Posts tagged throwing injury
Sham Surgery vs. Labral Repair for SLAP Tears
SLAP-labrum-repair-surgery

In previous blogs we have written on the recent research documenting the lack of differences between sham surgery and surgery for spinal and knee conditions.  For example, in the case of arthroscopic surgery for degenerative knee meniscal tears the evidence does not support its' use due to its' inability to perform better than sham knee surgery or placebo at both short and long term outcomes.  New research indicates some shoulder surgeries may not be more effective than placebo surgery.

The correlation between positive imaging (MRI) findings and baseball pitchers has been long established.  These imaging findings such as rotator cuff abnormalities, tears, or labral tears are found in the vast majority of baseball pitchers whether or not they have symptoms.  A recent article from the British Journal of Sports Medicine reported on the outcomes of either labral surgery, biceps tendon surgery, or a sham surgery on patients with labral (SLAP) tears (Schroder et al. 2017).  The authors followed 118 patients with a type II SLAP lesion who were randomized to either a labral repair, biceps tendon repair (tenodesis), or placebo surgery.  Consistent with the literature on arthroscopic surgery for knee injuries, no significant differences were noted in any outcomes between groups.  These results indicate the two procedures did not have any clinically significant benefit over a sham surgery.  

Imaging's Role in Youth Baseball

In our previous blog posts we have written on the limitations of MRI for many injuries and conditions.  In general, these expensive tests have high rates of false positives where patients without pain often have positive results including ligament/labrum tears or tendon changes.  The incidence of false of positives increases in athletes with the majority of major league baseball players, regardless of symptoms, demonstrating rotator cuff tears or labrum injury.   It appears these changes are no different in our little leaguers.  

An article in the Journal of Bone and Joint Surgery examined 10-13 year old little league baseball players.  Each player underwent an MRI on both elbows at the start of the season.   The authors found many of the players with or without pain had imaging findings in their elbow.  Adding to our existing data that many athletes have positive MRI findings without pain or injury.  Two factors were associated with a positive MRI and elbow pain including year round baseball play and working with a private pitching coach.  

Athletes are encouraged to work with a local Physical Therapist to treat their elbow pain and reduce their risk of throwing injuries. 

The Impact of Core and Leg Muscle Fatigue on Baseball Throwing Mechanics

As we move into Spring we begin to see our youth athletes return to the baseball diamond often with a sudden increase in practice volume.  The sudden increase in throwing volume, either in the field or on the mound, places the athlete's shoulder and elbow at greater risk of baseball injuries. The greatest risk factors for injury include throwing more than 80 pitches/game, playing baseball greater than 8 months/year, and pitching with arm fatigue. As discussed in our prior posts, an athlete's throwing velocity is driven by their legs strength and power. Athletes with leg weakness are more likely to suffer from progressive changes in performance and increased injury risks.

A recent study in the Orthopedic Journal of Sports Medicine authors analyzed the impact of fatigue on throwing velocity, accuracy, and throwing mechanics (Chalmers et al. 2016). Authors studied 28 elite adolescent (13-16 year old) pitchers as they pitched a simulated game (90 pitches). Each pitch was analyzed for velocity and accuracy while every 15th pitch was analyzed for pitching mechanics. As expected the velocity, accuracy, and mechanics suffered with increased pitch counts. Importantly, the authors showed the loss of velocity, accuracy, and biomechanics were preceded first by core and leg muscle fatigue.

This study adds to the importance of controlling pitch counts and treating the lower extremities in order to improve throwing performance and reduce injury risk.