities between objectively measured differences in GER and GIR compared with the HRT-corrected GERD and GIRD in injured baseball players. Consideration must be given to osseous adaptations that occur at the glenohumeral joint when evaluating and treating this population. [ABSTRACT FROM AUTHOR]

Background: The relationship between abnormalities of the ulnar collateral ligament (UCL) on magnetic resonance imaging (MRI) and elbow symptoms in baseball players remains unclear. Purpose/Hypothesis: This study aimed to compare findings of the UCL on microscopic MRI between asymptomatic and symptomatic elbows in baseball players. We hypothesized that the MRI grade of UCL injuries would exhibit no correlation with medial elbow symptoms in baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The study participants were skeletally mature baseball players who underwent high-resolution microscopic MRI of the medial elbow including for medical checkups. Elbows with previous surgical treatment or traumatic UCL injuries were excluded. The patients were divided into symptomatic and asymptomatic groups. The UCL appearance on microscopic MRI was categorized into 4 grades and compared between the groups. Abnormal findings in the medial elbow including bony fragments at the medial epicondyle, osteophytes or bony fragments in the sublime tubercle, and bone marrow edema (BME) in the sublime tubercle were also evaluated. Results: A total of 426 baseball players (426 elbows) with a mean age of 20 years (range, 14-41 years) were included. The asymptomatic and symptomatic groups included 158 and 268 elbows, respectively. In the asymptomatic group, based on MRI grading of the UCL, 46 (29%) elbows were rated as grade I, 64 (41%) as grade II, 40 (25%) as grade III, and 8 (5%) as grade IV. In the symptomatic group, 75 (28%) elbows were rated as grade I, 118 (44%) as grade II, 61 (23%) as grade III, and 14 (5%) as grade IV. There was no significant difference in the MRI grades between the groups (P =.9). BME in the sublime tubercle was more frequently seen in the symptomatic group than in the asymptomatic group (P <.001). Conclusion: There was no difference in MRI grades of the UCL between symptomatic and asymptomatic elbows in baseball players; approximately 30% of elbows demonstrated high-grade UCL injuries in both groups. BME in the sublime tubercle was more frequently seen in symptomatic elbows than in asymptomatic elbows. BME in the sublime tubercle was a better indicator of symptoms than was MRI grading of the UCL. [ABSTRACT FROM AUTHOR]

There is a plethora of research attempting to contrast high- and low-velocity pitchers to identify traits to target for increasing velocity. However, pitch velocity exists on a continuum. Therefore, our purpose is to display the analytical discrepancies between creating velocity subgroups and leaving velocity as a continuous variable by examining the influence of ball velocity on elbow valgus torque. Motion capture data for 1315 actively competing pitchers were retrospectively extracted from a private database. We compared three analytic methods: (1) linear regression of valgus torque on ball velocity, (2) t-test between low- and high-velocity groups formed by a median split, and (3) t-test between very low- and very high-velocity groups formed by upper and lower velocity quartiles. Linear regression indicates ball velocity influenced valgus torque (p < 0.001, R2 = 0.280). Median splitting reduced the predictability of ball velocity on valgus torque (p < 0.001, R2 = 0.180). Conversely, extreme group splitting artificially inflated the effect size (p < 0.001, R2 = 0.347). We recommend sports biomechanics researchers not discretise a continuous variable to form subgroups for analysis because (1) it distorts the relationship between the variables of interest and (2) a regression equation can be used to estimate the dependent variable at any value of the independent variable, not just the group means. [ABSTRACT FROM AUTHOR]

Objectives: In an analysis of injuries across professional baseball from 2011-2016, there were 4,478 hand injuries reported, resulting in 67,036 days missed. Fractures of the hand are significant injuries that often require surgical intervention, especially those of the phalanx. However, post-injury performance metrics after both operative and nonperative treatment of hand fractures have not been previously analyzed. Therefore, the purpose of this study was to report the demographics, time until return to sport (RTS), and offensive performance outcomes in professional baseball players with various hand fractures. Methods: The Major League Baseball (MLB) Health and Injury Tracking System (HITS) database was utilized to identify MLB and Minor League Baseball (MiLB) players who were diagnosed with a hand fracture from 2011-2022. The HITS database provided data reported by the player's sports medicine staff regarding mechanism/timing of injury, which specific joint was affected, whether operative or nonoperative treatment was pursued, the time until RTS, and offensive performance statistics. Hand fractures not related to baseball were excluded, and pitchers were excluded from the offensive performance analysis. Performance data was grouped into pre-injury (1 year prior to injury date) as well as various post-RTS time points, and performance data regarding operative vs. nonoperative treatment and player position (infielder, outfielder, catcher) was isolated. Results: Overall, 878 professional baseball players experienced a hand fracture over the 12-year study period. The majority of players were infielders (40%) or outfielders (30%), and the metacarpal was the most commonly affected joint (50%) (Table 1). Players returned to sport at a mean of 58±46 days after injury. There were 177 (20%) players who required operative treatment, and these players returned to sport later than players who underwent nonoperative treatment (85 days vs. 51 days, p<0.001) (Table 2). Rates of operative treatment and time until RTS did not differ based on player position (p>0.05). Joint fractured did not significantly affect time until RTS in players treated operatively, however in players treated nonoperatively fractures of the metacarpal took the longest time until RTS (63 days) while fractures of the distal phalanx took the shortest time (31 days). Position players experienced a significant drop in batting average, on-base percentage (OBP), slugging percentage (SLG), and on-base plus slugging percentage (OPS) (Table 3), and this pattern was similar when isolating performance outcomes between players who received non-operative and operative treatment. While catchers experienced the most significant loss of offensive performance, infielders and outfielders also experienced a significant drop in OPS that improved over time, but did not return to baseline, up to 1 year after hand fracture (Figure 1). Conclusions: Following hand fracture, professional baseball players were able to RTS in about two months after nonoperative treatment and in about three months after operative treatment. While player position did not affect time until RTS and rates of operative treatment, player position did affect offensive performance upon RTS, with catchers experiencing the most significant loss of offensive performance. Clinicians should consider the joint affected, treatment plan, and position of the player when planning a RTS timeline and when discussing performance expectations after RTS. [ABSTRACT FROM AUTHOR]

Background: Injuries in professional baseball players have become exceedingly common. Efforts to mitigate injury risk have focused on the kinetic chain, shoulder motion, and so forth. It is unclear whether grip strength is related to injury risk in professional baseball pitchers. Purpose/Hypothesis: The purpose of this study was to determine if grip strength was a risk factor for injury. It was hypothesized that pitchers with weaker grip strength would have a higher likelihood of sustaining a shoulder or elbow injury compared with pitchers with stronger grip strength. Study Design: Case-control study; Level of evidence, 3. Methods: All professional pitchers from a single Major League Baseball organization were included. Dominant and nondominant grip strength were measured after each pitching outing throughout the 2022 season. Injuries over the course of the season were recorded, and data were compared between pitchers who sustained a shoulder or elbow injury and those who did not. Results: Overall, 213 pitchers were included, of whom 53 (24.9%) sustained a shoulder or elbow injury during the season. The mean grip strength for all pitchers was 144.0 ± 20.8 lb (65.3 ± 9.4 kg). The mean dominant-arm grip strength was 142.6 ± 20.8 lb (64.7 ± 9.4 kg) for pitchers who did not sustain a shoulder or elbow injury and 148.2 ± 20.9 lb (67.2 ± 9.5 kg) for pitchers who did sustain an injury, with no significant group difference in grip strength (P >.05). Furthermore, there were no significant differences in change in grip strength over the course of the season between the groups. Conclusion: There was no significant difference in mean grip strength or change in grip strength over the course of a single season between professional baseball pitchers who sustained a shoulder or elbow injury and those who did not. [ABSTRACT FROM AUTHOR]

