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Background: Prior to the Major League Baseball (MLB) draft, some pitchers undergo predraft magnetic resonance imaging (MRI). This study aimed to evaluate pre-draft elbow MRI on baseball pitchers who were entering the MLB draft to determine the presence or absence of pathology, the associations between these pathologies and ulnar collateral ligament (UCL) tears, and interobserver reliability regarding common MRI pathology., Methods: Predraft elbow MRI performed on prospective MLB pitchers between 2011 and 2017 were deidentified and then reviewed by two separate authors. The authors graded the MRI on several factors including presence or absence of: UCL ossification, UCL appearance (heterogeneous or not), UCL thickening (and location), UCL tear (partial vs. full thickness and location), muscle strain, flexor tendon tear, posteromedial osteophyte, sublime tubercle enthesophyte, and osseous stress reactions., Results: Overall, 245 predraft elbow MRI were reviewed. MRI abnormalities were found in 70% (171/245) of pitchers. UCL thickening was found in 20% (50/245) of pitchers. Regarding UCL tears, 3% had a full thickness tear and 24% had a partial thickness tear. Of full thickness tears, 86% were distal and 1 was midsubstance. Of partial thickness tears, 41% (24/58) were distal, 12% (7/58) were midsubstance, and 47% (27/58) were proximal. Periligamentous edema was present in 36% of pitchers while 14% had a flexor pronator muscle strain., Conclusion: The majority (70%) of pitchers entering the MLB draft had abnormal findings on their MRI, most commonly involving changes to the UCL. Interobserver reliability was acceptable following the definition of pathology when reading predraft elbow MRI on MLB prospects., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Thoracic outlet syndrome (TOS) remains a rare diagnosis but is being recognized as a cause of upper extremity dysfunction in professional baseball players., Purpose/hypothesis: The purpose was to determine performance and return-to-play (RTP) outcomes in professional baseball players after surgical treatment of TOS. The hypothesis was that there would be a high RTP rate in professional baseball players after TOS surgery with no statistical differences in performance between pitchers who had TOS surgery and matched controls., Study Design: Cohort study; Level of evidence, 3., Methods: All professional baseball players who underwent surgical treatment of TOS between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Demographic and performance data (before and after surgery) for each player were recorded. Performance variables were then compared between players who underwent TOS surgery and matched controls. The matching criteria were no history of previous surgeries on affected arm, age at time of surgery, throwing side, level of play (Major or Minor League Baseball), and years of experience playing professional baseball., Results: Overall, 52 players underwent surgery for TOS, of whom 46 (88%) were pitchers. The type of TOS was neurogenic in 69% and venous in 29%. One player had arterial TOS. After TOS surgery, 79% of players returned to play at the same or higher level (RTSP) by 9.5 months and played ≥3 years after surgery. No differences were found in RTSP rate based on the type of TOS. No statistical difference was found in RTP rates between major and minor league players. Pitchers had a 76% RTSP, which was similar to the natural attrition for control pitchers ( P = .874). After TOS surgery, pitchers saw a decline in several performance metrics, but these declines were not different from those of control pitchers, indicating that the decline in performance after TOS surgery was no faster than is seen in healthy professional pitchers as they age., Conclusion: The rate of RTSP after surgery for TOS in professional baseball players was 79%. There was no difference in RTP based on the type of TOS. Pitchers who underwent surgery for TOS had no significant differences in pitching performance metrics after surgery compared with matched controls., Competing Interests: Presented as a poster at the annual meeting of the AOSSM, Colorado Springs, Colorado, July 2022.One or more of the authors has declared the following potential conflict of interest or source of funding: A.C. has received support for education from Medwest Associates, Smith & Nephew, Axogen, and SportsTek Medical; speaking fees from Covidien; a grant from DJO; and hospitality payments from Encore Medical and TriMed. P.N.C. has received IP royalties from Responsive Arthroscopy and DePuy; consulting fees from DePuy, DJ Orthopedics, Medical Device Business Services, and Encore Medical; hospitality payments from Smith & Nephew; support for education from Active Medical; and compensation for services other than consulting from Arthrex. B.J.E. has received consulting fees from Arthrex and DePuy; research support from Arthrex, DePuy, Linvatec, Smith & Nephew, and Stryker; and support for education from Pinnacle and Gotham Surgical. A.A.R. has received royalties and consulting fees from Arthrex and research support from Arthrex and Paragen Technologies; he holds stock or stock options in Paragen Technologies. H.R.H. has received consulting fees from Smith & Nephew, Stryker, and Wright Medical Technology; royalties from Stryker and Wright Medical Technology; and hospitality payments from Integra LifeSciences Corporation. K.M. and Z.T. are employees of Major League Baseball. J.F. has received support for education from ImpactOrtho and hospitality payments from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Background: Ulnar collateral ligament (UCL) injuries are a source of significant injury among baseball players, and are increasingly evaluated under ultrasound. The purpose of this study is to determine the effect of a single session of pitching upon UCL thickness and laxity via a cross sectional, controlled ultrasonographic study. We hypothesize that a single session of pitching will cause the ulnar collateral ligament to thicken and become more lax., Methods: This was a cross sectional comparative study of collegiate and high school pitchers. Pitchers underwent an ultrasonographic assessment of the UCL before and after a thirty-pitch bullpen warm-up. Laxity was measured as the change in the distance between the ulna and the trochlea with and without a 5-pound weight held in hand with the elbow at 30° of flexion. Pre- and post-throwing UCL thickness and medial laxity were statistically compared with paired tests., Results: Our study included 15 pitchers, 8 collegiate and 7 high school level athletes. All played baseball at least 6 days a week, and nearly all played for at least 10 months a year. Pitchers reported a peak velocity of 89 ± 6 (77 to 98) miles per hour. In the prior season, these pitchers pitched 56 ± 33 (10 to 120) games, throwing 62 ± 34 (25-140) pitches per game on average. After throwing, there was significantly less UCL laxity (P = .013). Post-throwing laxity was significantly positively correlated with both peak pitch velocity (P = .009) and an average number of pitches thrown per game (P = .10)., Conclusion: Throwing 30 pitches significantly decreases medial elbow laxity with stress, possibly due to flexor-pronator activation. Post-throwing medial laxity is correlated with both peak pitch velocity and average number of pitches thrown per game. Future studies should be conducted to determine the number of throws at which laxity begins to increase, as this may provide a workload management guideline for injury prevention., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: To systematically review (1) biomechanical properties of augmented elbow ulnar collateral ligament (UCL) repair compared with reconstruction and (2) clinical efficacy and complication rates of UCL repair with and without augmentation., Methods: A systematic review was completed August 15, 2023, identifying articles that (1) biomechanically compared suture augmented UCL repair and reconstruction and (2) clinically evaluated medial elbow UCL repairs. Search terms included: "UCL repair" OR "internal brace" OR "suture augmentation" AND "UCL reconstruction." For inclusion, biomechanical studies compared augmented repair with reconstruction; clinical studies required clinical outcomes with minimum 6-month follow-up. Biomechanical data included torsional stiffness, gap formation, peak torque, and failure torque. Clinical data included return to previous level of play, time to return, functional outcomes, and complications., Results: In total, 8 biomechanical and 9 clinical studies were included (5 with and 4 without augmentation). In most biomechanical studies, augmented repairs demonstrated less gap formation, with equivalent torsional stiffness, failure load, and peak torque compared with reconstruction. Clinical outcomes in 104 patients without augmentation demonstrated return to previous level of 50% to 94% for nonprofessional athletes and 29% for professional baseball pitchers. Suture augmented repairs in 554 patients demonstrated return to previous level from 92% to 96%, at 3.8 to 7.4 months, with Kerlan Jobe Orthopaedic Clinic scores of 86 to 95. The overall complication rate for augmented UCL repair was 8.7%; most commonly ulnar neuropraxia (6%)., Conclusions: Biomechanically, UCL repair with augmentation provided less gapping with equivalent torsional stiffness and failure compared with reconstruction. Clinically, augmented UCL repair demonstrated excellent return to previous level of play and Kerlan Jobe Orthopaedic Clinic scores with modest complications and time to return. Augmented UCL repair is biomechanically equivalent to reconstruction and may be a viable alternative to reconstruction in indicated athletes., Clinical Relevance: UCL repair with suture augmentation is biomechanically equivalent to reconstruction and clinically demonstrates excellent outcomes., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

The ulnar collateral ligament, also called the medial collateral ligament of the elbow, is the primary stabilizer against valgus loads. This ligament can be traumatically torn, such as in an elbow dislocation, or can tear through attritional damage with overhead sports. Although baseball pitching is the most common contributor, these injuries also occur with volleyball, gymnastics, and javelin throwing. Patients most commonly report a history of medial elbow pain with associated loss of command, control, and throw velocity. The ulnar nerve lies directly superficial to the posterior band of the ulnar collateral ligament and ulnar neuritis is commonly associated with ulnar collateral ligament pathology. Nonsurgical treatment, including rest from activity, flexor-pronator strengthening, and possible platelet-rich plasma injections, can be considered for partial-thickness tears. Surgical treatment can be considered for patients in whom nonsurgical treatment fails and full-thickness tears. Historically, surgical treatment involved reconstruction of the ligament with a tendon graft. Ipsilateral palmaris longus autograft has been the most commonly used graft, but contralateral palmaris, autograft hamstring tendons, and allograft tendon have also been used. This procedure has a high rate of return to play and a low complication rate, but most athletes require 12 to 18 months to fully return. More recently, repair of the ligament, with the addition of a biologic ingrowth ligament augmentation suture, has demonstrated similarly high rates of return to play and low complication rates, with a full return to play in 6 months.

