Background: Ulnar collateral ligament (UCL) reconstruction (UCLR) is commonly performed in Major League Baseball (MLB) pitchers, and there remain limited data on off-speed pitch performance in those that return to play after reconstruction.Purpose/Hypothesis: The purpose of this study was to evaluate the effect of primary UCLR on curveball (CB) and change-up (CU) pitch performance in terms of velocity along with novel pitching metrics including spin rate, hard-hit rate, and whiff rate. It was hypothesized that post-UCLR off-speed pitch spin rates, velocity, and whiff rate would decrease significantly compared with pre-UCLR levels, while hard-hit rates would increase.Study Design: Cohort study; Level of evidence, 3.Methods: Pitchers who underwent UCLR and returned to MLB level of play were identified from public records from 2016 to 2019. The Statcast system was used to collect spin rate, velocity, hard-hit, and whiff rate data for CB and CU pitches for preinjury seasons, as well as the first 2 seasons after return from UCLR. A matched-pair analysis was performed by matching each pitcher to an uninjured healthy pitcher from the same draft class and round.Results: A total of 29 pitchers met inclusion criteria and threw the pitches of interest. There were no statistically significant changes in CB or CU mean spin rate, pitch velocity, hard-hit rate, or whiff rate when comparing preinjury levels with the first and second seasons played after reconstruction. There were no significant differences in any pitching metrics when comparing the UCLR cohort with the healthy matched-pair cohort. The mean total number of CU pitches significantly decreased in the first season after UCLR (154.0 vs 67.9; P = .04) and compared with the matched-pair cohort at 1 year (67.9 vs 233.2; P = .001). Pitchers also threw fewer total pitches in the first season after returning from UCLR compared with preinjury baselines and healthy matched pairs.Conclusion: The results of this study demonstrate that pitchers who undergo UCLR and return to the MLB level can expect similar off-speed pitch performance in comparison with their preinjury levels and with pitchers without UCL injury.

This overview approaches the acromioclavicular joint (ACJ) and ACJ injuries from a mechanical perspective that places the ACJ complex-the scapula, clavicle, ACJ, AC and coracoclavicular ligaments, and periscapular muscles-into the context of its ability to facilitate scapulohumeral rhythm (SHR) functions of scapula placement and humeral mobility. Mechanical concepts underlying this perspective include linkage of the scapula and clavicle into a single segment, the "claviscapula," the role of the AC and coracoclavicular ligaments in torque transduction and horizontal and vertical stability, and the deleterious effects of decoupling the claviscapular segment. The clinical examination and surgical treatment should address anatomic restoration of individual structures and the effect on the functional integrity of the entire ACJ complex within SHR. This context, which unifies anatomic injury with functional consequences, can be used to create a more comprehensive understanding of the clinical presentation and effect on ACJ function and SHR.

Background Elbow and forearm injuries are common in high school baseball and softball players. Given the trends in overuse and early sport specialization, it may be prudent to provide an updated review of the epidemiological data to aid injury prevention efforts. Methods Data regarding elbow and forearm injuries in high school baseball and softball players from the 2005-2006 through 2018-2019 seasons was extracted from the National High School Sports-Related Injury Surveillance Study. Results There were 518 total elbow and forearm injuries reported for 5,738,470 athletic exposures (AEs) yielding an overall injury rate of 0.90/10,000 AEs. Baseball had an increase of 0.044 elbow/forearm injury increase per 10,000 AEs per year (P = .04, 95% Confidence Interval: 0.03, 0.085) while softball did not have a significant change. Baseball had a significantly higher injury rate in competition than practice (Injury rate ratio = 2.29, 95% CI: 1.86, 2.83). While there was no significant difference in overall injury rate for baseball pitchers than nonpitchers, softball nonpitchers had a significantly greater injury rate than pitchers (Injury rate ratio = 0.25, 95%; CI: 0.15, 0.42). Conclusion This study found that overall forearm and elbow rate of injury has increased for baseball since the 2005-2006 season. There was no significant trend in softball. Softball nonpitchers had a higher rate of injury than pitchers, while there was no difference between positions in baseball. This trend and difference between sports and positions imply the importance of injury prevention efforts tailored to each athlete.