We develop mathematical programming models to calculate enhanced "magic numbers" for determining playoff elimination and clinches in the Korean Baseball Organization. These magic numbers are disseminated on a website for fans seeking accurate updates on their team's postseason prospects. The website has received attention from Korean sports writers and fans alike. Sports media outlets often report on whether professional teams have clinched a playoff berth or, conversely, have been eliminated from one. Although the U.S. media have reported such results for years, particularly for Major League Baseball, no such equivalent outlets backed by rigorous mathematical models exist in South Korea. Motivated by the hiatus in most international professional sports (with a notable exception being Korean baseball) during the height of the COVID-19 pandemic in March 2020, we derive inspiration for the generation of so-called magic numbers by modifying an existing set of integer-programming optimization models that had been developed for U.S. Major League Baseball; the modifications tailor these models to the Korean Baseball Organization League by considering unique rules such as the fact that a game can end in a draw. Our results, which are new to Korean media, have generated interest among Korean baseball fans curious about up-to-date, precise information regarding whether their team still has a chance of qualifying for postseason play or whether it has been eliminated. Funding: This work was made possible, in part, by a generous donation from Columbia University and supported by award number 2227548 from the National Science Foundation, Division of Civil, Mechanical and Manufacturing Innovation (CMMI). [ABSTRACT FROM AUTHOR]

Background: Pitch counts are only one measure of the true workload of baseball pitchers. Newer research indicates that workload measurement and prevention of injury must include additional factors. Thus, current monitoring systems gauging pitcher workload may be considered inadequate. Purpose/Hypothesis: The purpose of this study was to develop a novel method to determine workload in baseball pitchers and improve processes for prevention of throwing-related injuries. It was hypothesized that our pitching workload model would better predict throwing-related injuries occurring throughout the baseball season than a standard pitch count model. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective observational study was conducted at an academic medical center and community baseball fields during the 2019 to 2023 seasons. Pitchers aged 13 to 18 years were monitored for pitching-related injuries and workload (which included pitching velocity; intensity, using preseason and in-season velocity as a marker of effort; and pitch counts). Results: A total of 71 pitchers had 313 recorded pitcher outings, 11 pitching-related injuries, and 24,228 pitches thrown. Gameday pitch counts for all pitchers ranged from 19 to 219 (mean, 77.5 ± 41.0). Velocity ranged from 46.8 to 85.7 mph (mean, 71.3 ± 5.8 mph). Intensity ranged from 0.7 to 1.3 (mean, 1.0 ± 0.08). The mean workload was 74.7 ± 40.1 for all pitchers. Risk factors significant for injury included throwing at a higher velocity in game (P =.001), increased intensity (eg, an increase in mean velocity thrown from preseason to in-season; P <.001), and being an older pitcher (P =.014). No differences were found for workload between injured and noninjured pitchers because the analysis was underpowered. Conclusion: Our workload model indicated that throwing at a higher velocity, throwing at a higher intensity, and older age were risk factors for injury. Thus, this novel workload model should be considered as a means to identify pitchers who may be at greater risk for injury. [ABSTRACT FROM AUTHOR]

Elbow injuries related to the throwing motion in baseball during the growth period present difficulties for early detection and may cause serious future disabilities. This study aimed to comprehensively determine the characteristics and clinical assessment of elbow pain in youth baseball players. Two hundred and sixteen young baseball players underwent elbow medical examination. Basic information and physical examination, clinical assessment, and ultrasonography results were examined. Univariate analyses were statistically performed between the pain-free (98 participants) and elbow pain (118 participants) groups. The mean age was 11.6 years, and ultrasonographic abnormalities were found on the medial side of the elbow in 37.5%. In total, 118 (54.6%) participants experienced elbow pain, with 64.4% of them complaining of elbow pain on the medial side. Players with multiple positions (≥2 positions) had a significantly higher prevalence of elbow pain. Height, weight, length of baseball experience, and positive rates of horizontal flexion and moving valgus stress tests were higher in the elbow pain group than in the pain-free group. The risk factors and clinical assessment for elbow pain are useful for the prevention and early detection of throwing elbow injuries in youth baseball players. [ABSTRACT FROM AUTHOR]

Background: Ulnar collateral ligament (UCL) injuries in youth pitchers continue to be concerning despite the institution of pitch count limits. Flexor-pronator mass fatigue can lead to diminished dynamic stability, resulting in greater stress on the UCL. Purpose/Hypothesis: To evaluate fatigue of the flexor-pronator mass by assessing changes in medial elbow laxity; noninvasively characterizing alterations in muscle glycogen; and identifying changes in subjective fatigue, strength, range of motion (ROM), pitching velocity, and accuracy with increasing pitches thrown by youth pitchers to their recommended 75-pitch count limit. It was hypothesized that, with increased pitches, medial elbow laxity would increase and that the glycogen content of the flexor-pronator mass would decrease. Study Design: Descriptive laboratory study. Methods: Healthy male pitchers aged 10 years (n = 22) threw 3 sets of 25 pitches with 12 minutes between sets (3 timepoints). Bilateral ulnohumeral joint gapping was measured by applying a standardized valgus force and utilizing ultrasound imaging. Relative changes in muscle glycogen in the bilateral flexor carpi radialis (FCR), and the flexor digitorum superficialis/flexor carpi ulnaris (FDS/FCU) muscles were measured with ultrasound software and recorded as fuel percentiles. Additional measures obtained included subjective fatigue, strength, ROM, velocity, and accuracy. Results: There were no differences in medial elbow joint-line gapping between the throwing and nonthrowing arms or between timepoints. The throwing arm demonstrated a significant decline in fuel percentile of the FCR from baseline to after 75 pitches (P =.05). There were no differences across timepoints for FDS/FCU fuel percentile values. Fatigue measurements for both arms were significantly higher at all timepoints compared with baseline (P ≤.03). Grip strength of the dominant arm after 75 pitches was decreased significantly compared with after 25 pitches (P =.02). Conclusion: Although an increase in medial elbow joint gapping was not demonstrated within the recommended 75 pitch count limit in 10-year-olds, a relative decrease in glycogen stores of the flexor-pronator mass did occur, as well as a decrease in grip strength, with increasing subjective fatigue. Clinical Relevance: This study provides a foundation for further objective testing of physiologic changes that occur with pitching to better guide pitch count limits and improve the safety of young athletes. [ABSTRACT FROM AUTHOR]

Background: Oblique strains have become a common injury among professional baseball players. The influence of player workload on oblique strains remains unknown. Purpose/Hypothesis: To determine whether workload is a risk factor for oblique strains in professional baseball players. We hypothesized that fewer days of rest, more innings pitched/fielded per game, and more batters faced/plate appearances per game would significantly increase a player's risk of sustaining an oblique strain. Study Design: Case-control study; Level of evidence, 3. Methods: All professional baseball players who sustained an oblique strain between 2011 and 2017 were identified using the Major League Baseball Health and Injury Tracking System. A separate dataset of player usage—days of rest per game, innings pitched or fielded per game, and batters faced or plate appearances per game—was used to determine the workload. We compared these usage variables between player games ≤2, ≤6, ≤12, and >12 weeks before a documented oblique strain with player games from a control group of players with no oblique strains. In a paired analysis, we compared acute (player games ≤2, ≤6, and ≤12 weeks preinjury) versus chronic (player games >12 weeks preinjury) workloads. Results: There were 311 oblique strains in pitchers and 392 oblique strains in position players during the study period. In pitchers, more innings pitched and more batters faced were associated with a subsequent oblique strain (P <.001 for all). In position players, fewer days of rest, more innings fielded, and more plate appearances were associated with a subsequent oblique strain (P <.001 for all). Pitchers who pitched ≥7 innings per game had a 2.4-fold (95% CI, 1.4-4.9) increased risk of subsequent oblique strain compared with those who pitched 1 inning per game. The percentage of position players with a subsequent oblique strain increased by 2.1-fold (95% CI, 1.3-3.5) with >4 plate appearances compared with 1 plate appearance per game. Conclusion: Our analysis demonstrated that workload was associated with an increased risk of sustaining an oblique injury in professional baseball players. High workload over time was more predictive of oblique strains compared to acute increases over chronic baseline workload. [ABSTRACT FROM AUTHOR]