Background: Ulnar collateral ligament (UCL) tears are common in baseball players. Although magnetic resonance imaging (MRI) is the most used imaging modality for UCL injuries, the inter-rater reliability of MRI analyzing specific characteristics of UCL pathology has not been defined. The purpose of this study was to define the inter-rater reliability of MRI for evaluating UCL characteristics., Methods: Three surgeons analyzed 45 noncontrast MRIs: 15 without UCL tears, 15 with intraoperatively confirmed partial-thickness tears, and 15 with intraoperatively confirmed full-thickness tears. Findings evaluated included ligament characteristics (periligamentous or osseous edema, ligament hypertrophy, calcifications, and partial- or full-thickness tearing) and location of the pathology (proximal, midsubstance, or distal). Fleiss' κ coefficients were used to assess interobserver reliability., Results: There were high rates of agreement for midsubstance (κ: 0.50) and distal (κ: 0.69) ligament edema and proximal osseous edema (κ: 0.48). There were low rates of agreement for proximal ligament edema (κ: 0.08), ligament thickening (κ: -0.02 to 0.20), and proximal to midsubstance calcifications (κ: -0.04 to 0.10). Midsubstance (κ: 0.55) and distal full-thickness tears (κ: 0.63) demonstrated higher agreement than proximal (κ: 0.29). Proximal partial-thickness tears (κ: 0.45) had higher agreement than midsubstance (κ: -0.02) or distal (κ: -0.02)., Conclusions: In our study, there was high inter-rater reliability regarding proximal osseous edema, midsubstance, and distal ligament edema and full-thickness tears. There was no agreement for midsubstance and distal partial-thickness UCL tears, but fair agreement for proximal tears. UCL tissue characteristics including ligament thickening and calcifications demonstrated low agreement. Challenges remain in effectively evaluating UCL tissue characteristics on noncontrast MRIs., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: The influence of player workload on hamstring and calf injuries in professional baseball players remains unknown., Hypothesis: Increased workload would significantly increase hamstring and calf strain injury risk., Study Design: Case-control., Level of Evidence: Level 3., Methods: All professional baseball players who sustained a hamstring or calf injury between 2011 and 2017 were identified using the Major League Baseball (MLB) Health and Injury Tracking System (HITS). A separate player usage dataset was used to determine workload. We then compared these variables between player games 2, 6, 12, and >12 weeks before a documented calf strain to player games from a noncalf injury control group. In a paired analysis, we compared the acute workload (2, 6, and 12 weeks) before injury with the injured player's workload >12 weeks before injury., Results: There were 175 unique calf strains (71% occurred in position players) and 1042 unique hamstring strains (97.8% occurred in position players) documented in the MLB HITS database from 2011 to 2017. In all time periods, position players with fewer days rest, more innings fielded, and more plate appearances were associated with a higher risk of subsequent hamstring and calf strains. Having only 1 day rest was associated with a 2.08-fold increase in percentage of players who sustained a subsequent calf strain compared with those with 4 days rest. Position players with >5 days of rest had a 4.03-fold decrease in percentage of players who sustained a hamstring strain compared with players with 1 day rest. Position players who fielded >9 innings per game had a 2.01-fold increase in percentage of players with a subsequent calf strain and a 3.68-fold increase in percentage of players who sustained a subsequent hamstring strain compared with players who only fielded 1 innings per game., Conclusion: Position players with fewer days rest, more innings fielded, and more plate appearance per game had an increased risk of sustaining a hamstring or calf injury., Clinical Relevance: Increased workload had a direct relationship with risk of hamstring and calf strains in professional baseball players. Teams should consider more days rest for position players to avoid calf injuries.

Background: Ulnar collateral ligament (UCL) tears are common in baseball players. When nonoperative management fails; reconstruction or repair may be necessary to restore physical function. There is no clear consensus regarding the indications for surgery based on magnetic resonance imaging (MRI) tear characteristics or the indications for selecting repair over reconstruction. The purpose of this study was to define the indications for UCL surgery based on MRI and to elucidate indications for UCL repair vs. reconstruction., Methods: Twenty-six orthopedic surgeons who treat baseball players were surveyed. Forty-five MRIs were reviewed: 15 without UCL tears, 15 with intraoperatively confirmed partial-thickness tears, and 15 with full-thickness tears. Factors investigated included ligament characteristics (periligamentous or osseous edema, ligament hypertrophy, calcification, partial or full-thickness tearing) and location (proximal, midsubstance, or distal). Surgeons were given a clinical scenario and asked whether 1) surgery was indicated and 2) whether repair or reconstruction was recommended. Odds ratios (OR) and 95% confidence intervals (95% CI) helped identify significant predictors for both queries., Results: The odds of recommending surgical treatment compared to nonoperative treatment were 2.4× more likely for a proximal partial-thickness tear, 3.2× for distal partial-thickness tear, 5.1× for distal full-thickness tear, and 7.0× for proximal full-thickness tear (P < .001). Significant indications for repair included distal partial (OR = 1.6, 95% CI 1.0, 2.1, P < .001) and full-thickness tears (OR = 1.7, 95% CI 1.1, 2.3, P < .001). Repair was 3× less likely recommended for midsubstance full-thickness tears (OR = 3.0, 95% CI -5.0, -1.0, P = .004). Ultrasound stress testing was requested in 78% of partial tears., Conclusions: Among surgeons surveyed, the highest odds for recommending operative treatment were proximal full-thickness tears, then distal full-thickness, distal partial-thickness, and proximal partial-thickness tears. Repair was most appropriate for partial and full-thickness distal tears, but relatively contraindicated for complete midsubstance UCL tears. Ultrasound stress testing was frequently requested for partial tears. Given the lack of consensus among surgeons, future prospective registries are necessary to determine whether these factors associate with clinical outcomes., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Introduction: Weighted baseball use in throwing programs is widespread; however, their use remains controversial. Prior research shows that weighted baseball programs can increase ball velocity but potentially increase throwing arm injuries. This study aims to ascertain perceptions of weighted baseballs among elite baseball players., Methods: A created online survey questioned common practices, throwing regimens, injury risk factors, and weighted baseball program use. The questions were modeled to ascertain the perceptions of elite baseball players to understand their experience with weighted baseballs. Descriptive statistical analysis was conducted., Results: Three hundred seventy-six baseball players with a mean age of 20 ± 2 years completed the survey; 64% of the players (239/376) were pitchers. 71% (267/376) reported the use of weighted baseballs. Of those, 75% (199/267) thought it made them a better player. Overall, 73% (275/377) thought weighted baseballs are a risk for injury. 17% (46/267) attributed their injury to using weighted baseballs. Overall, participants reported a mean 72% ± 30% likelihood of future weighted baseball use., Conclusion: Most of the participating elite adult baseball players reported prior weighted baseball use with a corresponding improvement in pitching performance despite a perceived increased injury risk. Nearly 20% of the players attributed pain or injury to weighted baseball use. Moreover, the players surveyed intend to continue using weighted baseballs because of the perceived performance benefit., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Background: Latissimus dorsi (LD) and teres major (TM) tears have become increasingly recognized injuries in professional baseball pitchers. The purpose of this study was to determine whether workload, as measured by the number of days of rest between outings, number of innings pitched, number of batters faced, and being a starting pitcher, is associated with an increased risk of sustaining an LD-TM tear in professional baseball pitchers., Methods: All professional baseball pitchers who sustained an LD-TM tear between 2011 and 2017 were identified using the Major League Baseball Health and Injury Tracking System. A separate player-usage data set was used to determine workload. We then compared workload variables between pitcher-games 2, 6, 12, and >12 weeks prior to a documented LD-TM tear and pitcher-games from a non-LD-TM tear control group. In a paired analysis, we compared the acute workload (2, 6, and 12 weeks) prior to injury and the injured pitchers' non-acute workload >12 weeks prior to injury., Results: A total of 224 unique LD-TM tears were documented in the Major League Baseball Health and Injury Tracking System database. In most periods, player-games with more innings pitched and more batters faced were associated with a higher incidence of subsequent LD-TM tears. The number of days of rest was not a significant predictor of an LD-TM tear in the acute workload setting, but pitchers who sustained an LD-TM injury averaged fewer days of rest over the previous ≥12 weeks than controls (P < .001). Pitchers who faced >30 batters per game showed a 1.57-fold increase in the percentage of pitchers with a subsequent LD-TM tear as compared with pitchers who faced ≤5 batters per game. Significantly more starting pitchers were in the case group that sustained LD-TM tears over multiple time points than in the control group., Conclusion: Having a greater pitcher workload and being a starting pitcher were associated with an increased risk of sustaining LD-TM tears in professional baseball players. The average number of days of rest was only a risk factor for LD-TM tears over a 3-month or longer period., (Copyright © 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Injury rates in baseball players of all ages are increasing. Identifying modifiable risk factors is paramount to implementing injury prevention programs., Purpose/hypothesis: The purpose was to evaluate the influence of weather (temperature, humidity, atmospheric pressure, and heat index) and game factors (start time, duration, single vs doubleheader) on injury rates in professional baseball players. We hypothesized that colder temperatures would be associated with significantly more injuries per game., Study Design: Case-control study; Level of evidence, 3., Methods: This was a retrospective database study. Two data sets were combined: 1 containing all injuries in Major and Minor League Baseball between 2011 and 2017 and 1 containing all games played in Major and Minor League Baseball during the same period to determine the number of injuries per game. Temperature, humidity, atmospheric pressure, and heat index were determined for each game using the data from the US Environmental Protection Agency. Additional game variables included the level of play, the turf type (natural vs artificial grass), the stadium type (open vs dome vs retractable), the game start time, the game duration, and whether the game was a doubleheader. Then, a multivariate analysis was conducted to determine which factors were associated with the number of injuries per game., Results: In total, our analysis included 33,587 injuries and 76,747 games. A total of 25,776 (33.6%) games contained an injury, and 41% of injuries occurred as multiples per game, with up to 9 injuries per game. The multivariate analysis identified significant associations between game duration and injuries per game ( P < .001; effect size, 0.013) and the level of play and injuries per game ( P < .001; effect size, 0.011). There were significant associations between the venue type ( P < .001), the game start time ( P < .001), humidity ( P < .001), the turf type ( P = .016), and barometric pressure ( P = .031); however, the effect size for each was <0.001, suggesting that these factors are clinically unimportant. Our overall model produced an R 2 of 0.04, indicating that these variables only predicted 4% of the variance in injury risk., Conclusion: In professional baseball, the weather is not associated with injury risk; however, game duration may contribute to injury risk.

