RESUMEN

BACKGROUND: Coronoid fractures are often part of a complex fracture-dislocation of the elbow. For an optimum prognosis, it is important to understand the characteristics of coronoid fractures in different elbow injury patterns. Significant differences in these characteristics have been observed in various studies, but these previous studies have suffered from limitations, such as insufficient quantification and unknown prognostic differences among different injury patterns. Therefore, we aimed to quantitatively analyze coronoid fracture characteristics and functional outcomes in different elbow injury patterns using 3D-CT. METHODS: All patients with coronoid fractures surgically treated at our hospital between January and December 2017 were categorized into three groups according to elbow injury pattern: PLRI, VPMRI and OFD. 3D models were reconstructed using Mimics 17.0, and the total volume (TV) and number of coronoid fragments (NCF) were measured. The coronoid process edge was classified into different anatomical regions, and each region was assigned a number to quantify the distribution of fracture lines. At the last follow-up, the ROM, VAS, MEPS, complications and reoperations were recorded. RESULTS: The ninety-two patients enrolled had an average age of 42±15 years and a male-to-female ratio of 66:26. The median TV in PLRI patients was less than that in VPMRI patients [431 (132, 818)mm3 vs. 1125 (746,1421)mm3,adjusted P<0.001] and OFD patients [431 (132, 818) mm3 vs. 2565 (381, 4076)mm3, adjusted P =0.001]. The median NCF in PLRI patients was also less than that in VPMRI patients [1 (1, 2) vs. 2 (1, 3), adjusted P=0.043]. Most of the PCFL-Rs (79%) were located around the volar edge of the lesser sigmoid notch. Compared with that of PLRI, the PCFL-Us of the VPMRI and OFD tended to be located on the more ulnodorsal side of the coronoid process edge. The median ROM [110 (90, 133), P=0.001] and the median MEPS [85 (68, 95), P=0.038] of patients with OFD were significantly less than those of patients with the other two patterns. The incidence of elbow stiffness (56%, 5/9, P=0.001) and implant-related irritation (44%, 4/9, P<0.001) in the OFD group was significantly higher than that in the other two groups. CONCLUSION: Coronoid fractures differ significantly in fragment volume, comminution severity and fracture line distribution among different elbow injury patterns. OFD has the worst functional outcomes among complex elbow injury patterns.

RESUMEN

Introduction: Proximal radio-ulnar translocation (PRUT) with elbow dislocation, without a fracture, is an extremely unusual injury. Case: A 6-year-old female child presented to us with posterior elbow dislocation, PRUT and incomplete ulnar nerve palsy. A hematoma aspiration and reduction of the elbow joint were done with a hyper-supination manoeuvre to reverse the translocation. She was managed with an above-elbow cast for 4 weeks and showed good radiological and functional outcomes on subsequent follow-ups until 1 year. Conclusion: Early recognition of PRUT and a thorough clinico-radiological assessment are mandatory when dealing with paediatric elbow injuries. Our cadaveric study with illustrations defines the mechanism of this rare injury for better understanding.

