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PubMedDate not supplied

Elbow injuries in throwing athletes: a current concepts review.

Repetitive overhead throwing imparts high valgus and extension loads to the athlete's elbow, often leading to either acute or chronic injury or progressive structural change. Tensile force is applied to the medial stabilizing structures with compression on the lateral compartment and shear stress posteriorly. Common injuries encountered in the throwing elbow include ulnar collateral ligament tears, ulnar neuritis, flexor-pronator muscle strain or tendinitis, medial epicondyle apophysitis or avulsion, valgus extension overload syndrome with olecranon osteophytes, olecranon stress fractures, osteochondritis dissecans of the capitellum, and loose bodies. Knowledge of the anatomy and function of the elbow complex, along with an understanding of throwing biomechanics, is imperative to properly diagnose and treat the throwing athlete. Recent advantages in arthroscopic surgical techniques and ligament reconstruction in the elbow have improved the prognosis for return to competition for the highly motivated athlete. However, continued overhead throwing often results in subsequent injury and symptom recurrence in the competitive athlete.

Athletic Injuries↗

PubMedDate not supplied

Throwing fracture of the humeral shaft. An analysis of 90 patients.

Ninety patients with humeral shaft fractures sustained during throwing were analyzed to determine what caused their injuries. All patients were recreational baseball players: 89 were men and 1 was a woman. The average age was 25 years (range, 12 to 43). The throwing style, type of pitch, fielding position, and type of ball used varied; however, the patients sustained their fractures while performing a hard throw in 87 (97%) of the occurrences. The actual courses of the balls thrown ranged from sideways to straight forward. All fractures were external rotation spiral fractures; 25 patients (28%) had a medial butterfly fragment, and 14 patients (16%) had radial nerve palsy. Fractures were most likely to have occurred in the distal half of the humerus, although they occurred frequently in the proximal half in patients in their early teens. We conclude that 1) the fracture can occur at any time during the acceleration phase before ball release, 2) this type of fracture can occur in any recreational baseball player attempting to perform a hard throw, and 3) the cause of this fracture is the throwing action itself.

Adolescent↗

PubMedDate not supplied

Humeral torsion in the throwing arm of handball players.

Sport-specific upper extremity strain, mostly unilateral, during growth may lead to adaptations in soft tissue and bone. We investigated 51 male professional handball players between 18 and 39 years of age (average, 27 years), 39 right-handed and 12 left-handed. Thirty-eight players had no shoulder problems, and 13 had chronic shoulder pain. Humeral retrotorsion was determined by radiograph. The differences between the throwing and contralateral arms were compared with those of 37 controls who had no history of unilateral strain either through sports or profession. Standard statistical analysis was performed using the t-test. The retrotorsional angle of the humerus in the handball professionals' throwing arm was an average of 9.4 degrees larger in the dominant side than in the nondominant, with a side-to-side difference up to 29 degrees. In the control group, no statistically significant difference was found. In the group without chronic shoulder pain, the side-to-side difference was an average of 14.4 degrees more in the throwing arm than the other side. Players with chronic shoulder pain did not exhibit this increase, even showing an average decrease of humeral retrotorsion of 5.2 degrees in the throwing arm. The humeral retrotorsion increase can be explained as an adaptation to extensive external rotation in throwing practice during growth. Athletes who do not adapt this way seem to have more strain on their anterior capsules at less external rotation and develop chronic shoulder pain because of anterior instability.

Adaptation, Physiological↗

PubMed2005

Comparison of the backward overhead medicine ball throw to power production in college football players.

The purpose of this study was to determine the relationship of the backward overhead medicine ball (BOMB) throw to power production in college football players. Forty National Collegiate Athletic Association Division II college football players were studied at the end of an 8-week off-season conditioning program for power output determined from a countermovement vertical jump on a force plate and for maximal distance in the standing BOMB throw. Although the reliability of the BOMB test was high (interclass correlation coefficient = 0.86), there was a significant learning effect across 3 trials (p < 0.01). Peak and average powers generated during the vertical jump correlated moderately but significantly with the best BOMB throw distance (r = 0.59 and 0.63, respectively). Considering power relative to body mass or lean body mass failed to produce significant correlations with BOMB throw distance (r = 0.27 and 0.28, respectively). Therefore, the BOMB throw may have limited potential as a predictor of total body explosive power in college football players.