Background: Meniscal injuries are common in athletes across many sports. How professional baseball players respond to partial meniscectomy is not well documented., Purpose/hypothesis: The purpose was to determine the performance and return-to-sports (RTS) rate in professional baseball players after arthroscopic partial knee meniscectomy and compare the results of partial medial meniscectomy versus partial lateral meniscectomy. The hypothesis was that there would be a high RTS rate in professional baseball players after partial meniscectomy with no difference in the RTS rate or timing of RTS between players who underwent partial medial meniscectomy versus partial lateral meniscectomy., Study Design: Cohort study; Level of evidence, 3., Methods: All professional baseball players who underwent arthroscopic partial meniscectomy between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Demographic and performance data (before and after injury) for each player were recorded. The RTS rate and timing of RTS were then compared between players who underwent partial medial meniscectomy versus partial lateral meniscectomy., Results: A total of 168 knees (168 players) underwent arthroscopic partial meniscectomy (mean age, 25 ± 5 years; 46% medial meniscectomy, 45% lateral meniscectomy, and 9% both medial and lateral meniscectomy). The most common mechanism of injury was fielding in the infield on natural grass. Injuries were spread evenly across positions: 18% catchers, 24% infielders, 20% outfielders, and 38% pitchers. The overall RTS rate was 80% (76% returned to the same or a higher level, and 4% returned to a lower level). For performance, pitchers saw significant decreases in usage but significant improvements in performance using the advanced statistics of fielding independent pitching ( P < .001) and wins above replacement ( P = .011). Hitters saw significant decreases in usage but increases in efficiency as seen by improvements in wins above replacement ( P = .003). Of the 79 athletes who returned during the same season, the median time to return to play was 42 days., Conclusion: The RTS rate after meniscectomy in professional baseball players was 80%. Player efficiency improved after surgery in pitchers and position players. No difference in the RTS rate or timing of RTS existed between players who underwent partial medial meniscectomy versus partial lateral meniscectomy.

Introduction: There has been recent interest in throwing from flat-ground versus the mound regarding stress on the elbow. Typical throwing progression programs begin with flat-ground work and progress to mound work., Methods: All baseball pitchers of ages 10 to 17 years who completed a 15-week pitching mechanics and velocity-training program were included. Players' pitch velocity was tested at four time points during training. Average velocity and maximum velocity of pitches from flat-ground were compared with those of mound, and change in velocity between testing sessions was also compared., Results: Thirty-six male pitchers (average age: 14.4 ± 1.6 years) were included. Fastball velocity increased by an average of 5.2 mph (95% confidence intervals 2.0 to 8.8 mph) at the end of the training program. When change in average and maximum velocity was compared between the four testing sessions, the most notable increase in velocity occurred between the third and fourth testing sessions. Both sessions were thrown from the mound., Conclusion: The 15-week baseball pitcher-training program markedly improved pitching velocity. Throwing from a mound compared with flat-ground resulted in the largest velocity increase. Therefore, when attempting to increase a pitcher's velocity, throwing from the mound should be an integral part of any velocity program., (Copyright © 2021 by the American Academy of Orthopaedic Surgeons.)

Background: Postoperative rehabilitation protocols after ulnar collateral ligament (UCL) reconstruction typically involve a structured interval throwing program. In an effort to minimize torque placed on the UCL, athletes are often instructed to throw with a crow hop, even at short throwing distances. However, the effect of the crow hop on medial elbow stress is unknown., Purpose/hypothesis: The purpose was to determine whether elbow stress differs with and without a crow hop across the throwing distances of a typical interval throwing program. We hypothesized that crow hop throws would generate lower torque on the elbow than standing throws at each distance of the interval throwing program., Study Design: Controlled laboratory study., Methods: Healthy high school and collegiate pitchers and position players were recruited from the surrounding area. Each player was outfitted with a wearable athletic sleeve and device that recorded elbow torque (Newton-meters), arm slot (degrees), arm speed (revolutions per minute), and shoulder rotation (degrees). Ball velocity (miles per hour) was measured using a radar gun. Players were instructed to perform 3 crow hop throws and 3 standing throws at distances of 30, 45, 60, 90, 120, 150, and 180 feet. A repeated measures analysis of variance was used to compare ball velocity, elbow torque, arm slot, arm speed, and shoulder rotation between crow hop and standing throws at each throwing distance., Results: Twenty athletes participated in this study (average age, 17.8 years; range, 15-25 years). The average medial elbow torque increased at each distance for both crow hop and standing throws at distances of 30, 45, 60, and 90 feet ( P < .05), after which there were no significant increases in elbow torque ( P > .05). The average torque was higher for crow hop throws than standing throws at distances of 30 feet (13.9 N·m vs 12.0 N·m; P = .002), 45 feet (21.8 N·m vs 19.3 N·m; P = .005), and 60 feet (28.0 N·m vs 24.5 N·m; P = .02)., Conclusion: Crow hop throws generated greater medial elbow torque than standing throws at distances up to 60 feet; however, there were no differences in elbow torque at distances greater than 60 feet between the 2 throw types. For both crow hop and standing throws, elbow stress increased at each distance interval up to 90 feet before plateauing at distances greater than 90 feet. The crow hop throwing technique does not reduce medial elbow stress during a simulated interval throwing program, and it may actually increase torque at shorter throwing distances., Clinical Relevance: The results of our study indicate that it would be prudent for players to initially perform standing throws at shorter distances and only later be allowed to employ a natural crow hop at greater distances to minimize torque placed on the medial elbow during UCL rehabilitation protocols.

Background: A fracture of the hook of the hamate is a common injury affecting professional baseball players. The treatment for these fractures ranges from nonoperative immobilization to excision of the fragment., Purpose/hypothesis: The purpose was to report the results of surgical treatment of hook of hamate fractures in professional baseball players and determine which factors are associated with return to sport (RTS) and time to RTS. The hypothesis was that there is a high rate of RTS in professional baseball players after surgical treatment of the hook of the hamate fracture with no significant decline in performance after RTS., Study Design: Descriptive epidemiology study., Methods: All professional baseball players who underwent excision of the hook of the hamate between 2010 and 2017 were included. Player characteristic and performance data (before and after surgery) were recorded. Performance metrics were then compared before and after surgery., Results: Overall, 261 players were included. Of total injuries, 96% were due to hitting, 86% occurred on the nondominant hitting side, and 89% were acute fractures (11% were nonunion cases). Most (95%) injuries occurred at the Minor League level and 96.2% of procedures were performed by hand fellowship-trained surgeons. Eight percent of players underwent concomitant procedures. The average tourniquet time was 31 ± 13 minutes. In total, 81% of players returned to sport at the same or higher level; 3% returned to sport at a lower level. The median time to RTS after surgery was 48 days (range, 16-246 days). The tourniquet time and number of days to RTS were significantly associated with one another ( P = .001; Spearman ρ = 0.290; N = 130). Player utilization significantly increased after surgery. While player efficiency, including batting average (BA), on-base percentage (OBP), and on-base plus slugging percentage (OPS), significantly decreased, these changes were numerically small (BA: 0.26 ± 0.04 preoperatively vs 0.25 ± 0.04 postoperatively; OBP: 0.34 ± 0.04 preoperatively vs 0.32 ± 0.04 postoperatively; OPS: 0.73 ± 0.12 preoperatively vs 0.70 ± 0.11 postoperatively) ( P < .001). There were no significant differences between rates of RTS to the same or higher level of play among acute fractures (81%) and nonunion cases (76%) ( P = .837)., Conclusion: After surgical excision for hook of hamate fractures in professional baseball players, 84% were able to RTS, with 81% returning to the same or higher level. The median time for players to RTS after surgery was 48 days. Player usage increased after surgery, while hitting efficiency slightly declined.

Background: The number of ulnar collateral ligament (UCL) tears in professional baseball players is increasing. UCL reconstruction (UCLR) is the treatment of choice in players with failed nonoperative treatment who wish to return to sports (RTS). It is unknown if UCL tear location influences the ability of players to RTS or affects their performance upon RTS., Purpose/hypothesis: The purpose was to compare the RTS rate and performance upon RTS in professional baseball players who underwent UCLR based on UCL tear location (proximal vs distal). It was hypothesized that no difference in RTS rate or performance upon RTS will exist between players with proximal or distal UCL tears., Study Design: Cohort study; Level of evidence, 3., Methods: All professional baseball players who underwent primary UCLR by a single surgeon between 2016 and 2018 were eligible for inclusion. Players with purely midsubstance tears or revision UCLR were excluded. Tear location was determined based on preoperative magnetic resonance imaging (MRI) and intraoperative findings. RTS rate and performance were compared between players with proximal versus distal UCL tears., Results: Overall, 25 pitchers (15 proximal and 10 distal tears) and 5 position players (2 proximal and 3 distal) underwent primary UCLR between 2016 and 2018. Of the 25 pitchers, 84% were able to RTS. Of the 5 position players, 80% were able to RTS. Among the total cohort of pitchers and position players, 12 out of 17 (71%) players with proximal tears were able to RTS, while of the 13 distal tears, 13 out of 13 (100%) players were able to RTS ( P = .05). With regard to performance data, pitchers with distal tears had higher utilization postoperatively and, as such, allowed statistically more hits ( P = .03), runs ( P = .015), and walks ( P = .021) postoperatively. However, the WHIP ([walks + hits]/innings pitched) was not different between players with proximal or distal tears, indicating that efficacy in games was not significantly different between groups., Conclusion: Professional baseball players who sustain a distal UCL tear and undergo UCLR may be more likely to RTS than those who sustain a proximal UCL tear and undergo UCLR. Players with distal UCL tears who underwent UCLR saw higher utilization postoperatively than those with proximal UCL tears. Further work is needed in this area to confirm this result.

Background: Ulnar collateral ligament reconstruction (UCLR) is a common procedure in professional baseball position players. Timing of return to hitting after UCLR is unknown., Purpose/hypothesis: The purpose was to determine the time to return to batting milestones after UCLR as well as the effect of UCLR upon batting performance in professional baseball players. The hypothesis was that position players would return to batting in an in-season game before fielding in an in-season game, and hitting performance would remain unchanged after UCLR., Study Design: Cohort study; Level of evidence, 3., Methods: All professional position players who underwent UCLR between 2010 and 2018 were included. Time to batting milestones after UCLR was analyzed. Batting performance before and after UCLR was compared and analyzed., Results: Overall, 141 UCLRs (96% performed on the dominant arm) in 137 position players were included (86% Minor League players). Four players underwent revision, all within 1 year of the primary UCLR. With regard to position, catchers and shortstops were overrepresented. With regard to batting side, 57% batted from the right and 12% batted as switch-hitters. Of the surgeries, 76% were on the trail/back arm. While 91% of players returned to some form of throwing, there was a progressive gradual decline as the rehabilitation process progressed, as only 77% were able to return to hitting in a real game and 75% were able to return to fielding in a real game. The first dry swing occurred at 150 ± 49 days after surgery, the first batting practice occurred at 195 ± 58 days after surgery, the first hitting in a real game occurred at 323 ± 92 days after surgery, and the first fielding in a real game occurred at 343 ± 98 days after surgery. However, players generally saw a decrease in their utilization, with fewer at bats ( P < .001) translating into fewer hits ( P < .001) and runs ( P < .001)., Conclusion: Professional position players begin swinging at 150 days (approximately 5 months) after UCLR, while they do not hit in batting practice until 195 days (approximately 6.5 months) and do not hit in a real game until 323 days (approximately 10.7 months) after UCLR. Players see a decrease in hitting utilization after UCLR. On average, players hit in a real game 20 days before fielding in a real game.