RESUMEN

BACKGROUND: Baseball is one of the most popular sports among youth athletes in the United States, and among these players, pitchers are at a particularly high risk of sustaining an injury. Overuse of the arm from repetitive pitching is a common mechanism for injury. Despite the attention that overuse injury has received, little is known regarding the mechanism that leads to elbow injury. This study aims to determine the effect of increasing pitch count on elbow flexion at ball release in a youth pitching cohort. The authors hypothesize that elbow flexion would increase as pitch count increases. METHODS: Study subjects included volunteers from youth baseball players from local teams and public advertisements. Retroreflective markers attached to bony landmarks were placed on the players according to International Shoulder Group recommendations. Pitchers threw an indoor simulated game. Three-dimensional marker trajectories were collected using a 12-camera optical motion capture system, and ball velocity was captured using a radar gun. Voluntary maximal isometric strength of the internal and external rotators was evaluated before and after pitching. Paired 2-tailed t tests were performed to determine if a significant change occurred between the fresh and fatigued sets. RESULTS: Twelve adolescent male pitchers were recruited. Eleven of 12 pitchers completed the prescribed 6 sets of 15 pitches, culminating in a 90-pitch simulated game. The ball speed in the second set was found to be the highest in all pitchers and was considered the "peak set" (P = .021), whereas ball speed was the slowest in the sixth set of pitches and was therefore considered the "fatigue set" (P = .001). There was a moderate but statistically significant inverse correlation between elbow flexion at ball release and maximum internal rotation velocity (P = .005). Elbow flexion at ball release was also significantly positively correlated with shoulder abduction at ball release (P = .004). Elbow flexion at ball release was not significantly correlated with ball velocity (P = .108). CONCLUSIONS: In a simulated game laboratory setting, increasing pitch count was associated with increasing elbow flexion angle at ball release in youth baseball pitchers. These findings demonstrate that pitching with fatigue may cause biomechanical changes that have been associated with increased rates of elbow injury in the adult throwing population. Further investigation on the association between elbow flexion angle and elbow injury in the youth baseball population is needed.

RESUMEN

Case: An 18-year-old right-handed male student presented after a road-traffic-accident; he had type-II Monteggia fracture dislocation associated with ipsilateral type-I capitellum fracture and comminuted lateral condyle avulsion fracture. He underwent open reduction and fixation of ulna with 3.5 DCP with autologous olecranon bone grafting and fixation of capitellum using Herbert screw along with lateral collateral ligament (LCL) repair using fiber wire. At 6-years follow-up good outcome was seen without functional restrictions despite 15 degrees of restriction in pronation. Conclusion: Monteggia type-II variant with type-I capitellum fracture and LCL avulsion is a unique combination that represents a novel variant of type-II Monteggia equivalent, which adds to the existing classification of Monteggia equivalents.

RESUMEN

BACKGROUND: The Kerlan-Jobe Orthopedic Clinic (KJOC) questionnaire is a self-reported performance and functional assessment tool with good reliability and validity for overhead athletes with shoulder and elbow injuries. This study aimed to develop a Japanese version of the KJOC (J-KJOC) to clarify its reproducibility and validity for use by Japanese university baseball players. METHODS: The J-KJOC was translated according to the guidelines for cross-cultural adaptation. A total of 88 university baseball players completed the J-KJOC and the Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaires. Thirty players completed the J-KJOC two times after a median interval of two weeks. We assessed the absolute reliability, construct validity, internal consistency, and test-retest reliability. RESULTS: Cronbach's alpha coefficients ranged from 0.88 and the intraclass correlation coefficient for the total score was 0.91. A fixed bias was absent in the J-KJOC scores (mean difference: -2.2, 95% CI: -4.8 to 0.5). Furthermore, the J-KJOC score was correlated with the Q-DASH-disability/symptom (r = -0.60, p<0.01) and Q-DASH-sports/music (r = -0.63, p<0.01) scores but not correlated with the Q-DASH-work score (r = -0.11, p = 0.316). CONCLUSIONS: The J-KJOC questionnaire demonstrated good reproducibility and validity for assessing upper arm performance in Japanese university baseball players. The results of this study support the use of the J-KJOC for Japanese-speaking baseball players. Further research using this instrument on other types of overhead athletes is needed to determine its wider utility in sports medicine applications.