Adult↗

PubMed2005

Strain on the ulnar nerve at the elbow and wrist during throwing motion.

BACKGROUND: It is well known that cubital tunnel syndrome frequently occurs in throwing athletes. The cause of cubital tunnel syndrome is considered to be mechanical stimuli on the ulnar nerve in the cubital tunnel. The hypothesis of the present cadaveric study was that the ulnar nerve is subjected to longitudinal strain in the cubital tunnel during the throwing motion. METHODS: Four phases of throwing (stance, wind-up, middle cock-up, and early acceleration) were passively simulated in seven fresh-frozen transthoracic cadaveric specimens that were fixed in an upright position to allow free arm movement. In each throwing phase, the elbow was sequentially flexed from 45 degrees to 90 degrees to 120 degrees to maximum flexion. The longitudinal movement of and strain on the ulnar nerve were measured with use of a caliper and a strain gauge at the proximal aspects of both the cubital tunnel and the canal of Guyon. RESULTS: The movement of the ulnar nerve at the proximal aspect of the cubital tunnel was significantly increased during all throwing phases with increased elbow flexion (p < 0.05). An average maximum movement of 12.4 +/- 2.4 mm was recorded during the wind-up phase with maximum elbow flexion. The movement at the proximal aspect of the canal of Guyon was approximately two-thirds of that at the proximal aspect of the cubital tunnel. The strain on the ulnar nerve at the proximal aspect of the cubital tunnel was significantly increased with elbow flexion in the stance, wind-up, and middle cock-up phases (p < 0.05). An average maximum strain of 13.1% +/- 6.1% was recorded during the early acceleration phase with maximum elbow flexion. The strain at the proximal aspect of the canal of Guyon was approximately half of that at the proximal aspect of the cubital tunnel. CONCLUSIONS: In the present study, the maximum strain on the ulnar nerve during the acceleration phase was found to be close to the elastic and circulatory limits of the nerve.

Aged↗

PubMed2001

Verbal instruction for correcting errors versus such instructions plus videotape replay on learning the overhand throw.

The influence of two methods of providing information to women, ages 19 to 22 years who were novices and learning the overhand throw with the nondominant arm, was examined. One group received verbal information on correcting errors, and a second group received the same information immediately prior to viewing a videotaped replay of a just completed throw. Performance was assessed quantitatively with respect to outcome (distance thrown) and qualitatively with respect to throwing form as measured on a 7-point rating scale by judges with a working knowledge of the overhand throw and with respect to throwing mechanics rated by a panel of experts in biomechanics using a scale of Leme and Shambes. Although the treatments led to better learning and performance, there was no significant difference between groups for distance thrown on the Leme and Shambes scale in Sessions 1-6 of 10 trials each on Session 7. The mean rating also indicated increased scores for both groups and better retention at posttest by the group receiving only verbal corrections. These results suggest that information provided by adding videotaped replay may be redundant and unnecessary for those in Sessions 1-6.

Adult↗

PubMed2003

Influence of instruction on velocity and accuracy of overarm throwing.

This study investigated the influence of instruction on the ball velocity and accuracy of a goal-directed overarm throw. 9 experienced Norwegian male team handball players executed a throwing task randomly seven times under 5 different instructions varying from emphasizing speed to accuracy. When instructions increasingly emphasized accuracy, velocity decreased. However, accuracy did not improve when subjects were instructed to focus on it. A possible explanation for this finding could lie in the specific subject group. The subjects were highly experienced team handball players with an average of 12 years in the sport. Thus, the accuracy they demonstrated at high velocity might actually be already extremely high and difficult to improve upon when reducing throwing velocity. Further, the velocity of throwing when instruction emphasized accuracy was approximately 85% of the maximal velocity, indicating that experienced team handball players are trained to throw accurately at relatively high velocity.