The transition period from high school to post-secondary can be particularly challenging for many, including varsity student-athletes (SAs). To better support SAs through this transitional experience, some institutions have created peer mentor programs. What is unclear, however, is the perceived value of these mentorship programs from the perspectives of multiple stakeholder positions. This paper contributes to the Scholarship of Teaching and Learning by presenting findings of a program evaluation that investigated the perceived value of a peer mentor program to its stakeholders. To accomplish this, semi-structured interviews were conducted with 30 participants to discuss SA's experiences with being a first year student, making the transition from high school to post-secondary studies, and also, to discuss their lived experiences with the peer mentor program developed for SAs. Using the findings from the inductive thematic analyses, the peer mentor program's effectiveness, areas of strengths, and areas of improvement are discussed to better align with the stakeholders' needs and experiences. Findings offer insights into a) the trials and tribulations of the first year SA experience, b) how peer mentor programs can better support SA's transition to post-secondary education, c) the benefits of conducting a program evaluation, and d) strategies to enhance the peer mentor program to better support students' needs. [ABSTRACT FROM AUTHOR]

Background: Treatment of ulnar collateral ligament (UCL) tears with suture tape augmentation has gained interest given preliminary reports of favorable biomechanical characteristics. No study to date has quantitatively assessed the biomechanical effects of multiple augmentation techniques relative to the native UCL. Purpose: To perform a systematic review and meta-analysis of controlled laboratory studies to assess and comparatively rank biomechanical effects of UCL repair or reconstruction with or without augmentation. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, OVID/Medline, and Cochrane databases were queried in January 2023. A frequentist network meta-analytic approach was used to perform mixed-treatment comparisons of UCL repair and reconstruction techniques with and without augmentation, with the native UCL as the reference condition. Pooled treatment estimates were quantified under the random-effects assumption. Competing treatments were ranked in the network meta-analysis by using point estimates and standard errors to calculate P scores (greater P score indicates superiority of treatment for given outcome). Results: Ten studies involving 206 elbow specimens in which a distal UCL tear was simulated were included. UCL reconstruction with suture tape augmentation (AugRecon) restored load to failure to a statistically noninferior magnitude (mean difference [MD], –1.99 N·m; 95% CI, –10.2 to 6.2 N·m; P =.63) compared with the native UCL. UCL reconstruction (Recon) (MD, –12.7 N·m; P <.001) and UCL repair with suture tape augmentation (AugRepair) (MD, –14.8 N·m; P <.001) were both statistically inferior to the native UCL. The AugRecon condition conferred greater load to failure compared with Recon (P <.001) and AugRepair (P =.002) conditions. AugRecon conferred greater torsional stiffness relative to all other conditions and was not statistically different from the native UCL (MD, 0.32 N·m/deg; 95% CI, –0.30 to 0.95 N·m/deg; P =.31). Medial ulnohumeral gapping was not statistically different for the AugRepair (MD, 0.30 mm; 95% CI, –1.22 to 1.82 mm; P =.70), AugRecon (MD, 0.57 mm; 95% CI, –0.70 to 1.84 mm; P =.38), or Recon (MD, 1.02 mm; 95% CI, –0.02 to 2.05 mm; P =.055) conditions compared with the native UCL. P-score analysis indicated that AugRecon was the most effective treatment for increasing ultimate load to failure and torsional stiffness, whereas AugRepair was the most effective for minimizing medial gapping. Conclusion: AugRecon restored load to failure and torsional stiffness most similar to the parameters of the native UCL, whereas Recon and AugRepair did not restore the same advantageous properties at time zero. Medial ulnohumeral gapping during a valgus load was minimized by all 3 treatments. Based on network interactions, AugRecon was the superior treatment approach for restoring important biomechanical features of the UCL at time zero that are jeopardized during a complete distal tear. [ABSTRACT FROM AUTHOR]

The aim of this study was to present the demographic and clinical characteristics of sports-related pure (rim-sparing) orbital blowout fractures and to analyze these differences by type of sport. Ten years of sports-related orbital fracture data were accumulated. Patients were classified into similar sports (i.e., soccer and futsal) wherein orbital blowout fractures were obtained, producing 14 groups. This study included 377 sides from 374 patients. The majority of patients were male (83.4%), and the mean population age was 20.9 ± 10.8 years. The most common sports causing injuries were baseball/softball, rugby/football, and martial arts. Single-wall fractures were found in 78.8% of patients, but baseball/softball had a higher frequency of multiple-wall fractures (p = 0.035). Concomitant ocular and periocular injuries occurred in 18.6% of patients, which were frequently caused by baseball/softball (p < 0.001). The field of binocular single vision (BSV) included primary gaze in 84.2% of patients. Surgical management was conducted in 52.1% of patients. This study showed that baseball and softball had the highest rate of multi-wall fractures and concomitant ocular and periocular injuries. The field of BSV measured during the first examination was acceptable in most cases. [ABSTRACT FROM AUTHOR]

Background Interval throwing programs (ITP) have been used for decades to enable baseball pitchers to return to competition after injury or surgery by gradually applying load to the throwing arm. Past programs have been based on personal experience; however, advances in our understanding of the biomechanics and workloads of throwing allow for a more modern data-based program to be developed. Hypothesis/Purpose To 1) develop a updated ITP for rehabilitation of modern baseball pitchers based upon biomechanical and throwing workload data, and 2) compare the updated program with a past program to determine differences in chronic workload and acute:chronic workload ratios (ACWR). Study Design Cross-sectional study Methods Workloads (i.e. daily, acute, chronic, and ACWR) for the original ITP were built from the prescribed throwing schedule. Elbow varus torque per throw was calculated based upon a relationship between elbow varus torque and throwing distance. Throw counts, daily/ chronic/acute workloads, and ACWR were calculated and plotted over time. A new ITP was built to model current pitcher's throwing schedules and gradually increased ACWR over time. Results The original ITP had a throwing schedule of 136 days, final chronic workload 15.0, and the ACWR above or below the "safe" range (i.e. 0.7 - 1.3) for 18% of the program with a peak of 1.61. The updated ITP was built to consist of a 217-day schedule, final chronic workload of 10.8, and deviated from the safe range for 9% of the program, with a peak of 1.33. Conclusion The newly created ITP is more familiar to modern baseball pitchers while exhibiting a more gradual buildup of chronic workload than traditional ITP programs. This ITP may be used to return baseball pitchers back to competition as safely and efficiently as possible, and potentially with less risk of setbacks or reinjury. The ITP may be used following common injuries or surgeries to the throwing shoulder and elbow, such as Tommy John surgery, while also serving as a basis for future development of shorter duration ITPs. Level of Evidence 2c [ABSTRACT FROM AUTHOR]

Background: Nearly 8 million high school students in the United States participate in sports each year. With the lack of recent population data, an update to previous studies on US high school athletes is needed. Purpose: To update the epidemiology of sports injuries in high school athletes in the United States. Study Design: Descriptive epidemiology study. Methods: The data from the National Health School Sports-Related Injury Surveillance Study, including 100 nationally representative high schools, were obtained for 9 high school sports (boys' football, soccer, basketball, wrestling, and baseball and girls' soccer, basketball, volleyball, and softball) between the 2015 and 2019 academic years. Injury rates were calculated as the ratio of injuries per 1000 athlete exposures (AEs), defined as 1 athlete participating in 1 practice or competition. Data on injured body area, injury type (sprains/strains, concussions, contusions, and fractures), time loss, and need for surgery were also obtained. Rate ratios (RRs) with 95% CIs and P values were calculated. Results: Athletic trainers reported 15,531 injuries during 6,778,209 AEs, with an overall rate of 2.29 injuries per 1000 AEs. Injury rates were highest in football (3.96), girls' soccer (2.65), and boys' wrestling (2.36). The overall injury rate was lower in girls' sports (1.86) compared with boys' sports (2.52) (RR, 0.74 [95% CI, 0.71-0.76]; P <.001) and was higher in competition compared with practice (RR, 3.39 [95% CI, 3.28-3.49]; P <.001). The most commonly injured body areas were the head/face (24.2%), ankle (17.6%), and knee (14.1%). Sprains/strains (36.8%) and concussions (21.6%) were the most common diagnoses. Overall, 39.2% and 34% of injuries resulted in a time loss of <1 week and 1 to 3 weeks, respectively. Surgery was required in 6.3% of injuries, with wrestling (9.6%), girls' basketball (7.6%), and boys' baseball (7.4%) being the sports with the highest proportion of injuries needing surgery. Conclusion: Study findings demonstrated that boys' football, girls' soccer, and boys' wrestling had the highest injury rates, with boys' sports overall having higher injury rates than girls' sports. Sprains/strains and concussions were the most common diagnoses. Few injuries required surgery. [ABSTRACT FROM AUTHOR]

