Preseason weakness of external rotation and SS strength is associated with in-season throwing-related injury resulting in surgical intervention in professional baseball pitchers. Thus, preseason strength data may help identify players at risk for injury and formulate strengthening plans for prevention.

The newly described method, using suture anchors for repair of patellar tendon ruptures, may be clinically equal or superior to the established method of using transpatellar tunnels.

Purpose To assess the ability of volar locked plating to achieve and maintain normal radiographic parameters for articular stepoff, volar tilt, radial inclination, ulnar variance, and radial height in distal radius fractures. Methods We performed a retrospective review of 185 distal radius fractures that underwent volar locked plating with a single plate design over a 5-year period. We reviewed radiographs and recorded measurements for volar tilt, radial inclination, ulnar variance, radial height, and articular stepoff. We used logistic regression to determine the association between return to radiographic standard norms and fracture type. Results At the first and final postoperative follow-up visits, we observed articular congruence less than 2 mm in 92% of fractures at both times. Normal volar tilt (11°) was restored in 46% at the first follow-up and 48% at the final one. Radial inclination (22°) was achieved in 44% at the first follow-up and 43% at the final one, and ulnar variance (01 ± 2 mm) was achieved in 53% at the first follow-up and 53% at the final one. In addition, radial height (14 ± 1mm) was restored in 14% at the first follow-up and 12% at the final one. More complex, intra-articular fractures (AO class B and C and Frykman types 3, 4, 7, and 8) were less likely to be restored to normal radiographic parameters. However, because of the small sample size for some fracture types, it was difficult to discover significant associations between fracture type and radiographic outcome. Conclusions Volar locked plating for distal radius fractures achieved articular stepoff less than 2 mm in most fractures but only restored and maintained normal radiographic measurements for volar tilt, radial inclination, and ulnar variance in 50% of fractures. The ability of volar locked plating to restore and maintain ulnar variance and volar tilt decreased with more complex intra-articular fracture types.

Proximal fractures of the fifth metatarsal are most common in young male athletes. These fractures are devastating to athletes because they are slow to heal and have a high potential for delayed union, nonunion, and refracture. 4,9,[14][15][16][17][18][19]26,28 These fractures can be acute, stress, or combined acute/stress fractures of the proximal portion of the fifth metatarsal. The Jones fracture 4,8 was first described by Jones in 1902 13 and involves the proximal third of the fifth metatarsal, distal to the insertion of the fibularis (peroneus) brevis tendon, 1.5 cm from the tuberosity of the fifth metatarsal (figure 1). 5,7,8,16,23 Jones described the mechanism of injury in vivid terms: "so powerful are the ligaments that dislocation is rare. It is obviously easier to break the bone than to dislocate it." 13 The fifth metatarsal is subjected to 3-point bending (figure 1) when the foot lands in a relatively inverted position. Forces are imposed at the proximal end of the fifth metatarsal by the ground reaction force and soft tissues such as the fibularis brevis, lateral bands of the plantar fascia, and ligamentous/capsular tissue between the cuboid and the base of the fifth metatarsal. Force is also imposed by the ground reaction force at the distal end of the metatarsal as a result of the foot being in a relatively inverted position. Finally, the base of the fourth metatarsal applies a force in response to the previously described forces, completing the 3-point bending stress that may produce a stress fracture in response to cumulative fatigue, an acute fracture following sufficiently high-magnitude loading, or a combination of the two. Weight bearing that occurs with the foot in an inverted position, therefore, tends to promote the t studY design: Preintervention and postintervention, repeated-measures experimental design.t oBJectives: The objective was to investigate the effects of foot orthoses with medial arch support on ankle inversion angle and plantar forces and pressures on the fifth metatarsal during landing for a basketball lay-up and during the stance phase of a shuttle run.t Background: Proximal fractures of the fifth metatarsal, specifically the Jones fracture, are common in sports. Wearing foot orthoses with medial arch support could increase the ankle inversion angle and the plantar forces and pressure on the fifth metatarsal that may increase the risk for fifth metatarsal fracture.t MetHods and Measures: Three-dimensional (3-D) videographic, force plate, and in-shoe plantar force and pressure data were collected during landing after a basketball lay-up and during the stance phase of a shuttle run with and without foot orthoses with medial arch support for 14 male subjects. Two-way ANOVAs with repeated measures were performed to compare ankle inversion angle, maximum forces, and pressure on the fifth metatarsal head and base between conditions and between tasks.t results: The maximum ankle inversion angle and maximum plantar force and pressure on the base of the fifth metatarsal during both ...

Osteoarthritis of the acromioclavicular joint is a frequent cause of shoulder pain and can result in significant debilitation. It is the most common disorder of the acromioclavicular joint and may arise from a number of pathologic processes, including primary (degenerative), posttraumatic, inflammatory, and septic arthritis. Patients often present with nonspecific complaints of pain located in the neck, shoulder, and/or arm, further complicating the clinical picture. A thorough understanding of the pertinent anatomy, disease process, patient history, and physical examination is crucial to making the correct diagnosis and formulating a treatment plan. Initial nonoperative management is aimed at relieving pain and restoring function. Typical treatments include anti-inflammatory medications, physical therapy, and injections. Patients who continue to exhibit symptoms after appropriate nonsurgical treatment may be candidates for operative resection of the distal clavicle through either open or arthroscopic techniques.

Background:Many factors are believed to contribute to throwing injuries in baseball pitchers, in particular overuse and poor throwing mechanics. The impact of fatigue on pitching biomechanics in live-game situations is not well understood.Hypothesis:Pitchers will demonstrate significant deviation in their pitching motions with increasing levels of fatigue.Study Design:Descriptive laboratory study.Methods:Eleven National Collegiate Athletic Association (NCAA) Division I collegiate baseball pitchers were filmed in multiple live-game situations throughout a single season using 2 orthogonal high-speed cameras at 120 Hz. The first fastball of each inning and, when available, the fastball subsequent to the 15th and 30th pitch of each inning were recorded and analyzed for 26 kinematic parameters. Pitch count and velocity were recorded. Kinematic differences were assessed for association with pitch count and subjective fatigue measures over the course of each inning and game through the season.Results:Twenty-six games were recorded. Pitchers had a mean of 97.2 ± 16.1 pitches per start and 1079 ± 251 pitches per collegiate season. Increased hip lean at hand separation, elbow height at foot contact, and hip flexion and shoulder tilt at maximum external rotation were seen in innings lasting longer than 15 pitches. Maximum external rotation of the shoulder and elbow height at foot contact decreased over the course of a game. Hip lean at hand separation and elbow height at foot contact increased over the course of the season. Season pitch count was weakly correlated with increased shoulder external rotation and shoulder alignment at maximum external rotation and with shoulder abduction at ball release. Elbow flexion decreased with greater season pitch counts.Conclusion:Hip lean, elbow height, and shoulder external rotation were the most sensitive kinematic parameters to inning, game, and season fatigue. Pitch count and fatigue have a significant impact on live-game pitching kinematics.Clinical Relevance:Fatigue likely alters pitching mechanics. Recognition of kinematic alterations may better demonstrate fatigue-related injury risk and may assist injury prevention in addition to standardized limitations of innings and pitches thrown.

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