Adult↗

PubMed2002

Data-Based Interval Throwing Programs for Collegiate Softball Players.

OBJECTIVE: To construct interval throwing programs followed by a simulated game for collegiate softball players at all positions. The programs are intended to be used as functional progressions within a comprehensive rehabilitation program for an injured athlete or to augment off-season conditioning workouts. DESIGN AND SETTING: We collected data over a single season of National Collegiate Athletic Association softball at the University of Delaware and Goldey Beacom College. We observed 220 half-innings of play and 2785 pitches during data collection. SUBJECTS: The subjects were collegiate-level softball players at all positions of play. MEASUREMENTS: We recorded the number of pitches for pitchers. For catchers, we recorded the number of sprints to back up a play, time in the squat stance, throws back to the pitcher, and the perceived effort and distance of all other throws. We also collected the perceived effort and distance of all throws for infielders and outfielders. RESULTS: Pitchers threw an average of 89.61 pitches per game; catchers were in the squat stance 14.13 minutes per game; infielders threw the ball between 4.28 times per game and 6.30 times per game; and outfielders threw distances of up to 175 feet. CONCLUSIONS: We devised the interval throwing programs from the data collected, field dimensions, the types of injuries found to occur in softball, and a general understanding of tissue healing. We designed programs that allow a safe and efficient progressive return to sport.

Journal Article↗

PubMed1989

Rehabilitation of the throwing shoulder.

Rehabilitation of the injured throwing arm should not be directed simply toward beginning strengthening exercises and returning the athlete to throwing as soon as possible. The total comprehensive program has been described and consists of seven phases that begin with making the proper diagnosis of a shoulder injury. Once the proper diagnosis is made, the pathophysiology of throwing injuries has to be understood by the physician, the trainer, and the athlete, and then the actual treatment begins in phase III. Initial treatment many times consists of a short period of relative rest as well as physical therapy modalities to relieve pain, and once pain is relieved phase IV begins, which is the actual techniques of range of motion, flexibility, and strengthening maneuvers. Once adequate flexibility, range of motion, and pain-free motion have been achieved, as well as adequate endurance strength, proper warm-up techniques are begun, and then a return to throwing is achieved in phase VI. The total rehabilitative cycle is concluded with phase VII, which consists of an off-season conditioning program to verify that the athlete will maintain year-round maximum condition of not only the throwing shoulder but of the entire athlete.

Biomechanical Phenomena↗

PubMed1999

Timing accuracy in human throwing.

This study examines the precision required in the timing of muscle activations and projectile release to hit a target of 20 cm in diameter oriented horizontally either 6 or 8 m away. Over-arm throws, constrained to the sagittal plane, were simulated using a muscle-actuated, two-segment model representing the forearm and hand plus projectile. The parameters defining the modeled muscles and the anthropometry were specific to two male subjects. An objective function specified that throws must be both fast and accurate. Once an optimal solution had been found, the sensitivity of these timings was investigated. The times of activation or release were changed and the simulation model re-run with the new timings, and it was determined whether the projectile would still have struck the target. For one set of simulations, to hit the target at 8 m, the optimal throw was achieved with a time delay between the onset of wrist activation and elbow extensor activation [Proximal-distal (PD) delay] of 49 ms and a release time of 83.4 ms. At this optimal point in the solution space, the launch window was 1.2 ms (assuming the original PD delay). The launch window was the time available within which the projectile must be released and still strike the target. The window during which the wrist flexors could be activated was 10. 41 ms (assuming the projectile was released at the pre-planned optimal time). The control scheme which required the least timing precision had a PD delay of 56 ms and a release time of 89.4 ms. Errors in timing could occur in activation and release simultaneously under this scheme, the timing windows were 4 ms in PD delay and 2.4 ms in release. Similar results were found for a second set of simulations. These simulations revealed the precise timings required in muscle activations and release required for fast accurate throws.

Biomechanical Phenomena↗

PubMed2002

Throwing darts: timing is not the limiting factor.

