Increased Pitch Velocity Is Associated With Throwing Arm Kinetics, Injury Risk, and Ulnar Collateral Ligament Reconstruction in Adolescent, Collegiate, and Professional Baseball Pitchers: A Qualitative Systematic Review

Manzi, Joseph E.; Kew, Michelle E.; Zeitlin, Jacob; Sudah, Suleiman Y.; Sandoval, Tyler; Kunze, Kyle N.; Haeberle, Heather S.; Ciccotti, Michael C.; Carr, James B.; Dines, Joshua S.

doi:10.1016/j.arthro.2023.01.004

Cited by 10 publications

(6 citation statements)

References 45 publications

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“…Although these programs have demonstrated success at improving maximum velocity, they have also been shown to pose a risk for pitching-related injury in similar patient populations. 25,29,36 This phenomenon, increased risk of injury with increased velocity, was observed in our population as well.…”

Section: Discussionsupporting

confidence: 83%

Workload Risk Factors for Pitching-Related Injuries in High School Baseball Pitchers

Zaremski,

Pazik,

Vasilopoulos

et al. 2024

Am J Sports Med

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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.

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Section: Discussionsupporting

confidence: 83%

Workload Risk Factors for Pitching-Related Injuries in High School Baseball Pitchers

Zaremski,

Pazik,

Vasilopoulos

et al. 2024

Am J Sports Med

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“…9,21 Relationships between pitching velocity, number of pitches, and age have also been shown to correlate with UCL injuries. 4,13,16,23 This understanding of the mechanism of UCL injury is consistent with the increased prevalence of UCL injuries in pitchers compared with nonpitching players as well as the increased prevalence of UCLR with increasing pitching velocity in professional players seen in the past decade. 7,8,13…”

supporting

confidence: 67%

“…4,13,16,23 This understanding of the mechanism of UCL injury is consistent with the increased prevalence of UCL injuries in pitchers compared with nonpitching players as well as the increased prevalence of UCLR with increasing pitching velocity in professional players seen in the past decade. 7,8,13 Diagnostic evaluation of the elbow involves the use of plain radiographs and magnetic resonance imaging (MRI) with or without intra-articular contrast. Although MRI can allow for more definitive soft tissue visualization and identification of partial tears, than plain radiographs, it still does not diagnose ligaments that could be intact but may be functionally deficient.…”

supporting

confidence: 65%

The Utility of Stress Ultrasound in Identifying Risk Factors for Elbow Ulnar Collateral Ligament Tear: A Longitudinal Study of 203 Professional Baseball Players

Hanna,

Popper,

Sonnier

et al. 2024

Am J Sports Med

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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.

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“…Enforcement of PC policies in non-high-school baseball competition including tournaments, which are not under the regulations of state high-school associations with penalties applied to the coach and team if not followed Consistency and standardization of PC policy guidelines by state including non-high-school baseball programs based on age level, similar to MLB PitchSmart. This will ease confusion, particularly when traveling across state lines 96 If any pitcher throws 25 pitches in a game, no live game pitching the next day if 14 years or older*…”

Section: Table 2 Additional Recommendations For Reducing Overuse Thro...mentioning

confidence: 99%

Pitching Restriction Policies in Adolescent and High-School Baseball Pitchers: Is It Time for an Updated Paradigm?

Zaremski,

Bowers,

Kriz

2023

Clinical Journal of Sport Medicine

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Increased Pitch Velocity Is Associated With Throwing Arm Kinetics, Injury Risk, and Ulnar Collateral Ligament Reconstruction in Adolescent, Collegiate, and Professional Baseball Pitchers: A Qualitative Systematic Review

Cited by 10 publications

References 45 publications

Workload Risk Factors for Pitching-Related Injuries in High School Baseball Pitchers

Workload Risk Factors for Pitching-Related Injuries in High School Baseball Pitchers

The Utility of Stress Ultrasound in Identifying Risk Factors for Elbow Ulnar Collateral Ligament Tear: A Longitudinal Study of 203 Professional Baseball Players

Pitching Restriction Policies in Adolescent and High-School Baseball Pitchers: Is It Time for an Updated Paradigm?

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