Background: Injuries in younger baseball athletes continue to increase despite work characterizing risk factors. Three‐dimensional (3D) motion capture may identify suboptimal pitching mechanics that predispose an athlete to injury, but 3D‐motion analysis is often inaccessible. Thus, there is a gap between the current biomechanics literature and its practical application in young athletes. The current study aims to assess the reliability of the pitch efficiency rating (PER) as a systematic tool to evaluate throwing mechanics in developing baseball pitchers. Objective: To determine the feasibility of application and reliability of a novel, scientifically informed tool (PER) for the assessment of pitching mechanics. Design: Reliability study using Bland–Altman methods for assessing agreement between two raters. Setting: Academic medical center through community outreach. Participants: Pitching mechanics were assessed and rated with the PER for 40 athletes (26 high school, 14 Division III), average age 19.0 years old (range 15.3–23.7 years old). Interventions: N/A. Main Outcome Measures: Interrater and intrarater reliability as calculated by intraclass correlation coefficient (ICC). Results: For initial readings comparing interrater reliability between Rater 1 and Rater 2, the ICC was calculated at 0.80 (95% confidence interval [CI] 0.66–0.89) and 0.76 (95% CI 0.60–0.86) for the second set of ratings. Regarding intrarater reliability across reads, ICC was found to be 0.63 (95% CI 0.43–0.79) for Rater 1, and 0.91 for Rater 2 (95% CI 0.85–0.95). Conclusions: The present study introduces the PER as a potential tool for evaluating pitching mechanics. However, the intrarater reliability of the PER did not meet preestablished criteria in one of the two pilot raters. Further study is needed to continue to assess the reliability of the tool across diverse demographics. [ABSTRACT FROM AUTHOR]

Background: Injuries to the medial ulnar collateral ligament (UCL) are common among baseball pitchers due to repetitive stress on the soft tissue stabilizers of the elbow during pitching. Dynamic stress ultrasound (SUS) can be used to evaluate the UCL and ulnohumeral joint to identify anatomic risk factors of those who will require UCL reconstruction (UCLR). Purpose: To determine whether any adaptive or morphological changes detectable on SUS can predict injury to the UCL in professional baseball pitchers. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 203 professional baseball pitchers who underwent SUS at preseason training sessions over the course of 18 years were categorized into 1 of 2 groups: those without a history of shoulder, arm, elbow, or forearm surgery or injuries (healthy cohort; n = 184) and those who underwent UCLR the same season as SUS (UCLR cohort; n = 19). Ligament thickness, joint spacing, and laxity were compared. An additional matched cohort analysis was conducted using 10 players from each group to detect differences in the progression of UCL and ulnohumeral joint measures in the year before injury. Results: The UCLR cohort, when compared with the healthy cohort, had higher relative (ie, nondominant-side measurements subtracted from dominant-side measurements) resting ulnohumeral joint space (median, 0.50 vs 0.20 mm, respectively; P =.006) and higher rates of hypoechoic foci (57.9% vs 30.4%, respectively; P =.030). Players of both groups had similar dominant UCL thickness (P =.161), ulnohumeral joint space at rest (P =.321), space under stress (P =.498), and laxity (P =.796). Groups did not differ in terms of relative UCL thickness, ulnohumeral joint space under stress, or relative laxity. In the year before UCL injury, the UCLR cohort, compared with the matched healthy cohort, had a greater increase in mean dominant UCL thickness (0.94 vs –0.60 mm, respectively; P =.038) and a greater increase in relative median UCL thickness (1.35 vs –0.35 mm, respectively; P =.045). Players in the healthy cohort were statistically older than those in the UCLR cohort (23 vs 22 years, respectively; P =.004). No differences in ulnohumeral stress spacing or laxity were detected. Conclusion: SUS of players who underwent UCLR demonstrated a progressive increase in UCL thickness over 1 year, higher rates of hypoechoic foci, and increased ulnohumeral rest space compared with SUS of uninjured players. [ABSTRACT FROM AUTHOR]

Collegiate baseball players with professional aspirations often participate in summer leagues; foremost among them is the Cape Cod Baseball League (CCBL). Injuries acquired during the collegiate baseball season can be carried into the CCBL season and vice versa. To assess the history of throwing arm injury and current functionality in midseason CCBL players. Cross-sectional study. Online questionnaire. A total of 123 CCBL players participated. Qualifying athletes were ≥18 years old and were rostered CCBL players with remaining collegiate eligibility. After collecting background information, we used the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow questionnaire to assess the history of throwing arm injury and current functionality. The maximum KJOC score is 100.0; higher scores correspond with greater functionality. The mean KJOC score was 86.6 ± 14.5 (n = 92); 24.5% (23/94) of players reported a prior diagnosis of throwing arm injury other than a strain or sprain. A total of 49 (49/96, 51.0%) players had undergone rehabilitation for a throwing arm injury, and 7 (7/96, 7.3%) had experienced a medical procedure. Players with no previous treatment (n = 41, mean KJOC score = 88.9 ± 19.0) more frequently demonstrated KJOC scores of ≥90 than players with such treatment (n = 55, 80.9 ± 17.1; P <.001). The 18 players with time-loss arm injury in the last year had lower mean KJOC scores (71.3 ± 20.0) than players with no injury or time loss (90.3 ± 9.8; P <.001). Similarly, players who reported current arm trouble (n = 15) had lower KJOC scores (71.6 ± 17.5) than players with healthy arms (89.5 ± 11.9; P <.001). The average KJOC score of the CCBL players was <90, with particularly low scores in athletes with prior arm injury and treatment. [ABSTRACT FROM AUTHOR]

Background In the rehabilitation of injured baseball pitchers, there is lack of consensus on how to guide a player back to pitching. It is unknown how different contemporary interval throwing programs (ITPs) progress in the amount of throwing workload. Purposes To 1) evaluate three prominent ITPs commonly employed in baseball pitcher rehabilitation and assess whether these ITPs produce training loads that increase in a controlled, graduated manner and 2) devise an ITP that produced training loads which increased steadily over time. Study Design Cross-sectional study Methods Three publicly available ITPs from prominent sports medicine institutions were analyzed. Elbow varus torque per throw was calculated from a 2nd order polynomial regression based upon a relationship between recorded torque measurements and throwing distance measured from a database of 111,196 throws. The relative rate of workload increase was measured as an acute:chronic workload ratio (ACWR). For each ITP, throw counts, daily/ acute/chronic workloads, and ACWR were calculated and plotted over time. Finally, an original ITP was devised based upon a computational model that gradually increases ACWR over time and finished with an optimal chronic workload. Results Each ITP exhibited a unique progression of throwing distances, quantities, and days to create different workload profiles. The three ITPs had throwing schedules ranging from 136 days to 187 days, ACWR spiked above or fell below a literature-defined "safe" range (i.e. 0.7 - 1.3) 19, 21, and 23 times. A novel ITP, predicated on a 146-day schedule and with a final chronic workload of 14.2, was designed to have no spikes outside of the safe range. Conclusion Existing ITPs widely utilized for rehabilitation of baseball pitchers exhibit significantly inconsistent variation in the rate of throwing load progression. Computational modeling may facilitate more incremental workload progression in ITPs, thereby reducing injury during rehabilitation and more efficiently condition a pitcher for return to competition. Level of Evidence 3b [ABSTRACT FROM AUTHOR]