It has been argued that precision in throwing is limited by the precision in the timing of the release. When precision is the only goal, as in throwing darts, one could therefore expect people to throw in a way that reduces sensitivity for imprecision in timing. We show that subjects do not do so, but throw in a way that reduces the sensitivity for speed errors instead. They even appear to vary the timing of release to compensate for the errors in the hand's movement. Thus timing does not appear to be the limiting factor.

Adult↗

PubMed2006

Relationship between side medicine-ball throw performance and physical ability for male and female athletes.

The purpose of the study was to examine the factors contributing to performance of a side medicine-ball throw (S-MBT) and a fast side medicine-ball throw (FS-MBT) and to analyze some of the factors which account for the difference in side medicine ball throw performance between the sexes. Sixteen males and ten females were evaluated by S-MBT, FS-MBT, isometric maximal trunk rotation torque (IMTRT), One repetition maximum of Parallel Squat (1RM(PS)) and Bench Press (1RM(BP)), Bench Press peak power (BP(PP)), Static Squat Jump peak power (SSJ(PP)) and vertical jump height. Males demonstrated significantly greater scores than females in all measurements. Significant correlations were observed in males, but not in females, between the distances during S-MBT and the IMTRT values (r = 0.596-0.739, P < 0.05-0.01) and the 1RM(PS) values (r = 0.683-0.725, P < 0.01). In FS-MBT performance, significant correlations were observed in males, but not in females, between the ball velocity values during FS-MBT and the IMTRT values (r = 0.611-0.687, P < 0.05-0.01), 1RM(BP) values (r = 0.596-0.655, P < 0.05-0.01) and 1RM(PS) values (r = 0.679-0.718, P < 0.01). These results suggested that the contributing factors of S-MBT and FS-MBT performance were deferent in males and females. Hence, the side medicine-ball throw test would be useful to examine the trunk rotation power of male athletes, but may have a limited potential as a predictor of trunk rotation power for female athletes.

Adolescent↗

PubMed1992

Effects of changes in segmental values and timing of both torque and torque reversal in simulated throws.

An overarm throw in the sagittal plane was simulated using a three-segment model representing the upper arm, forearm and hand plus ball. Torque inputs at each joint were turned on at systematically varied times and maintained constant once initiated. All simulations began from identical initial conditions. The aim was to determine the sequence of onset of joint torques which gave the maximal range which the ball would travel and the maximal velocity of the ball irrespective of direction. Best throws proved to be sequential in that joint torques were turned on in a proximal to distal (P-D) temporal sequence. The P-D sequence was also demonstrated by time of peak joint angular velocities. The P-D sequence also proved to be best when segmental constants and joint torques were changed. As this sequence is a common feature of skilled throwing and striking, it is concluded that the linked segmental nature of the limb, irrespective of normal muscle characteristics, primarily predisposes the system to the use of a P-D sequence. The algebraic sign of the shoulder and elbow torques was reversed instantaneously to represent the use of antagonistic muscles. This led to increased output if performed late in the throw and in a P-D sequence. It is concluded that the use of antagonism leads to beneficial redistributions of angular velocity amongst limb segments.

Arm↗

PubMed2006

Arthroscopic capsular release for painful throwing shoulder with posterior capsular tightness.

Posterior capsular tightness with glenohumeral internal rotation deficit is usually considered to be an acquired condition of the throwing shoulder and is usually treated conservatively. However, because posterior capsular tightness is sometimes irreversible, we have performed arthroscopic capsular release for painful throwing shoulder with posterior capsular tightness. The true loss of internal rotation and posterior stiffness was confirmed by examination with the patient under anesthesia, and contracture of the posterior capsule and the posterior band of the inferior glenohumeral ligamant was observed arthroscopically. Because an extensive adhesion between the capsule and the fascia of the external rotators was noted, a capsular release was performed from 6 o'clock to 11 o'clock (in the right shoulder) to completely expose the muscle belly of the external rotators. Of the first 16 consecutive patients, 4 had no concomitant lesions and underwent posterior capsular release alone. With a minimum of 2 years' follow-up, it was ascertained that the throwing pain completely disappeared in 14 patients and improved in 2. In all, 11 patients returned to their preinjury performance level, and 5 returned to a lower level of function. In the 4 patients who had no concomitant lesions, throwing pain completely disappeared, and all were able to return to their preinjury performance level.

