title: Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: a prospective study.
abstract: BACKGROUND
  Injuries to the elbow joint in baseball pitchers appear common. There appears to be a correlation between shoulder range of motion and elbow injuries.
  
  
  OBJECTIVE
  To prospectively determine whether decreased ROM of the throwing shoulder is correlated with the onset of elbow injuries in professional baseball pitchers.
  
  
  METHODS
  Cohort study; Level of evidence, 2.
  
  
  METHODS
  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 assessed with the subject supine and the scapula stabilized per methods previously established. Elbow injuries and days missed because of elbow injuries were assessed and recorded by the medical staff of the team. Throwing and nonthrowing shoulder measurements were compared by using Student t tests; 1-tailed Fisher exact tests were performed to identify significant associations between shoulder motion and elbow injury. Nominal logistic regression was performed to determine the odds of elbow injury.
  
  
  RESULTS
  Significant differences were noted during side-to-side comparisons within subjects. There were 49 elbow injuries and 8 surgeries in 38 players, accounting for a total of 2551 days missed. Neither glenohumeral internal rotation deficit nor external rotation insufficiency was correlated with elbow injuries. Pitchers with deficits of >5° in total rotation in their throwing shoulders had a 2.6 times greater risk for injury. Pitchers with deficit of ≥5° in flexion of the throwing shoulder had a 2.8 times greater risk for injury.
  
  
  CONCLUSIONS
  Bilateral differences in shoulder total rotation and flexion had a significant effect on the risk for elbow injuries in pitchers. Clinicians need to be aware of these findings and plan preventive programs that address these issues in hopes of reducing elbow injuries.
authors.affiliation: Champion Sports Medicine, Physiotherapy Associates, Birmingham, Alabama, USA American Sports Medicine Institute, Birmingham, Alabama, USA kwilkpt@hotmail.com.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Wilk
authors.affiliation: Champion Sports Medicine, Physiotherapy Associates, Birmingham, Alabama, USA American Sports Medicine Institute, Birmingham, Alabama, USA.
authors.forename: Leonard C
authors.initials: LC
authors.lastname: Macrina
authors.affiliation: American Sports Medicine Institute, Birmingham, Alabama, USA.
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Fleisig
authors.affiliation: American Sports Medicine Institute, Birmingham, Alabama, USA.
authors.forename: Kyle T
authors.initials: KT
authors.lastname: Aune
authors.affiliation: Tampa Bay Rays Baseball Organization, Tampa, Florida, USA.
authors.forename: Ron A
authors.initials: RA
authors.lastname: Porterfield
authors.affiliation: Tampa Bay Rays Baseball Organization, Tampa, Florida, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Harker
authors.affiliation: American Sports Medicine Institute, Birmingham, Alabama, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Evans
authors.affiliation: American Sports Medicine Institute, Birmingham, Alabama, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Andrews
mesh_terms: D053587:Arthrometry, Articular; D001484:Baseball / Q000293:injuries*; D001696:Biomechanical Phenomena; D004551:Elbow Joint / Q000503:physiopathology; D006801:Humans; D008297:Male; D010808:Physical Examination; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D012306:Risk; D012399:Rotation; D012785:Shoulder Joint / Q000503:physiopathology*; D055815:Young Adult; D000092464:Elbow Injuries
keywords: GIRD; baseball; external rotation; internal rotation; shoulder