Objectives: Nonoperative management vs. early reconstruction for partial tears of the medial ulnar collateral ligament (MUCL) remains controversial, with the most common treatment options for partial tears consisting of rest, rehab, platelet rich plasma (PRP), and/or surgical intervention. However, whether the improved outcomes reported for treatments such as MUCL reconstruction (UCLR) or nonoperative management with a series of PRP injections justifies their increased upfront costs remains unknown. Thus, the purpose of this study was to compare the cost-effectiveness of an initial trial of physical therapy alone, an initial trial of physical therapy plus a series of PRP injections, and early UCLR to determine the preferred cost-effective treatment strategy for baseball pitchers with partial tears of the MUCL. Methods: A Markov Chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1,000 simulated pitchers undergoing nonoperative management with and without PRP vs. early UCLR for partial MUCL tears. Utility values, RTP rates, and transition probabilities were derived from the published literature. Costs were determined based on the typical patient undergoing each treatment strategy at our institution. Outcome measures included costs, acquired playing-years (PYs), and the incremental cost-effectiveness ratio (ICER). Results: Mean total costs resulting from nonoperative management without PRP, nonoperative management with PRP, and early UCLR were $22,520, $24,800, and $43,992, respectively. On average, early UCLR produced an additional 4.0 PYs over the 10-year time horizon relative to nonoperative management, resulting in an ICER of $5,395/PY, which falls well below the $50,000 willingness-to-pay threshold (WTP). Overall, early UCLR was determined the preferred cost-effective strategy in 77.5% of pitchers included in the microsimulation model, with nonoperative management with PRP determined the preferred strategy in 15% of pitchers and nonoperative management alone in 7.5% of pitchers. Conclusions: Based on Monte Carlo microsimulation and probabilistic sensitivity analysis, early UCLR was demonstrated to be more cost-effective than an initial trial of nonoperative management for partial tears of the MUCL for the majority of high-level baseball pitchers. It is important to note that this model does not consider the unique experiences, goals, situations, career trajectory, and pitching horizons of individual patients, and thus a shared decision-making discussion should be conducted regarding optimal initial treatment for partial MUCL tears. This is particularly true as many athletes can successfully be treated non-operatively, which generally results in a quicker return to play when successful compared to surgery. [ABSTRACT FROM AUTHOR]

Objectives: The recent development of advanced analytics and biomechanical analysis has been widely embraced throughout Major League Baseball (MLB), driving player development and personnel decisions. At the same time, the rate of ulnar collateral ligament (UCL) injury has been rising steadily over the past decade. The purpose of this study was to evaluate the effect of commonly used advanced analytic or biomechanical pitching metrics on UCL injury rates. Methods: We performed a retrospective case-control study on all MLB pitchers who underwent UCL reconstruction or primary repair from April 2018 to May 2023. Exclusion criteria included pitchers without two qualifying seasons (i.e. >100 pitches in a calendar year) of pre-operative data or who had previously undergone surgery on their UCL. Matched controls were identified in a 2:1 manner by using season, age, position, handedness, and pitch count as covariates, similar to previous studies. Biomechanical pitch-tracking data evaluating mean velocity, pitch type and percentage, release extension, spin rate, vertical and horizontal movement, approach angle, and release point were collected. Industry-standard advanced metrics such as Fangraphs Wins Above Replacement (fWAR), expected fielding-independent pitching (xFIP), and Skill-interactive Earned Run Average (SIERA) were compared. Recently developed advanced metrics that measure overall movement of pitches (Stuff+), strike-zone command (Location+), and overall ability (Pitching+) were also examined. Data was obtained entirely from public web sources. Statistical analysis of the season prior to injury (T1, T2, and T3) and index season of injury consisted of unpaired t-tests comparing the cases versus matched controls. Subgroup analyses of starting and relieving pitchers, along with right- and left-handed pitchers was also conducted to identify specific risk factors. Changes in the three seasons prior to injury were also analyzed to see if large changes between seasons were independent risk factors for UCL injury, providing potential insight into offseason training regimens. Results: 112 MLB pitchers who underwent UCLR or UCL-repair were compared to 224 matched controls. Mean age was 28.1 + 3.4 years for cases and 28.4 + 3.2 years in controls, with 73% being right-handed and 32% being starting pitchers (Table 1). Cases averaged slightly higher pitch counts and innings pitched during T1 compared to controls (p = 0.30 and 0.10 respectively), with significantly higher fWAR (p < 0.01). During both the T1 and/or index season, cases had significantly superior velocity, xFIP, Pitching+, and Location+ compared to controls (Tables 2 and 3). SIERA and Stuff+ were slightly higher but not significant in the cases as well (p > 0.05). Controls had a significantly greater horizontal release point and approach angle (p = 0.04), while cases had a slightly higher vertical release point and greater release extension then controls (p > 0.05; Table 3). There were also no differences in mean spin rate, vertical or horizontal movement, vertical approach angle, or pitch type distribution (p > 0.05). Statistically significant changes in the two seasons prior to injury included Pitching+ (4.59 to -0.46; p = 0.02) with notable but nonsignificant increases in Stuff+ (p = 0.08), Location+ (p = 0.10), and a larger amount of pitches thrown (p = 0.07). There was otherwise no significant pre-injury change in the three seasons prior to injury in velocity, pitch types, spin rates, movements, or release points and angles for relief pitchers (p > 0.05). Conclusions: MLB pitchers who throw harder, have superior strike-zone command and overall pitching ability (Pitching+) were more at risk for UCL injury. Superior performance-based rate metrics also predisposed to injury. More horizontal release points and approach angles were potentially protective against UCL injury, while pitch counts, vertical release points, and overall pitch movement were similar but slightly higher in cases. Large offseason and yearly increases in Pitching+ were also found to be risk factors for UCL injury, suggesting that perhaps more regulated training regimens may help prevent injury. In this analysis, several advanced analytic and biomechanical performance metrics commonly used in MLB were evaluated as potential risk factors for UCL injury for the first time. [ABSTRACT FROM AUTHOR]

Clinical Scenario: The impact of concussion in baseball athletes is far reaching although typically less studied than collision sports. The neuromotor sequelae of these injuries can have lasting effects on the high level of coordination needed in baseball skills. In professional athletes, the long-term effects of concussion combined with the high demands for performance can potentially shorten athletes’ careers. Clinical Question: Do Major League Baseball players who have had a concussion compared with those with no history of concussions have decreased batting performance after they return to full participation? Summary of Key Findings: Seven articles meeting criteria for level 2 evidence were identified in this critically appraised topic. Four of 7 studies found deficits in batting performance following concussion. However, the 3 studies that did not identify differences lacked a comparative control group. Clinical Bottom Line: Evidence supports a relationship between concussion and decreased batting performance. This suggests there is a demand for screening and rehabilitation strategies aimed at improving sport-specific neuromotor and coordination skills in these individuals. Strength of Recommendation: Collectively, the body of evidence included to answer the clinical question aligns with the strength of recommendation of B. [ABSTRACT FROM AUTHOR]

Background: Prevention of pitching-related elbow pain in youth baseball players is important. Overhead pitching involves a whole-body motion, including head-neck rotation. A limited range of motion of head-neck rotation may cause inefficient pitching motion; however, this association is unclear. Purpose: To determine whether the range of motion of head-neck rotation is associated with the history of pitching-related elbow pain in youth baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 311 youth baseball players were selected and asked to complete a questionnaire survey about their age, weight, height, sex, baseball experience, main position, pitching side, and previous/current elbow pain during pitching. The range of motion of the upper and lower limb joints, head-neck rotation, and thoracic kyphosis angle were measured. Binomial logistic regression analysis was used to identify factors associated with the history of elbow pain related to pitching. Results: There were 101 players with a history of pitching-related elbow pain (history group) and 142 players with no pitching-related elbow pain (no-history group). The history group had significantly lower values than the no-history group regarding the range of motion of head-neck rotation on the nondominant side (74.9°± 9° vs 77.7°± 9.6°; P =.02) and overall head-neck rotation (150.6°± 14.7° vs 154.9°± 18.4°; P =.04). Binomial logistic regression analysis identified head-neck rotation on the nondominant side (odds ratio [OR], 0.97 [95% CI, 0.94-1.00]), shoulder horizontal adduction on the dominant side (OR, 0.98 [95% CI, 0.96-1.00]), height (OR, 1.04 [95% CI, 1.00-1.08]), and playing position (pitcher) (OR, 0.40 [95% CI, 0.21-0.76]) as factors associated with a history of pitching-related elbow pain. Conclusion: Our cross-sectional analysis demonstrated that youth baseball players with a history of pitching-related elbow pain had limited head-neck rotation range of motion on the nondominant side, and this was a significant factor associated with the history of pitching-related elbow pain. [ABSTRACT FROM AUTHOR]

