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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: 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.

Introduction: Humeral avulsion of the inferior glenohumeral ligament is a rare injury in athletes and can involve different parts of the complex. Axillary pouch avulsion, in particular, has only recently been recognized in the literature, but has never been described in professional baseball pitchers., Materials and Methods: A retrospective review of professional baseball players presenting to our institution over 5 years was performed. Patients with Bankart lesions or fractures were excluded. Preoperative MRI was retrospectively correlated with the clinical and arthroscopic findings, as available., Results: Four professional baseball pitchers were identified, all who had axillary pouch humeral avulsions of the inferior glenohumeral ligament. There was a concomitant avulsion of the anterior band in one patient. Associated findings included labral tears (n = 2) and partial thickness tear of the rotator cuff (n = 2). Three patients ultimately had their axillary pouch avulsions repaired at most recent follow-up., Conclusions: APHAGL lesions can be seen in overhead athletes such as baseball pitchers and should be carefully considered as a potential cause of disability. Appropriate diagnosis is important to ultimately elucidate the optimal management of these lesions.