Improve your Baseball Swing
Perhaps the classic sports model for overuse is baseball pitching. During recent years, new understanding of the biomechanics and pathoanatomy of throwing injury have given us insight into the causes of shoulder pain in the athlete. A thorough understanding of these advances is essential to the successful approach to treating overuse injury in the baseball pitcher. Throwing sports continue to contribute significantly to the overall incidence of shoulder injury. In particular, the past 30 years has seen a significant growth in organized baseball. Children as young as 5 years old are involved and soon after may participate in multiple leagues. This is in contrast to 30 years ago when organized baseball was not available until the athletes reached the age of 9 (Table 21-3). In general, young athletes today tend to focus on single-sport specialization rather than the free-play concept of multisport involvement. Those athletes involved in free play tend to play multiple sports in a...
Models of motor behavior have explored the properties of neurons and their connections to explain how a network of neurons generates persistent activity in response to an input of brief duration, such as seeing a baseball hit out of the batter's box, and how networks respond to changes in input to update a view of the environment for goal-directed behaviors, such as catching the baseball 400 feet away while on the run.4 A wiring diagram for hauling in a fly ball, especially with rapidly changing weights and directions of synaptic activity, seems impossibly complex. Researchers have begun, however, to describe some clever solutions for rapid and accurate responses that evolve within interacting, dynamic systems such as the CNS.5 Each theory contains elements that describe, physiologically or metaphorically, some of the processes of motor control. These theories lead to experimentally backed notions that help explain why rehabilitative therapies help patients.
The aim of rehabilitation is to restore a sport-specific function to, or above, pre-injury levels. In cricket it could be the perfect bowling action, in tennis the serve, in baseball the throw, in football ball control or in gymnastics landing. This type of training requires knowledge and understanding of the sport's specific demands and is usually prescribed and supervised by a sports therapist in close collaboration with a coach. After surgery or long immobilisation, this final stage of rehabilitation training is the most time-consuming and risky. In the final stage of rehabilitation after healing of an injury, functional training back to full performance level must be gradual, over a period of time that corresponds to the functional requirements of the muscles and the healing process of the underlying injury. This period could vary from a few weeks after a simple ankle sprain to a year after complicated knee surgery. The training has to be specific and, preferably, performed in a...
Involve small objects that are propelled at high velocity, such as baseball, softball, hockey, lacrosse, jai alai, and racquetball, and those with high levels of physical contact and collision, such as football, basketball, rugby, hockey, martial arts, and boxing. Nearly 75 of facial fractures occur in the mandible, zygoma, and nose. Sports participation is the most common cause of mandibular fractures (31.5 ), followed closely by motor vehicle accidents (27.2 ). A recent study of facial fractures sustained during recreational baseball and softball demonstrated that the zygoma or zygomatic arch was the most common fracture, followed by temporoparietal skull fractures and orbital blowout fractures. There is some evidence to indicate that the nasal bones are the most commonly fractured bones in the face however, many of these patients do not seek medical treatment or are managed in the outpatient setting, therefore the statistics may not be completely accurate. As is true for all...
Physical examination of the injured shoulder for some has unfortunately become somewhat of a lost art because of the difficulty of the examination itself, the subtleties of the normal athletic shoulder that often make comparison to the opposite side unreliable, and the ever-increasing reliance on magnetic resonance imaging (MRI) for definitive diagnosis. As helpful a tool as the MRI is, it is of concern that completely asymptomatic shoulders demonstrate pathology that might be erroneously attributed to an athlete with symptoms. Sher et al1 demonstrated a 34 rate of tears of the rotator cuff in painless volunteers. Miniaci et al2 showed that 79 of asymptomatic professional baseball pitch
Reaction times increased with distance of the arrow to the likely dot, suggesting that participants mentally scan from the arrow to answer the question (Finke & Pinker, 1982, 1983). Mental scanning may be part of catching or hitting the ball in baseball, tennis, and other sports.
A phase approach is helpful in sorting out the problem of the paradoxes of creativity (see above) Creative individuals seem to combine apparently contradictory or even incompatible factors including thinking processes (e.g., divergent versus convergent thinking), personal motivation (e.g., intrinsic versus extrinsic motivation), and personal feelings (e.g., thrill of the chase versus fear of failure). Martindale described this as involving moving backwards and forwards between poles, and labeled it 'oscillation.' In cricket-playing countries, people who are good at this are described in everyday language as all-rounders,' while in baseball terms until recently they might have been known as 'switch-hitters.' A phase approach suggests that both poles of the paradoxes really are of central importance, but not simultaneously - certain properties wax and wane in importance depending on what phase of the innovation process is currently active. Particular human properties may foster...