Background: While many injuries to the rotator cuff in professional baseball players can be managed nonoperatively, recovery fails to occur with nonoperative treatment in some players and surgery on the rotator cuff is performed in an attempt to return to sport (RTS)., Methods: All professional baseball players who underwent rotator cuff surgery between 2010 and 2016 were included by use of the Major League Baseball injury database. Demographic and performance data (before and after surgery) for each player were recorded. Preoperative and postoperative performance metrics were then compared., Results: Overall, 151 professional baseball players underwent rotator cuff débridement (n = 130) or rotator cuff repair (n = 21). In the rotator cuff repair group, 6 (28.6%) underwent single-row repair, 5 (23.8%) underwent double-row repair, and 10 (47.6%) underwent side-to-side repair. Among the 11 players who underwent either single- or double-row repair, the average number of anchors used per repair was 2.09 ± 1.1 (range, 1-4). Most performance metrics declined following rotator cuff débridement. For players who underwent débridement, the RTS rate was 50.8% (42.3% at the same level or a higher level and 8.5% at a lower level). For players who underwent repair, the RTS rate was 33.3% (14.3% at the same level or a higher level and 19% at a lower level). Most players underwent at least 1 concomitant procedure at the time of rotator cuff surgery., Conclusion: Rotator cuff débridement is significantly more common than repair in professional baseball players, with 86% of all rotator cuff surgical procedures reported as débridement. RTS rates following débridement and repair are disappointing, at 50.8% and 33.3%, respectively. For players who do return, performance declines after surgery., (Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Recent studies evaluating nonoperative treatment of elbow ulnar collateral ligament (UCL) injuries augmented with platelet-rich plasma (PRP) have shown promising results. To date, no comparative studies have been performed on professional baseball players who have undergone nonoperative treatment with or without PRP injections for UCL injuries., Hypothesis: Players who received PRP injections would have better outcomes than those who did not receive PRP., Study Design: Cohort study; Level of evidence, 3., Methods: The Major League Baseball (MLB) Health and Injury Tracking System identified 544 professional baseball players who were treated nonoperatively for elbow UCL injuries between 2011 and 2015. Of these, 133 received PRP injections (PRP group) before starting their nonoperative treatment program, and 411 did not (no-PRP group). Player outcomes and a Kaplan-Meier survival analysis were compared between groups. In addition, to reduce selection bias, a 1:1 matched comparison of the PRP group versus the no-PRP group was performed. Players were matched by age, position, throwing side, and league status: major (MLB) and minor (Minor League Baseball [MiLB]). A single radiologist with extensive experience in magnetic resonance imaging (MRI) interpretation of elbow injuries in elite athletes analyzed 243 MRI scans for which images were accessible for tear location and grade interpretation., Results: Nonoperative treatment of UCL injuries resulted in an overall 54% rate of return to play (RTP). Players who received PRP had a significantly longer delay in return to throwing ( P < .001) and RTP ( P = .012). The matched cohort analysis showed that MLB and MiLB pitchers in the no-PRP group had a significantly faster return to throwing ( P < .05) and the MiLB pitchers in the no-PRP group had a significantly faster RTP ( P = .045). The survival analysis did not reveal significant differences between groups over time. The use of PRP, MRI grade, and tear location were not statistically significant predictors for RTP or progression to surgery., Conclusion: In this retrospective matched comparison of MLB and MiLB pitchers and position players treated nonoperatively for a UCL tear, PRP did not improve RTP outcomes or ligament survivorship, although there was variability with respect to PRP preparations, injection protocols, time from injury to injection, and rehabilitation programs. MRI grade and tear location also did not significantly affect RTP outcomes or progression to surgery.

Background: Ulnar collateral ligament reconstruction (UCLR) is a successful procedure in professional baseball players. It is unclear whether graft choice affects results., Purpose: Determine performance and rate of return to sport (RTS) in professional baseball players after UCLR and compare performance and RTS rate, as well as injury rates, between players who underwent UCLR with hamstring versus palmaris autograft., Hypothesis: A high RTS rate exists in professional baseball players after UCLR, with no significant difference in injury rates, RTS rates, or performance specifically related to primary outcome performance variables-WHIP ([walks + hits]/innings pitched), fielding independent pitching (FIP), and wins above replacement (WAR)-between those who undergo UCLR with palmaris versus hamstring autograft., Study Design: Cohort study; Level of evidence, 3., Methods: All professional baseball players who underwent UCLR with hamstring autograft between 2010 and 2015 were included. Surgical details were gathered from operative reports. Players with hamstring UCLR were compared with a matched control group of players who underwent UCLR with palmaris autograft., Results: Overall, 195 players underwent UCLR with hamstring autograft. No differences in RTS rates or timing to RTS were found between the hamstring and palmaris groups. Significantly more subsequent injuries to the contralateral lower extremity were seen in the hamstring group versus the palmaris group (25 vs 13, respectively) ( P = .040). More subsequent injuries to the upper extremity were found in the palmaris group versus the hamstring group (73 vs 55, respectively), although this difference was not significant ( P = .052). No consistent differences in performance metrics upon RTS existed between hamstring and palmaris groups, although both groups significantly declined in many performance metrics after surgery. Both hamstring and palmaris groups showed a decline postoperatively in WAR (0.86 vs 0.35 and 1.23 vs 0.34, respectively) and WHIP (1.33 vs 1.44 and 1.36 vs 1.51, respectively); FIP did not decline (4.56 vs 5.27 and 4.51 vs 4.53, respectively). No significant difference in WAR, WHIP, or FIP existed between groups postoperatively., Conclusion: Baseball players who underwent UCLR with hamstring autograft were more likely to sustain a subsequent lower extremity injury, whereas those who underwent UCLR with palmaris autograft had a trend toward sustaining more upper extremity injuries. No difference in performance or RTS rates existed between groups. Both groups significantly declined in WAR and WHIP after UCLR.

Background: Latissimus dorsi and teres major (LD/TM) tears are becoming an increasingly common cause of injury and disability among professional baseball pitchers., Purpose/hypothesis: To determine performance and return to sport (RTS) among professional baseball pitchers after LD/TM tears treated operatively and nonoperatively and to compare the RTS rate and performance between pitchers who sustained an LD/TM tear and matched controls. The authors hypothesized a high RTS rate among professional baseball pitchers after LD/TM tears, with no significant difference in RTS rate or performance between cases and controls for operative and nonoperative treatment-specifically, in the primary performance outcome variables of WHIP ([walks + hits] / innings pitched), fielding independent pitching, and wins above replacement., Study Design: Cohort study; Level of evidence, 3., Methods: All professional baseball pitchers who sustained an LD/TM tear between 2011 and 2016 were identified with the Health and Injury Tracking System database of Major League Baseball. Demographic and performance data (before and after injury) were recorded for each player. Performance metrics were then compared between cases and matched controls by operative and nonoperative treatment., Results: Overall, 120 pitchers had a documented LD/TM tear; 42 (35%) were major league players. Most players (n = 107, 89.2%) were treated nonoperatively. Time to return to the same level of competition was 170 ± 169 days (mean ± SD) for pitchers treated nonoperatively and 406 ± 146 days for those treated operatively. The RTS rate among players treated nonoperatively and operatively was identical at 75%. Players treated nonoperatively had no change in fielding independent pitching or wins above replacement after injury but had a higher (ie, worse) WHIP after injury ( P = .039); they also performed significantly worse in several secondary performance metrics, including number of games played per year ( P < .001). Players treated operatively had no change in any measured performance metrics after surgery. No difference existed between cases and controls in the primary performance variables., Conclusion: The majority of LD/TM tears are treated nonoperatively. The RTS rate is 75% for professional baseball pitchers after LD/TM tears treated operatively or nonoperatively. Players treated nonoperatively saw a decline in several performance metrics, while players treated operatively had no significant difference in performance after surgery.

Background: Injuries remain a significant problem for professional baseball players. There is little information regarding the incidence and outcomes of shoulder surgical procedures among these athletes., Purpose/hypothesis: To report the incidence, pathology, procedure type, demographics, and return-to-sport (RTS) rate of shoulder surgery among Major League Baseball (MLB) players. Most shoulder procedures would be performed on pitchers with a history of injury; the labrum would be the most commonly involved; and that the RTS rate would be >50%., Study Design: Descriptive epidemiology study., Methods: All MLB players who underwent surgery between 2012 and 2016 were identified from a database prospectively maintained by MLB. Demographic information and details regarding the procedure were recorded and RTS rates determined. Only those players with a minimum 2-year follow-up were included., Results: There were 581 shoulder procedures performed (542 players; pitchers, 60%; incidence, 1.48%). Overall, 19% of surgical procedures were performed on major league players and 81% on minor league players. Most players were between 20 and 25 years old. The majority of procedures were performed on the posterior and anterior labrum. Of these, 67% involved labral repair. Within rotator cuff surgery, 84% involved debridement; most tears were articular sided (87%); and 75% involved the supraspinatus. Overall, 11% of players had prior shoulder surgery, and 76% spent time on the disabled list before surgery. The overall rate of RTS was 63%. Of those who returned, 86% returned to at least the same level of play or higher as before surgery. Of those who returned to their prior level of play, 73% later ascended to a higher level of play or could not ascend to a higher level because they were already in the majors., Conclusion: Shoulder surgery is uncommon among professional baseball players. Of those players who require surgery, the majority are pitchers and minor league players. Most procedures involve the labrum. Rotator cuff tears are mostly articular-sided supraspinatus tears. The overall RTS rate is 63%. Of those who return, 86% are able to return to the same or higher level of play as before surgery.

