Journal of Orthopaedic & Sports Physical Therapy, 1993
Surgical reconstruction of the anterior cruciate ligament (ACI) using a patellar tendon autograft... more Surgical reconstruction of the anterior cruciate ligament (ACI) using a patellar tendon autograft is a common orthopaedic procedure. Complications such as arthrofibrosis, patellar fracture, significant donor site pain, and quadriceps muscle weakness can occur from this procedure. Previous studies have not documented the effects of isolated graft procurement without concomitant ligamentous reconstruction on the donor extremity. This case study documents the clinical outcome results of an individual who underwent a central one-third graft harvest from his contralateral uninjured knee for an ACL graft of his injured ACI-deficient knee. The results indicate that at 4 months following graft procurement, the knee extensors were equal to the preoperative isokinetic test results of that leg. In addition, the patient exhibited full range of motion and no patellofemoral complaints or dysfunction. At 12 months postsurgery, the graft donor leg was 5-goh stronger than the preoperative test results. The results of this case study suggest that isolated harvesting of a 10mm central patellar tendon free graft may not result in significant quadriceps muscle weakness or contribute to donor site pain.
Journal of Orthopaedic & Sports Physical Therapy, 1994
sokinetic testing is a commonly utilized tool for the assessment of muscular strength in the orth... more sokinetic testing is a commonly utilized tool for the assessment of muscular strength in the orthopaedic and sports medicine setting. Isokinetics are frequently chosen because o f their inherent patient safety (2 l), objectivity (108.1 15), and reproducibility in testing measures (28,64,113). Most often, the interpretation of isokinetic test data has been limited to the assessment of peak torque (
Journal of Orthopaedic & Sports Physical Therapy, 1997
of a patient whose history suggests subtle glenohumeral joint instability may be extremely diffic... more of a patient whose history suggests subtle glenohumeral joint instability may be extremely difficult for the clinician due to the normal amount of capsular laxity commonly present in most individuals. An essential component of the physical examination is a thorough and meticulous subjective history which includes the mechanisms of injury and/or dysfunction, chief complaint, level of disability, and aggravating movements. The physical examination must include an assessment of motion, static stability testing, muscle testing, and a neurologic assessment. A comprehensive understanding of various stability testing maneuvers is important for the clinician to appreciate. The evaluation techniques discussed in this paper should assist the clinician in determining the passive stability of the glenohumeral joint.
Journal of Orthopaedic & Sports Physical Therapy, 1997
houlder instability is a vague, nonspecific term which actually represents a wide spectrum of cli... more houlder instability is a vague, nonspecific term which actually represents a wide spectrum of clinical pathologies, ranging from gross instability to subtle subluxation. Patients exhibiting shoulder instability are commonly encountered by therapists, athletic trainers, and physicians in both the general orthopaedic and sports medicine population. Often, an appropriate clinical diagnosis is difficult due to the excessive amount of capsular laxity normally seen and appreciated during clinical examination of the glenohumeral joint. Clinicians may become perplexed when attempting to determine the amount of normal acceptable laxity vs. pathological ligamentous laxity. The purpose of this paper is to discuss current concepts related to the anatomic stabilizing structures of the glenohumeral joint. The glenohumeral joint is inherently unstable and exhibits the greatest amount of motion found in any joint in the human body (116). Additionally, the glenohumeral joint is the most commonly dislocated major joint in the human body (20,47). Thus, the shoulder joint sacrifices stability for mobility. Although the glenohumeral joint exhibits significant physiologic motion, only a few millimeters of humeral head displacement occur during these movements in the normal individual (1,35,36,40, 75,76,103). Conversely, on clinical examination, Matsen et al (55) have Significant contemporary advances have permitted a more comprehensive understanding and development of some interesting concepts about the glenohumeral joint. The purpose of this review paper was to discuss current concepts related to the anatomic stabilizing structures of the shoulder joint complex and their clinical relevance to shoulder instability. The clinical syndrome of shoulder instability represents a wide spectrum of symptoms and signs which may produce various levels of dysfunction, from subtle subluxations to gross joint instability. The glenohumeral joint attains functional stability through a delicate and intricate interaction between the passive and active stabilizing structures. The passive constraints include the bony geometry, glenoid labrum, and the glenohumeral joint capsuloligamentous structures. Conversely, the active constraints, also referred to as the active mechanisms, include the shoulder complex musculature, the proprioceptive system, and the musculoligamentous relationship. The interaction of the active and passive mechanisms which provide passive and active glenohumeral joint stability will be thoroughly discussed in this paper.