RESUMEN

Hypothesis and/or Background: The incidence of elbow medial ulnar collateral ligament (MUCL) injuries has been increasing, leading to advances in surgical treatments. However, it is not clear that there is consensus among surgeons regarding diagnostic imaging, the indications for acute surgery and postoperative rehabilitation. The purpose of this study is evaluate surgeon variability in the presurgical, surgical, and postsurgical treatment of MUCL injuries regarding the imaging modalities used for diagnosis, indications for acute surgical treatment, and postoperative treatment recommendations for rehabilitation and return to play (RTP). Our hypothesis is that indications for acute surgical treatment will be highly variable based on MUCL tear patterns and that agreement on the time to RTP will be consistent for throwing athletes and inconsistent for nonthrowing athletes. Methods: A survey developed by 6 orthopedic surgeons with expertise in throwing athlete elbow injuries was distributed to 31 orthopedic surgeons who routinely treat MUCL injuries. The survey evaluated diagnostic and treatment topics related to MUCL injuries, and responses reaching 75% agreement were considered as high-level agreement. Results: Twenty-four surgeons responded to the survey, resulting in a 77% response rate. There is 75% or better agreement among surveyed surgeons regarding acute surgical treatment for distal full thickness tears, ulnar nerve transposition in symptomatic patients or with ulnar nerve subluxation, postoperative splinting for 1-2 weeks with initiation of rehabilitation within 2 weeks, the use of bracing after surgery and the initiation of a throwing program at 3 months after MUCL repair with internal brace by surgeons performing 20 or more MUCL surgeries per year. There were a considerable number of survey topics without high-level agreement, particularly regarding the indications for acute surgical treatment, the time to return to throwing and time RTP in both throwing and nonthrowing athletes. Discussion and/or Conclusion: The study reveals that there is agreement for the indication of acute surgical treatment of distal MUCL tears, duration of bracing after surgery, and the time to initiate physical therapy after surgery. There is not clear agreement on indications for surgical treatment for every MUCL tear pattern, RTP time for throwing, hitting and participation in nonthrowing sports.

RESUMEN

Introduction and importance: Several authors have also made reference to a less prevalent condition known in elbow as ulnar nerve subluxation. However, this particular condition tends to manifest primarily in young individuals who engage in professional sports or activities involving extensive use of the forearm. A more severe form of ulnar nerve subluxation, which is ulnar nerve dislocation, gives rise to a characteristic dislocation and relocation of the nerve at the elbow during flexion and extension of the forearm. Due to the rarity of this condition in clinical settings and its predominant occurrence as subluxation in younger patients, there are instances where traumatic ulnar nerve dislocation can be overlooked and misdiagnosed with two commonly encountered pathological conditions as ulnar nerve entrapment or medial epicondylitis. Case presentation: The authors present a 51-year-old male with chronic pain when moving his right forearm following a fall that caused a direct force injury to his elbow. The patient was misdiagnosed and treated as medial epicondylitis and early-stage ulnar nerve entrapment. However, the symptoms did not improve for a long time. The authors performed the ulnar nerve anterior transposition surgery using the subcutaneous transposition technique and the result is very good without any pain. Clinical discussion: The ulnar nerve can naturally be subluxed or dislocated if Osborne's ligament is loose or when there are anatomical variations in the medial epicondyle. In some case, this ligament can be ruptured by trauma. The symptoms of ulnar instability are caused by friction neuritis. Dynamic ultrasound of the ulnar nerve in two positions show clearly this condition. Conclusion: Post-traumatic ulnar nerve dislocation is a rare condition, and the recurrent characteristic of it leads to neuritis or neuropathy. The condition can be overlooked or misdiagnosed as medial epicondylitis or early-stage ulnar nerve entrapment. The nerve transposition surgery will give good result.

RESUMEN

On-field screening for 'elbow injury in baseball', a condition commonly seen in youth baseball players, was conducted over two years on 160 elementary school students in Ibaraki Prefecture, Japan. This on-field screening was conducted in collaboration with the Ibaraki Prefecture High School Baseball Federation. Pitchers, catchers, symptomatic players, and players who had previously experienced elbow pain were given a comprehensive evaluation that included a physical exam and ultrasound. Out of the 135 students who were successfully screened, 10 were diagnosed with osteochondritis dissecans of the humeral capitellum (OCD). Notably, seven among these were asymptomatic. This assessment identified limited range of motion and pain when extending their elbow as significant risk factors for OCD. An attempt at on-field screening for baseball elbow injuries in collaboration with the local baseball federation was introduced. The risk factors for OCD were identified. Considering these factors, more efficient screening will be possible in the next attempt.