Background: Isolated ulnar nerve decompression/transposition is an uncommon surgical procedure among professional baseball players., Purpose/hypothesis: To determine performance and rate of return to sport (RTS) among professional baseball players after isolated ulnar nerve decompression/transposition, including those who required decompression/transposition after ulnar collateral ligament reconstruction (UCLR), and to compare outcomes between cases and matched controls. The authors hypothesized a high rate of RTS among professional baseball players undergoing isolated ulnar nerve decompression/transposition with no difference in RTS rate or performance between cases and controls as related to earned run average, WHIP ([walks + hits]/innings pitched), wins above replacement, and on base + slugging percentage., Study Design: Cohort study; Level of evidence, 3., Methods: Utilizing the injury database of Major League Baseball, we identified all professional baseball players who underwent isolated ulnar nerve decompression/transposition between 2010 and 2016. De-identified demographic and performance data (before and after surgery) for each player were recorded from Major League Baseball records. Performance metrics were then compared between cases and matched controls., Results: The study included 52 players; 83% were pitchers; and 14 underwent prior UCLR. Most surgical procedures (92%) were anterior subcutaneous transpositions. Overall, 62% of players were able to successfully RTS, and 56% returned to the same or higher level. There was no significant difference between cases and controls in the majority of pre- and postoperative performance metrics-specifically, earned run average, WHIP, wins above replacement, and on base + slugging percentage. When players who had UCLR before ulnar nerve decompression/transposition were compared with controls with a history of UCLR but no subsequent ulnar nerve decompression/transposition, the only performance difference of all the recorded metrics was that cases allowed more walks per 9 innings (4.4 vs 2.8, P = .011)., Conclusion: Anterior subcutaneous transposition is the most common surgical procedure among professional baseball players to address ulnar neuropathy at the elbow. Players have a 62% rate of RTS, which is lower than expected for this nonreconstruction or repair procedure. For players who successfully RTS, performance metrics versus matched controls remained the same except for allowing significantly more walks per 9 innings. Postoperatively, pitchers with UCLR before ulnar nerve decompression/transposition who had a successful RTS performed the same as matched controls with prior UCLR without subsequent ulnar nerve decompression/transposition.

Background: Ulnar collateral ligament reconstruction (UCLR) is a successful procedure among professional baseball pitchers. It is unclear if hamstring tendon harvest side for UCLR affects the outcome or alters the risk for subsequent hamstring injury., Hypothesis: Players with prior UCLR with ipsilateral (drive leg) hamstring autograft will have the same return-to-sport (RTS) rate and performance upon RTS but a higher number of subsequent lower extremity injuries than those with contralateral (landing leg) hamstring autograft., Study Design: Cohort study; Level of evidence, 3., Methods: All players between 2010 and 2015 who underwent UCLR with hamstring autograft were included. Surgical details of their procedures were recorded from operative reports. Outcomes for UCLR with hamstring autograft harvested from the drive leg were compared with UCLR with the graft harvested from the landing leg., Results: Overall, 191 players underwent UCLR with hamstring autograft (drive leg, n = 58, 30%; landing leg, n = 133, 70%). The docking technique was more common in the drive leg group, while the figure-of-8 technique was more common in the landing leg group ( P > .001). More patients in the landing leg group underwent concomitant treatment of the ulnar nerve than the drive leg group ( P < .001). No difference existed in RTS rates or timing of RTS between groups. No differences in subsequent ipsilateral or contralateral hamstring injuries occurred between players who underwent UCLR with hamstring autograft from the drive leg or the landing leg ( P≥ .999 and P = .460, respectively). No difference in overall upper or lower extremity injury rates existed between groups (all P > .05), and no difference in performance metrics existed between groups upon RTS., Conclusion: No difference in RTS rate, performance upon RTS, or subsequent injury rates (hamstring, lower extremity, or upper extremity) existed between players who underwent UCLR with hamstring autograft whether the graft came from the drive or the landing leg.

Purpose: To determine return to play (RTP) rates after biceps tenodesis (BT) in professional baseball players., Methods: Major League Baseball has maintained a prospective database containing all major and minor league baseball players who have undergone shoulder surgery since 2010. All players who had undergone BT were included. Minimum follow-up was 24 months, and thus we included data from 2010 to 2013. Using this database we determined the incidence, demographics, prior surgery history, concomitant procedures, RTP rates, and time to RTP., Results: Between 2010 and 2013, 17 professional baseball players underwent BT. Seventy-one percent of the 17 were pitchers, and 29% of the 17 were in the major league. Forty-seven percent of the 17 had a history of a prior shoulder surgery and 47% of the 17 underwent concomitant labral repair. For all players, RTP after BT was 35%, whereas RTP after BT without a concomitant reconstructive procedure was 44% in 10 ± 6 months, and 25% for those who underwent both BT and a concomitant reconstructive procedure (P = .620). All players who RTP were able to return to at least 20 games at their preoperative level of play. Return to professional play was 80% among position players and 17% among pitchers (P = .028). For those pitchers who RTP, performance was not statistically changed., Conclusions: Professional baseball players who undergo BT have a 35% rate of return to their prior level of play. Whereas pitchers have only a 17% rate of RTP, position players have an 80% rate of RTP. Of those who returned, all returned to their prior level of play. The pitchers who returned had no significant change in performance statistics., Level of Evidence: Level IV, therapeutic study, a case series., (Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Ulnar collateral ligament reconstruction (UCLR) has become a common procedure among baseball players of all levels. There are several graft choices in performing UCLR, one of which is a hamstring (gracilis or semitendinosus) autograft. It is unclear whether the hamstring muscle from a pitcher's drive leg (ipsilateral side of the UCLR) or landing leg (contralateral side of the UCLR) is more active during the pitching motion. We hypothesized that the landing leg semitendinosus will be more electromyographically active than the drive leg., Methods: Healthy, elite male pitchers aged 16-21 years were recruited. Sixteen pitchers (average age, 17.6 ± 1.6 years; 67% threw right handed) underwent electromyographic analysis. Pitchers threw 5 fastballs at 100% effort from the wind-up with electromyographic analysis of every pitch. Activation of the semitendinosus and biceps femoris in both legs was compared within pitchers and between pitchers., Results: Hamstring activity was higher in the drive leg than in the landing leg during each phase and in sum, although the difference was significant only during the double support phase (P = .021). On within-pitcher analysis, 10 of 16 pitchers had significantly more sum hamstring activity in the drive leg than in the landing leg, while only 4 of 16 had more activity in the landing leg (P = .043)., Conclusion: During the baseball pitch, muscle activity of the semitendinosus was higher in the drive leg than in the landing leg in most pitchers. Surgeons performing UCLR using hamstring autograft should consider harvesting the graft from the pitcher's landing leg to minimize disruption to the athlete's pitching motion., (Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Context: The overhand pitch is one of the fastest known human motions and places enormous forces and torques on the upper extremity. Shoulder and elbow pain and injury are common in high-level pitchers. A large body of research has been conducted to understand the pitching motion., Evidence Acquisition: A comprehensive review of the literature was performed to gain a full understanding of all currently available biomechanical and clinical evidence surrounding pitching motion analysis. These motion analysis studies use video motion analysis, electromyography, electromagnetic sensors, and markered motion analysis. This review includes studies performed between 1983 and 2016., Study Design: Clinical review., Level of Evidence: Level 5., Results: The pitching motion is a kinetic chain, in which the force generated by the large muscles of the lower extremity and trunk during the wind-up and stride phases are transferred to the ball through the shoulder and elbow during the cocking and acceleration phases. Numerous kinematic factors have been identified that increase shoulder and elbow torques, which are linked to increased risk for injury., Conclusion: Altered knee flexion at ball release, early trunk rotation, loss of shoulder rotational range of motion, increased elbow flexion at ball release, high pitch velocity, and increased pitcher fatigue may increase shoulder and elbow torques and risk for injury.

Hypothesis: Pitchers who return to sport (RTS) sooner will have a higher risk of revision ulnar collateral ligament reconstruction (UCLR) than those who return later., Methods: All professional (major and minor league) baseball pitchers who underwent UCLR between 1974 and 2016 were identified. Date of the index UCLR was recorded. The date of the first game back at any professional level after surgery and the date the pitcher returned to the same level of play (if applicable) were recorded. Length of time between these dates was compared for pitchers who required a revision UCLR and those who did not., Results: Overall, 569 pitchers (average age, 24.8 ± 4.1 years) underwent UCLR and had reliable game logs after surgery. No statistically significant difference existed in the length of time to RTS at any professional level or at the same professional level between those pitchers who did not require a revision UCLR and those who did (P = .442, P = .238). Pitchers who required revision UCLR returned to any level of play almost 2 months earlier (14.7 vs. 16.5 months) and returned to the same level of play >2 months earlier (15.2 vs. 17.7 months) than matched controls who did not require revision UCLR, although this was not statistically significant (P = .179, P = .204)., Conclusion: No statistically significant difference existed in the length of time to RTS after UCLR in professional baseball players who required a revision UCLR and those who did not., (Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine differences among healthy pitchers at various levels of competition regarding pitching history, pitching mechanics, and prevalence of breaking pitches., Methods: Demographic, anthropometric, pitching history, and kinematic data were collected on healthy youth pitchers using dual orthogonal high-speed video analysis. Players were grouped by maturity level (9 to 12 [prepubescent], 13 to 15 [pubescent], 16 to 17 [mature], and 18 to 22 years [adult]). Groups were compared regarding pitch counts, pitching mechanics, and use of breaking pitches. Mechanics were assessed for favorable observational parameters (e.g., closed foot orientation at foot-strike) and measurable parameters at cocking, foot-strike, and ball release (e.g., knee flexion)., Results: Two hundred ninety-five pitchers were included. Sixty-three were 9 to 12, 130 were 13 to 15, 78 were 16 to 17, and 24 were 18 to 22 years of age. Older pitchers threw more pitches per game (41, 52, 69, and 50 by age group; P < .001), per season (766, 975, 1,079, and 881; P = .017), and per year (901, 1,343, 2,064, and 1,302; P < .001). They were more likely to pitch for multiple teams, for more than 9 months, in showcases, and in violation of pitch count recommendations. Older pitchers were more likely to maintain their hand on top of the ball, maintain closed shoulders at foot-strike, achieve hip and shoulder separation, and lead with their hips. Older pitchers achieved greater relative stride-length, greater knee flexion at front-foot contact, and increased lead hip flexion at ball release. Pitchers began throwing curveballs and sliders at 12.6 and 13.5 years, respectively., Conclusions: As pitchers age, they throw more pitches per game, per season, and per year and are more likely than younger pitchers to violate pitch count recommendations. Older pitchers tend to pitch with improved mechanics and velocity. The proportion of pitchers throwing breaking pitches increases with age, with the greatest increase occurring between ages 12 and 13., Level of Evidence: Level II, cross-sectional study., (Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Ulnar collateral ligament injury and its subsequent surgical reconstruction are some of the most common issues among Major League Baseball (MLB) players., Purpose/hypothesis: The purpose of this study was to determine factors predictive of ulnar collateral ligament reconstruction (UCLR) among MLB pitchers. The hypothesis was that pitchers who underwent UCLR would have higher preinjury peak fastball pitch velocity., Study Design: Case-control study; Level of evidence, 3., Methods: Data on pitch velocity, number, and type (fastball, curveball, etc) for every pitcher and game within MLB from April 2, 2007 to April 14, 2015 were gathered from the publically available PitchFx database. Pitcher demographic information was also recorded. Data from after 2012 were excluded to avoid lead-time bias. Using publically available information, the names and approximate dates of surgery for every MLB pitcher who ever underwent UCLR, including those before 2007 and after 2012, were collected. Each pitcher-game was then classified as "control," "preinjury," or "postoperative." Control and preinjury pitchers were then compared to determine risk factors for UCLR., Results: Overall, 1327 pitchers were included, of whom 309 (26.8%) had undergone UCLR. Of these, 145 had preinjury velocity data. Peak pitch velocity was significantly higher among preinjury pitchers than control pitchers (mean [95% CI], 93.3 mph [92.8-93.8] vs 92.1 mph [91.9-92.3]; P < .001), as was mean pitch velocity (87.8 mph [87.3-88.3] vs 86.9 mph [86.7-87.1]; P = .001). Both demonstrated a dose-response relationship. Although height did not differ (P = .934), weight was significantly higher for preinjury pitchers than controls (P = .005). Pitch counts per year were significantly lower for preinjury pitchers compared with control pitchers, although preinjury pitchers threw more breaking pitches (P = .003). On multivariate regression, peak pitch velocity was the primary independent predictor of whether a pitcher underwent UCLR (P < .001), with mean velocity (P = .013), body mass index (P = .010), and age (P = .006) being secondary predictors. However, a model constructed with these variables only explained 7% of the variance in UCLR rates. Pitch counts were not significant predictors., Conclusion: Higher pitch velocity is the most predictive factor of UCLR in MLB pitchers, with higher weight and younger age being secondary predictors, although these factors only explained 7% of the variance in UCLR rates., (© 2016 The Author(s).)