Journal of Orthopaedic & Sports Physical Therapy, 2006
Articular cartilage lesions of the knee joint are common in patients of varying ages. Some articu... more Articular cartilage lesions of the knee joint are common in patients of varying ages. Some articular cartilage lesions are focal lesions located on one aspect of the tibiofemoral or patellofemoral joint. Other lesions can be extremely large or involve multiple compartments of the knee joint and these are often referred to as osteoarthritis. There are numerous potential causes for the development of articular cartilage lesions: joint injury (trauma), biomechanics, genetics, activities, and biochemistry. Numerous factors also contribute to symptomatic episodes resulting from lesions to the articular cartilage: activities (sports and work), joint alignment, joint laxity, muscular weakness, genetics, dietary intake, and body mass index. Athletes appear to be more susceptible to developing articular cartilage lesions than other individuals. This is especially true with specific sports and subsequent to specific types of knee injuries. Injuries to the anterior cruciate ligament and/or menisci may increase the risk of developing an articular cartilage lesion. The treatment for an athletic patient with articular cartilage lesions is often difficult and met with limited success. In this article we will discuss several types of knee articular cartilage injuries such as focal lesions, advanced full-thickness lesions, and bone bruises. We will also discuss the risk factors for developing full-thickness articular cartilage lesions and osteoarthritis, and describe the clinical evaluation and nonoperative treatment strategies for these types of lesions in athletes.
Journal of Orthopaedic & Sports Physical Therapy, 2003
Descriptive postoperative follow-up research. Objectives: The purpose of this investigation was t... more Descriptive postoperative follow-up research. Objectives: The purpose of this investigation was to describe the return-to-competition rate and functional outcome of overhead athletes following arthroscopic thermal-assisted capsular shrinkage (TACS). Background: Traditional open procedures to correct instability in overhead athletes, such as capsulolabral repairs and capsular shifts, have produced less-than-favorable results, which have led to the development of TACS. Currently there are no long-term follow-up studies documenting the efficacy of this procedure in groups greater than 31 subjects or for a time period greater than 27 months. Methods and Measures: Two hundred thirty-one consecutive overhead athletes who due to symptoms of hyperlaxity had previously undergone a TACS procedure from 1997 to 1999 were selected for inclusion in the study. During a 1-month period, 130 of these athletes (mean age ± SD, 24 ± 6 years; 113 male, 17 female) were contacted by phone for follow-up at a mean of 29.3 months postoperatively (range, 15.4-46.6 months). Of the 130, 105 participated in baseball (80 pitchers), 14 in softball, 4 in football (quarterbacks), 4 in tennis, and 3 in swimming. Fifty-four (42%) subjects were professional, 49 (38%) collegiate, 16 (12%) high school, and 11 (8%) recreational athletes. One hundred twenty-three of the 130 (95%) underwent 1 or more concomitant procedure(s) at the time of TACS. Most commonly performed were labral debridements (69%), rotator cuff debridements (65%), and superior labral repairs (35%). Subjects who returned to competition were retrospectively evaluated using a modified Athletic Shoulder Outcome Rating Scale to subjectively assess pain, strength and endurance, stability, intensity, and performance. Overall results were based on a 90-point scale with scores of 80 to 90 representing excellent, 60 to 79 good, 40 to 59 fair, and less than 40 poor results. Results: One hundred thirteen out of 130 subjects (87%) returned to competition. Mean (±SD) time from surgery to return to competition was 8.4 ± 4.6 months. Mean outcome score for all subjects was 79/90; 75 (66%) subjects had excellent, 24 (21%) good, 11 (10%) fair, and 3 (3%) poor result. The mean outcome score for males was 80/90 and for females was 70/90.