Background: The optimal limb position during stress ultrasound (SUS) evaluation of elbow valgus laxity has not been standardized. Purpose: To compare 2 elbow positions (at 90° and 30° of flexion) and report which position method better represents the increased valgus laxity characteristics of baseball players. Study Design: Controlled laboratory study. Methods: Eighteen college baseball players with no history of elbow pain or elbow disorders who belonged to a college baseball club between April and November 2021 participated in this study. The medial elbow joint space (MEJS) was recorded by ultrasonography at rest and under valgus stress, and the difference in MEJS between the conditions was considered the valgus laxity. For all participants, the MEJS was recorded at 90° and 30° of elbow flexion. In the 90° of flexion position, the participant was positioned in the supine position with abduction and external rotation of the shoulder, and 2.5 kgf of valgus stress was applied proximally to the wrist. In the 30° of flexion position, the participant was positioned in the sitting position with abduction and external rotation of the shoulder, and 3.0 kgf of valgus stress was applied to the ulnar head. Valgus laxity on the throwing and nonthrowing sides was compared between the 2 elbow positions using paired t tests or Wilcoxon signed-rank tests after checking the normality. Results: There was a significant difference in valgus laxity on the throwing side between the 90° and 30° of flexion positions (1.9 vs 1.1 mm, respectively; P =.002), whereas no significant difference between positions was seen on the nonthrowing side (P =.06). Conclusion: SUS with the elbow flexed at 90° more clearly detected valgus laxity in the study participants than the 30° of flexion position. Clinical Relevance: The quantitative evaluation of valgus laxity is important for baseball players to assess the risk of ulnar collateral ligament injury. [ABSTRACT FROM AUTHOR]

To assess the reporting and representation of ethnic and racial minorities in comparative studies of ulnar collateral ligament (UCL) injuries and treatment in baseball athletes. A systematic review of the literature was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. The literature search was conducted by two independent reviewers using the PubMed, Scopus, and Cochrane Library databases. Studies were included if they were UCL of the elbow clinical comparative studies, including randomized clinical trials, cohort studies, case series, and epidemiological studies. Studies were excluded if they were related to ulnar collateral ligament of the thumb, lateral ulnar collateral ligament of the elbow, biomechanical studies, non-surgical studies, non-baseball studies, and systematic reviews and meta-analyses. The Methodological Index for Non-Randomized Studies (MINORS) criterion was used to assess quality of studies included. A total of 108 studies were included for analysis, of which only one reported race and ethnicity in their demographics. Additionally, of the 108 studies included, only four reported Country of Origin, a subset of Race and Ethnicity, in their demographics. Race and Ethnicity demographics are scarcely reported in comparative studies evaluating ulnar collateral ligament reconstruction. Future studies evaluating similar populations should strongly consider reporting racial and ethnic demographics as this may provide clarity on any potential effect these might have on post-surgical outcomes, particularly in high-level pitchers. [ABSTRACT FROM AUTHOR]

Opioid use is only recommended in selected cases of musculoskeletal (MSK) injuries. We assessed factors associated with increased opioid use in MSK injuries. In a retrospective analysis of over four million workers with MSK injuries using the Swiss National Accident Insurance Fund (Suva) database, we analyzed risk factors by multivariate logistic regression. Injury severity was associated with pain medication, opioid, and strong opioid use. Whereas fractures, contusions, and ruptures had higher odds for any pain medication use, increased odds for strong opioids were observed in fractures, superficial injuries, and other injuries. Injuries of the shoulders, elbow, chest, back/spine, thorax, and pelvis/hips showed high odds for opioid use (odds ratio (OR) > 2.0). Injuries of the shoulders had higher odds for strong opioid use (OR 1.136; 95% CI 1.040–1.241). The odds for using strong opioids increased from 2008 OR 0.843 (95% confidence interval (CI) 0.798–0.891) to 2018 OR 1.503 (95% CI 1.431–1.578), compared to 2013. Injury severity, type of injury, and injured body parts influenced the use of pain medication and overall opioid use in musculoskeletal injuries. Strong opioids were more often used in fractures but also in superficial and other minor injuries, which indicates that other factors play a role when prescribing strong opioids. [ABSTRACT FROM AUTHOR]

The large stream of data from wearable devices integrated with sports routines has changed the traditional approach to athletes' training and performance monitoring. However, one of the challenges of data-driven training is to provide actionable insights tailored to individual training optimization. In baseball, the pitching mechanics and pitch type play an essential role in pitchers' performance and injury risk management. The optimal manipulation of kinematic and temporal parameters within the kinetic chain can improve the pitcher's chances of success and discourage the batter's anticipation of a particular pitch type. Therefore, the aim of this study was to provide a machine learning approach to pitch type classification based on pelvis and trunk peak angular velocity and their separation time recorded using wearable sensors (PITCHPERFECT). The Naive Bayes algorithm showed the best performance in the binary classification task and so did Random Forest in the multiclass classification task. The accuracy of Fastball classification was 71%, whilst the accuracy of the classification of three different pitch types was 61.3%. The outcomes of this study demonstrated the potential for the utilization of wearables in baseball pitching. The automatic detection of pitch types based on pelvis and trunk kinematics may provide actionable insight into pitching performance during training for pitchers of various levels of play. [ABSTRACT FROM AUTHOR]

Background: Currently, most pitching instructors suggest a shorter arm path—the total distance the arm travels during pitching. Theoretically, this combination allows for better body segment sequencing, a more efficient energy transfer through the kinetic chain, and increased ball velocity, while limiting elbow varus torque. Hypothesis: Shorter arm paths would be associated with increased ball velocity and decreased elbow varus torque. Study Design: Descriptive laboratory study. Methods: A total of 182 professional pitchers threw 8 to 12 fastball pitches while evaluated by 3-dimensional motion capture (480 Hz). The arm path was calculated as the total distance the hand marker traveled during the pitch. The pitch was divided into early, late, and total arm paths. A linear regression model assessed the interpitcher relationship between arm path, elbow varus torque, and ball velocity. A linear mixed-effects model with random intercepts assessed intrapitcher relationships. Results: Interpitcher comparison showed that total arm path weakly correlated with greater elbow varus torque (P =.025). Strong correlations were found between ball velocity and early (R 2 = 0.788; P <.001), late (R 2 = 0.787; P =.024), and total arm paths (R 2 = 0.792; P <.001). Strong positive intrapitcher correlations were found between elbow varus torque and early (R 2 = 0.962; P <.001) and total arm path (R 2 = 0.964; P <.001). For individual pitchers, there was a large variation in the early (30.1 ± 15.7 cm) and late (21.4 ± 12.1 cm) arm path. For every 30-cm (11.8-inch) increase in early arm path (the mean range for an individual pitcher), there was a 1.29-N (β = 0.0429) increase in elbow varus torque and a 0.354 m/s (0.79 mph) (β = 0.0118) increase in ball velocity. Conclusion: A shorter arm path correlated with decreased elbow varus torque and decreased ball velocity in intrapitcher comparisons. Determining the individual mechanics that decrease elbow varus torque may help coaches and trainers correct these patterns. Clinical Significance: A shorter arm path during the pitch can decrease elbow varus torque, which limits the load on the medial elbow but also has a detrimental effect on ball velocity. An improved understanding of the impact of shortening arm paths on stresses on the throwing arm may help minimize injury risk. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Ulnar collateral ligament injuries are common in baseball pitchers, with excessive elbow varus torque linked to medial elbow injuries. Trunk tilt, or motion in the frontal plane, could be an identifiable and modifiable factor in medial elbow loading. Clinical Question: In high school through professional baseball pitchers, how does increased contralateral trunk tilt compared with no/limited contralateral trunk tilt influence elbow varus torque? Summary of Key Findings: Four studies were included: all were labeled as "controlled" or "descriptive laboratory studies," representing cross-sectional observational analytic design. One study compared biomechanics of professional pitchers with and without ulnar collateral ligament reconstruction. Two studies measured biomechanics in college pitchers, one of which also included simulations of joint angles. The fourth study measured biomechanics of high school pitchers. All studies measured trunk tilt and its relationship to elbow varus torque, with 3 of the studies linking increased contralateral trunk tilt with increased elbow varus torque. Clinical Bottom Line: Moderate evidence indicated as contralateral trunk tilt increased, so did elbow varus torque, indicating trunk tilt may be a modifiable factor to decrease medial elbow loading during pitching. Strength of Recommendation: Majority consistent findings from the level 3 cross-sectional observational analytic designs suggest grade B evidence in support of trunk tilt as a factor in increasing elbow varus torque. [ABSTRACT FROM AUTHOR]

