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Immediate Changes and Recovery of the Supraspinatus, Long Head

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Immediate Changes and Recovery of the Supraspinatus, Long Head Original Article Clinics in Orthopedic Surgery 2021;13:385-394 • https://doi.org/10.4055/cios20187 Immediate Changes and Recovery of the Supraspinatus, Long Head Biceps Tendon, and Range of Motion after Pitching in Youth Baseball Players: How Much Rest Is Needed after Pitching? Sonoelastography on the Supraspinatus Muscle- Tendon and Biceps Long Head Tendon Joo Han Oh, MD, Joon Yub Kim, MD*,#, Kyoung Pyo Nam, MD*, Heum Duck Kang, MA†,#, Ji Hyun Yeo, MD‡ Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, *Department of Orthopedic Surgery, Yeson Hospital, Bucheon, †Baseball Academy, Seongnam, ‡Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Goyang, Korea Background: Baseball players are subjected to repeated loads on the supraspinatus and long head biceps tendon from youth, and repetitive pitching motions can cause shoulder injuries. The purpose of this study was to evaluate the immediate changes caused by pitching in the supraspinatus muscle-tendon, long head of the bicep tendon (LHBT), and shoulder range of motion (ROM) and to verify their recovery over time in youth baseball players. Methods: Fifteen youth baseball players (mean age, 11.5 ± 1.3 years) were enrolled. The thicknesses of the supraspinatus tendon and LHBT and the strain ratios (SRs) of supraspinatus muscle and tendon were measured by sonoelastography. ROMs of shoulder joints (abduction, external rotation at 90° of abduction [ABER], and internal rotations at 90° of abduction [ABIR]) and horizontal adduction (HA) were measured using a goniometer. All measurements were performed on the throwing shoulders before and im- mediately after pitching (mean pitch count, 78.3 ± 13.3) and at 30 minutes, 24 hours, and 72 hours after pitching. Results: The thickness of supraspinatus tendon (6.64–6.27 mm, p = 0.026) and that of LHBT (2.56–2.26 mm, p = 0.021) significantly decreased immediately after pitching. The SRs of supraspinatus muscle tended to decrease, whereas SRs of supraspinatus tendon tended to increase immediately after pitching. ABER increased (119.7°–127.3°, p = 0.001) and HA decreased (34.7°–29.3°, p = 0.023) immediately after pitching. All immediate changes recovered 72 hours after pitching. Conclusions: The immediate effects of pitching on the supraspinatus muscle-tendon, LHBT, and shoulder ROM in youth baseball players were confirmed in the current study. These changes were recovered to pre-pitch levels 72 hours after pitching. Therefore, we recommend that youth baseball players should rest for three days after pitching to minimize the risk of shoulder injury. Keywords: Baseball, Supraspinatus, Elasticity, Recovery, Rest Received July 22, 2020; Revised November 18, 2020; Accepted November 24, 2020 Correspondence to: Ji Hyun Yeo, MD Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, Korea Tel: +82-31-961-7274, Fax: +82-31-961-9339 E-mail: [email protected] #Current affiliation: 210 Orthopedics, Seoul, Korea Copyright © 2021 by The Korean Orthopaedic Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Clinics in Orthopedic Surgery • pISSN 2005-291X eISSN 2005-4408 386 Oh et al. Immediate Changes and Recovery after Pitching in Youth Baseball Players Clinics in Orthopedic Surgery • Vol. 13, No. 3, 2021 • www.ecios.org Repetitive pitching is known to damage structures in the in harder tissue.2,13,14) As muscle lesions usually become shoulder joint, such as the rotator cuff tendon, the long harder due to muscle contraction and tendon lesions head of the bicep tendon (LHBT), and the labrum.1-3) become softer due to intratendinous softening, strain in- Many baseball players experience injuries, such as rota- creases in tendon lesions and decreases in muscle lesion tor cuff tears and superior labral anterior to posterior when measured by musculoskeletal sonoelastography.15) In (SLAP) lesions due to repetitive pitching. These types of addition to the studies using sonoelastography for the di- shoulder injuries are not limited to adult players and are agnosis of musculoskeletal diseases,15-17) sonoelastography also frequently observed in youth baseball players.1,2,4,5) has been used in several studies on the rotator cuff and Furthermore, it has been reported that about 20% of youth LHBT.2,12,18,19) baseball players experience shoulder pain during a single Baseball pitchers have a characteristic range of mo- baseball season4-6) and that the risk of shoulder injuries tion (ROM) of their shoulder joints, which is important among youth baseball players is increasing.4,7) for understanding the pitcher’s shoulder.20) In general, Risk factors for shoulder injuries and diseases are throwing shoulders exhibited a decrease in internal rota- not fully understood.6) The shoulder joints of baseball tion (IR) and an increase in external rotation (ER) at 90° players are subjected to repeated loads