# Background Previous research on upper extremity range of motion has compared in-person to virtual measures for sagittal plane motions (flexion/extension) showing good-excellent reliability. Since upper extremity evaluation includes motion in all planes, it is important to assess whether transverse plane motion (rotation, supination, pronation) can be reliably measured during a virtual assessment. # Purpose To evaluate the reliability (test/re-test inter-rater and intra-rater) of goniometric measurements of shoulder internal rotation and forearm pronation/supination obtained in-person and virtually. # Study Design Observational cohort, Reliability study # Methods Subjects 18-60 years of age with no upper extremity injuries were recruited for range of motion (ROM) testing in a standing position with measurements performed with a standard goniometer. Shoulder internal rotation was measured using the Hand-Behind-the-Back method and forearm pronation/supination were measured with shoulder adducted to the body and elbow flexed. Before in-person measurements were obtained, a static image of end range was captured using a mobile device with a camera. Within 10 days of the in-person measurements, clinicians measured the range of motion on the static image using the same standard goniometric methods as the in-person measurements. Inter-rater and intra-rater reliability were determined via intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) at the 90% and 95% confidence level. # Results The inter-rater reliability (ICC≥0.94) and intra-rater reliability (ICC≥0.91) for all in-person and virtual measurements were classified as excellent (SEM: 0.79-1.74°, MDC90: 2.12-4.06°, MDC95: 2.20-4.82°). When combining the three examiners’ measurements for each motion, there was a statistically significant difference between in-person and virtual internal rotation (77.5±9.0° vs. 75.3±9.0°, p=0.001). The only statistically significant difference found between examiners occurred for the in-person measurement of pronation (examiner 3: 3.9° greater compared to examiner 1, p=0.044). # Conclusion Virtual assessment compared to in-person goniometric measurements showed excellent inter- and intra-rater reliabilities (ICC >0.75). This suggests clinicians trained in goniometry can utilize this technique either in person or on a virtual platform. Level of Evidence 3b

Context: The quality and interprogram variability of publicly available throwing programs have not been assessed. Objective: To (1) identify publicly available interval throwing programs, (2) describe their components and structure, and (3) evaluate their quality, variability, and completeness. Data Sources: Google, Bing, Yahoo; keyword: “interval throwing program.” Study Selection: Baseball-specific publicly available programs. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Independent evaluation by 2 authors using a novel 21-item Quality Assessment Rubric (QAR). Results: Of the 99 included programs, 54% were designed for return from injury/surgery; 42% explicitly stated no expected timeline for completion, and approximately 40% did not provide criteria to initiate the program. Program construction was highly variable. There were broad-ranging shortest (mean: 40±8 ft, range: 20-45 ft) and longest (mean: 150±33 ft, range: 90-250 ft) long toss distances, and variable maximum numbers of mound pitches thrown before returning to game play (range: 40-120, mean: 85). Only 63% of programs provided guidelines for handling setbacks, and standardized warm-ups, arm care, and concomitant training were absent in 32%, 63%, and 47% of programs, respectively. Mean QAR completion rate and QAR item response rate were low (62 ± 4% [range, 24-91%], 62 ± 24% [range, 7-99%], respectively). Finally, only 20 (20%) programs provided at least 1 peer-reviewed reference, most of which were published >10 years ago. Conclusion: Publicly available interval throwing programs are readily available but demonstrate significant interprogram heterogeneity across multiple areas including target audience, program construction, progression, and execution. The quality and consistency of publicly available interval throwing programs is poor at this time, which may limit their utility and effectiveness for baseball players attempting to return to competition. This work identifies a multitude of deficiencies in currently available throwing programs that should be targets of future improvement efforts.