Background: Osteochondritis dissecans (OCD) affects the shoulder in only 0.6% of patients aged 2 to 19 years with disease most commonly in the humeral head. When the glenoid is affected, it is often in male overhead throwing athletes and treated with fixation via autologous osteochondral plugs following bone marrow aspirate. Indications: The primary indication for surgical management of OCD is failure of conservative management, often with imaging showing disruption of the glenoid subchondral plate. This patient is an 18-year-old male pitcher with over 2 years of chronic, deep-seated shoulder pain unresponsive to conservative management. Technique Description: We present a primary arthroscopic technique of autologous bone marrow aspirate concentrate graft for management of OCD in an 18-year-old college baseball pitcher. The patient was placed in the left lateral decubitus position with an axillary roll and standard portals were established. A loose fragmented flap with no underlying osseous material was debrided and a 3-cm central area of bony loss was identified. Bone marrow aspirate of 80 mL was taken from the anterior superior iliac crest. The aspirate was mixed with Biocartilage (Arthrex) to fill the defect flush with the surrounding tissue and sealed with fibrin glue. Ports were closed and an abduction sling was applied. Results: A recent review article demonstrated that athletes who underwent surgical management of OCD lesions returned to sports an average of 1.2 months sooner than those managed non-operatively, though this difference was not significant. This patient had a full return to play at 9 months. At 1-year follow-up, he made a full recovery and is currently playing professionally without shoulder pain. Discussion/Conclusion: Autologous bone marrow aspirate defect filling is a viable treatment of OCD, even in high-level overhead throwing athletes. It allows for arthroscopic treatment with long-term success in the treatment of pain and function. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. [ABSTRACT FROM AUTHOR]

Context: Baseball pitching is a coordinated movement involving the spine. A previous study indicated that increased thoracic kyphosis angle in a standing position was a risk factor for medial elbow injuries in youth baseball players. However, spinal alignments in single-leg standing and their relationships with medial elbow injuries, scapular alignment, or hip joint range of motion are unclear. Objective: To examine the difference in spinal alignment between standing and single-leg standing positions in youth baseball players and analyze their relationship with elbow injuries, scapular alignment, or hip joint range of motion. Design: Cross-sectional study. Setting: University laboratory. Participants: There were 51 youth baseball players with medial epicondylar fragmentation (medial elbow injury group) and 102 healthy youth baseball players (control group). Main Outcome Measures: Thoracic kyphosis, lumbar lordosis, and trunk inclination angles during standing and single-leg standing, forward scapular posture, and hip joint range of motion. Results: In the single-leg standing position, the thoracic kyphosis and backward trunk inclination angles were significantly higher in the medial elbow injury group than in the control group (P =.016 and P =.046, respectively). In the standing position, no significant difference was observed between both groups. The thoracic kyphosis angle in single-leg standing was positively correlated with the bilateral forward scapular posture in the medial elbow injury (P =.008 and P <.001 on the throwing and nonthrowing sides, respectively) and control (P =.010 and P =.032 on the throwing and nonthrowing sides, respectively) groups. Conclusions: High thoracic kyphosis and backward trunk inclination angles are characteristics during single-leg standing in youth baseball players with medial elbow injuries. Spinal alignment measurement in single-leg standing may be useful for identifying youth baseball players who are at risk for sustaining medial elbow injury. [ABSTRACT FROM AUTHOR]

In Major League Baseball (MLB), player injuries requiring injured list (IL) stints are common occurrences during the regular season. Injuries to pitchers may be of specific interest to prevent and detect as they may have a detrimental effect on team performance. In the present study, the effect between team wins and frequency of pitcher injuries is assessed over the 2009–2019 regular seasons (a total of n = 2,584 pitcher injuries were analysed). The study further aimed to determine if changes in pitcher performance, as quantified by changes in common pitching statistics, including strikeout and walk percentage, can predict whether a pitcher, who has already incurred an IL stint, will require a second IL stint over the same time period. Results suggest that while only a weak relationship exists between team wins and frequency of pitcher injuries, that a decrease in strikeout percentage for a pitcher returning from the IL is associated with an increased likelihood of a second IL stint. Future research should take into consideration a player's value or contribution to their team's success when assessing the effect injuries have on team performance as well as the type of injury sustained. [ABSTRACT FROM AUTHOR]

Background: Young baseball players with medial elbow injuries are known to have high forearm flexor-pronator muscle elasticity; however, the causal relationship between forearm muscle elasticity and the occurrence of medial elbow injuries remains unclear. Purpose/Hypothesis: The purpose of this study was to determine whether the forearm flexor-pronator muscle elasticity is a risk factor for medial elbow injury in young baseball players. It was hypothesized that high flexor carpi ulnaris (FCU) elasticity would be a risk factor for medial elbow injuries. Study Design: Cohort study; Level of evidence, 2. Methods: Young baseball players (aged 9-12 years) with no history of elbow injuries underwent examination during which the strain ratios (SRs) of the pronator teres, flexor digitorum superficialis, and FCU muscles were measured using ultrasound strain elastography as an index of elasticity. Additionally, the participants completed a questionnaire assessing age, height, weight, months of experience as a baseball player, position in baseball, number of training days per week, number of throws per day, and elbow pain during throwing; then the range of motion of the shoulder and hip internal/external rotation were measured. One year after the baseline measurements, the occurrence of new medial elbow injuries was evaluated. Multivariate logistic regression analysis was subsequently conducted to determine risk factors for medial elbow injuries. Cutoff points for significant SR values obtained from the multivariate logistic regression analysis were calculated using the receiver operating characteristic curve. Results: Of the 314 players, 76 (24.2%) were diagnosed with medial elbow injury. Multivariate logistic regression analysis showed that a 0.1 increase in the SR of the FCU muscle (odds ratio [OR], 1.211; 95% CI, 1.116-1.314) and number of throws per day (OR, 1.012; 95% CI, 1.001-1.022) were significantly associated with medial elbow injuries. Receiver operating characteristic curve analyses revealed that the optimal cutoff for the SR of the FCU muscle was 0.920 (area under the curve, 0.694; sensitivity, 75.0%; specificity, 56.7%). Conclusion: Increased FCU elasticity is a risk factor for medial elbow injury. Evaluation of the FCU elasticity may be useful in identifying young baseball players at high risk of medial elbow injuries and may facilitate prevention of medial elbow injury. As shown by the results of multivariate logistic regression analysis, FCU elasticity itself may be useful in identifying young baseball players at high risk of elbow injuries. However, we believe that other factors, such as the number of pitches per day, need to be considered to improve its accuracy. [ABSTRACT FROM AUTHOR]