Internal impingement is a pathologic condition typically seen in overhead throwing athletes. Baseball pitchers are most commonly afflicted, although athletes participating in other sports requiring repetitive shoulder abduction and external rotation such as tennis, volleyball, javelin throwing, and swimming are at risk.1-6 Patients typically present with complaints of posterior shoulder pain when the arm is abducted and maximally externally rotated (late cocking and acceleration phases of throwing). Symptoms may be vague and reported by the athlete only as a gradual onset of loss of velocity or control during competition, often known as dead arm syndrome (Box 23-1). Other common complaints are feeling tight and uncomfortable while throwing, along with difficulty warming up.7 The majority of athletes do not recall a single acute event, but many report an acute exacerbation of previous lesser symptoms as the impetus for seeking medical attention. Concomitant labral injury is not...
Restricted from looking ahead in the text, their typing speed was dramatically reduced. During the mastery of typewriting the expert typist has acquired the skill to look ahead in the text in order to prepare future keystrokes. Similarly, the rapid reaction times of athletes such as hockey goalies, baseball hitters, and tennis players, have also been found to reflect the ability to anticipate future events.
Named after the famous left-handed pitcher, Tommy John surgery is more formally named medial collateral ligament (MCL) replacement. With the repetitive strain during activities like throwing in baseball, athletes put repetitive stress on the MCL, resulting in eventual laxity.
Ontological categories refer to a set of categories to which people partition the world in terms of its most fundamental features (as opposed to characteristic and defining features Chi, 1997). For example, two highlevel categories that people are likely to partition the different types of entities in the world into are substances and processes. Each type of entity is conceptualized as having certain fundamental properties. For example, substances such as sand can be contained in a box, but processes such as a baseball game, cannot however, processes can last for 2 hours, but substances cannot. Misconceptions are miscategorizations of entities into wrong ontological categories. For example, students typically misconceive heat or electricity as a substance that can move from one location to another (Chi, Slotta, & de Leeuw, 1 994). Continued study of some entity that is initially believed as belonging to category X might reveal properties that are not consistent with its ontolog-
Patients typically present with a history of a minor pain while participating in an activity. For example, a softball player may report feeling a twinge in his back while throwing a ball. Then, later that night the discomfort may increase. When the patient wakes up the next day, the pain may have worsened. He may feel a spasm in his back. The pain may radiate into the buttock but rarely will radiate beneath the knee. The pain will be aggravated by movement and made better by rest. After 24-48 hours, the pain generally starts getting better, although it may not completely heal for 1-3 weeks.
During a sudden change of direction while running, and quick starts and stops. Factors such as weakness or tightness of the adductor muscles can predispose an athlete to a groin strain. This injury is commonly seen in soccer players as well as football, ice hockey, basketball, tennis, and baseball players.
The stretch weakness of the muscles that precedes the chronic muscle strain may result from a habitual position of forward shoulders, round upper back, or the combination of these two faults. It also may result from the shoulders being pulled forward by overdeveloped, short anterior shoulder-girdle muscles. Repetitive movements associated with some sports, such as baseball, may contribute to overdevelopment of shoulder adductor muscles. Occupations that require continuous movement with the arms in a forward position, such as piano playing, contribute to stretching of the trapezius muscles.
Upon release this time, she went, buck wild, back to drinking and getting high. She had a job at McDonalds, but was arrested and incarcerated for trying to rob a store with a baseball bat. Subsequently, she spent 3 more years in prison. This is when I turned my life around. I participated in all these programs. However, when she was released, nothing was stable, going back and forth between people's houses. I felt homeless. I stayed at shelters for a week at a time, but mostly hotels. She had entitlements, an intake appointment at a local mental health clinic, and a case manager who wanted to help her with housing, but, I never met him because I started using heroin. He was trying to get me my own place, but I was off my meds and using heroin. She began shoplifting, I was actually taking orders. I had fences. One lady might want 20 pairs of jeans from the GAP and if you insulate a duffle bag with duct tape the beepers don't go off, or you carry in a huge Bed, Bath and...
Multiple studies have indicated that remarks about pain and pain behaviors such as moaning, groaning, holding or rubbing painful areas of the body, altered posture, witnessed medication use, extensive resting time, frequent position shifts, altered posture, or the use of equipment such as sunglasses and baseball caps to avoid exposure to light, all serve to communicate the presence of headaches to an observer. Over time such pain displays lead to lowering of both sensory and pain thresholds, and increase the frequency and severity of pain experienced.
Rotator cuff and biceps muscles are required for normal shoulder function. According to Gowan and his associates 52 , two groups of muscles control the shoulder during the pitching motion in professional baseball pitchers. The first group of muscles demonstrates increased electromyographic activity during the early and late cocking phase and decreased activity during the acceleration phase. This group of muscles positions the arm for the delivery of the pitch. The second group of muscles demonstrates increased elec-tromyographic activity during the acceleration phase of the pitch. Using the same measurement technique, Glousman and coworkers 45 showed changes in the electromyographic pattern in baseball pitchers with chronic anterior instability of the glenohumeral joint. Alteration of the normal neuromuscular balance in patients with anterior instability can cause changes in joint kinematics that can lead to repetitive microtrauma of the glenohumeral joint.