Journal of Orthopaedic & Sports Physical Therapy, 2002
Glenohumeral joint instability is a common pathology observed in the orthopedic and sports medici... more Glenohumeral joint instability is a common pathology observed in the orthopedic and sports medicine settings. Overhead athletes often exhibit a certain degree of acquired laxity that can lead to various pathologies. Unfavorable results often observed with traditional open procedures to correct instability in the overhead athlete have led to the development of arthroscopic thermal-assisted capsular shrinkage (TACS). TACS is not commonly used as an isolated procedure in overhead athletes; various procedures are often performed concomitantly. The overall outcome greatly depends on a postoperative rehabilitation program that must be assessed and adjusted frequently based on several factors. Knowledge of the basic science of TACS as well as emphasis on dynamic stabilization, proprioception, and neuromuscular control are vital to the rehabilitation program for overhead athletes. The purpose of this paper is to discuss the basic science and clinical application of thermal-assisted capsular shrinkage of the glenohumeral joint as well as the postoperative rehabilitation for the overhead athlete and the patient with congenital laxity and related multidirectional instability.
Journal of Orthopaedic & Sports Physical Therapy, 1993
The physical examination of the thrower's elbow presents the clinician with the clinical challeng... more The physical examination of the thrower's elbow presents the clinician with the clinical challenge of differentially diagnosing specific pathologies. The examination should include a thorough history and a well-organized physical examination, which relies on an extensive knowledge of the functional anatomy of the elbow. The components of an elbow examination include inspection/ observation, palpation of bony and soh tissues, range of motion assessment, resisted muscle testing (both manual and mechanical), neurologic testing, and special tests. The special tests commonly performed on the thrower's elbow are the Tinel test, tennis elbow sign, ulnar collateral ligament stability testing, valgus extension overload test, and radiocapitella chondromalacia test. Other tests include radiographic examination, such as computerized tomograph arthrogram and magnetic resonance imaging testing. Information presented in this paper will provide the clinician with a systematic and thorough evaluation process for the thrower's elbow.
Journal of Orthopaedic & Sports Physical Therapy, 2009
Patient in beach-chair position, with the coracoid process, acromioclavicular joint, clavicle, an... more Patient in beach-chair position, with the coracoid process, acromioclavicular joint, clavicle, and acromion marked for the left shoulder. For an open rotator cuff repair, a 3-to 6-cm incision is marked parallel to the lateral border of the acromion.
Clinical Orthopaedics & Related Research, 2012
Background Repetitive overhead throwing motion causes motion adaptations at the glenohumeral join... more Background Repetitive overhead throwing motion causes motion adaptations at the glenohumeral joint that cause injury, decrease performance, and affect throwing mechanics. It is essential to define the typical range of motion (ROM) exhibited at the glenohumeral joint in the overhead thrower. Questions/purposes We (1) assessed the glenohumeral joint passive range of motion (PROM) characteristics in professional baseball pitchers; and (2) applied these findings clinically in a treatment program to restore normal PROM and assist in injury prevention. Methods From 2005 to 2010, we evaluated 369 professional baseball pitchers to assess ROM parameters, including bilateral passive shoulder external rotation (ER) at 45°of abduction, external and internal rotation (IR) at 90°abduction while in the scapular plane, and supine horizontal adduction. Results The mean ER was greater for the throwing and nonthrowing shoulders at 45°of abduction, 102°and 98°, respectively. The throwing shoulder ER at 90°of abduction was 132°compared with 127°on the nonthrowing shoulder. Also, the pitcher's dominant IR PROM was 52°c ompared with 63°on the nondominant side. We found no statistically significant differences in total rotational motion between the sides. Conclusions Although we found side-to-side differences for rotational ROM and horizontal adduction, the total rotational ROM was similar. Clinical Relevance The clinician can use these PROM values, assessment techniques, and treatment guidelines to accurately examine and develop a treatment program for the overhead-throwing athlete.
Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk m... more Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isola...
Objectives: The purpose of this study was to determine whether GIRD and/or bilateral difference i... more Objectives: The purpose of this study was to determine whether GIRD and/or bilateral difference in total rotational motion (TRM) of the glenohumeral joint (external rotation + internal rotation) correlated with elbow injuries in professional baseball pitchers. Methods: This study was conducted over eight competitive seasons (2005-2012). Each year during spring training, the same examiners assessed passive range of motion (PROM) of both the dominant and non-dominant shoulders of professional pitchers using a bubble goniometer. In total, 505 examinations were conducted on 296 pitchers. Glenohumeral joint motion was assessed in supine with the arm at 90 degrees of abduction and in the plane of the scapula for ER and IR. During ER and IR ROM assessment, the scapula was stabilized per methods previously established. Elbow injuries and days missed due to injury were assessed and recorded by the medical staff of the team. Results: Significant differences were noted during side-to-side comp...
