title: Effect of posteroinferior capsule tightness on contact pressure and area beneath the coracoacromial arch during pitching motion.
abstract: BACKGROUND
  Tightness of the posteroinferior capsule is assumed to be the cause of internal rotation loss in baseball pitchers. Although the relationship between posterior capsule and subacromial impingement has been recognized, this relationship during the baseball-pitching motion is unclear.
  
  
  OBJECTIVE
  Contact pressure during baseball-pitching motion increases with posterior capsule tightness.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Eight fresh-frozen shoulders were used. The peak contact pressure and area on the coracoacromial arch were measured on a custom-designed shoulder experimental device capable of 6 degrees of freedom motion. Simultaneously, the sites of peak pressure on the coracoacromial arch and humerus were observed from various angles. The posteroinferior capsule tightness was simulated by plicating the capsule in the region from 6 to 8 o'clock. The static testing positions correlated to the early cocking, late cocking, acceleration, deceleration, and follow-through phases of the pitching motion.
  
  
  RESULTS
  The peak contact pressure during the follow-through phase (0.63 + or - 0.50 MPa) significantly increased with posteroinferior capsule tightness (1.00 + or - 0.65 MPa) (P = .014). Additionally, the contact area on the coracoacromial ligament during the follow-through phase (0.98 + or - 0.67 cm(2)) significantly increased with posteroinferior capsule tightness (1.47 + or - 0.91 cm(2)) (P < .001). The site of the peak contact pressure did not change between the 2 conditions.
  
  
  CONCLUSIONS
  Our findings demonstrate that posteroinferior capsule tightness leads to higher contact pressure under the subacromial arch and increased contact area, particularly on the coracoacromial ligament during the follow-through phase.
  
  
  CONCLUSIONS
  This tightness may affect risk of injury of the rotator cuff and its surrounding tissues by increasing subacromial contact during pitching.
authors: Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
authors: Takayuki
authors: T
authors: Muraki
authors: Nobuyuki
authors: N
authors: Yamamoto
authors: Kristin D
authors: KD
authors: Zhao
authors: John W
authors: JW
authors: Sperling
authors: Scott P
authors: SP
authors: Steinmann
authors: Robert H
authors: RH
authors: Cofield
authors: Kai-Nan
authors: KN
authors: An
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D054874:Athletic Performance / Q000502:physiology*; D001484:Baseball / Q000502:physiology*; D002062:Bursitis / Q000503:physiopathology; D002102:Cadaver; D006801:Humans; D008875:Middle Aged; D011312:Pressure; D016059:Range of Motion, Articular; D012399:Rotation; D017006:Rotator Cuff / Q000503:physiopathology; D012782:Shoulder / Q000502:physiology*; D019534:Shoulder Impingement Syndrome / Q000503:physiopathology