Objectives: Three biomechanical traits which are concerning for potential injury to the ulnar collateral ligament (UCL) in baseball players include: the Tommy John Twist, an open front (landing) foot position, and early swinging gate (opening) of the hips. Our objective was first to determine if these risk factors were more commonly found in those who had undergone an ulnar collateral ligament reconstruction (UCLR) versus controls and second to determine if viewing standard video and/or broadcast video would allow a predictable identification of these three factors. Our hypothesis was the three aforementioned factors would be present in a higher frequency in those with previous UCLR and that the reviewers would have at least a substantial level of agreement of identification. Methods: Twenty (20) consecutive professional pitchers who underwent UCLR (height=188.0±6.9cm; weight=96.5±8.1kg; throw left=5; throw right=15) were analyzed and compared to 20 controls (height=188.5±6.0cm; weight=94.5±9.1kg; throw left=4; throw right=16) with similar height and weights and handedness (p≥0.46). 3 fastballs from 3 separate games were obtained for each pitcher from publicly available video and adjusted to a very low speed for review. The 3 factors analyzed included: Tommy John Twist (at the maximum abducted, externally rotated position of the shoulder, the palm (and ball) faces center field), open front foot position (front foot not aligned with the catcher or closed [open to first base side for a right hander or third base side for a left hander]), and early swinging gate of the hips (at the maximum abducted, externally rotated position of the shoulder, the hips have already rotated and are facing home plate). 6 reviewers with experience and current positions in professional baseball and familiarity with pitching biomechanics performed the video reviews. Both the number of subjects and the number of reviewers was appropriately powered. Each pitch from each of the pitchers was graded: yes, indeterminant, or no, for each of the biomechanical factors of interest. Reviews were conducted on two separate occasions by each reviewer 1 month apart. The frequency of responses was calculated and compared between the UCLR and control groups. Inter-rater agreement was calculated via Fleiss’ Kappa (K). Agreement (K) was interpreted as: ≤ 0=poor, 0.01-0.20=slight, 0.21-0.40=fair, 0.41-0.60=moderate, 0.61-0.80=substantial, and 0.81-1.00=almost perfect. Results: There was significantly greater percentages of “yes” responses (p<0.01) in the UCLR group versus the control group for Tommy John Twist (9%), open front foot position (9%), and early swinging gate of the hips (14%) for both rating sessions (Table 1). Agreement was similar (fair to moderate) for control and UCLR pitchers for identifying Tommy John Twist (K=0.28-0.48). However, the agreement for UCLR pitchers was moderate (K=0.41-0.46) for all 9 pitches of Early Swinging Gate, while the agreement for control pitchers was fair (K=0.29-0.38) for 8 of 9 pitches. Finally, the agreement for UCLR pitchers was moderate to substantial (K=0.50-0.67) for Open Front Foot while agreement for control pitchers was fair to moderate (K=0.27-0.46). Conclusions: The identification of particular, concerning high-risk biomechanical factors in those who have had UCLR was more common and identifiable versus controls. Presence of any of these factors in a pitcher could warrant a discussion of correctability. However, based on the range of indeterminant responses of 5-25%, along with Kappa values of fair to substantial, the shortcomings of video quality and position of the camera angle suggest an improved and reproducible method for video analysis should be employed.

Altered scapular motion and altered position during motion have been termed scapular dyskinesis.1 The definition of dyskinesis is the alteration of normal scapular kinematics. "Dys" (alteration of) "kinesis" (motion) is a general term that reflects loss of normal control of scapular motion. An alternative term that is often used interchangeably is dyskinesia. Dyskinesia is usually applied to abnormal active (voluntary) movements mediated by neurologically controlled factors. The scapular rotations (upward/downward rotation, anterior/posterior tilt, and internal/external rotation) are accessory motions, which by definition are involuntary in nature. The scapular translations can be performed voluntarily, but there are times when the scapula translates during arm motion without conscious consideration from the individual person. In addition to these motion distinctions, there are many other factors that can cause the altered scapular position and motion, such as bony injury (clavicle fractures, acromioclavicular joint separations), soft tissue disruption (scapular muscle detachments), and internal derangement (labral injury, compromised capsular tissue). Therefore, the more inclusive term dyskinesis is preferred.