Purpose: To determine if shoulder and elbow kinematics, pitching velocity and accuracy, and pain change during a simulated baseball game in adolescent pitchers., Methods: Adolescent male pitchers aged 13 to 16 years were included. Pitchers were excluded if they had undergone previous shoulder or elbow surgery, currently had a known shoulder or elbow injury, or were unable to complete the simulated game for any reason. Shoulder range of motion was assessed before and after the game. Velocity and accuracy were measured for every pitch, and every 15th pitch was videotaped from 2 orthogonal views in high definition at 240 Hz. Quantitative and qualitative mechanics were measured from these videos. Perceived fatigue and pain were assessed after each inning using a visual analog scale. Data were statistically analyzed using a repeated-measures analysis of variance., Results: Twenty-eight elite adolescent pitchers were included. These pitchers, on average, were aged 14.6 ± 0.9 years (mean ± standard deviation), had been pitching for 6.3 ± 1.7 years, and threw 94 ± 58 pitches per week. Our experimental model functioned as expected in that pitchers became progressively more fatigued (0.3 ± 0.6 to 3.5 ± 2.1), had more pain (0.1 ± 0.4 to 1.6 ± 2.2), and pitched with a lower velocity (73 ± 5 mph to 71 ± 6 mph) as pitch number increased (P < .001, P = .001, and P < .001, respectively). Knee flexion at ball release progressively increased (49° ± 15° to 53° ± 15°) with pitch number (P = .008). Hip-to-shoulder separation significantly decreased as pitch number increased, from 90% ± 40% at pitch 15 to 40% ± 50% at pitch 90 (P < .001). Upper extremity kinematics remained unchanged (P > .271 in all cases, 91% power for elbow flexion at ball release). External rotation and total range of motion in the pitching shoulder significantly increased after pitching (P = .007 and P = .047, respectively)., Conclusions: As pitchers progress through a simulated game, they throw lower-velocity pitches, become fatigued, and have more pain. Core and leg musculature becomes fatigued before upper extremity kinematics changes., Clinical Relevance: On the basis of these results, there is the potential that core strengthening and leg strengthening may be valuable adjuncts to prevent upper extremity injury. Further studies specifically looking at this must be conducted., (Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Major League Baseball (MLB) players are at significant risk for both chronic, repetitive overuse injuries as well as acute traumatic injuries. Pitchers have been shown to be at higher risk for sustaining injuries, especially upper extremity injuries, than position players. The past several MLB seasons have seen a dramatic rise in the number of ulnar collateral ligament reconstructions performed in MLB pitchers. Several recent prospective studies have identified risk factors for injuries to both the shoulder and elbow in MLB pitchers. These risk factors include a lack of external rotation, a lack of total rotation, and a lack of flexion in the throwing arm. Thus far, no study has demonstrated a correlation between cumulative work (number of games pitched, total pitches thrown, total innings pitched, innings pitched per game, and pitches thrown per game) and injuries in MLB pitchers, despite several studies showing this correlation in youth pitchers. Although many risk factors have been translated into guidelines for prevention, no study has been conducted to determine whether adherence to these guidelines effectively prevents injuries. Further studies are necessary to define exactly how injuries in MLB players can be prevented.

Background: Shoulder and elbow injuries are a common cause of pain, dysfunction, and inability to play in overhead throwers. Pitch velocity plays an integral part in the etiology of these injuries; however, the demographic and biomechanical correlates with throwing velocity remain poorly understood. We hypothesized that pitchers with higher velocity would have shared demographic and kinematic characteristics., Methods: Normal preseason youth and adolescent pitchers underwent dual-orthogonal high-speed video analysis while pitch velocity was collected with a radar gun. Demographic and pitching history data were also collected. Kinematic data and observational mechanics were recorded. Multivariate regression analysis was performed., Results: A total of 420 pitchers were included, with a mean pitching velocity of 64 ± 10 mph. After multivariate logistic regression analysis, the most important correlates with pitch velocity were age (P < .001; R(2) = 0.658), height (P < .001; R(2) = 0.076), separation of the hips and shoulders (P < .001; R(2) = 0.027), and stride length (P < .001; R(2) = 0.016); in combination, these 4 variables explained 78% of the variance in pitch velocity. Each year of age was associated with a mean 1.5 mph increase in velocity; each inch in height, with 1.2 mph; separation of the hips and shoulders, with 2.6 mph; and a 10% increase in stride length, with 1.9 mph., Conclusion: Pitch velocity is most strongly correlated with age, height, separation of the hips and shoulders, and stride length., (Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the factors within pitcher demographic characteristics, pitching history, and pitch kinematics, including velocity, that correlate with a history of pitching-related injury., Methods: Demographic and kinematic data were collected on healthy youth and adolescent pitchers aged 9 to 22 years in preseason training during a single preseason using dual orthogonal high-speed video analysis. Pitchers who threw sidearm and those who had transitioned to another position were excluded. Players were asked whether they had ever had a pitching-related shoulder or elbow injury. Multivariate logistic regression analysis was performed on those variables that correlated with a history of injury., Results: Four hundred twenty pitchers were included, of whom 31% had a history of a pitching-related injury. Participant height (P = .009, R(2) = 0.023), pitching for more than 1 team (P = .019, R(2) = 0.018), and pitch velocity (P = .006, R(2) = 0.194) served as independent correlates of injury status. A model constructed with these 3 variables could correctly predict 77% of injury histories. Within our cohort, the presence of a 10-inch increase in height was associated with an increase in a history of injury by 20% and a 10-mph increase in velocity was associated with an increase in the likelihood of a history of injury by 12%. Playing for more than 1 team increased the likelihood of a history of injury by 22%., Conclusions: Pitch velocity, pitcher height, and pitching for more than 1 team correlate with a history of shoulder and elbow injury. Current recommendations regarding breaking pitches may not prevent injury. Pitchers should be cautioned about pitching for more than 1 team. Taller pitchers and high-velocity pitchers may be at risk of injury., (Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Superior labral anterior-posterior (SLAP) tears are a common cause of shoulder pain and dysfunction in overhand throwers. Treatment outcomes remain unpredictable, with a large percentage of athletes unable to return to sport. There is considerable debate about the optimal treatment between debridement, repair, and tenodesis., Hypothesis: Labral repair more closely restores neuromuscular control and motion during the overhand pitch than tenodesis of the long head of the biceps., Study Design: Controlled laboratory study., Methods: Eighteen pitchers, including 7 uninjured controls, 6 players pitching after SLAP repair, and 5 players pitching after subpectoral biceps tenodesis (BT), underwent simultaneous surface electromyographic measurement at 1500 Hz and motion analysis at 120 Hz with a 14-camera markerless motion analysis system and high-speed video (120 Hz) to confirm accurate motion tracking. Patients had undergone surgery at least 1 year previously and had returned to pitching with a painless shoulder., Results: No significant differences were observed in the long head of the biceps muscle, short head of the biceps muscle, deltoid, infraspinatus, or latissimus activity between controls, patients after SLAP repair, and patients after BT. The variability from pitch to pitch for each study participant was similar between groups. Based on visual inspection of the activity time plots, BT appeared to more closely restore the normal pattern of muscular activation within the long head of the biceps muscle than did SLAP repair. There were no significant differences between controls and postoperative patients in the majority of pitching kinematics; however, pitchers after SLAP repair showed significantly altered patterns of thoracic rotation (P = .034) compared with controls and were significantly less likely to fall into previously published normal values for lead knee flexion at front foot contact (P = .019)., Conclusion: While both BT and SLAP repair can restore physiologic neuromuscular control, pitchers who undergo SLAP repair may exhibit altered patterns of thoracic rotation when compared with controls and pitchers who undergo BT., Clinical Relevance: While both tenodesis and SLAP repair can restore physiologic neuromuscular control, SLAP repair may alter pitching biomechanics., (© 2014 The Author(s).)

Adolescent baseball players, especially pitchers, are at increased risk for shoulder and elbow injuries as their level of competition increases. The intersection of the adolescent growth spurt with the high levels of elbow valgus and shoulder rotational torques placed upon the arm during overhand pitching predisposes the shoulder and elbow to physeal injuries. Little League shoulder and Little League elbow syndromes most commonly represent pathology at the physeal regions of the proximal and distal humerus and proximal ulna sustained from repetitive loads caused by overhead throwing. There is a growing understanding that these injuries occur on a wide spectrum from delayed physeal closure and physeal widening to acute transphyseal fracture. Although operative intervention is infrequently required, patient and parent counseling can be complex. Health care professionals who care for adolescent baseball players also can play an important role in prevention. Appropriate counseling requires a comprehensive understanding of the clinical, radiographic, and biomechanical aspects of these injuries. This review summarizes these major concepts, focusing on the best available evidence from recent biomechanical and clinical studies on shoulder and elbow injuries in adolescent baseball pitchers.