After Jake was diagnosed, I had trouble trying to muster up feelings of joy upon hearing about a friend's daughter who sang in the school play or a friend's son who excelled at baseball, while my own son couldn't even speak let alone hold a baseball bat. I confided in my closest friends about how I was feeling, but even then I felt somewhat disconnected. They were compassionate and caring, yet I got the sense that they didn't really understand what I was going through. And so, I
We have other children besides our son with an ASD How do we explain the diagnosis to them so that they can accept
If there are siblings in the family, they need to be told about their brother's or sister's ASDs in an appropriate way. Don't be afraid to tell them, but also keep in mind that they may be overwhelmed. Often parents don't give siblings information about ASDs because they're trying to protect them. But this kind of thinking can backfire, and siblings can become frustrated, impatient, and nonaccepting of their brother or sister who cannot play with them, seems to ignore them, or throws horrific tantrums. Also, if siblings are not told the truth about ASDs, they tend to develop their own misconceptions. One child believed that he caused his brother's condition because he secretly hated him when he was born. Another child was afraid to be in the same room with his sister because he thought her condition was contagious, and he might catch it. One little boy kept trying to force a baseball cap onto his brother's head to keep his brains from falling out any more.
Rotational and torsional sports have certain characteristics in common. Baseball, golf, and the javelin all require rotation and have distinctly different demands on the spine. The javelin requires a tremendous amount of force to be generated in going from a hyperextended to a full flexion follow-through position. You do not throw a javelin 200 feet with your arm. While shoulder and arm injuries are common in javelin throwers, the key is rigid abdominal strength that produces the torque necessary to throw the javelin. Attempting to throw with the arm only will produce arm injury and in no way can generate any type of distance. Every arm injury in a javelin thrower has to be treated with trunk exercises and trunk strengthening. A rotatory lumbar spine injury in a javelin thrower is a completely debilitating injury that requires tremendous care and correction prior to returning to the sport. Baseball Some of the most difficult cases of lumbar spine problems are seen in baseball...
The diagnosis of subarachnoid haemorrhage is made on the history of sudden severe headache. Some patients liken the onset to being hit on the back of the head with a baseball bat. A CT scan will show subarachnoid blood in 90 of cases scanned within 24 h of the haemorrhage. A cerebral angiogram will demonstrate an aneurysm if present (Fig. 19.2).
Neuromuscular control, and core stabilization while simulating the stance position of baseball pitching. neuromuscular control, and core stabilization while simulating the stance position of baseball pitching. 39. Murray TA, Cook TD, Werner SL, et al The effects of extended play on professional baseball pitchers. Am J Sports Med 2001 29 137-142. 44. Crockett HC, Gross LB, Wilk KE, et al Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. Am J Sports Med 2002 30 20-26. 72. Reinold MM, Wilk KE, Reed J, et al Interval sport programs Guidelines for baseball, tennis, and golf. J Orthop Sports Phys Ther 2002 32 293-298.
One of the most common causes of lower back pain in the young athlete involves a stress fracture of the pars interarticularis. The pars interarticularis is stressed with lumbar extension. Athletes who participate in activities involving repetitive extension (e.g., gymnasts, ballet dancers, divers, baseball pitchers) are at increased risk to suffer a pars stress fracture. Once a pars fracture has occurred, particularly if it occurs bilaterally, the athlete may go on to develop a spondylolisthesis. This is when one vertebral body moves in relation to the adjacent one. The degree of spondylolisthesis can be graded (Table 8.1).
Symptoms which have been associated with decreased anterograde flow or retrograde flow in the vertebral artery are episodes with dizziness, diplopia, decreased vision or oszillopsia. The attacks are brief and may be elicited by exercise of the arm. A difference in the wrist or the antecubital pulses and a difference of blood pressure between the two arms are reliable signs which indicate subclavian steal syndrome. Causes of stenosis or occlusion of the vertebral artery are arteriosclerosis, Takayashu disease and temporal arteritis or mechanical trauma, as have been reported by bowlers or baseball pitchers.
Hand shot.34 Symptoms of lateral epicondylitis include pain localized to the lateral epicondyle or lateral aspect of the elbow. A common history includes exertion involving grip and deviation of the wrist. Baseball pitchers may not be able to grip a ball and throw with elbow extension, while carpenters overuse their arms with hammering, and politicians describe symptoms secondary to shaking countless hands. Instrument players, especially violin and keyboard players, who use excessive twisting motions and or poor coordination patterns have increased propensity for developing lateral epicondylitis.18,19
Risk factors for ulnar neuropathy are poorly defined. Arthritis of the elbow may be a contributing cause. Persons who habitually rest the flexed elbow on a table or chair, specifically those with chronic pulmonary disease, can compress the nerve. There is a much lower incidence of ulnar neuropathy as an occupational disorder compared with CTS, but musicians who use one arm in a flexed position (cellists, violinists) commonly develop ulnar neuropathy. In baseball pitchers, particularly those who employ the slider and curve ball pitch are more at risk than fast ball pitchers. Other than these exposures, ulnar neuropathy is more common in the nondominant side, suggesting that repeated elbow flexion is more important etiologically than is repeated muscular usage. Ulnar neuropathy at the elbow is the most common anesthesia-related compressive neuropathy.