Hypothesis and/or Background:The incidence of elbow medial ulnar collateral ligament (MUCL) injuries has been increasing, leading to advances in surgical treatments. However, it is not clear that there is consensus among surgeons regarding diagnostic imaging, the indications for acute surgery and postoperative rehabilitation. The purpose of this study is evaluate surgeon variability in the presurgical, surgical, and postsurgical treatment of MUCL injuries regarding the imaging modalities used for diagnosis, indications for acute surgical treatment, and postoperative treatment recommendations for rehabilitation and return to play (RTP). Our hypothesis is that indications for acute surgical treatment will be highly variable based on MUCL tear patterns and that agreement on the time to RTP will be consistent for throwing athletes and inconsistent for nonthrowing athletes. Methods:A survey developed by 6 orthopedic surgeons with expertise in throwing athlete elbow injuries was distributed to 31 orthopedic surgeons who routinely treat MUCL injuries. The survey evaluated diagnostic and treatment topics related to MUCL injuries, and responses reaching 75% agreement were considered as high-level agreement. Results:Twenty-four surgeons responded to the survey, resulting in a 77% response rate. There is 75% or better agreement among surveyed surgeons regarding acute surgical treatment for distal full thickness tears, ulnar nerve transposition in symptomatic patients or with ulnar nerve subluxation, postoperative splinting for 1-2 weeks with initiation of rehabilitation within 2 weeks, the use of bracing after surgery and the initiation of a throwing program at 3 months after MUCL repair with internal brace by surgeons performing 20 or more MUCL surgeries per year. There were a considerable number of survey topics without high-level agreement, particularly regarding the indications for acute surgical treatment, the time to return to throwing and time RTP in both throwing and nonthrowing athletes. Discussion and/or Conclusion:The study reveals that there is agreement for the indication of acute surgical treatment of distal MUCL tears, duration of bracing after surgery, and the time to initiate physical therapy after surgery. There is not clear agreement on indications for surgical treatment for every MUCL tear pattern, RTP time for throwing, hitting and participation in nonthrowing sports.

Scapular dyskinesis is an extremely common component of shoulder pathology, especially in the overhead athlete; despite its prevalence, proper diagnosis and management of scapular disorders remains an enigma for many clinicians. An understanding of the contribution of the scapula to pathomechanics and clinical symptoms is necessary to optimize both surgical and nonsurgical treatment of shoulder disorders. Without correction of scapular dysfunction, even effective management of the pathoanatomy is unlikely to produce optimal results. It is important to examine the role of the scapula in common shoulder pathologies and elucidate a case-based treatment strategy for both surgical and nonsurgical shoulder disorders.

It has long been hypothesized that physical function is best achieved when core strength and stability are optimized. This concept can be applied to both the upper and lower extremities; however, it may be more critical for appreciating upper extremity physical function such as in overhead throwing or lifting tasks. Overhead activities require the shoulder to be exposed to and sustain repetitive loads. The segmental activation of the body's links, known as the kinetic chain, allows this to occur effectively. Proper muscle activation is achieved through the generation of energy from the central segment (ie, the core). The energy must be transferred to the terminal links of the shoulder, elbow, and hand for overhead tasks to be executed. The kinetic chain is best characterized by the following 3 components: optimized anatomy, reproducible efficient motor patterns, and the sequential generation of forces. However, anatomical or physiological deficits, such as weakness and/or tightness in the core musculature or altered core stability, can lead to deleterious effects in the shoulder. An appreciation of the role of core strength and stability in kinetic chain function and of how the usage of kinetic chain–based rehabilitation will improve upper extremity physical function will assist the clinician in overcoming existing deficits.

Musculoskeletal rehabilitation is a dynamic process that is aimed at resolving identified physical impairments or injury. To address the deleterious effects of physical impairments and injury, multimodal treatment regimens are frequently employed and can produce promising results.1,2 With many tools available to a clinician, the most common and possibly most important tools are patient education and home exercise programs (HEPs). Patient education involves informing the patient of the diagnosis, providing an expected prognosis and outcome, explaining the purpose of the exercises, and prescribing activity modification to avoid exacerbating current symptoms and to reduce or eliminate poor motor patterns. Most often, activity modification requires a review and modification of activities of daily living (ADL) and/or complex tasks such as manual labor or athletic maneuvers.