Hypothesis: The young throwing athlete is susceptible to medial elbow injury due to valgus overload. We hypothesized that this injury can occur during the throwing motion with an acute episode of medial elbow pain resulting in an inability to effectively participate in throwing activities. In addition, appropriate treatment of acute, medial epicondyle avulsion fractures in baseball players can result in an asymptomatic elbow with subsequent return to play within a year of injury., Materials and Methods: A case series of all youth baseball players with medial epicondyle avulsion fractures that occurred while throwing were identified. We studied several variables, including demographics, adherence to USA Baseball youth pitching recommendations, clinical history, radiographic findings, treatment, and outcome., Results: Eight skeletally immature baseball players, who were a mean age of 13 years (range, 11-15 years), presented with medial epicondyle fractures that occurred while throwing. All 8 players experienced sudden pain during throwing, and all 5 players with appropriate age and position qualifications did not conform to the USA Baseball youth pitching recommendations. Anteroposterior radiographs documented average fracture displacement of 5.1 mm (range, 2.5-10 mm). Five of 8 players had 5 mm or less of displacement and were selected for nonoperative treatment. Three of 8 players had more than 5 mm of displacement and underwent open reduction and internal fixation. All players were able to return to play at an average of 7.6 months (range, 4-10 months)., Discussion: Medial epicondyle avulsion fractures can occur with a characteristic acute presentation while throwing in youth baseball players. Prevention may be possible when conforming to established USA Baseball youth pitching recommendations. Once an acute medial epicondyle avulsion fracture occurs, these injuries may be managed using published treatment algorithms, with successful return to play in less than 1 year., (Copyright © 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

Background: Sports-related injuries remain a significant problem for collegiate baseball players. Although some studies reported the epidemiology of sports-related injuries among collegiate baseball players, the latest information on sport-related injuries should be provided. Purpose: To examine the current trends of sports-related injuries among collegiate baseball players in the Pacific 12 (PAC-12) Conference. Study Design: Descriptive epidemiology study. Methods: Demographic and injury data were obtained from a database of the PAC-12 Health Analytics Program between 2016 and 2021. Injury incidence, type, mechanism, and outcome were analyzed. The annual incidence of injuries was defined as the number of injuries per total players for 1 year. Detailed reports of the 20 most common specific diagnoses were generated. Results: A total of 1434 sports-related injuries occurred in 6 years, with the number increasing from 2016 (n = 75; incidence, 8.5 per 100 player-years) to 2021 (n = 378; incidence, 43 per 100 player-years). Most of the injuries occurred in pitchers (33.6%), were acute (76.6%), resulted in missed time (68.8%), and were new injuries (86.9%). In addition, most injuries were caused by noncontact events (53.2%) and occurred during in-season games (39.9%) and practice (47.4%). Only 1.3% of sports-related injuries did not result in a return to the previous activity level. Rotator cuff tendon injuries were the most common specific diagnoses (n = 98), followed by ulnar collateral ligament (UCL) injuries (n = 63), hamstring muscle strains (n = 60), ankle ligament sprains (n = 46), and hand/wrist fractures (n = 40). UCL injuries had the highest proportion of surgical interventions (41.3% of all UCL injuries) and the longest days to clearance (167 ± 197 days) among the 20 most common diagnoses. Conclusion: The number of sports-related injuries among PAC-12 collegiate baseball players has increased by approximately 5 times over the past 6 years. Rotator cuff tendon injuries followed by UCL injuries, hamstring muscle strains, ankle ligament sprains, and hand/wrist fractures are the most common specific diagnoses among this cohort of collegiate baseball players. Of the 20 most common specific diagnoses, UCL injuries most often require surgical interventions and had the longest return to playtime. [ABSTRACT FROM AUTHOR]

Background: Oblique strains have become a common injury among professional baseball players. The influence of player workload on oblique strains remains unknown. Purpose/Hypothesis: To determine whether workload is a risk factor for oblique strains in professional baseball players. We hypothesized that fewer days of rest, more innings pitched/fielded per game, and more batters faced/plate appearances per game would significantly increase a player's risk of sustaining an oblique strain. Study Design: Case-control study; Level of evidence, 3. Methods: All professional baseball players who sustained an oblique strain between 2011 and 2017 were identified using the Major League Baseball Health and Injury Tracking System. A separate dataset of player usage—days of rest per game, innings pitched or fielded per game, and batters faced or plate appearances per game—was used to determine the workload. We compared these usage variables between player games ≤2, ≤6, ≤12, and >12 weeks before a documented oblique strain with player games from a control group of players with no oblique strains. In a paired analysis, we compared acute (player games ≤2, ≤6, and ≤12 weeks preinjury) versus chronic (player games >12 weeks preinjury) workloads. Results: There were 311 oblique strains in pitchers and 392 oblique strains in position players during the study period. In pitchers, more innings pitched and more batters faced were associated with a subsequent oblique strain (P <.001 for all). In position players, fewer days of rest, more innings fielded, and more plate appearances were associated with a subsequent oblique strain (P <.001 for all). Pitchers who pitched ≥7 innings per game had a 2.4-fold (95% CI, 1.4-4.9) increased risk of subsequent oblique strain compared with those who pitched 1 inning per game. The percentage of position players with a subsequent oblique strain increased by 2.1-fold (95% CI, 1.3-3.5) with >4 plate appearances compared with 1 plate appearance per game. Conclusion: Our analysis demonstrated that workload was associated with an increased risk of sustaining an oblique injury in professional baseball players. High workload over time was more predictive of oblique strains compared to acute increases over chronic baseline workload. [ABSTRACT FROM AUTHOR]

Background: Although pitch count and rest guidelines have been promoted for youth and adolescent baseball players for nearly 2 decades, compliance with guidelines remains poorly understood. Purpose/Hypothesis: The purpose of this study was to determine the frequency of compliance with Major League Baseball (MLB) Pitch Smart guidelines as well as the association between compliance and range of motion (ROM), strength, velocity, injury, and pitcher utilization. It was hypothesized that pitchers in violation of current recommendations would have increased strength, velocity, and injury. Study Design: Case-control study; Level of evidence, 3. Methods: This was a prospective, multicenter study of 115 high school pitchers throughout the United States. Pitchers were surveyed about their compliance with current off-season, rest-related guidelines, and history of injury. During the preseason, pitchers underwent standardized physical examinations, and pitch velocity was measured. Pitch counts were collected during the baseball season that followed. Dynamometer strength testing of shoulder forward flexion, and external rotation as well as grip strength was recorded. We compared pitchers who were compliant with recommendations with those who were noncompliant using Student t and Mann-Whitney U tests. Results: Based on preseason data, 84% of pitchers had violated current Pitch Smart guidelines. During the season, 14% had at least 1 violation of the Pitch Smart guidelines. Across both the preseason survey and in-season pitch counts, 89% of players had at least 1 violation of the Pitch Smart guidelines. While there were no significant differences in ROM or strength, the noncompliant group had higher maximum pitch velocity than the compliant group (74 ± 8 vs 69 ± 5 mph [119 ± 13 vs 111 ± 8 kph], respectively; P =.009). Players' self-reported velocity differed significantly from the direct measurement, for both peak velocity (80 ± 6 vs 73 ± 8 mph [129 ± 9 vs 117 ± 13 kph], respectively; P <.001) and mean velocity (73 ± 8 vs 53 ± 27 mph [117 ± 13 vs 85 ± 43 kph], respectively; P <.001). Conclusion: Most high school pitchers were not fully compliant with current Pitch Smart guidelines, and they tended to overestimate their peak velocity by 7 mph (11 kph). Pitchers who threw with greater velocity were at higher risk for violating Pitch Smart recommendations. [ABSTRACT FROM AUTHOR]

Background: Internal impingement is a common cause of shoulder pain and dysfunction in baseball pitchers. Purpose/Hypothesis: The purpose of this study was to determine if the amount of rest days between outings, the number of innings pitched in each outing, and the number of batters faced in each outing are risk factors for internal impingement in professional baseball pitchers. It was hypothesized that a higher workload would significantly increase a pitcher's risk of developing internal impingement. Study Design: Case-control study; Level of evidence, 3. Methods: All professional (Major and Minor League) baseball pitchers who were diagnosed with internal impingement between 2011 and 2017 were identified using the Major League Baseball's Health and Injury Tracking System. A separate player usage data set was used to determine workload. The authors compared workload variables (days of rest, innings pitched, and batters faced per game) between each of 4 injury-exposure groups (pitchers with documented internal impingement <2, <6, <12, and >12 weeks after a game) and a control group of pitchers with no internal impingement using Student t tests or Mann-Whitney U tests. In a within-pitcher paired analysis of the injury groups, the workload variables during 3 acute periods (<2, <6, and <12 weeks preinjury) were compared with the baseline values (>12 weeks preinjury). Results: Overall, there were 624 professional baseball pitchers diagnosed with internal impingement during the study period. Compared with pitcher games (n = 213,964), pitchers in all 4 injury-exposure groups had significantly more innings pitched per game (P ≤.003 for all) and faced significantly more batters per game (P <.001 for all). There were significantly more starting pitchers in each of the injury-exposure groups when compared with the controls (P <.001 for all). However, when comparing acute and baseline workloads in the pitchers diagnosed with internal impingement, there were no significant differences in the number of innings pitched, batters faced, or days of rest. Conclusion: This analysis revealed significantly greater pitcher workload and percentage of starting pitchers in professional baseball players diagnosed with internal impingement when compared with healthy controls. However, this injury did not seem to be associated with an acute increase in workload. [ABSTRACT FROM AUTHOR]