RESUMEN

BACKGROUND: Young baseball players with medial elbow injuries are known to have high forearm flexor-pronator muscle elasticity; however, the causal relationship between forearm muscle elasticity and the occurrence of medial elbow injuries remains unclear. PURPOSE/HYPOTHESIS: The purpose of this study was to determine whether the forearm flexor-pronator muscle elasticity is a risk factor for medial elbow injury in young baseball players. It was hypothesized that high flexor carpi ulnaris (FCU) elasticity would be a risk factor for medial elbow injuries. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Young baseball players (aged 9-12 years) with no history of elbow injuries underwent examination during which the strain ratios (SRs) of the pronator teres, flexor digitorum superficialis, and FCU muscles were measured using ultrasound strain elastography as an index of elasticity. Additionally, the participants completed a questionnaire assessing age, height, weight, months of experience as a baseball player, position in baseball, number of training days per week, number of throws per day, and elbow pain during throwing; then the range of motion of the shoulder and hip internal/external rotation were measured. One year after the baseline measurements, the occurrence of new medial elbow injuries was evaluated. Multivariate logistic regression analysis was subsequently conducted to determine risk factors for medial elbow injuries. Cutoff points for significant SR values obtained from the multivariate logistic regression analysis were calculated using the receiver operating characteristic curve. RESULTS: Of the 314 players, 76 (24.2%) were diagnosed with medial elbow injury. Multivariate logistic regression analysis showed that a 0.1 increase in the SR of the FCU muscle (odds ratio [OR], 1.211; 95% CI, 1.116-1.314) and number of throws per day (OR, 1.012; 95% CI, 1.001-1.022) were significantly associated with medial elbow injuries. Receiver operating characteristic curve analyses revealed that the optimal cutoff for the SR of the FCU muscle was 0.920 (area under the curve, 0.694; sensitivity, 75.0%; specificity, 56.7%). CONCLUSION: Increased FCU elasticity is a risk factor for medial elbow injury. Evaluation of the FCU elasticity may be useful in identifying young baseball players at high risk of medial elbow injuries and may facilitate prevention of medial elbow injury. As shown by the results of multivariate logistic regression analysis, FCU elasticity itself may be useful in identifying young baseball players at high risk of elbow injuries. However, we believe that other factors, such as the number of pitches per day, need to be considered to improve its accuracy.

Asunto(s)

RESUMEN

Posterior dislocation of the elbow joint is the second commonest large joint dislocation that can be experienced due to various traumatic incidents. Although it may be associated with fractures and vascular lesions, in this case report, we describe a patient who encountered a posterolateral elbow dislocation following a fall on their arm with an extended elbow. This dislocation was followed by delayed thrombosis of the brachial artery, necessitating a revascularization surgery. For optimal patient care, physicians should remain vigilant, being cautious about potential vascular injuries both before and after performing a closed reduction of the elbow joint. The suspicion of vascular injury should be even more pronounced when bony lesions or open injuries are present. Effective management of such cases requires a collaborative effort between orthopedic and vascular surgeons. The preferred surgical approach involves the utilization of a saphenous graft, with the essential prerequisite of achieving a stable elbow joint before proceeding with revascularization.

RESUMEN

CLINICAL SCENARIO: Osteochondritis dissecans (OCD) of the capitellum is a condition occurring at the elbow and often seen in both baseball players and gymnasts due to the repetitive loading of the radiocapitellar joint. Treatment options for OCD vary and are dependent on lesion presentation, elbow motion, and growth plate maturity. OCD lesions categorized as unstable can be treated with an osteochondral autograft transplantation surgery (OATS). FOCUSED CLINICAL QUESTION: In an adolescent population, what are the return to sport rates and clinical outcomes following OATS in baseball players and gymnasts with unstable OCD lesions? SUMMARY OF KEY FINDINGS: Three articles met the inclusion criteria for this appraisal, and all indicate an OATS procedure should be considered in the management of unstable OCD lesions. Return to play outcomes were favorable for both baseball players and gymnasts. Self-reported patient function and elbow extension all improved following an OATS. CLINICAL BOTTOM LINE: An OATS procedure is a favorable option for the management of OCD lesions of the elbow in baseball players and gymnasts. STRENGTH OF RECOMMENDATION: There is level B evidence to support return to sport and clinical outcomes in baseball players and gymnasts following an OATS procedure. This score is directly related to the quality of evidence that currently exists on the topic.

