Is there evidence for successful RTP rates in professional baseball players following conservative treatment of a UCL injury? Summary of Key Findings: Three retrospective studies met the inclusion criteria and were included. Of those, 2 reported RTP rates following a non-operative rehabilitation program of a UCL injury while 1 reported RTP rates after injection therapy in subjects who attempted a trial of conservative treatment. All 3 studies considered location and grade of UCL tear. Successful RTP rates (66-100%) were reported in professional baseball players following non-operative treatment of partial UCL injuries. Clinical Bottom Line: Current evidence supports high success with RTP rates up to 100% after non-operative treatment of grade 1 UCL injuries in professional baseball players and between 66-94% for a grade 2 and above. Strength of Recommendation: There is level C evidence for high RTP rates following non-operative treatment of partial UCL injuries in professional baseball players.
Context: Ulnar collateral ligament (UCL) reconstructions continue to increase without consensus on an evidence-based treatment protocol for nonoperative management. Currently, there is no consensus on an effective nonoperative protocol for partial UCL injuries that uses return-to-play (RTP) rates in determining the outcome of conservative treatment. Objective: To systematically review RTP rates after conservative treatment of partial UCL injuries in overhead athletes along with descriptive components of each conservative intervention to identify an effective evidence-based nonoperative rehabilitation protocol. Data Sources: Articles in PubMed, CINAHL, MEDLINE, Academic Search Complete, and SPORTDiscus were identified in October 2018 based on the following terms: overhead athlete, ulnar collateral ligament, nonoperative treatment, and return to play. Study Selection: Seven retrospective, level 4 studies (n = 196) qualified for analysis. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Study design, level of evidence, demographics, sample size, sports involved, level of competition, grade or type of UCL diagnosis, conservative treatment components, and percentage RTP were extracted. Results: Overall, RTP rates after conservative treatment ranged between 42% and 100% (mean, 78% ± 20%). The most frequently reported components of rehabilitation protocols were (1) a period of rest, (2) stretching, (3) strengthening, and (4) a throwing program. Platelet-rich plasma injections were included in 5 (71%) of the 7 protocols with a rehabilitation period. Conclusion: Conservative treatment is a viable option for partial UCL tears in overhead athletes. A successful rehabilitation protocol includes the use of patient-reported outcomes, a sport-specific tailored treatment plan, kinetic chain strengthening, and an interval throwing program. Factors such as age, grading of tear, level of play, sport, and athlete’s perceived well-being should all be considered during treatment decisions.
Context: A single clinical assessment device that objectively measures scapular motion in each anatomical plane is not currently available. The development of a novel electric goniometer affords the ability to quantify scapular motion in all three anatomical planes. Objective: Investigate the reliability and validity of an electric goniometer to measure scapular motion in each anatomical plane during arm elevation. Design: Cross-sectional. Setting: Laboratory setting. Patients or Other Participants: Sixty participants (29 females, 31 males) were recruited from the general population. Intervention(s): An electric goniometer was used to record clinical measurements of scapular position at rest and total arc of motion (excursion) during active arm elevation in two testing sessions separated by several days. Measurements were recorded independently by two examiners. In one session, scapular motion was recorded simultaneously with a 14-camera three-dimensional optical motion capture system. Main Outcome Measures: Reliability analysis included examination of clinical measurements for scapular position at rest and excursion during each condition. Both the intra-rater reliability between testing sessions and the inter-rater reliability recorded within the same session were assessed using Intraclass Correlation Coefficients (ICC2,3). The criterion-validity was examined by comparing the mean excursion values of each condition recorded by the electric goniometer to the 3D optical motion capture system. Validity was assessed by evaluating the average difference and root mean square error (RMSE). Results: The between session intra-rater reliability was moderate to good (ICC2,3: 0.628–0.874). The within session inter-rater reliability was moderate to excellent (ICC2,3: 0.545–0.912). The average difference between the electric goniometer and 3D optical motion capture system ranged from −7° to 4° and the RMSE was between 7–10°. Conclusions: The reliability of scapular measurements is best when a standard operating procedure is used. The electric goniometer provides an accurate measurement of scapular excursions in all three anatomical planes during arm elevation.
Clinical Scenario: Assessing movement of the scapula is an important component in the evaluation and treatment of the shoulder complex. Currently, gold-standard methods to quantify scapular movement include invasive technique, radiation, and 3D motion systems. This critically appraised topic focuses on several clinical assessment methods of quantifying scapular upward rotation with respect to their reliability and clinical utility. Clinical Question: Is there evidence for noninvasive methods that reliably assess clinical measures of scapular upward rotation in subjects with or without shoulder pathologies? Summary of Key Findings: Four studies were selected to be critically appraised. The quality appraisal of diagnostic reliability checklist was used to score the articles on methodology and consistency. Three of the 4 studies demonstrated support for the clinical question. Clinical Bottom Line: There is moderate evidence to support reliable clinical methods for measuring scapular upward rotation in subjects with or without shoulder pathology. Strength of Recommendation: There is moderate evidence to suggest there are reliable clinical measures to quantify scapular upward rotation in patients with or without shoulder pathology. Keywords: scapula, CAT, clinical assessment Clinical ScenarioQuantifying movement of the scapula is an important component in the evaluation and treatment of the shoulder complex due to its role in scapulohumeral rhythm during overhead motion. 1-3 Scapular upward rotation has been identified to be an essential component of glenohumeral elevation. 4 Restrictions in the scapular upward rotation have been linked to pathologies such as impingement, instability, and tendinopathies. 4,5 Challenges clinicians face when measuring scapular motion include the deep position of the scapula under the overlaying musculature and soft tissue, and along with its multidirectional axis of rotation. 1,6,7 To accurately quantify scapular movement, fluoroscopy, and intracortical pinning have been utilized as the gold-standard methods of scapular assessment. 8,9 However, due to the obstacles behind radiography and 3D instrumentation, such as radiation, invasive technique, cost for equipment, and time investment, it has become apparent that there is a clinical need for a reliable and valid noninvasive method to measure scapular kinematics. 10,11 In the literature, different assessment methods have been reported, focusing on the reliability of each respective method. In this critically appraisal topic (CAT), several methods of quantifying scapular kinematics are appraised for their respective reliability and clinical utility of each method designed to measure scapular upward rotation. Focused Clinical QuestionIs there evidence for noninvasive methods that reliably assess clinical measures of scapular upward rotation in subjects with or without shoulder pathologies? Summary of Search• The initial literature search using the Boolean Operators:Term (TX) scapular rotation, OR TX scapular motion, AND TX upward rotation...
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