Differences in Passive Shoulder Range of Motion Between Baseball Players With Neurogenic Thoracic Outlet Syndrome and Matched Healthy Controls

Abstract

Background: Neurogenic thoracic outlet syndrome (nTOS) is becoming more recognized as a diagnosis in the throwing athlete. Currently, there is limited information on the clinical presentation and development of nTOS in baseball players. Purpose: To compare passive shoulder range of motion (ROM) and anatomic humeral retrotorsion (HRT) of baseball players diagnosed with nTOS with a group of healthy, matched controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 53 adolescent baseball players diagnosed with nTOS (age, 17.2 ± 2.3 years; height, 180.9 ± 10.1 cm; weight, 80.0 ± 13.3 kg) were compared with 53 healthy baseball players (age, 17.2 ± 2.4 years; height, 183.9 ± 9.0 cm; weight, 83.8 ± 11.5 kg). Participants were measured for shoulder internal rotation (IR) and external rotation (ER) ROM and HRT. All measurements were taken bilaterally, and the differences (throwing to nonthrowing arm) were used to calculate mean values for glenohumeral internal rotation difference, glenohumeral external rotation difference (GERD), total rotational motion difference (TRMdiff), and anatomic humeral retrotorsion difference. Group comparisons were made between the nTOS and control players using multivariate analysis of variance, and descriptive comparisons were made with independent t tests. Results: There were no significant differences between groups in age, height, weight, or years of experience. Players in the nTOS group had significantly less throwing arm ER compared with controls (103.4° ± 10.4° vs 109.6° ± 7.5°, respectively; P = .001) and GERD (3.0° ± 9.2° vs 8.8° ± 9.2°, respectively; P = .002). TRMdiff was significantly greater in nTOS (–11.1° ± 11.1°) than in controls (–3.7° ± 9.4°) ( P < .001). Conclusion: In the current study, adolescent baseball players diagnosed with nTOS were evaluated with shoulder ROM differences when compared with a matched healthy cohort. A loss of throwing arm ER appeared to be the main factor behind shoulder ROM changes in the nTOS group.

Performance and Return to Play After Surgery for Thoracic Outlet Syndrome in Professional Baseball Players: A Matched Cohort Analysis

“…They also report activity-related fatigue including decreasing pitch velocity, distal upper extremity numbness, paresthesia, and weakness. Garrison et al 14 reported that adolescent baseball players with a diagnosis of NTOS had significantly less external rotation of the affected shoulder compared with healthy matched controls.…”

Proposed Musculoskeletal Examination of Youth and Adolescent Baseball Players

“…A number of studies have looked at factors related to injury in the youth baseball population over the past year ranging in topics from; early sport specialization (ESS) (12)(13)(14)(15)(16), pitch counts (17)(18)(19)(20)(21)(22)(23), prethrowing protocols (24,25), imaging findings (26), to body region-specific inquiries (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43) in search for opportunities to reduce the risk of injury in this population. We will review a wide range of articles and their relevance to injury risk in this population.…”

“…Numerous studies have investigated normative values for shoulder strength and range of motion in the throwing shoulder and their relation to upper extremity injury (30)(31)(32)34). Descriptive profiles of youth baseball players (ages 5 to 12.9 years) have been established for shoulder internal rotation and external rotation passive range of motion, total arc and shoulder internal and external rotation strength at neutral and 90 degrees abduction (34).…”

“…Descriptive profiles of youth baseball players (ages 5 to 12.9 years) have been established for shoulder internal rotation and external rotation passive range of motion, total arc and shoulder internal and external rotation strength at neutral and 90 degrees abduction (34). Recently, differences in shoulder passive range of motion, external rotation, and total range of motion (TRM) or total arc have been identified in youth baseball players (age, 17.2 ± 2.3 years) presenting with neurogenic thoracic outlet syndrome when compared with healthy controls (31). A recent study by Rosen et al (30) reported glenohumeral internal rotation deficits (GIRD) in throwers with elbow pain average 32.7 degrees compared with 14.5 degrees in a nonpainful group of youth pitchers.…”