title: Postoperative restoration of upper extremity motion and neuromuscular control during the overhand pitch: evaluation of tenodesis and repair for superior labral anterior-posterior tears.
abstract: BACKGROUND
  Superior labral anterior-posterior (SLAP) tears are a common cause of shoulder pain and dysfunction in overhand throwers. Treatment outcomes remain unpredictable, with a large percentage of athletes unable to return to sport. There is considerable debate about the optimal treatment between debridement, repair, and tenodesis.
  
  
  OBJECTIVE
  Labral repair more closely restores neuromuscular control and motion during the overhand pitch than tenodesis of the long head of the biceps.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Eighteen pitchers, including 7 uninjured controls, 6 players pitching after SLAP repair, and 5 players pitching after subpectoral biceps tenodesis (BT), underwent simultaneous surface electromyographic measurement at 1500 Hz and motion analysis at 120 Hz with a 14-camera markerless motion analysis system and high-speed video (120 Hz) to confirm accurate motion tracking. Patients had undergone surgery at least 1 year previously and had returned to pitching with a painless shoulder.
  
  
  RESULTS
  No significant differences were observed in the long head of the biceps muscle, short head of the biceps muscle, deltoid, infraspinatus, or latissimus activity between controls, patients after SLAP repair, and patients after BT. The variability from pitch to pitch for each study participant was similar between groups. Based on visual inspection of the activity time plots, BT appeared to more closely restore the normal pattern of muscular activation within the long head of the biceps muscle than did SLAP repair. There were no significant differences between controls and postoperative patients in the majority of pitching kinematics; however, pitchers after SLAP repair showed significantly altered patterns of thoracic rotation (P = .034) compared with controls and were significantly less likely to fall into previously published normal values for lead knee flexion at front foot contact (P = .019).
  
  
  CONCLUSIONS
  While both BT and SLAP repair can restore physiologic neuromuscular control, pitchers who undergo SLAP repair may exhibit altered patterns of thoracic rotation when compared with controls and pitchers who undergo BT.
  
  
  CONCLUSIONS
  While both tenodesis and SLAP repair can restore physiologic neuromuscular control, SLAP repair may alter pitching biomechanics.
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA p.n.chalmers@gmail.com.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Chalmers
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Trombley
authors.affiliation: Department of Orthopaedic Surgery, Academic Teaching Hospital Landeskrankenhaus, Feldkirch, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Cip
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Monson
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Forsythe
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Nicholson
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Bush-Joseph
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Cole
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Wimmer
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Romeo
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Nikhil N
authors.initials: NN
authors.lastname: Verma
mesh_terms: D000328:Adult; D001484:Baseball / Q000293:injuries / Q000502:physiology*; D001696:Biomechanical Phenomena; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery*; D016022:Case-Control Studies; D004576:Electromyography; D006801:Humans; D008297:Male; D009068:Movement / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology / Q000601:surgery; D020127:Recovery of Function / Q000502:physiology; D012399:Rotation; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000502:physiology* / Q000601:surgery; D053656:Tenodesis; D013909:Thorax; D055815:Young Adult
keywords: baseball/softball; biceps tendon; biomechanics; general; glenoid labral; motion analysis/kinesiology; shoulder; superior labral anterior-posterior (SLAP) tear