Repetitive trauma to the area of the A-1 digital pulley is seen in baseball catchers, gymnasts, weightlifters, workers who employ handled gripping tools such as pliers, and musicians who encounter persistent pressure from holding an instrument.20 Direct pressure from a hard surface applied to the flexor tendon at the
For the lower body, trunk control plays a vital role in the ability to rotate and transfer torque safely. Trunk strengthening exercises such as sit-ups and spine extensions produce strength. Flexibility produces a protective range of motion but often the key is providing trunk strength and control at the proper moment during the athletic activity. For example, a baseball hitter goes from flexion through rotation to extension. If his trunk musculature does not maintain rigid control, despite these changes in the axis of alignment, he may lose power or get a back injury. Therefore, one can have strong muscles but, if they do not fire in sequence at the proper time, they will not protect the athlete from injury and certainly will not enhance performance. A key to producing a safe range of motion is to begin trunk control in the safe neutral position, establish muscle control in that position, and maintain it through the necessary range of motion to perform the athletic activity.
Direct blows to the anterior, posterior, or lateral aspect of the neck can be serious, depending on the force of the blow, the object involved, and the cervical spine position. For example, contact with a puck, softball, or baseball moving at full speed can be serious. Contact with an opposing player's stick, arm, knee, or elbow is fairly common in contact sports and results in mild to moderate injury. In football, piling on, late hits, and hitting on the numbers can cause serious head and neck injuries.
For example, in one study, weight-shift training in hemiparetic patients while standing improved the symmetry of weight bearing and balance in stance, but the gains did not improve lower extremity symmetry during walking.50 This finding is consistent with motor learning concepts. Practice at hitting a golf ball is not likely to improve a baseball player's batting average any more than a static therapy can train a patient to perform a dynamic activity. For gait, a task-specific physical therapy has to include stepping at reasonably normal speeds, not weight shifting alone. A program of early locomotor training made possible by body weight-supported treadmill stepping fits into this conceptual model.51
The ulnar nerve is vulnerable to injury at the elbow as it courses under fascia at the medial epicondyle and is tethered by the flexor carpi ulnaris.55 Cubital tunnel syndrome may result from direct trauma, as in being hit on the elbow by a batted ball, or from sustained elbow flexion that compresses the ulnar nerve, as in playing a musical instrument that requires prolonged elbow flexion postures. For musicians, nerve compressions and tendonitis necessitate evaluation of postures, changes in technique (often correlates with changes in teachers), increases in playing times, and inefficient movement patterns. Cubital tunnel syndrome also is associated with athletes who play sports that increase tension and compression forces at the elbow, including baseball, tennis, racquetball, and javelin throwing. Workers whose jobs involve sustained elbow flexion are more prone to cubital tunnel syndrome problems.
The most common blunt force is the contusion (Fig. 19.22). The pattern contusion is a common injury that helps identify the causative weapon. A blow from a linear object leaves a contusion that is characterized by a set of parallel lines separated by an area of central clearing. The blood underlying the striking object is forcibly displaced to the sides, which accounts for the pattern's appearance. Pattern injuries that an emergency physician should recognize include those caused by the hand (slap marks, fingertip contusions, grab marks, choke holds, fingernail abrasions), solid objects (baseball bat, tire iron, 2 by 4, belt, shoe, comb), and bite marks. Figure 19.22.
In addition to his research efforts, Milken has attempted to raise the profile of prostate cancer. He has lobbied Congress and worked with other advocacy groups, such as the National Prostate Cancer Coalition, to organize public events. Since 1996 the Prostate Cancer Foundation has worked with major league baseball teams to In a variety of ways NPCC attempts to increase awareness of prostate cancer, and especially of how important it is that men be tested. It has worked with major league baseball on an education campaign, ''Take a Swing Against Prostate Cancer'' with the National Hockey League on a ''Hockey Fights Cancer'' program and with NASCAR drivers such as Dale Earnhardt, Jr., and Jimmie Johnson on a ''NASCAR Young Guns Consumer Challenge,'' in which fans can donate at NASCAR races to fight prostate cancer. The NPCC has promoted September as Prostate Cancer Awareness Month, an extension of work by the Prostate Cancer Education Council, a smaller advocacy group in Denver. In many...