Objective: Pediatric injuries associated with participation in sports are common. Understanding the epidemiology and trends of sports-related injuries is an important component of injury prevention efforts and is the objective of this study. Methods: A retrospective review of sports injuries presenting during the course of 1 year (2019) to the emergency department (ED) of Benjamin Russell Hospital for Children, a large academic children's hospital, was performed. Inclusion criteria focused on patients 18 years old and younger whose ED visit resulted from active participation in a sport. Cases were identified using International Classification of Diseases, Tenth Revision codes. Demographic data were collected and included sex, age, race, injury specifics (sport, location, type, and mechanism). Descriptive statistics were performed and categorical variables were analyzed using the χ2 test. Results: A total of 1333 injuries seen by the ED during 2019 were sports injuries. Most commonly, these injuries were associated with football (43%), basketball (36%), soccer (11%), or baseball (8%). Considering sports-related injuries, 428 (32%) patients were 12 years and younger and 905 (68%) were 12 years old and older. The median age was 13 years (interquartile range 4 years). Other demographic findings included male sex 1143/1333 (86%) and Black race 835/1333 (63%). School was the most common location for sports injuries (28%). When comparing injuries by age groups (younger than 12 vs 12 and older), football and baseball injuries were more common in those younger than 12 years (53% vs 38%, z = 5.2, P < 0.00001; and 14.0%vs. 5.6%, z = 4.9, P < 0.00001, respectively), whereas basketball and soccer injuries were more common in those 12 years and older (43% vs 22%, z = 7.4, P < 0.00001; and 11.4% vs 9.3%, z = 5.9, P < 0.00001, respectively). When comparing injuries by sex, football and baseball injuries were more common in males (49% vs 6%, z = 11.1, P < 0.00001; and 9.4% vs. 2.1%, z = 3.3, P < 0.00001, respectively), whereas basketball and soccer injuries were more common in females (59% vs 32%, z = 7.2, P < 0.00001; and 27% vs 8%, z = 7.8, P < 0.00001, respectively Conclusions: Sports injuries that are commonly encountered in the ED differ in age and sex. Basketball and soccer injuries were more likely to be encountered in older females, whereas baseball and football injuries were more likely seen in younger males. This may reflect efforts that have been previously focused on the sports considered to be higher risk, especially for concussive injuries. This information can help guide future preventive efforts provided by primary physicians, schools, and coaches. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Stress ultrasonography (SUS) has provided clinicians with an alternative means of evaluating ulnar collateral ligament (UCL) injury by dynamically assessing ulnohumeral joint space gapping under applied valgus stress. However, 3 previous cadaveric studies have evaluated the biomechanical effect of partial UCL tears at different anatomic locations with conflicting results. Purpose/Hypothesis: The purpose of this study was to use in vivo data from patients with magnetic resonance (MR)–confirmed partial UCL tears to determine if anatomic partial tear location influenced the resultant stability of the elbow in terms of ulnohumeral joint gapping on SUS. It was hypothesized that no difference would be seen in the amount of ulnohumeral joint gapping based on MR-identified anatomic partial UCL tear location. Study Design: Cohort study; Level of evidence, 3. Methods: All patients diagnosed with elbow injury from 2015 to 2020 were screened to identify competitive baseball pitchers with a partial UCL tear who received an SUS. Partial UCL tear was diagnosed via surgeon and radiologist interpretation of elbow MR imaging (MRI) as well as confirmation at the time of surgery as documented in the operative report. Demographic, injury, and treatment data were collected from the clinic notes, MRI reports, and stress ultrasound reports. Ulnohumeral joint gapping on SUS was calculated as the difference between ulnohumeral joint gapping without valgus stress versus ulnohumeral joint gapping with valgus stress (delta) as performed by a musculoskeletal radiologist. Results: Overall, 60 male baseball pitchers (age, 19.2 ± 2.1 years), including 22 (37%) high school, 26 (43%) collegiate, and 12 (20%) professional pitchers, were evaluated. Regarding the location of partial UCL tears, 32 (53%) pitchers had proximal tears and 28 (47%) had distal tears. The mean delta value cohort was 2.1 ± 1.1 mm, and 34 pitchers (57%) had delta values >2.0 mm. Ulnohumeral joint gapping (high school [1.9 mm] vs collegiate [2.6 mm] vs professional [1.6 mm]; P =.004) and the percentage of pitchers with delta values >2.0 mm (45% vs 77% vs 33%; P =.017) differed based on level of competition. After controlling for age, body mass index, and level of competition in a multivariate linear regression, tear location was not related to ulnohumeral joint gapping (P =.499). Conclusion: No difference was observed in the amount of ulnohumeral joint gapping on SUS in symptomatic baseball pitchers with MR-identified partial UCL tears at differing anatomic locations. The findings of this study are contrary to previous cadaveric studies that have evaluated the effects of UCL tear characteristics on delta laxity. [ABSTRACT FROM AUTHOR]

Background: Little League elbow, including humeral epicondylitis and osteochondritis dissecans, is a severe throwing injury in school-aged pitchers. Recent rule revisions have been implemented, and thus, prevention awareness may have increased. Purpose: To compare the incidence of elbow injury in 2011 from a previous study with that in 2021 and examine changes in the incidence and characteristics of players with elbow injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A survey based on the 2011 survey was conducted from September 1 to December 31, 2021, among 4060 third- to sixth-grade Little League players belonging to 203 teams in Kyoto, Japan. This survey included a 23-item checklist on physical condition and injury. The participants were classified into 2 groups according to the presence or absence of an elbow injury in the dominant arm during the season. The Wilcoxon rank-sum test was conducted to compare differences in basic information between the 2 groups. We also compared the differences in the 23 checklist items between the 2 groups using the chi-square or Fisher exact probability test. Results: Overall, 98 teams (1335 players; age range, 8-12 years) returned the questionnaires (collection rate, 32.9%). The final analysis population (excluding incomplete questionnaires) was 678 (mean age, 10.6 ± 1.1 years). Elbow injuries accounted for 30.7% of all injury sites in the players. Overall, 61 players (9.0%) reported elbow injuries in 2021 compared with 19.1% of the players in the 2011 survey (P <.01) A significantly higher percentage of players with elbow injuries had elbow pain in extension (item 2 on the survey checklist, P <.001) and flexion (item 4, P <.0024), were regular players (item 5, P =.0288), played baseball under fatigue (item 8, P =.0028), and had lower and upper limb inflexibility (item 17, P =.0379; item 18, P =.0146; and item 22, P =.0085). Conclusion: Study findings indicated that the incidence of elbow injuries has decreased significantly over the past 10 years, although the elbow joint still accounted for almost one-third of all injuries in Japanese youth baseball players. [ABSTRACT FROM AUTHOR]

Assessing scapular position and motion during functional arm movement patterns may add relevant information to the evaluation of the clinical status and athletic performance of overhead sports athletes' shoulders. This study aimed to examine the three-dimensional scapular kinematics of elite volleyball players with (n = 11) and without scapular dyskinesis (n = 11) in comparison to non-athletes (n = 27). Four distinct arm elevation/depression tasks were assessed: shoulder abduction/adduction, flexion/extension, scaption, and a diagonal movement pattern mimicking throwing (proprioceptive neuromuscular facilitation diagonal 2 for flexion/extension or PNF–D2–flx/ext). Kinematic data was recorded from the spiking/dominant shoulder using an electromagnetic system (FASTRAK, Polhemus Inc., Colchester, VT, USA); MotionMonitor v9 software, Innovative Sports Training, Inc., Chicago, IL, USA). The study compared scapular rotations at 15° intervals of humero-thoracic (HT) angles, ranging from minimum to 120°. Significantly different 3D scapular kinematics were observed between traditional arm motion tasks and PNF–D2 arm motion task (HT angle × task interaction effect, p < 0.001, 0.275 ≤ η p 2 ≤ 0.772). However, when considering the combined influence of phase, HT angle, task, and group factors, no differences were found between groups (phase × HT angle × task × group, p ≥ 0.161, 0.032 ≤ η p 2 ≤ 0.058). The inclusion of a functional arm movement pattern when evaluating scapular position and movement in overhead athletes does not appear to be mandatory. However, these findings are preliminary and highlight the need for more research in this area. [ABSTRACT FROM AUTHOR]