Objectives: Determine the performance and return to play (RTP) outcomes for professional baseball players that undergo surgical treatment for thoracic outlet syndrome. Methods: All professional baseball players who underwent surgical treatment of TOS between 2010-2017 were identified using the major league baseball (MLB) HITS (Health and Injury Tracking System) database. Demographic and performance data (pre and post-surgery) for each player was recorded. Standard demographic and return to play outcomes were measured for all players and compared between different types of TOS and league status. Performance variables were analyzed for pitchers and compared to a 1:1 matched set of control pitchers. Results: Overall, 52 players underwent surgery for TOS of which 46 (88%) were pitchers. Neurogenic TOS was the most common and seen in 69% of players. Venous TOS was seen in 29% of players, and a single player had arterial TOS. Following TOS surgery, 79% of players returned to play at the same level (RTSP) and played at least 3 years after surgery. There was no differences in RTSP rate based on the type of TOS. There was no statistically significant difference in RTP and RTSP rates between major and minor league players. In pitchers only, there was a 76% RTSP, which was not different from the natural attrition of control pitchers (p=0.874). Following TOS surgery, pitchers saw a decline in several performance metrics, but not statistically different when compared to the control pitchers. This indicated that the decline in performance following TOS surgery was similar to the decline seen in healthy professional pitchers as they age. Conclusions: The most common type of TOS seen in professional baseball players is neurogenic. The RTSP rate following surgery for TOS in all professional baseball players is 79%. There was no statistically significant difference in ability to RTP based on the type of TOS or league status. Pitchers who underwent surgery for TOS had no significant difference in pitching performance metrics following surgery compared to matched controls. Overall, surgery for thoracic outlet syndrome can help prolong a professional baseball players career and help pitchers maintain their performance over time similar to their peers who have not had surgery for TOS. [ABSTRACT FROM AUTHOR]

Background: Meniscal repair is an effective treatment option for certain meniscal injuries to preserve meniscal function and limit the progression of knee osteoarthritis. Outcomes after meniscal repair in professional baseball players are not well documented. Purposes/Hypothesis: The purposes of this study were to determine performance and return to sport (RTS) in professional baseball players after meniscal repair and compare the results of medial versus lateral meniscal repair. It was hypothesized that there would be a high RTS rate, with no difference in the rate or timing of RTS between players who underwent medial versus lateral meniscal repair. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent meniscal repair between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Descriptive information and performance data (before and after injury) for each player were recorded. The rate and timing of RTS were then compared between players who underwent medial versus lateral meniscal repair. Results: Included were 31 patients (mean age, 24 ± 3 years). There were 6 players (19%) who had failed repair, underwent subsequent meniscectomy within 2 years of meniscal repair, and were thus excluded from the performance analysis. Of the remaining 31 players, 68% returned to the same or a higher level of play, and 6% of players returned to a lower level of play. Most repair procedures (60%) were performed using the all-inside technique, and 72% of players underwent lateral meniscal repair. The mean time missed was 187 ± 67 days, and the mean time to RTS at full competitive play was 209 ± 84 days. There were no significant differences in the rate or timing of RTS between players who underwent medial versus lateral meniscal repair (P ≥.999 and P =.574, respectively). Pitchers saw a decrease in usage but no change in performance after meniscal repair. For batters, most metrics were unchanged, but there was a significant decrease in base stealing and on-base percentage after surgery. Conclusion: The RTS rate after meniscal repair in Major League Baseball players was 74% at a mean of 209 days; 19% of players had failed repair and underwent subsequent meniscectomy within 2 years of repair. No difference in the rate or timing of RTS was observed between players who underwent medial versus lateral meniscal repair. [ABSTRACT FROM AUTHOR]

Background: Bicipital disorders are common among overhead athletes, especially professional baseball players. The ideal treatment for bicipital problems in professional baseball players is unknown. Purpose/Hypothesis: The purpose was to determine the return-to-sport (RTS) rate and performance after RTS in professional baseball players who underwent biceps tenodesis. It was hypothesized that there will be a high RTS rate in this population, with no difference between the biceps tenodesis and control groups in the RTS rate or performance. Study Design: Case series; Level of evidence, 4. Methods: All professional Major League Baseball players who underwent biceps tenodesis between 2014 and 2017 were included. Players with concomitant rotator cuff repair were excluded. Demographic and performance data (preoperative and postoperative) were recorded for each player. Performance metrics were then compared between players with biceps tenodesis and matched controls (no history of biceps tenodesis). Results: Included were 14 players (mean age, 27 ± 4 years; 12 pitchers, 2 position outfielders). Most surgeries (79%) were open subpectoral tenodeses, 2 were arthroscopic biceps transfers, and 1 was an arthroscopic suprapectoral tenodesis. Fixation methods included cortical button (42%), interference screw (25%), suture anchor (25%), and drill holes (8%). Most players (79%) underwent concomitant procedures (43% underwent superior labral anterior-posterior repairs). While 86% (12/14) were able to RTS, 50% (7/14) returned at the same or a higher level, and 50% of the whole study were either unable to return or returned to a lower level. Among pitchers, 100% (12/12) were able to RTS, but only 50% (6/12) were able to return to the same or a higher level. For those players who did RTS, it took 245 ± 84 days, and their performance after RTS was unchanged and did not differ from that of matched controls. Conclusion: Open subpectoral tenodesis was the most common tenodesis technique performed on professional baseball players. While 86% of players returned to sport after biceps tenodesis, only 50% returned to the same or higher level. No decline in performance was noted in players who returned successfully. [ABSTRACT FROM AUTHOR]

Background: There are some professional baseball players who begin their career as a position player and later convert to a pitcher; injury rates in these players are unknown. Purpose: To compare injury rates of professional baseball players who started their career as position players and converted to pitchers with a control group of pitchers who have been only pitchers throughout their professional career. Hypothesis: Injury rates would be lower in the conversion players. Study Design: Cohort study; Level of evidence, 3. Methods: All players who began their professional baseball career as position players and converted to pitchers between 2011 and 2018 were included. All injuries that occurred after they converted to pitchers were included. The conversion players were matched 1 to 1 with a control group of pitchers who entered professional baseball as pitchers and never changed position. Injury rates were compared between groups. The performance between groups was also compared. Results: Overall, 221 players were identified who converted from position players to pitchers. There were significantly more injuries per year in the control pitcher group (0.8 ± 0.9) than in the conversion pitcher group (0.7 ± 0.9; P =.015). Injuries in the control group resulted in 61 ± 112 days missed per injury, while injuries in the conversion player group resulted in 54 ± 102 days missed per injury (P =.894). Injury characteristics differed between groups. However, in both groups, most of the injuries were related to pitching or throwing, were noncontact or gradual overuse injuries, and involved the upper extremity. Converted pitchers had lower pitcher usage, with fewer games and innings pitched (P <.001), with significantly worse statistics for walks plus hits per inning pitched (P =.018). Conclusion: Professional baseball players who convert from position players to pitchers are injured at lower rates than control pitchers. Conversion pitchers have lower pitcher usage, which may contribute to their reduced injury rates. [ABSTRACT FROM AUTHOR]

Background: There has been minimal research investigating injury and pitching performance differences between Major League Baseball (MLB) and other professional leagues. Purpose/Hypothesis: This 2-team comparison between MLB and Japan's Nippon Professional Baseball (NPB) involved affiliated players over 5 years. We hypothesized that teams would differ in the injury incidence, mechanism of injury, pitch velocity, and pitch type usage. Study Design: Descriptive epidemiology study. Methods: Between 2015 and 2019, pitching data as well as injury statistics for the highest level and minor league affiliates of the Los Angeles Angels (MLB) and the Hiroshima Toyo Carp (NPB) were reviewed for significant differences in the injury prevalence, injury type, mechanism of injury, and days missed. In total, 3781 MLB and 371 NPB injuries were studied. Results: MLB-affiliated players were significantly younger, taller, and heavier (P <.001) than were NPB-affiliated players. MLB-affiliated pitchers threw faster than did their NPB counterparts (P =.026). MLB minor league pitchers threw more curveballs than did NPB minor league pitchers (P =.004), and MLB minor league relief pitchers threw more sliders than did NPB minor league relief pitchers (P =.02). The MLB team had a 3.7-fold higher incidence of injuries versus the NPB team (0.030 vs 0.008 injuries per player-game, respectively) as well as more repeat injuries, with fewer days missed per injury (15.8 ± 54.7 vs 36.2 ± 55.1 days, respectively; P <.001). The MLB team also had a higher percentage of injuries that were throwing related (P <.001), were contact related (P <.001), and occurred outside of competition (P <.001) compared with the NPB team. Conclusion: This is the first empirical study examining injury trends and pitching characteristics between MLB and NPB athletes. MLB-affiliated pitchers threw faster and relied more on breaking pitches in comparison with NPB-affiliated pitchers. From injury data, MLB players were younger, taller, and heavier with a higher percentage of throwing-related injuries, contact injuries, and injuries sustained outside of competition. Overall, the MLB team indicated a 3.7-fold higher rate of reported injuries with fewer days missed per injury than did the NPB team. Competitive conditions are distinctly different between MLB and NPB, and thus, more extensive research collaborations in the future can identify best practices to advance health and performance for both leagues. [ABSTRACT FROM AUTHOR]

Background: The results of open reduction and internal fixation (ORIF) of stress reactions and fractures of the olecranon among professional baseball players with regard to return to sport (RTS) are unknown. Purpose/Hypothesis: To determine the RTS rate and performance of professional baseball players after ORIF of acute, displaced olecranon fractures and olecranon stress fractures and to compare the RTS rate and performance with that of matched controls. The authors hypothesized that there is a high rate of RTS among professional baseball players after ORIF of acute, displaced olecranon fractures and olecranon stress fractures with no significant difference in rate of RTS or performance between cases and controls. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent ORIF of the olecranon between 2010 and 2016 were included. Demographic and performance data (before and after surgery) for each player were recorded. Performance metrics were then compared between cases and a group of matched controls. Results: Overall, 52 professional baseball players (mean ± SD age, 22.6 ± 3.6 years) underwent ORIF of an olecranon fracture. The majority of players sustained a primary olecranon stress fracture (73%) that was fixed with 1 screw (60%), with an overall RTS rate of 67.5%. No difference in RTS rate existed between matched controls and the cases. No significant difference existed between the primary pre- and postoperative performance metrics (ie, change in performance) for pitchers who underwent ORIF of an acute, displaced olecranon fracture or ORIF of a primary olecranon stress fracture. No significant difference existed between pitchers who underwent ORIF of a primary olecranon stress fracture and matched controls in any of the primary performance metrics. Three cases and 2 controls underwent ulnar collateral ligament reconstruction later in their careers after olecranon ORIF. Conclusion: Professional baseball players who undergo ORIF of an olecranon fracture (acute, displaced, or stress) have an RTS rate of 67.5% (57.6% to the same or higher level), which is no different from natural attrition among matched controls. No decline in performance metrics was seen among players who were able to RTS when compared with their preoperative performance or the performance of matched controls. [ABSTRACT FROM AUTHOR]