Managing the painful shoulder in overhead athletes can be difficult because of a lack of time-loss injuries in overhead sports and focusing primarily on either pathoanatomic causes or movement impairments. Although managing the painful shoulder can be challenging, the combination of identifying pathoanatomic causes with movement impairments can provide a more focused rehabilitation approach directed at the causes of shoulder pain. Understanding the potential influence of scapular positioning as well as mobility and/or strength impairments on shoulder pain can help clinicians develop more directed rehabilitation programs. Furthermore, sports-specific methods such as long toss or the use of weighted balls for achieving physiological or performance-based gains have limited empirical evidence regarding their clinical and performance-based benefits, which may impede the rehabilitation process. Applying a comprehensive evaluation approach prior to and throughout the treatment process can assist clinicians with selecting the most appropriate treatment based on patient need. Reconsidering traditional treatments based on existing evidence may help refine the treatment process for overhead athletes with shoulder pain.

Although lateral elbow pain and medial ulnar collateral ligament injury are common musculoskeletal pathologies in overhead athletes, the evidence supporting specific interventions for managing these conditions is scarce. Management of these conditions has been guided mostly by expert opinion rather than empirical evidence, yet the lack of comparative data in the literature has not negatively affected return-to-play rates following surgery. However, an understanding of what is known regarding unimodal and multimodal treatments for lateral elbow pain and medial ulnar collateral ligament injury is needed for clinicians to select evidence-based treatment pathways and highlight what is not known to develop future high-quality investigations.

It is a great honor to be asked to be Guest Editors for this special issue of JSES entitled "Current concepts: mechanics and pathology in the core, shoulder, and elbow in the throwing athlete: Proceedings of the 1st Annual Kibler Sports Medicine Lectureship." The papers in this issue represent the content of the talks given by the invited speakers of the symposium on this topic on February 10, 2023, which was associated with the lectureship. The educational format of the symposium was developed to examine and address specific topics regarding the throwing athlete that contain elements of controversy regarding performance, injury, and treatment, and each presenter/author was asked to bring to their topic a focus on presenting information that would serve as a basis for "moving the needle" on the scholarship of the specific topic. Presenters were encouraged to bring insight and leading-edge information to serve as a basis for stimulating new thoughts on the topic.

Context: A common component within rehabilitation recommendations for baseball pitchers is employment of an interval throwing program. However, there is a lack of a consistent set of advocated guidelines for program content and implementation for athletes at the professional and collegiate levels. Design: Cross-sectional study. Methods: A survey was developed to obtain clinician views regarding the composition and implementation of interval throwing programs for baseball pitchers. The survey was divided into demographic information and sections on criteria to begin throwing programs, frequency of throwing, soreness management, warm-up components, program components and regulation of a program, and criteria to achieve permitting live throwing. Clinicians including physicians, physical therapists, and certified athletic trainers who evaluate and treat musculoskeletal injuries among baseball pitchers at the professional-level and/or collegiate-level clinician received the survey. Responses were tabulated and compared between the professional-level clinician and collegiate-level clinician groups using chi-square analyses with statistical significance set at P ≤ .05. Results: The survey was completed by 166 clinicians (collegiate level = 81, professional-level clinician = 85). There were no statistical differences between groups for allowing warm-up throws, program regulation, maximum distance allowed, managing soreness, or criteria to achieve before permitting live throwing. Between-group differences included criteria to begin a program (≤.03), warm-up distance (P ≤ .02), nonthrowing warm-up methods (P ≤ .04), non-warm-up distance (P ≤ .01), using ratings of perceived exertion (P < .01), throwing frequency (P < .01), and program components (P ≤ .04). Conclusions: Responses appear to mirror interval throwing program designs previously reported in the literature but there are modifications and additions utilized by clinicians at different playing levels.