Most patients with isolated ACL injury do well with activities of daily living. They typically can participate in limited sporting activities, but will have difficulty with vigorous activity. Daniel et al4 divided various sports and occupations into tiered levels based on the intensity of the activity. Sports that require jumping, pivoting, and hard cutting such as basketball, football, and soccer are considered level I sports. Sports such as baseball, racket sports, and skiing require lateral motion but less jumping and hard cutting than level I sports and are considered level II. Sporting activities that do not require cutting, pivoting or lateral motion such as jogging, running, and swimming are considered level III. Additionally, Daniel et al4 expanded this classification to include occupations that similarly require cutting and pivoting type maneuvers. The challenge to the surgeon is to decide which patients will benefit from operative or nonoperative management....
An apophyseal avulsion fracture of the pelvis is a fracture through the physis of a secondary center of ossification. These commonly involve the anterior superior iliac spine, anterior inferior iliac spine, and ischial tuberosity apophysis. These fractures occur almost exclusively in 11- to 17-year-old patients. They are most commonly seen in soccer, track, football, and baseball. In most cases, these fractures occur during fast running, hurdling, pitching, or sprinting.15 These injuries usually do not occur due to direct trauma. They may occur as a consequence to a hip dislocation. Fractures of the anterior superior iliac spine result from the pull of the sartorius and the tensor fascia lata muscles. Fractures through the anterior inferior iliac spine result from pull of the straight head of the rectus femoris muscle. A forceful sprint or a swing of a baseball bat will typically avulse the anterior superior iliac spine.
Osteochondritis dissecans represents a special problem. Detached lesions can either be removed and debrided 46 or reattached by fixation. Both procedures are reported to be successful regarding pain, and make return to sports possible in most cases 47 . Successful conservative treatment of early osteochon-dritis in young baseball players (detected by MRI) has been reported 43 . Two lesions healed after rest and reduction of sports activities, whereas one lesion in a player who did not reduce activities, progressed. Osteochondritis may therefore at least in the early stages have a potential for healing.
Another potential site of suprascapular nerve entrapment has been noted at the spinoglenoid notch, where the suprascapular nerve and artery enter the infraspinatus fossa to innervate the infraspinatus muscle 186 . Entrapment of the suprascapular nerve at the spinoglenoid notch is rare, and much less common than at the suprascapular notch, which has been reported to have an incidence of 0.4 187 . The inferior transverse scapular ligament or spinogle-noid ligament has been described as acting to entrap the suprascapular nerve in volleyball players 188 , throwing athletes including baseball pitchers 189 , and weight lifters 190 .
Medial instability is believed to be a result of repetitive overload to the ulnar collateral ligament 33 . Clinical and electromyographic studies of motions during the baseball pitch form the basis for dividing it into five stages wind-up, early cocking, late cocking, acceleration and follow-through. In the late cocking stage, the arm is in maximal external rotation and the elbow in full extension and under maximal valgus stress to accumulate as much elastic energy as possible for the pitch. During the acceleration stage, a large valgus stress is still applied to the elbow 34 . In extension, the ulnar collateral ligament is not the only structure securing valgus stability, as the anterior capsule and the lateral joint compartment (the radiohumeral joint) contribute significantly. So during pitching and throwing, intense stretching is applied to the ulnar collateral ligament, and compression to the lateral joint. If the load on the ligament exceeds the rate of repair, it will result in...
Athletic activities can result in a wide variety of joint injuries through either direct trauma or repetitive stress 61 . Although the predilection for specific injuries varies with the sport (e.g. elbow instability in baseball players, shoulder dislocations in football players and wrestlers, knee injuries in basketball players), all injuries can be debilitating and often involve ligamentous structures. Ligaments are structures that are known to play an important role in mediating normal joint mechanics. These parallel-fibered, dense connective tissues share the transmission of forces with other periarticular tissues to provide joint stability 62 .
Thrombosis of the ulnar artery in Guyon's canal may occur in sports such as judo, karate, basketball, hockey, handball and lacrosse 3,5,77,78 . It may occur as a result of a single traumatic event or as a repetitive trauma 10 . The ulnar nerve and ulnar artery are susceptible to injury in Guyon's canal. Injury to the ulnar artery may involve only the intima, in which case thrombosis occurs. A true aneurysm results from fusiform swelling of all three areas of the arterial wall, and false aneurysm is the result of a rupture of the vessel with encapsulation of a resulting hematoma 75 . A pseudoaneurysm results if the outer layers are disrupted, allowing a bulge of the vessel 75 . Patients present with pain and coldness of the fingers and palm. In advanced cases distal ulcerations of the skin can develop. When examining patients with these symptoms, Tinel's sign may indicate nerve involvement and if absent, this suggests a primary vascular etiology. Allen's test is the most important...