International journal of sports physical therapy, 2013
In most shoulder conditions a loss of glenohumeral motion results in shoulder performance impairm... more In most shoulder conditions a loss of glenohumeral motion results in shoulder performance impairments. However, in the overhead athlete loss of glenohumeral internal rotation, termed glenohumeral internal rotation deficiency (GIRD), is a normal phenomenon that should be expected. Without a loss of glenohumeral internal rotation the overhead athlete will not have the requisite glenohumeral external rotation needed to throw a baseball at nearly 100 miles per hour, or serve a tennis ball at velocities of 120 miles per hour or more. Not all GIRD is pathologic. The authors of this manuscript have defined two types of GIRD; one that is normal and one that is pathologic. Anatomical GIRD (aGIRD) is one that is normal in overhead athletes and is characterized by a loss of internal rotation of less than 18°-20° with symmetrical total rotational motion (TROM) bilaterally. Pathologic GIRD (pGIRD) is when there is a loss of glenohumeral internal rotation greater than 18°-20° with a corresponding...
Injuries to the elbow joint in baseball pitchers appear common. There appears to be a correlation... more Injuries to the elbow joint in baseball pitchers appear common. There appears to be a correlation between shoulder range of motion and elbow injuries. To prospectively determine whether decreased ROM of the throwing shoulder is correlated with the onset of elbow injuries in professional baseball pitchers. Cohort study; Level of evidence, 2. For 8 consecutive years (2005-2012), passive range of motion of both the throwing and nonthrowing shoulders of all major and minor league pitchers within a single professional baseball organization were measured by using a bubble goniometer during spring training. In total, 505 examinations were conducted on 296 pitchers. Glenohumeral external rotation and internal rotation were assessed in the supine position with the arm at 90° of abduction and in the plane of the scapula. The scapula was stabilized per methods previously established. Total rotation was defined as the sum of external rotation and internal rotation. Passive shoulder flexion was ...
Journal of Orthopaedic & Sports Physical Therapy, 1993
Surgical reconstruction of the anterior cruciate ligament (ACI) using a patellar tendon autograft... more Surgical reconstruction of the anterior cruciate ligament (ACI) using a patellar tendon autograft is a common orthopaedic procedure. Complications such as arthrofibrosis, patellar fracture, significant donor site pain, and quadriceps muscle weakness can occur from this procedure. Previous studies have not documented the effects of isolated graft procurement without concomitant ligamentous reconstruction on the donor extremity. This case study documents the clinical outcome results of an individual who underwent a central one-third graft harvest from his contralateral uninjured knee for an ACL graft of his injured ACI-deficient knee. The results indicate that at 4 months following graft procurement, the knee extensors were equal to the preoperative isokinetic test results of that leg. In addition, the patient exhibited full range of motion and no patellofemoral complaints or dysfunction. At 12 months postsurgery, the graft donor leg was 5-goh stronger than the preoperative test results. The results of this case study suggest that isolated harvesting of a 10mm central patellar tendon free graft may not result in significant quadriceps muscle weakness or contribute to donor site pain.
Journal of Orthopaedic & Sports Physical Therapy, 1994
sokinetic testing is a commonly utilized tool for the assessment of muscular strength in the orth... more sokinetic testing is a commonly utilized tool for the assessment of muscular strength in the orthopaedic and sports medicine setting. Isokinetics are frequently chosen because o f their inherent patient safety (2 l), objectivity (108.1 15), and reproducibility in testing measures (28,64,113). Most often, the interpretation of isokinetic test data has been limited to the assessment of peak torque (
Journal of Orthopaedic & Sports Physical Therapy, 1997
of a patient whose history suggests subtle glenohumeral joint instability may be extremely diffic... more of a patient whose history suggests subtle glenohumeral joint instability may be extremely difficult for the clinician due to the normal amount of capsular laxity commonly present in most individuals. An essential component of the physical examination is a thorough and meticulous subjective history which includes the mechanisms of injury and/or dysfunction, chief complaint, level of disability, and aggravating movements. The physical examination must include an assessment of motion, static stability testing, muscle testing, and a neurologic assessment. A comprehensive understanding of various stability testing maneuvers is important for the clinician to appreciate. The evaluation techniques discussed in this paper should assist the clinician in determining the passive stability of the glenohumeral joint.
