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Upper extremity injuries
Published in Youlian Hong, Roger Bartlett, Routledge Handbook of Biomechanics and Human Movement Science, 2008
Ronald F. Zernicke, William C. Whiting, Sarah L. Manske
The coupling of valgus torque and elbow extension in throwing can produce a valgus-extension overload that strains the ulnar collateral ligament and can lead to other medial elbow injuries, including ulnar collateral ligament sprain or rupture and avulsion fracture. The largest internal varus torque developed in the medial tissues to resist the external valgus torque occurs near the end of the cocking phase of throwing (Fleisig et al., 1995). In baseball pitching, the ulnar collateral ligament approaches its maximal capacity, making it vulnerable to injury (Fleisig et al., 1995). In the cocking and acceleration phase, as substantial internal varus torque is generated, the elbow extends from 85˚ to 20˚ (Fleisig et al., 1995). The combination of internal varus torque and elbow extension supports the ‘valgus extension loading’ mechanism for medial elbow injury — a common injury to baseball pitchers and javelin throwers.
Homo Sapiens (“Us”): Strengths and Weaknesses
Published in Michael Hehenberger, Zhi Xia, Huanming Yang, Our Animal Connection, 2020
Michael Hehenberger, Zhi Xia, Huanming Yang
We can run and have surprisingly good endurance, but many animals can beat our speed. We can jump, but to many animals our leaps look quite ordinary. The many advantages of our upright walk are partly compensated by lower back pain, aching hips and knees, and by ligaments that cannot support extreme movements. That applies, e.g., to the ACL (anterior cruciate ligament) of our knees. It is frequently torn whenever athletes compete with each other. Another weak link is the ulnar collateral ligament (UCL) of our elbow which is frequently overused by (baseball) athletes who throw “fastballs.” To repair a torn UCL’s, the surgeon often replaces the elbow tendon with another tendon of the patient’s body.
Homo Sapiens (“Us”): Strengths and Weaknesses
Published in Michael Hehenberger, Zhi Xia, Our Animal Connection, 2019
We can run and have surprisingly good endurance, but many animals can beat our speed. We can jump, but to many animals our leaps look quite ordinary. The many advantages of our upright walk are partly compensated by lower back pain, aching hips and knees, and by ligaments that cannot support extreme movements. That applies, e.g., to the ACL (anterior cruciate ligament) of our knees. It is frequently torn whenever athletes compete with each other. Another weak link is the ulnar collateral ligament (UCL) of our elbow which is frequently overused by (baseball) athletes who throw “fastballs.” To repair a torn UCL’s, the surgeon often replaces the elbow tendon with another tendon of the patient’s body.
Impact of shoe and cleat type on youth baseball pitching biomechanics
Published in Sports Biomechanics, 2022
Jacob R. Gdovin, Chip Wade, Charles C. Williams, Lauren A. Luginsland, Samuel J. Wilson, John C. Garner
Injuries to the medial elbow, including those to the ulnar collateral ligament (UCL), occur during the late-cocking phase due to excessive torque at the elbow (Fleisig et al., 1995). While some researchers (Anz et al., 2010) believe that injury risk to the elbow is associated with the amount of elbow varus torque in the late-cocking phase of the pitch, it has not been clearly established due to conflicting results among studies (Hurd et al., 2012; Post, Laudner, McLoda, Wong, & Meister, 2015). The UCL is responsible for generating 54%, or 34 Nm, of the varus torque when the elbow is flexed at 90° in attempt to stabilise and prevent valgus movement (Morrey & An, 1983). Unfortunately, the elbow is flexed at 90° during the late-cocking and early acceleration phases. Although the aforementioned study was completed in vitro and may differ when actively pitching, we can assume the UCL was responsible for 19.3 Nm and 18.0 Nm in the MC × PM and MC × FG conditions, respectively, if in fact, the UCL did produce 54% of the varus torque. This suggests wearing a MC may cause the UCL in youth pitchers to produce upwards of 60% of the UCL’s 32Nm maximum load (Fleisig et al., 1995) while a TS generates 56%.
The ulnar collateral ligament loading paradox between in-vitro and in-vivo studies on baseball pitching (narrative review)
Published in International Biomechanics, 2021
Bart Van Trigt, Liset (W) Vliegen, Ton (Ajr) Leenen, DirkJan (Hej) Veeger
In all of the studies mentioned earlier, only the study of Jackson et al. (2016) took material fatigue into account. Most measurement protocols started with a preload and increased the load until failure. However, as mentioned before, most of the UCL injuries are overuse injuries and related to fatigue and pitch count. Therefore, it would be useful to take material fatigue of the UCL into account.
Predicting Multiple Injuries to Major League Baseball Pitchers: A Logistic Regression Analysis over the 2009 – 2019 Regular Seasons
Published in Research in Sports Medicine, 2022
In a review of the literature regarding injuries to MLB players, many studies have examined injuries to pitchers. For example, Posner et al. (2011) discovered that pitchers incur injuries at greater rates (and specifically upper extremity injuries) compared to fielders. Similarly, injury recovery time, as quantified by the mean number of days spent on the IL, is greater for pitchers than it is for fielders (Posner et al., 2011). Ciccotti et al. (2017) somewhat confirm this result as they determined that pitchers are more likely to incur elbow injuries compared to fielders and require a greater length of time on the IL to recover from their injury when treated non-surgically. When an elbow injury is treated surgically, this may mean that the pitcher strained, frayed, or tore their ulnar collateral ligament (UCL). The type of surgery performed to repair a torn UCL is commonly referred to as “Tommy John surgery.” Makhni et al. (2014) determined, in a longitudinal analysis over the 1999–2011 seasons, that among pitchers who required Tommy John surgery, 57% required a second IL stint due to an injury to their surgically repaired arm. Additionally, performance metrics in commonly measured pitching statistics (earned run average (ERA), average walks and hits per innings pitched (WHIP), and opponent batting average (oBA)), deteriorated in those who were able to return to play compared to their performance prior to surgery (Makhni et al., 2014). Further, Jones et al. (2013) found that those pitchers who reinjured their reconstructed UCL to such a degree to require a revision UCL reconstruction, only 50% and 35% of relief and starting pitchers, respectively, were able to return to their workload pre-revision surgery. However, not all injuries requiring surgery lead to deteriorated on-field performance for pitchers. Cerynik et al. (2008) determined that other than a decrease in innings pitched (which may be confounded with age rather than injury), pitchers requiring shoulder surgery to repair glenoid labral injuries had no deterioration in ERA or WHIP post-surgery.