Clinical presentation typically includes atrophic weakness of hands and forearms, slight spasticity of the legs, and generalized hyperreflexia. Other findings may include hand and finger stiffness, cramping, fasciculations, and atrophy and weakness of tongue, pharyngeal, and laryngeal muscles. There is no sensory loss. The disease is characterized by middle life presentation and death is usually within 2 to 6 years. Diagnosis is made on the basis of history and neurologic examination and electromyography (EMG) nerve conduction studies. Riluzole is a medication to treat ALS and may improve the neurologic function and survival. Its mechanism is not well understood. Physical therapy, occupational therapy, and speech therapy are necessary treatments. Symptomatic treatment for depression, secretion control, pain, fatigue, muscle spasms, and constipation are supportive measures. The disease is also called Lou Gehrig's disease, named for the New York Yankee's baseball player who died from...
ADD is known to affect athletic participation in a number of ways, including lessened motivation to participate, impaired motor skills, and decreased performance success.39,40 Methylphenidate has been shown to improve the attention of youths with ADD during baseball games, as reflected in higher rates of on-task behavior while on the field and better knowledge of their current game-specific situation.41 Methylphenidate has also been demonstrated to improve visual tracking by athletes with ADD during table tennis by maintaining their gaze on the ball in flight for significantly longer periods of time.42 Athletes with ADD who use methylphenidate should be aware of a possible increased risk of heat-related illness due to the stimulant's cardiovascular properties. However, methylphe-nidate may not only help athletes with ADD to succeed at work or school, but it may help them to more fully participate in athletics, thereby receiving a boost in self-esteem that many patients with ADD need.
The first step in the differential-directed approach is to understand how pathologies present as chief complaints, so that the initial differential is complete but focused. It should be noted that this is rarely as easy as the example given. This is clearly illustrated if we substitute a 20-year-old baseball pitcher with pain into the example. Rather than suspecting just a rotator cuff tear, the initial diagnosis might include instability, labral pathology, impingement, internal impingement, or a combination of these. Thus, a deeper understanding of the chief complaint and how it relates to the history is necessary to come to an accurate differential. Even in difficult presentations, we still formulate an initial differential that may tip us off to what we are looking for while keeping us directed toward the appropriate diagnosis.
Participation in contact sports such as hockey, boxing, soccer, baseball, football, and wrestling can result in dental trauma. In the United States, the National Youth Sports Foundation estimates that more than 5 million teeth will be avulsed in sporting events each year. The Centers for Disease Control and Prevention in 2001 estimated that approximately one third of all dental injuries in the United States are sports related. After trauma, the dentition should be examined for fractures and mobility. Injuries to the teeth and supporting structures should be treated emergently.
Athletes need to regain their confidence in returning to play. An athlete who has physically recovered may not be mentally recovered from the trauma of the injury and, thus is at risk of further injury. This is often observed in baseball players who are hit in the face by a pitch or hit ball. Psychological recovery from facial fractures can be assessed in controlled practice situations. A consult with a sports psychologist may be necessary if difficulties linger. Many sports have safety measures to limit the incidence of facial injuries, and attention should be paid to the rules of use. Racquetball players should always play with goggles to limit orbital blowout injuries. In hockey, face guards with helmets are required in lower levels of play but not at the professional level. Although baseball is not considered a contact sport, sliding injuries can result in ankle sprains and fractures as well as serious head injuries. In 1995, the US Consumer Product Safety Commission performed an...
Extrinsic causes can be further subdivided into primary and secondary causes of impingement. Primary extrinsic impingement is due to chronic overhead movements such as that seen with baseball players, quarterbacks, swimmers, and volleyball players. Secondary extrinsic impingement is caused by muscular imbalance. This is seen in throwing athletes, more specifically those who perform overhead press while training.
Biceps tendonitis is an inflammation of the long head tendon of the biceps. This disorder can result from impingement as it passes through the humeral bicipital groove and inserts on the superior aspect of the labrum of the glenohumeral joint or as an isolated inflammatory injury. Bicipital tendonitis can also be a secondary injury as a result of compensation to other disorders such as labral tears, intra-articular pathology and rotator cuff pathology. Bicipital tendonitis is more common in overhead athletes such as baseball pitchers, swimmers, and tennis player and can be the result of overuse syndrome of the shoulder, which is also common in gymnasts and rowing kayaking athletes. Trauma may cause direct injury to the tendon as the arm is moved into excessive abduction and external rotation.
The SLAP (Superior Labral Anterior to Posterior) and other glenoid labral tears are common in throwing athletes and athletes involved in repetitive overhead sports such as baseball, tennis, or volleyball. Labral tears can also result from trauma such as a fall on an outstretched arm or direct impact on the shoulder.
A particularly interesting property of accretion is that it is self-strengthening. Many psychology studies have confirmed that what is encoded, comprehended, and inferred depends on the individual learner's prior knowledge. For example, Spilich, Vesonder, Chiesi, and Voss (1979) presented a passage describing a fictitious baseball game. Not only was the amount of recall of the individuals with high prior baseball knowledge greater (suggesting that the information was properly encoded), but the pattern of recall also differed. The high-knowledge individuals recalled more information directly related to the goal structure of the game (Spilich et al., 1979) as well as the actions of the game and the related changes in the game states (Voss, Vesonder, & Spilich, 1980), whereas the low-knowledge individuals recalled the teams, the weather, and other less important events and confused the order of the actions. Moreover, high-knowledge individuals were better than low-knowledge individuals...