Asunto(s)

RESUMEN

BACKGROUND: The purpose of this study was to investigate outcomes and return to sport metrics in recreational athletes who suffered simple elbow dislocations and were treated operatively or nonoperatively. METHODS: The study included patients between the ages of 16 and 65 who were recreational athletes and had experienced a simple elbow dislocation, with at least 2 years having passed since the injury. Patient-reported outcomes including Mayo Elbow Performance Score (MEPS), Subjective Elbow Value (SEV), Oxford Elbow Score (OES) and Visual Analog Scale (VAS) were collected. Return to sport metrics were assessed. RESULTS: A total of 44 patients (21 females, mean age 43.8 years [95% CI, 39.1-48.5]) who were recreational athletes before their injury completed follow-up at mean 7.6 years (95% CI, 6.7-8.5). There were 29 patients (65.9%) who were treated operatively. Mean MEPS was 93.3 (95% CI, 90.2-96.4), mean SEV was 94.9 (95% CI, 91.9-97.9) and mean OES was 43.3 (95% CI, 41.3-45.4). A total of 36 (81.8%) patients returned to their pre-injury sport. Mean time to return to sport was 21.7 (95% CI, 16.8-26.5) weeks. There was a significant difference in OES (P = .019) and SEV (P = .030) that favored the nonoperative group; however, no significant differences for MEPS, VAS, satisfaction, arc of motion and return to sport were present between groups. A total of five (11.4%) complications were observed and one (2.3%) required revision. CONCLUSIONS: Good outcomes and a high return to sport rate can be expected in recreational athletes following operative and nonoperative treatment of simple elbow dislocations. However, as many as one-in-five patients may not return to pre-injury sport.

Asunto(s)

RESUMEN

The objective was to evaluate pediatric patients with acute elbow dislocation and/or associated fracture to determine which were indicated for surgical intervention, using a single institution, Institutional Review Board (IRB) approved retrospective review of patients who presented to the Emergency Department (ED) with an acute elbow dislocation. Inclusion criteria were age ≤ 18 years, acute elbow dislocation injury, and appropriate imaging. A total of 117 patients were included 37 had a simple elbow dislocation, 80 had an associated fracture (medial epicondyle 59, lateral condyle 9, radial head/neck 7, other 5). A total of 62% (73/117) were male. The average age was 10.3 years (range 4-17). Mechanisms of injury included: falls from height/playground equipment (46), trampoline (14), and sports (57). All 37 patients with a simple elbow dislocation were successfully treated with closed reduction. Of the 80 patients with an associated fracture, 30 (38%) went on to open reduction internal fixation (ORIF). A total of 59 patients had an associated medial epicondyle fracture; 24 (41%) of whom went on to ORIF. Nine patients had an associated lateral condyle fracture, five (56%) of whom went on to ORIF. Patients with a simple elbow dislocation can be successfully treated with a closed reduction in the ED. However, 30/80 patients with an associated fracture (medial epicondyle, lateral condyle, or radial neck) required operative management.

