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.