Background: Alterations in glenohumeral internal rotation (GIR), glenohumeral external rotation (GER), and total range of motion (TROM) have been linked with increased injury risk. GER capacity has been measured routinely with the forearm in neutral rotation (GERN), but a recent study reported GERN was greater than GER with the forearm in pronation (GERP) in Minor League pitchers. This work has not yet been replicated or extended to other groups. Hypothesis: GERP would be significantly less than GERN in Independent League baseball pitchers, and there would be no difference in GERP or GERN measurements between this new group and the previous group of Minor League pitchers. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Goniometric measurements were recorded for bilateral GIR, GERN, and GERP, and resulting TROM for 37 Independent League baseball pitchers. These data were compared with the previous study. All motions were compared individually between groups, between throwing and nonthrowing arm, and both within and between techniques (forearm neutral or pronated). Results: GERP was significantly less than GERN for both arms within each group tested ( P < 0.01). Independent League pitchers had greater between arm differences for GIR (-16.9° vs -6.9°), GERN (+15.1° vs -0.6°), and GERP (+13.1° vs -5.9°) compared with Minor League pitchers. TROM for the Independent League pitchers was not statistically different for either measurement technique, while TROM for the throwing arm of the Minor League pitchers was statistically reduced with varying effect sizes ( d = 0.35-0.99) compared with the nonthrowing arm ( P < 0.01). Conclusion: This study confirmed earlier findings that the pronated forearm resulted in decreased GER capacity, illustrating the adaptive response to throwing and the need to evaluate for this variable. Clinical Relevance: GERP should be evaluated in all groups of pitchers, but there may be variations within tested groups.

Background: Ulnar collateral ligament (UCL) injuries in youth pitchers continue to be concerning despite the institution of pitch count limits. Flexor-pronator mass fatigue can lead to diminished dynamic stability, resulting in greater stress on the UCL. Purpose/Hypothesis: To evaluate fatigue of the flexor-pronator mass by assessing changes in medial elbow laxity; noninvasively characterizing alterations in muscle glycogen; and identifying changes in subjective fatigue, strength, range of motion (ROM), pitching velocity, and accuracy with increasing pitches thrown by youth pitchers to their recommended 75-pitch count limit. It was hypothesized that, with increased pitches, medial elbow laxity would increase and that the glycogen content of the flexor-pronator mass would decrease. Study Design: Descriptive laboratory study. Methods: Healthy male pitchers aged 10 years (n = 22) threw 3 sets of 25 pitches with 12 minutes between sets (3 timepoints). Bilateral ulnohumeral joint gapping was measured by applying a standardized valgus force and utilizing ultrasound imaging. Relative changes in muscle glycogen in the bilateral flexor carpi radialis (FCR), and the flexor digitorum superficialis/flexor carpi ulnaris (FDS/FCU) muscles were measured with ultrasound software and recorded as fuel percentiles. Additional measures obtained included subjective fatigue, strength, ROM, velocity, and accuracy. Results: There were no differences in medial elbow joint-line gapping between the throwing and nonthrowing arms or between timepoints. The throwing arm demonstrated a significant decline in fuel percentile of the FCR from baseline to after 75 pitches ( P = .05). There were no differences across timepoints for FDS/FCU fuel percentile values. Fatigue measurements for both arms were significantly higher at all timepoints compared with baseline ( P≤ .03). Grip strength of the dominant arm after 75 pitches was decreased significantly compared with after 25 pitches ( P = .02). Conclusion: Although an increase in medial elbow joint gapping was not demonstrated within the recommended 75 pitch count limit in 10-year-olds, a relative decrease in glycogen stores of the flexor-pronator mass did occur, as well as a decrease in grip strength, with increasing subjective fatigue. Clinical Relevance: This study provides a foundation for further objective testing of physiologic changes that occur with pitching to better guide pitch count limits and improve the safety of young athletes.