RESUMEN

Background: The posterior interosseus nerve (PIN) may be encountered when using the extensile extensor digitorum communis (EDC)-splitting approach to the elbow. An accurate means of estimating its location remains elusive. The purpose of this investigation is to identify whether the methods described in previous studies can be improved upon to more accurately estimate the PIN's location using the transepicondylar distance (TED). Methods: Forty-five fresh-frozen cadavers were dissected using the EDC-splitting approach. Method A (N = 39) used an electronic caliper measuring along the midlateral border of the radius from the lateral epicondyle (LE) and radiocapitellar joint in supination, neutral position, and pronation. Method B (N = 16) used a sterile tape measure, measuring from the LE in pronation only along an axis from the LE to Lister's tubercle passing through the center capitellum. Results: In method A, the mean TED was 63.4 ± 6.1 mm. Of the 6 measurements, the TED was most correlated to the actual distance to the PIN from the LE in pronation (68.3 ± 7.3 mm; R2 = 0.266). The median difference between the estimated and actual distances was -5.6 mm (-19.3 mm to 7.6 mm). In method B, the mean TED was 68.4 ± 8.7 mm, and the mean measured distance from the LE in pronation was 68.7 ± 9.4 mm. The TED closely correlated with the measured distance to the PIN (R2 = 0.95, P < .001). The mean difference between the estimated and actual distances was ±2.0 mm (range -4.0 mm to 2.0 mm), significantly more precise than method A (P = .007). Conclusion: Using a tape measure, the TED predicted the PIN's location within a mean ±2 mm in pronation along an axis from the LE to Lister's tubercle, using an EDC-splitting approach. This technique is simple and comparatively more accurate than those used previously.

RESUMEN

Skeletal muscle works as a dynamic joint stabilizer, assisting the underlying ligaments in restricting joint angulation by actively resisting external loads. Despite its clinical importance, little is known about the muscle strength required to produce torque to help ligaments restrict joint angulation within the physiological range permitted by the joint structure. In this study, we introduce a method for measuring the strength of the elbow musculature in restraining valgus angulation and present the values obtained in 20 healthy young men. Each participant was fastened to a Biodex dynamometer, with the elbow joint flexed to 90° and the varus-valgus axis aligned to the dynamometer's rotation axis. Maximal voluntary isometric ramp contraction of shoulder internal rotators was performed while the humeroulnar joint gap was monitored with an ultrasound apparatus. The largest torque recorded while the humeroulnar joint gap did not exceed a predetermined individualized threshold was considered to be the elbow varus strength of the participant. The elbow varus strength of the dynamic stabilizer was found to be 41 ± 12 Nm, which agreed with the value estimated by our musculoskeletal model. The inter-operator reliability test indicated excellent reliability (ICC (2,1) = 0.91). These findings suggest that the present method is valid for measuring the strength of the elbow musculature in restraining the valgus angulation. Measurements of this aspect of strength are expected to provide insights for understanding and preventing elbow injuries.

Asunto(s)

RESUMEN

BACKGROUND: Hip strength is an important factor for control of the lumbo-pelvic-hip complex. Deficits in hip strength may affect throwing performance and contribute to upper extremity injuries. HYPOTHESIS: Deficits in hip abduction isometric strength would be greater in those who sustained an upper extremity injury and hip strength would predict injury incidence. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Minor League baseball players (n = 188, age = 21.5 ± 2.2 years; n = 98 pitchers; n = 90 position players) volunteered. Hip abduction isometric strength was assessed bilaterally with a handheld dynamometer in side-lying position, expressed as torque using leg length (N·m). Hip abduction strength asymmetry was represented by [(trail leg/lead leg) × 100]. Overuse or nontraumatic throwing arm injuries were prospectively tracked. Poisson regression models were used to estimate relative risk ratios associated with hip asymmetry; confounders, including history of prior overuse injury in the past year, were included. RESULTS: Hip abduction asymmetry ranged from 0.05% to 57.5%. During the first 2 months of the season, 18 players (n = 12 pitchers) sustained an upper extremity injury. In pitchers, for every 5% increase in hip abduction asymmetry, there was a 1.24 increased risk of sustaining a shoulder or elbow injury. No relationship between hip abduction strength and injury was observed for position players. CONCLUSION: Hip abduction asymmetry in pitchers was related to subsequent upper extremity injuries. The observed risk ratio indicates that hip abduction asymmetry may contribute a significant but small increased risk of injury. CLINICAL RELEVANCE: Hip abduction muscle deficits may affect pitching mechanics and increase arm stress. Addressing hip asymmetry deficits that exceed 5% may be beneficial in reducing upper extremity injury rates in pitchers.

