Overuse Injuries of the Upper Extremity in Baseball

Rizio, Louis; Uribe, John W.

doi:10.1016/s0278-5919(05)70262-3

Cited by 39 publications

(28 citation statements)

References 46 publications

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“…Three of the most common injuries in throwing athletes occur at the shoulder (shoulder labrum tears and shoulder instability) and elbow (medial epicondylitis) (Altchek and Dines, 1995;Anz et al, 2010;Badia and Stennett, 2006;Fleisig et al, 2011;Fleisig et al, 1995;Fleisig et al, 1996;Jobe et al, 1996;Meister, 2000;Rizio and Uribe, 2001). The amount of passive external rotation at the shoulder during the armcocking phase (when elastic energy is stored) is known to be correlated with such injuries (Miyashita et al, 2008a;Miyashita et al, 2008b).…”

Section: Discussionmentioning

confidence: 99%

“…The flexed elbow position also results in very high valgus torques at the elbow during both the arm-cocking and early acceleration phases (Fleisig et al, 1995;Loftice et al, 2004;Sabick et al, 2004;Werner et al, 1993). This high torque, which is aligned differently from the plane of the joint, stretches the ulnar collateral ligament that stabilizes the elbow, potentially leading to painful inflammation or tearing from many repeated throws (Fleisig et al, 1995;Fleisig et al, 1996;Rizio and Uribe, 2001). Similarly, shoulder instability and the problems it can cause [e.g.…”

Section: Discussionmentioning

confidence: 99%

“…anterior ligament laxity, increased likelihood of dislocation (Meister, 2000)] may be driven by use of the capsular ligaments to store elastic energy. While these injuries directly result from forelimb positioning necessary to maximize elastic energy storage, it may be possible to protect against such injuries by limiting the frequency of high-speed throwing (Feltner and Dapena, 1986;Fleisig et al, 2011;Fleisig et al, 1996;Gainor et al, 1980;Rizio and Uribe, 2001;Sabick et al, 2004) or wearing mildly restrictive garments (such as a compression shirt) to prevent over rotation. Finally, morphological shifts known to occur in hominins may affect the performance of each of the motions targeted in this study.…”

Section: Discussionmentioning

confidence: 99%

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Upper body contributions to power generation during rapid, overhand throwing in humans

Roach

Lieberman

2014

Journal of Experimental Biology

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High-speed and accurate throwing is a distinctive human behavior. Achieving fast projectile speeds during throwing requires a combination of elastic energy storage at the shoulder, as well as the transfer of kinetic energy from proximal body segments to distal segments. However, the biomechanical bases of these mechanisms are not completely understood. We used inverse dynamics analyses of kinematic data from 20 baseball players fitted with four different braces that inhibit specific motions to test a model of power generation at key joints during the throwing motion. We found that most of the work produced during throwing is generated at the hips, and much of this work (combined with smaller contributions from the pectoralis major) is used to load elastic elements in the shoulder and power the rapid acceleration of the projectile. Despite rapid angular velocities at the elbow and wrist, the restrictions confirm that much of the power generated to produce these distal movements comes from larger proximal segments, such as the shoulder and torso. Wrist hyperextension enhances performance only modestly. Together, our data also suggest that heavy reliance on elastic energy storage may help explain some common throwing injuries and can provide further insight into the evolution of the upper body and when our ancestors first developed the ability to produce high-speed throws.KEY WORDS: Throwing, Biomechanics, Elastic energy storage, Kinetic chain, Human evolution INTRODUCTIONThe human forelimb is derived relative to other hominoids and to earlier hominins (Larson, 1993;Larson, 2007). One reason the human shoulder may be so different is selection for humans' unique ability to throw objects overhand with both accuracy and high velocity. Today, most high-speed throwing occurs during sports, but in the past throwing was probably crucial for hunting, defense against predators, and aggressive interactions. Regardless of their purpose, high-speed overhand throws are produced using a stereotypic, whip-like motion involving the whole body.The throw begins with movement of the legs and progresses quickly up the trunk and arm, ending with rapid movement of the throwing hand as the projectile is released. There has been considerable inquiry into how this complex motion generates high projectile velocities, and which joints and joint-specific angular motions are primarily responsible Fleisig et al., 1995;Hirashima et al., 2007;Hirashima et al., 2008;Hong et al., , 1985;Putnam, 1993). Previous work has shown that large angular velocities of torso rotation, shoulder internal rotation, elbow extension and wrist flexion all occur at the moment of release and significantly contribute to projectile speed ( Fig. 1) (Fleisig et al., 1995;Fleisig et al., 1996;Hirashima et al., 2007;Pappas et al., 1985). This study focuses on how these large angular velocities are produced in the upper body. RESEARCH ARTICLEAngular movements are produced when torques act across joints, generating mechanical work and power. Muscles are the source of...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Upper body contributions to power generation during rapid, overhand throwing in humans

