Return to Sport Following Shoulder Surgery in the Elite Pitcher

Abstract

T he shoulder is an integral part of the kinetic chain in the throwing motion. 22 Elite pitchers throw a baseball in excess of 95 mph, with the generation of over 7250 degrees of motion in internal rotation per second. 13 The kinematics of the throwing motion progresses through several distinct phases, with potential functional and/or pathologic adjustments occurring at each stage. 23 Although the entire throwing motion takes less than 2 seconds, repetitive microtrauma over the course of a career may lead to several osseous and/or soft tissue adaptations of the thrower's shoulder (Table 1). 4,5,9,12,14,18,25,43,47,[49][50][51] The resultant changes demonstrate significant differences from the general population, baseball Study Selection: Levels I-IV evidence were eligible for inclusion if performance-based (eg, RTS) and/or clinical outcomebased reporting of outcomes were reported following surgical treatment of shoulder pathology in elite pitchers (major or minor league or collegiate).Data Extraction: Subject, shoulder, and pre-and postoperative performance-based variables of interest were extracted. All shoulder surgery types were potentially inclusive (eg, open, arthroscopic, rotator cuff, labrum, biceps, acromioclavicular joint, fracture). Study methodological quality was analyzed using the Modified Coleman Methodology Score (MCMS).Results: Six studies were analyzed (287 elite male pitchers [mean age, 27 years] who underwent shoulder surgery, with 99% on the dominant, throwing shoulder). MCMS was 38 (poor). Most pitchers were professional, with a mean career length of 6.58 years and postoperative clinical follow-up of 3.62 years. In 5 of 6 studies, multiple diagnoses were addressed concomitantly at surgery. Rate of RTS was 68% at mean 12 months following surgery. Twenty-two percent of Major League Baseball (MLB) pitchers never RTS in MLB. Overall performance did improve following surgery; however, this did not improve to pre-injury levels. Conclusion:In this systematic review, the rate of return to elite baseball pitching following surgery was established. Performance tended to decrease prior to surgery and gradually improve postoperatively, though not reaching pre-injury levels of pitching.Level of Evidence: IV (systematic review of studies level I-IV evidence), therapeutic.

Epidemiology of Shoulder Surgery Among Professional Baseball Players

“…Surgery of the shoulder for an overhead athlete is commonly the last resort, as the results of small series showed variable ability of players to RTS after these surgical procedures, often with one-third or more unable to achieve their preinjury levels of play. 6,10,19 Players may recover well from one specific procedure but not from another and thus fail to return to the same level of play. 19 Unfortunately, no comparative information is currently available.…”

Predicting Injury in Professional Baseball Pitchers From Delivery Mechanics: A Statistical Model Using Quantitative Video Analysis

“…It has been well established that pitchers who sustain upper-extremity injuries often do not return to pre-injury level of play. [24][25][26][27]29 However, the data on re-injury risk are surprisingly limited. In the current study, the RR for recurrent upper-extremity injury was 2.40, 2.99, and 6.34 for 1, 2, and 3 previous major upper-extremity injuries, respectively, compared with pitchers without prior injury.…”

Return to Play After Shoulder Surgery in Throwers

“…37 Unfortunately, due to concurrent diagnoses, the investigators were unable to compare return to sport for the varying surgical techniques and diagnoses, but the study does offer considerable insight into expectations when treating elite pitchers. 42 …”