Asunto(s)

RESUMEN

BACKGROUND: Adolescent baseball players with a history of medial elbow injury are often reinjured during demanding practice sessions or games. The physical characteristics of baseball players with a history of medial elbow injury have been reported in several previous studies, but the nature of their medial elbow stabilizers is unknown. This study investigated the difference in characteristics of elbow valgus laxity and medial elbow stabilizer parameters between baseball players with and without a history of medial elbow injury, prior to and during repetitive pitching. METHODS: Sixteen high school baseball players with no history of medial elbow injury (No-Injury group) and 14 high school baseball players with a history of medial elbow injury (Injury History group) participated. The participants pitched 100 fastballs. Medial elbow joint-space gapping and strain ratio indicating tissue elasticity of ulnar collateral ligament (UCL) and forearm flexor-pronator muscles (FPMs) were measured by ultrasound before pitching and following each of five 20-pitch blocks. Student t tests and Mann-Whitney U tests were used to compare each parameter between groups. RESULTS: Medial elbow joint-space gapping and UCL elasticity were not significantly different between the 2 groups in each pitching block (P > .05). The strain ratio of FPMs before pitching and after 100 pitches in the Injury History group were significantly greater than that in the No-Injury group (No-Injury vs. Injury History group: before pitching, 0.47 ± 0.19 vs. 0.68 ± 0.26, P = .016; 100 pitches, 0.35 ± 0.12 vs. 0.53 ± 0.20, P = .007). In the other pitching blocks, there was no significant difference between groups, but the effect size was medium and showed a similar tendency (20 pitches, P = .069, Cohen d = 0.69; 40 pitches, P = .116, Cohen d = 0.59; 60 pitches, P = .102, Cohen d = 0.62; 80 pitches, P = .058, Cohen d = 0.72). CONCLUSIONS: The results of this study indicate that FPM elasticity at baseline and during repetitive pitching in players with a history of medial elbow injury was harder than in players without injury history. This may suggest that baseball players with a history of medial elbow injury increase support of their previously injured medial elbow by hardening FPM elasticity to counteract elbow valgus stress generated during pitching, which may lead to long-term change in the FPMs. Therefore, physical management for this change may be important to prevent reinjury in baseball players with a history of medial elbow injury.

Asunto(s)

RESUMEN

PURPOSE OF REVIEW: Golf is a sport that can be played by an athlete of any age, which enhances its popularity. Each golfer's swing is unique, and there is no "right" way to swing the golf club; however, the professional golfer often has more of a consistent swing as opposed to an amateur golfer. A collaborative, team approach involving the golfer with a swing coach, physical therapist, and physician often can be informative on how to prevent golf injury, but also how to treat golf injury if it occurs. RECENT FINDINGS: As a rotational sport, the golfer needs to be trained and treated with respect for how the body works as a linkage system or kinetic chain. A warm-up is recommended for every golfer before practicing or playing, and this warm-up should account for every segment of the linkage system. Though it has been thought of as a relatively safe sport, injuries can be seen with golfers of any age or skill level, and upper body injuries involving the cervical and thoracic spine, shoulder, elbow, and wrist are common. A narrative review is provided here of the epidemiology of golf injury and common injuries involving each of these upper body regions. In addition, treatment and injury prevention recommendations are discussed.

RESUMEN

Injuries in the elbow area, such as lateral and medial epicondylitis, are the leading causes of consultation with health specialists. Therefore, this research proposes the mechatronic design of an orthosis with a graphic interface that supports professionals in the rehabilitation of the elbow joint through the execution of flexion-extension and pronation-supination movements. For the development of the rehabilitation prototype, mechatronic design, co-design, and IDEF0 methodologies are used, performing activities such as actuator characterization, simulations, and modeling, among others. Through the execution of a case study in a real environment, the device was validated, where the results suggest a functional and workable prototype that supports the treatment of pathologies in the elbow area through the execution of the mentioned movements, supposing that this is a low-cost alternative with elements to improve, such as the industrial design and new functionalities. The developed proposal shows potential as an economical product that health professionals can use. However, some limitations related to the design and functionalities in the application domain were identified.