due to throwing of abduction (ABD), and these changes are associated with baseballs from youth.8) Baseball pitching creates tremen- glenohumeral IR deficits and throwing arm injuries.10) dous forces on the glenohumeral joint and adjacent struc- Extremely repetitive forces on the throwing shoulder dur- tures9) and causes changes to the rotator cuff and LHBT.1-3) ing pitching cause structural remodeling to the shoulder Some studies have reported rotator cuff tendon and LHBT joint structures and may be responsible for unique shoul- complex injuries in shoulder joints caused by repetitive der ROMs in baseball players.21) The osseous structural throwing. However, research on immediate changes to changes, such as greater humeral retroversion, begin in shoulder muscles and tendons due to pitching is limited. youth.22) However, the immediate effects of pitching on Several studies have investigated the immediate effects of the shoulder ROM in youth baseball players have not been pitching on the supraspinatus muscle and LHBT in adult determined.21) Furthermore, limited research has been baseball players,2,10,11) but no similar study has evaluated conducted on the recovery of the shoulder ROM or on these effects in young baseball players. As was previously changes of the muscle-tendon over time in youth baseball suggested, because shoulder injuries in baseball players players. begin from youth, research is needed on the immediate ef- Several studies have been conducted on the im- fects of pitching on the shoulder structures of young play- mediate effects of pitching on shoulder ROM in adult ers.4,7) baseball players. Kibler et al.23) measured shoulder ROMs One study confirmed the long-term effects of pitch- before and 72 hours after pitching23) and reported that ER ing on the thicknesses of the supraspinatus and LHBT.2) In had recovered 72 hours after pitching. However, no study this study, the thickness of the supraspinatus tendon and has addressed the immediate effects of pitching on shoul- LHBT tended to decrease after pitching. Forceful contrac- der ROMs in youth baseball players, and there is a lack of tion and traction may cause thinning of tendons. These comprehensive research on the proper rest time needed results suggest that the thickness of supraspinatus tendon by youth players for safer pitching. Present guidelines are and LHBT might be a parameter of the immediate effect largely based on clinical experience. of pitching. Therefore, the purpose of this study was to evaluate To date, one study has assessed the supraspinatus the immediate changes caused by pitching on the supra- muscle-tendon, as well as long head biceps tendon, using spinatus muscle-tendon and LHBT, and shoulder ROM sonoelastography after pitching in professional baseball and to verify their recovery over time in youth baseball pitchers.2) The measurement of strain assesses the quality players. and condition of the human tissue.12) Sonoelastography is an examination method, which evaluates strain or elas- 13) METHODS ticity of tissue. Tissue strain induced by compression can be measured by sonoelastography.14) The principle Participants of sonoelastography is that tissue compression produces This study included 15 healthy, male youth baseball play- strain (displacement) within the tissue, which is more pro- ers who were registered at The Baseball Academy in South nounced in softer tissue than in harder tissue. Therefore, Korea. We conducted this study in compliance with the the strain is measured greater in softer tissue and lesser principles of the Declaration of Helsinki. The protocol of 387 Oh et al. Immediate Changes and Recovery after Pitching in Youth Baseball Players Clinics in Orthopedic Surgery • Vol. 13, No. 3, 2021 • www.ecios.org this study was approved by the Institutional Review Board of sonoelastography of the shoulder joint, conducted all of Myongji Hospital (IRB No. 2018-11-010), and written measurements jointly. One fellow measured all outcomes informed consents were obtained from all guardians. The during the entire study period and the other fellow simul- subjects had no history of injuries or present pain in their taneously checked whether measurements had been made throwing arms at the time of measurements. All subjects correctly. Outcomes were recorded only when the two fel- were right-handed overhead throwers. The mean subject lows agreed on the measurements taken. age was 11.5 ± 1.3 years and mean time spent playing baseball at a competitive level (career) was 3.4 ± 1.7 years. Pitching All subjects were year-round players. Other demographic The participants threw as many fastballs as possible at characteristics are summarized in Table 1. maximum effort at a pitching distance of 14 m. At least 10 seconds of rest was allowed between each pitch. The pitch- Parameters and Time of Measurements ing continued until the participants felt fatigue or soreness The parameters measured in this study were (1) the thick- in their throwing arms.
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