Roach

Lieberman

2014

Journal of Experimental Biology

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“…The mechanics of high velocity throwing, especially pitching, explain the constellation of elbow injuries seen in the overhead athlete [2][3][4][5]. Valgus forces have been estimated to reach 64 N m during the late cocking and early acceleration phases of throwing, and compressive forces of 500 N have been documented at the lateral radiocapitellar joint [2,12].…”

Section: Anatomy and Biomechanicsmentioning

confidence: 99%

“…Several authors have described the most common injuries seen in the throwing athlete's elbow [1][2][3][4][5][6][7]. MCL injuries, ulnar neuritis, valgus extension overload with osteophyte formation and posteromedial impingement, flexor pronator strain, medial epicondyle pathology, and osteochondritis dissecans (OCD) of the capitellum have all been described as sequelae of the overhead throwing motion.…”

Section: Introductionmentioning

confidence: 99%

The Thrower's Elbow: Arthroscopic Treatment of Valgus Extension Overload Syndrome

O’Holleran¹,

Altchek

2006

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Injury to the medial collateral ligament of the elbow (MCL) can be a career-threatening injury for an overhead athlete without appropriate diagnosis and treatment. It has been considered separately from other athletic injuries due to the unique constellation of pathology that results from repetitive overhead throwing. The past decade has witnessed tremendous gains in understanding of the complex interplay between the dynamic and static stabilizers of the athlete's elbow. Likewise, the necessity to treat these problems in a minimally invasive manner has driven the development of sophisticated techniques and instrumentation for elbow arthroscopy. MCL injuries, ulnar neuritis, valgus extension overload with osteophyte formation and posteromedial impingement, flexor pronator strain, medial epicondyle pathology, and osteochondritis dissecans (OCD) of the capitellum have all been described as sequelae of the overhead throwing motion. In addition, loose body formation, bony spur formation, and capsular contracture can all be present in conjunction with these problems or as isolated entities. Not all pathology in the thrower's elbow is amenable to arthroscopic treatment; however, the clinician must be familiar with all of these problems in order to form a comprehensive differential diagnosis for an athlete presenting with elbow pain, and he or she must be comfortable with the variety of open and arthroscopic treatments available to best serve the patient. An understanding of the anatomy and biomechanics of the thrower's elbow is critical to the care of this population. The preoperative evaluation should focus on a thorough history and physical examination, as well as on specific diagnostic imaging modalities. Arthroscopic setup, including anesthesia, patient positioning, and portal choices will be discussed. Operative techniques in the anterior and posterior compartments will be reviewed, as well as postoperative rehabilitation and surgical results. Lastly, complications will be reviewed.

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Valgus Extension Overload

Gerhardt

Cain

2015

Elbow Ulnar Collateral Ligament Injury

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Overuse Injuries of the Upper Extremity in Baseball

Cited by 39 publications

References 46 publications

Upper body contributions to power generation during rapid, overhand throwing in humans

Upper body contributions to power generation during rapid, overhand throwing in humans

The Thrower's Elbow: Arthroscopic Treatment of Valgus Extension Overload Syndrome

Valgus Extension Overload

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