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Effect of Forearm Position on Glenohumeral External Rotation Measurements in Baseball Players
Enjoy this discussion with one of the authors, Dr. Aaron Sciascia.
Background: Alterations in glenohumeral internal rotation (GIR), glenohumeral external rotation (GER), and the total arc of motion (TAM) have been linked with increased injury risk in the shoulder and elbow. These motions have been routinely measured with the forearm in neutral rotation (GIRN, GERN, TAMN). GER capacity appears to be especially important. The throwing motion, however, requires forearm pronation as GER occurs to achieve optimal cocking (GERP). No previous studies have evaluated GERP to determine GER capacity or pronated TAM (TAMP) values.
Hypothesis: There would be significant differences between GERN and TAMN and between GERP and TAMP. Study Design: Cross-sectional.Level of Evidence: Level 3.
Methods: Sixty asymptomatic male Minor League Baseball players (32 pitchers, 28 position players) participated in the study and were tested on the first day of spring training. Passive range of motion measurements were recorded using a long-arm bubble goniometer for GIRN, GERN, and GERP on both arms. TAM was calculated separately as the sum of internal and external rotational measurements under neutral and pronated conditions.
Results: Within pitchers and position players, all measurements were statistically reduced for the throwing arm (P ≤ 0.03) except for GERN of the pitchers. GERP measures were significantly less than GERN for both arms of each group (P < 0.01): pitchers throwing arm +11.8°/nonthrowing arm +4.8°, position players throwing arm = +8.6°/nonthrowing arm +4.0°.
Conclusion: The forearm position of pronation, which appears to be mediated by tightness of the biceps, decreases GER capacity and TAM. GER and TAM should be calculated in neutral and pronated positions, considering that 80% of the players have a demonstrated difference between 8° and 12°.
Clinical Relevance: Measurement of GERP more accurately reflects the GER required in throwing, allows better quantification of the motion capacity necessary to withstand the loads in throwing, and may suggest interventions for at risk athletes.
Aaron Sciascia, PhD, ATC, PES, SMTC, FNAP
Aaron is the Clinical Outcomes and Research Director at Lexington Clinic and serves as adjunct faculty for Moravian University's Doctorate in Athletic Training program in Bethlehem, PA. He has been previously honored with the Founders' Award from the American Society of Shoulder and Elbow Therapists (ASSET), has previously served ASSET as President, and holds the distinction of Fellow within the Society. He is a Distinguished Fellow of the Athletic Training Academy within the National Academies of Practice, and is an Affiliate Member of the American Shoulder and Elbow Surgeons. Aaron has produced multiple peer-reviewed articles, textbooks, and chapters related to function, evaluation, and treatment of the shoulder and scapula. He also serves as an associate editor for the International Journal of Athletic Therapy and Training.
Description
Effect of Forearm Position on Glenohumeral External Rotation Measurements in Baseball Players
Join us for a discussion with two of the authors, Dr. Aaron Sciascia and Dr. W. Ben Kibler, interviewed by Dr. Amee L Seitz. Click the "download the paper!" tab to read the paper before the meeting.
Paper Overview:
Background: Alterations in glenohumeral internal rotation (GIR), glenohumeral external rotation (GER), and the total arc of motion (TAM) have been linked with increased injury risk in the shoulder and elbow. These motions have been routinely measured with the forearm in neutral rotation (GIRN, GERN, TAMN). GER capacity appears to be especially important. The throwing motion, however, requires forearm pronation as GER occurs to achieve optimal cocking (GERP). No previous studies have evaluated GERP to determine GER capacity or pronated TAM (TAMP) values.
Hypothesis: There would be significant differences between GERN and TAMN and between GERP and TAMP.
Study Design: Cross-sectional.
Level of Evidence: Level 3.
Methods: Sixty asymptomatic male Minor League Baseball players (32 pitchers, 28 position players) participated in the study and were tested on the first day of spring training. Passive range of motion measurements were recorded using a long-arm bubble goniometer for GIRN, GERN, and GERP on both arms. TAM was calculated separately as the sum of internal and external rotational measurements under neutral and pronated conditions.
Results: Within pitchers and position players, all measurements were statistically reduced for the throwing arm (P ≤ 0.03) except for GERN of the pitchers. GERP measures were significantly less than GERN for both arms of each group (P < 0.01): pitchers throwing arm +11.8°/nonthrowing arm +4.8°, position players throwing arm = +8.6°/nonthrowing arm +4.0°.
Conclusion: The forearm position of pronation, which appears to be mediated by tightness of the biceps, decreases GER capacity and TAM. GER and TAM should be calculated in neutral and pronated positions, considering that 80% of the players have a demonstrated difference between 8° and 12°.
Clinical Relevance: Measurement of GERP more accurately reflects the GER required in throwing, allows better quantification of the motion capacity necessary to withstand the loads in throwing, and may suggest interventions for at-risk athletes.