Ocular injury is common in sports and largely preventable if athletes wear appropriate eye protection. The highest risk sports are those in which intentional injury can occur (e.g., boxing and combative martial arts) and those in which hard projectiles, sticks, or fingers are likely to encounter the eye. High-risk sports include basketball, baseball, softball, cricket, lacrosse, squash, racquetball, fencing, and all varieties of hockey. Squash and racquetball are particularly concerning because of the high likelihood of severe injury. Athletes with preexisting monocular visual impairment must understand the importance of protecting the good eye, and preparticipation visual acuity assessment of binocular and monocular vision is essential. The American Society for Testing and Materials (ASTM) is the primary U.S. organization for certifying eyewear for sports, and experts have provided recommendations for eye protection for different sports (Vinger, 2000).
Football, baseball, basketball, and other sports are national passions and players often are obsessed with playing regardless of whether they are grade schoolers or professionals The third example, a professional football player with a stable long finger metacarpal fracture, wants to return to playing football as soon as possible. The splinting goal for this football player is to maintain the hand in a position that facilitates safe healing of his metacarpal fracture. The referring physician deems the fracture stable and recommends a protective playing cast. The therapist fabricates an adapted fiberglass cast for the patient to wear during
TOS (discussed later) can also cause the SSS by causing compression or kinking of the proximal sub-clavian artery. This phenomenon is most common in athletes such as baseball pitchers, swimmers, golfers, and others who vigorously and repetitively abduct the upper extremity.
A contusion to the hook of the hamate or pisiform can cause swelling that can compress the ulnar nerve or compress the Tunnel of Guyon (ulnar artery and ulnar nerve). Falling on the palmar surface of the hand is a common mechanism of injury but direct trauma from the handle of a baseball bat or racquet can also be the cause.
Impact via the handle of a club, racquet, or bat or (2) shearing forces arising from the hypothenar muscles as well as the flexor tendons to the ring and small fingers. The nondominant hand is most commonly involved in golf and baseball, whereas the dominant hand is more common in tennis and racquetball.1
Disruption of the terminal extensor tendon at its insertion on the distal phalanx is one of the most common tendon injuries in sports. It is known as mallet finger, drop finger, or baseball finger. This is especially common in softball, baseball, and basketball and in football receivers.1 The injury usually occurs when a ball or other object hits the tip of the finger resulting in a flexion force while the extensor is actively contracting. The mallet deformity also may result from a direct blow to the dorsum of the DIP joint or secondary to a hyperextension force at this joint.69 In certain cases in which wearing a splint is not practical, such as in the health care professional, a single longitudinal K wire may be placed percutaneously across the DIP joint to maintain extension and allow continued function. This technique has limited application and is not usually recommended in the athlete. Continued participation in most sports is allowed during treatment of mallet finger as long...
As to the effects of creatine on actual strength and sports performance, the supplement has had mixed results at best. Some authors have demonstrated improvement in short-duration events like repeated sprints,75 although this has not been reproduced in other trials.76 Other investigators have shown improvement in specific soccer drills,77 but again this has not held for studies with athletes from other sports such as rugby or softball.78,79 Kilduff et al80 noted that subjects with the largest increases in body mass had the greatest increases in strength, suggesting that there are some athletes who are responders to creatine while others are not.
Hand and wrist injuries are common in all sports. They are more common in children than adults 7 . A study from the Cleveland Clinic showed that 14.8 of all athletic participants under the age of 16 years sustained upper extremity injuries. Of these 16 involved the hand and 9 involved the wrist 8 . Of 113 injuries of the hand and wrist 97 occurred in football, six in soccer, three in wrestling, three in baseball, two in basketball, one in ice hockey and one in rugby. They reported 96 fractures, 35 sprains and four dislocations. Metacarpal fractures accounted for 38 of the 96 fractures. There were 12 distal radius fractures and 11 scaphoid fractures. They reported 12 thumb injuries including 12 ulnar collateral ligament tears 8 . Baseball and softball injuries most often result from direct blows by the ball. One study stated that fractures accounted for 46 , and 33 of these injuries were sprains. One injury that should be noted is a fracture of the hook of the hamate in a baseball or...
The shoulder joint sits at the center of action for most sports involving the upper extremity. Baseball pitching, tennis, gymnastics, and competitive swimming are sports that share certain similarities (Table 21-2). These overhead endeavors, while all unique, rely heavily on individual accomplishment and intensive, repetitive training. Athletes in these sports may have lengthy careers beginning at a very young age. These sports all require coordinated unrestricted shoulder motion for full participation and success. The capacity for nearly global range of motion is impressive and unique to the shoulder joint. This range of motion allows an athlete to perform the specialized maneuvers necessary to throw a baseball, serve a tennis ball, or swim a race.