Adolescent↗

PubMed2006

Throwing shoulder injury involving the anterior rotator cuff: concealed tears not as uncommon as previously thought.

PURPOSE: In throwing athletes, partial rotator cuff tears are usually located posterior to the site of the common rotator cuff tears seen in the general nonthrowing population. However, they sometimes have tears located around the anterior aspect of the supraspinatus tendon. In this study we investigated the characteristics of anterior rotator cuff tears in throwing athletes. We then compared several factors between anterior tears and posterior tears to investigate those related to the presence of anterior tears or the occurrence of such tears. METHODS: We divided 37 athletes with partial rotator cuff tears into those with anterior tears (n = 17) and those with posterior tears (n = 20). The clinical profile, range of motion and joint laxity with patient under general anesthesia, and operative findings were retrospectively compared between the 2 groups. RESULTS: Among the 17 anterior rotator cuff tears, 12 tears were confined to the anterior one third of the supraspinatus tendon. Interestingly, concealed intratendinous degenerative tears were found in 6 shoulders. These appeared to be very shallow articular-side tears located around the attachment of the greater tuberosity, but severe tears were exposed after resection of the residual capsular portion of the tendon. Posterior capsular tightness was significantly related to the occurrence of anterior tears, whereas a greater tuberosity notch was significantly related to posterior tears. CONCLUSIONS: Anterior rotator cuff tears are not uncommon in throwing athletes, and a concealed type of tear was a representative lesion. Different mechanisms may be involved in the development of anterior and posterior rotator cuff tears resulting from throwing injuries. Posterior capsular tightness might influence the occurrence of anterior tears. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Athletic Injuries↗

PubMed1991

Optimum timing of muscle activation for simple models of throwing.

In diverse throwing activities, muscles contract in sequence, starting with those furthest from the hand. This paper uses simple mathematical models, each with just two muscles, to investigate the consequences of this sequential contraction. One model was suggested by shot putting, another by underarm throwing and the third by overarm throwing, but all are much simpler than real human movements. In each case there is an optimum delay between activation of the more proximal muscle and of the more distal one, that maximizes the speed at which the missile leaves the hand. If the delay is shorter than optimal, the throw is completed sooner and less time is available for contraction of the proximal muscle: it may shorten faster, exerting less torque, or through less than its full range of movement, and so do less work. If it is longer than optimal, less time is available for contraction of the distal muscle, which therefore does less work. The optimal delay is in some cases longer than would maximize total work because the delay influences the proportion of the work that appears as kinetic energy of the missile.

Arm↗

PubMed1999

Elbow injuries in the throwing athlete. Difficult diagnoses and surgical complications.

Elbow injuries in throwing athletes can be challenging from the diagnostic and management perspectives. The stress of repetitive throwing does predispose athletes to certain conditions with which treating clinicians need to be familiar. An understanding of the anatomy of the elbow and the biomechanics of throwing is essential to making the correct diagnosis and instituting proper care. Failure of nonoperative measures often requires surgical intervention. A thorough understanding of the anatomy and the spectrum of conditions that can occur is needed before decisions regarding surgical management can be made. The operative approach to elbow pathology, whether performed open or arthroscopically, should be completed by orthopedists who have experience with the clinical conditions and the appropriate technical facility to provide comprehensive care. This article has reviewed the anatomy, biomechanics, and spectrum of conditions that affect throwing athletes' elbows as well as the potential complications that can be associated with surgical management.

Arthroscopy↗

PubMed2001

Sex differences in throwing: monkeys having a fling.

Fast and accurate throwing was undoubtedly important to ancestral hominids, and was subject to sexual-selection pressures that generated a male advantage in throwing accuracy that persists in modern humans. The balance of evidence, including that from a recent comparative study of throwing in humans and capuchin monkeys, suggests that high-performance throwing involves unique adaptations in the domains of spatial targeting, precision timing, and multi-joint motor control.

Journal Article↗