Journal of Orthopaedic & Sports Physical Therapy, 1997
houlder instability is a vague, nonspecific term which actually represents a wide spectrum of cli... more houlder instability is a vague, nonspecific term which actually represents a wide spectrum of clinical pathologies, ranging from gross instability to subtle subluxation. Patients exhibiting shoulder instability are commonly encountered by therapists, athletic trainers, and physicians in both the general orthopaedic and sports medicine population. Often, an appropriate clinical diagnosis is difficult due to the excessive amount of capsular laxity normally seen and appreciated during clinical examination of the glenohumeral joint. Clinicians may become perplexed when attempting to determine the amount of normal acceptable laxity vs. pathological ligamentous laxity. The purpose of this paper is to discuss current concepts related to the anatomic stabilizing structures of the glenohumeral joint. The glenohumeral joint is inherently unstable and exhibits the greatest amount of motion found in any joint in the human body (116). Additionally, the glenohumeral joint is the most commonly dislocated major joint in the human body (20,47). Thus, the shoulder joint sacrifices stability for mobility. Although the glenohumeral joint exhibits significant physiologic motion, only a few millimeters of humeral head displacement occur during these movements in the normal individual (1,35,36,40, 75,76,103). Conversely, on clinical examination, Matsen et al (55) have Significant contemporary advances have permitted a more comprehensive understanding and development of some interesting concepts about the glenohumeral joint. The purpose of this review paper was to discuss current concepts related to the anatomic stabilizing structures of the shoulder joint complex and their clinical relevance to shoulder instability. The clinical syndrome of shoulder instability represents a wide spectrum of symptoms and signs which may produce various levels of dysfunction, from subtle subluxations to gross joint instability. The glenohumeral joint attains functional stability through a delicate and intricate interaction between the passive and active stabilizing structures. The passive constraints include the bony geometry, glenoid labrum, and the glenohumeral joint capsuloligamentous structures. Conversely, the active constraints, also referred to as the active mechanisms, include the shoulder complex musculature, the proprioceptive system, and the musculoligamentous relationship. The interaction of the active and passive mechanisms which provide passive and active glenohumeral joint stability will be thoroughly discussed in this paper.
Journal of Orthopaedic & Sports Physical Therapy, 2006
Articular cartilage lesions of the knee joint are common in patients of varying ages. Some articu... more Articular cartilage lesions of the knee joint are common in patients of varying ages. Some articular cartilage lesions are focal lesions located on one aspect of the tibiofemoral or patellofemoral joint. Other lesions can be extremely large or involve multiple compartments of the knee joint and these are often referred to as osteoarthritis. There are numerous potential causes for the development of articular cartilage lesions: joint injury (trauma), biomechanics, genetics, activities, and biochemistry. Numerous factors also contribute to symptomatic episodes resulting from lesions to the articular cartilage: activities (sports and work), joint alignment, joint laxity, muscular weakness, genetics, dietary intake, and body mass index. Athletes appear to be more susceptible to developing articular cartilage lesions than other individuals. This is especially true with specific sports and subsequent to specific types of knee injuries. Injuries to the anterior cruciate ligament and/or menisci may increase the risk of developing an articular cartilage lesion. The treatment for an athletic patient with articular cartilage lesions is often difficult and met with limited success. In this article we will discuss several types of knee articular cartilage injuries such as focal lesions, advanced full-thickness lesions, and bone bruises. We will also discuss the risk factors for developing full-thickness articular cartilage lesions and osteoarthritis, and describe the clinical evaluation and nonoperative treatment strategies for these types of lesions in athletes.
