Less glenohumeral external rotation associated with elbow injury in adolescent pitchers
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Key takeaways:
- Dominant shoulder motion was correlated to the humeral torsion angle in healthy pitchers.
- Researchers found the correlation was not found in the injured pitchers.
WASHINGTON – Decreased glenohumeral external rotation may be associated with elbow injury in the throwing arms of adolescent baseball pitchers, according to research presented, here.
“Torsion was not associated with injury in our study, which does go against some other previous reports,” Steven M. Karnyski, MD, said during a presentation at the American Orthopaedic Society for Sports Medicine Annual Meeting. “Torsion does contribute to motion change in healthy pitchers, but clearly there are other factors at play in the injured group in our study. Decreased external rotation, regardless of humeral torsion, was associated with injury in adolescent pitchers in the study.”
In the prospective study, researchers enrolled baseball players aged 13 to 17 years into two groups. A healthy group of 29 pitchers were currently pitching in the community without complaints and had no surgical history in their throwing extremity. The injured group of 25 pitchers were those who sought treatment for an injury in their throwing elbow. Researchers measured bilateral standard shoulder internal and external rotation in degrees using a bubble goniometer with the scapulothoracic joint manually stabilized. Bilateral humeral torsion angles were also measured using ultrasound and bubble goniometer to calculate humeral torsion-corrected shoulder range of motion.
Researchers found the dominant shoulder of pitchers in both groups showed a significant increase in humeral retrotorsion with increased standard shoulder external rotation and glenohumeral internal rotation deficit (GIRD). Injured pitchers displayed less standard and humeral torsion-corrected external rotation of the dominant shoulder, as well as less standard external rotation of the nondominant shoulder compared with the healthy pitchers. Dominant shoulder motion was correlated to the humeral torsion angle in healthy pitchers, suggesting the osseous adaptation of humerus significantly contributed to these findings. However, researchers found the correlation was not found in the injured pitchers, suggesting that soft tissue factors played a larger role in the development of GIRD and external rotation gain in this group.
“Injured pitchers displayed less standard shoulder external rotation of both shoulders and less humeral torsion-corrected external rotation of the dominant shoulder compared to healthy pitchers,” Michael B. Banffy, MD, co-author of the study and associate professor and fellowship director for Cedars-Sinai Kerlan-Jobe Institute, said in a press release. “This suggests a baseline difference in the soft tissue and/or the structure of the pitchers’ shoulders between groups. From a clinical standpoint, this study indicates that rehabilitation programs, including modalities to improve external rotation, may be of benefit for adolescent baseball pitchers with elbow injuries.”
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