Objectives: Ulnar Collateral Ligament (UCL) tears are common in baseball players. When non-operative management fails; reconstruction or repair may be necessary to restore physical function. There is no clear consensus regarding the indications for surgery based on magnetic resonance imaging (MRI) tear characteristics, or the indications for selecting repair over reconstruction. The purpose of this study was to define the indications for UCL surgery based on MRI and to elucidate indications for UCL repair vs reconstruction. Methods: Twenty-six orthopaedic surgeons who treat baseball players were surveyed. Forty-five MRIs were reviewed: 15 without UCL tears, 15 with intra-operatively confirmed partial-thickness tears, and 15 with full-thickness tears. Factors investigated included ligament characteristics (peri-ligamentous or osseous edema, ligament hypertrophy, calcification, partial or full-thickness tearing) and location (proximal, mid-substance, or distal). Surgeons were given a clinical scenario and asked whether 1) surgery was indicated and 2) whether repair or reconstruction was recommended. Odds ratios (OR) and 95% confidence intervals (95%CI) helped identify significant predictors for both queries. Results: The odds of recommending surgical treatment compared to non-operative treatment were 2.4x more likely for a proximal partial-thickness tear, 3.2x for distal partial-thickness tear, 5.1x for distal full- thickness tear, and 7.0x for proximal full-thickness tear (p<0.001). Significant indications for repair included distal partial (OR=1.6, 95%CI 1.0, 2.1, p<0.001) and full-thickness tears (OR=1.7, 95%CI 1.1, 2.3, p<0.001). Repair was 3x less likely recommended for mid-substance full-thickness tears (OR=3.0, 95%CI - 5.0, -1.0, p=0.004). Ultrasound stress testing was requested in 78% of partial tears. Conclusions: Among surgeons surveyed, the highest odds for recommending operative treatment were proximal full-thickness tears, then distal full-thickness, distal partial-thickness, and proximal partial- thickness tears. Repair was most appropriate for partial and full-thickness distal tears, but relatively contraindicated for complete mid-substance UCL tears. Ultrasound stress testing was frequently requested for partial tears. Given the lack of consensus among surgeons, future prospective registries are necessary to determine whether these factors associate with clinical outcomes.

Background:Scapula kinematics is recognized to be a crucial variable in shoulder dysfunction. Nevertheless, quantitative scapula tracking and measurement are not part of the current clinical evaluation. The main concern is measurement accuracy.Methods:To assess the accuracy of the wearable sensor technology Showmotion a cadaver experiment was designed, allowing a direct comparison between sensors directly pinned to the scapula and superficial sensors. A measurement protocol was adopted to evaluate errors in measurement, mimicking the suggested in vivo evaluation. Sensors were simultaneously placed above (supraspinal) and below (infraspinal) the scapular spine to determine if one placement resulted in fewer errors compared to the other.Results:Mean and standard deviations of the supraspinal sensor root mean square error (RMSE) in flexion-extension movements resulted in 3.59° ± 2.36°, 4.73° ± 2.98°, and 6.26° ± 3.62° for upward-downward rotation (up-down), anterior-posterior tilt and internal-external (intra-extra) rotation, respectively, while 2.16° ± 1.21°, 2.20° ± 1.02°, and 4.46° ± 2.16° for the infraspinal sensor. In abduction-adduction movements, mean and standard deviations of the supraspinal sensor RMSE resulted in 4.26° ± 2.98°, 5.68° ± 4.22°, and 7.04° ± 4.36° for up-down rotation, anterior-posterior tilt, and intra-extra rotation, respectively, while 2.38° ± 1.63°, 2.47° ± 1.77°, and 4.92° ± 3.14° for the infraspinal sensor. The same behavior was confirmed in shrug movements, where 4.35° ± 3.24°, 4.63° ± 3.09°, and 5.34° ± 6.67° are mean and standard deviations of the supraspinal sensor RMSE for up-down rotation, anterior-posterior tilt, and intra-extra rotation, respectively, while 2.76° ± 1.87°, 2.83° ± 2.53°, and 4.68° ± 5.22° for the infraspinal sensor.Conclusion:This method of quantitative assessment of scapular motion is shown to have good accuracy and low error between the sensor measurements and actual bone movement in multiple planes of scapular motion, both over the entire range of motion and in its individual segment intervals. The decreased amount of error with the infraspinal sensor placement suggests that placement is ideal for clinical quantitative assessment of scapular motion.

The purpose of this study was to determine if subjective pain scales commonly used (a) are correlated to each other and with algometric measurements and (b) differ between collegiate athletes and noncollegiate athletes. There were consistent significant positive correlations between all pain scales, regardless of groupings (collegiate athletes: r = .234–.730, p ≤ .007; noncollegiate athletes: r = .518–.820, p ≤ .002; female: r = .437–.690, p ≤ .010; male: r = .492–.784, p ≤ .005). These findings suggest that the pain scales studied could be used with both athletic and nonathletic populations. Algometric assessments may be better suited for patients with altered pain processing compared with those without.