Journal of Orthopaedic & Sports Physical Therapy, 2003
Descriptive postoperative follow-up research. Objectives: The purpose of this investigation was t... more Descriptive postoperative follow-up research. Objectives: The purpose of this investigation was to describe the return-to-competition rate and functional outcome of overhead athletes following arthroscopic thermal-assisted capsular shrinkage (TACS). Background: Traditional open procedures to correct instability in overhead athletes, such as capsulolabral repairs and capsular shifts, have produced less-than-favorable results, which have led to the development of TACS. Currently there are no long-term follow-up studies documenting the efficacy of this procedure in groups greater than 31 subjects or for a time period greater than 27 months. Methods and Measures: Two hundred thirty-one consecutive overhead athletes who due to symptoms of hyperlaxity had previously undergone a TACS procedure from 1997 to 1999 were selected for inclusion in the study. During a 1-month period, 130 of these athletes (mean age ± SD, 24 ± 6 years; 113 male, 17 female) were contacted by phone for follow-up at a mean of 29.3 months postoperatively (range, 15.4-46.6 months). Of the 130, 105 participated in baseball (80 pitchers), 14 in softball, 4 in football (quarterbacks), 4 in tennis, and 3 in swimming. Fifty-four (42%) subjects were professional, 49 (38%) collegiate, 16 (12%) high school, and 11 (8%) recreational athletes. One hundred twenty-three of the 130 (95%) underwent 1 or more concomitant procedure(s) at the time of TACS. Most commonly performed were labral debridements (69%), rotator cuff debridements (65%), and superior labral repairs (35%). Subjects who returned to competition were retrospectively evaluated using a modified Athletic Shoulder Outcome Rating Scale to subjectively assess pain, strength and endurance, stability, intensity, and performance. Overall results were based on a 90-point scale with scores of 80 to 90 representing excellent, 60 to 79 good, 40 to 59 fair, and less than 40 poor results. Results: One hundred thirteen out of 130 subjects (87%) returned to competition. Mean (±SD) time from surgery to return to competition was 8.4 ± 4.6 months. Mean outcome score for all subjects was 79/90; 75 (66%) subjects had excellent, 24 (21%) good, 11 (10%) fair, and 3 (3%) poor result. The mean outcome score for males was 80/90 and for females was 70/90.
Journal of Orthopaedic & Sports Physical Therapy, 2002
Glenohumeral joint instability is a common pathology observed in the orthopedic and sports medici... more Glenohumeral joint instability is a common pathology observed in the orthopedic and sports medicine settings. Overhead athletes often exhibit a certain degree of acquired laxity that can lead to various pathologies. Unfavorable results often observed with traditional open procedures to correct instability in the overhead athlete have led to the development of arthroscopic thermal-assisted capsular shrinkage (TACS). TACS is not commonly used as an isolated procedure in overhead athletes; various procedures are often performed concomitantly. The overall outcome greatly depends on a postoperative rehabilitation program that must be assessed and adjusted frequently based on several factors. Knowledge of the basic science of TACS as well as emphasis on dynamic stabilization, proprioception, and neuromuscular control are vital to the rehabilitation program for overhead athletes. The purpose of this paper is to discuss the basic science and clinical application of thermal-assisted capsular shrinkage of the glenohumeral joint as well as the postoperative rehabilitation for the overhead athlete and the patient with congenital laxity and related multidirectional instability.
Journal of Orthopaedic & Sports Physical Therapy, 1993
The physical examination of the thrower's elbow presents the clinician with the clinical challeng... more The physical examination of the thrower's elbow presents the clinician with the clinical challenge of differentially diagnosing specific pathologies. The examination should include a thorough history and a well-organized physical examination, which relies on an extensive knowledge of the functional anatomy of the elbow. The components of an elbow examination include inspection/ observation, palpation of bony and soh tissues, range of motion assessment, resisted muscle testing (both manual and mechanical), neurologic testing, and special tests. The special tests commonly performed on the thrower's elbow are the Tinel test, tennis elbow sign, ulnar collateral ligament stability testing, valgus extension overload test, and radiocapitella chondromalacia test. Other tests include radiographic examination, such as computerized tomograph arthrogram and magnetic resonance imaging testing. Information presented in this paper will provide the clinician with a systematic and thorough evaluation process for the thrower's elbow.
Journal of Orthopaedic & Sports Physical Therapy, 2009
Patient in beach-chair position, with the coracoid process, acromioclavicular joint, clavicle, an... more Patient in beach-chair position, with the coracoid process, acromioclavicular joint, clavicle, and acromion marked for the left shoulder. For an open rotator cuff repair, a 3-to 6-cm incision is marked parallel to the lateral border of the acromion.