Injury that usually results from an activity such as throwing an object over the head (e.g., pitching a baseball). The result is a tear of the labrum of the superior glenoid muscle. A SLAP tear is thought to be due to the long head of the biceps tendon pulling on the superior labrum when the humerus decelerates during a throwing motion, resulting in a tear.
The biomechanical etiology for injury to these structures is controversial. Two possible causes have been reported, although neither is universally accepted. The most prevalent theory has been termed rotational instability, which describes the ability of the throwing shoulder to overrotate into a position of hyperex-ternal rotation during the late cocking and acceleration phases of the throwing motion. At maximal external rotation, the undersurface of the rotator cuff becomes entrapped between the humeral head and posterior superior glenoid labrum. This extreme position is resisted actively by the subscapularis and passively by the anterior band of the inferior glenohumeral ligament. Most shoulders, even those without symptoms, can achieve this position, and it is not considered pathologic.2,22 However, this physiologic posture gradually creates pathology in overhead throwers because throwing imparts progressive microtrauma to the anterior capsular structures. Fatigue of the...
The mechanical actions involved in the overhand throwing pattern are used in many sports such as volleyball, tennis, baseball, basketball, water polo, and javelin throwing. This repetitive and ballistic action could cause microtrauma to the muscles involved. These muscles are often compressed in the subacromial space, especially the supraspinatus muscle and the long head of the biceps brachii muscle. The position of abduction and external rotation followed by internal rotation could cause an unstable or loose-fitting biceps tendon to sublux or slip out of its groove. With overuse this slipping could lead to tendonitis. Such a position could also cause subluxing of the glenohumeral joint in the athlete who has joint laxity or a previous dislocation. Finally, the overhand throw pattern could lead to eventual glenoid labrum damage.
The compressive type of stress is more common in sports that require high body weight and massive strengthening such as football and weight lifting. Torsional stresses occur in throwing athletes such as baseball players and golfers. Motion sports that put tremendous tensile stresses on the spine include gymnastics, ballet, dance, pole vault, and high jump.
Crockett HC, Gross LB, Wilk KE, et al Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. Am J Sports Med 2002 30 20-26. Lyman S, Fleisig GS, Andrews JR, et al Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med 2002 30 463-468. Mair SD, Uhl TL, Robbe RG, Brindle KA Physeal changes and range-of-motion differences in the dominant shoulders of skeletally immature baseball players. J Shoulder Elbow Surg 2004 13 487-491. Osbahr DC, Cannon DL, Speer KP Retroversion of the humerus in the throwing shoulder of college baseball pitchers. Am J Sports Med 2002 30 347-353. Reagan KM, Meister K, Horodyski MB, et al Humeral retroversion and its relationship to glenohumeral rotation in the shoulder of college baseball players. Am J Sports Med 2002 30 354-360.
Nerve disorders can be common in certain athletic endeavors such as cycling, baseball, karate, rugby and handball 3 . Problems in these athletes may include carpal tunnel syndrome, cyclist's palsy, gymnast palsy and Wartenberg's syndrome. The cause of these disorders is believed to be mechanical compression secondary to local tissue edema, blunt trauma, adjacent joint synovitis or equipment constraints which results in compression and vascular compromise of the nerve. This mechanical compression causes venous obstruction and subsequent congestion, resulting in anoxia. This anoxia results in greater edema and an inflammatory response, with the end result being fibroblastic proliferation and constriction of the nerve 3 .
Cubital tunnel syndrome occurs when the nerve is compressed as it runs beneath the aponeurosis of the flexor carpi ulnaris just distal to the medial epicondyle (cubital tunnel). Activities that involve repetitive or sustained elbow flexion, such as baseball pitching, can injure and stretch
A 27-year-old professional baseball player with preexisting insertional Achilles tendonitis suffered an acute injury to the affected lower extremity. Examination was consistent with an Achilles tendon sleeve rupture. Magnetic resonance imaging was consistent with an insertional rupture of the Achilles with insufficient distal soft tissue for primary tendon-to-tendon repair. Minimally invasive techniques are not appropriate for this type of rupture, and formal open repair using a J-type incision is very useful. Operative repair was performed with resection of the prominent superior calcaneal tuberosity and fixation of the tendon to the broad cancellous surface with a suture anchor. The diseased portion of the tendon was resected, and the remaining distal stump was repaired as an augmentation once the tendon was secured to the calcaneus.
Baseball For Boys
Since World War II, there has been a tremendous change in the makeup and direction of kid baseball, as it is called. Adults, showing an unprecedented interest in the activity, have initiated and developed programs in thousands of towns across the United States programs that providebr wholesome recreation for millions of youngsters and are often a source of pride and joy to the community in which they exist.