Clinical Orthopaedics & Related Research, 2012
Background Repetitive overhead throwing motion causes motion adaptations at the glenohumeral join... more Background Repetitive overhead throwing motion causes motion adaptations at the glenohumeral joint that cause injury, decrease performance, and affect throwing mechanics. It is essential to define the typical range of motion (ROM) exhibited at the glenohumeral joint in the overhead thrower. Questions/purposes We (1) assessed the glenohumeral joint passive range of motion (PROM) characteristics in professional baseball pitchers; and (2) applied these findings clinically in a treatment program to restore normal PROM and assist in injury prevention. Methods From 2005 to 2010, we evaluated 369 professional baseball pitchers to assess ROM parameters, including bilateral passive shoulder external rotation (ER) at 45°of abduction, external and internal rotation (IR) at 90°abduction while in the scapular plane, and supine horizontal adduction. Results The mean ER was greater for the throwing and nonthrowing shoulders at 45°of abduction, 102°and 98°, respectively. The throwing shoulder ER at 90°of abduction was 132°compared with 127°on the nonthrowing shoulder. Also, the pitcher's dominant IR PROM was 52°c ompared with 63°on the nondominant side. We found no statistically significant differences in total rotational motion between the sides. Conclusions Although we found side-to-side differences for rotational ROM and horizontal adduction, the total rotational ROM was similar. Clinical Relevance The clinician can use these PROM values, assessment techniques, and treatment guidelines to accurately examine and develop a treatment program for the overhead-throwing athlete.
Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk m... more Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isola...
Objectives: The purpose of this study was to determine whether GIRD and/or bilateral difference i... more Objectives: The purpose of this study was to determine whether GIRD and/or bilateral difference in total rotational motion (TRM) of the glenohumeral joint (external rotation + internal rotation) correlated with elbow injuries in professional baseball pitchers. Methods: This study was conducted over eight competitive seasons (2005-2012). Each year during spring training, the same examiners assessed passive range of motion (PROM) of both the dominant and non-dominant shoulders of professional pitchers using a bubble goniometer. In total, 505 examinations were conducted on 296 pitchers. Glenohumeral joint motion was assessed in supine with the arm at 90 degrees of abduction and in the plane of the scapula for ER and IR. During ER and IR ROM assessment, the scapula was stabilized per methods previously established. Elbow injuries and days missed due to injury were assessed and recorded by the medical staff of the team. Results: Significant differences were noted during side-to-side comp...
International journal of sports physical therapy, 2013
In most shoulder conditions a loss of glenohumeral motion results in shoulder performance impairm... more In most shoulder conditions a loss of glenohumeral motion results in shoulder performance impairments. However, in the overhead athlete loss of glenohumeral internal rotation, termed glenohumeral internal rotation deficiency (GIRD), is a normal phenomenon that should be expected. Without a loss of glenohumeral internal rotation the overhead athlete will not have the requisite glenohumeral external rotation needed to throw a baseball at nearly 100 miles per hour, or serve a tennis ball at velocities of 120 miles per hour or more. Not all GIRD is pathologic. The authors of this manuscript have defined two types of GIRD; one that is normal and one that is pathologic. Anatomical GIRD (aGIRD) is one that is normal in overhead athletes and is characterized by a loss of internal rotation of less than 18°-20° with symmetrical total rotational motion (TROM) bilaterally. Pathologic GIRD (pGIRD) is when there is a loss of glenohumeral internal rotation greater than 18°-20° with a corresponding...
Injuries to the elbow joint in baseball pitchers appear common. There appears to be a correlation... more Injuries to the elbow joint in baseball pitchers appear common. There appears to be a correlation between shoulder range of motion and elbow injuries. To prospectively determine whether decreased ROM of the throwing shoulder is correlated with the onset of elbow injuries in professional baseball pitchers. Cohort study; Level of evidence, 2. For 8 consecutive years (2005-2012), passive range of motion of both the throwing and nonthrowing shoulders of all major and minor league pitchers within a single professional baseball organization were measured by using a bubble goniometer during spring training. In total, 505 examinations were conducted on 296 pitchers. Glenohumeral external rotation and internal rotation were assessed in the supine position with the arm at 90° of abduction and in the plane of the scapula. The scapula was stabilized per methods previously established. Total rotation was defined as the sum of external rotation and internal rotation. Passive shoulder flexion was ...
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