Trakis James E, McHugh Malachy P, Caracciolo Philip A, Busciacco Lisa, Mullaney Michael, Nicholas Stephen J
Fortius Physical Therapy, New York, NY, USA.
Am J Sports Med. 2008 Nov;36(11):2173-8. doi: 10.1177/0363546508319049. Epub 2008 Jul 2.
A high prevalence of throwing-related shoulder and elbow pain has been documented in adolescent baseball pitchers.
Pitchers with a history of throwing-related pain will have weakened dominant-arm posterior shoulder musculature and greater dominant-arm glenohumeral total range of motion (ROM) loss compared with pitchers without throwing-related pain.
Controlled laboratory study.
Twenty-three adolescent pitchers (age 15.7 +/- 1.4 years) were tested. Twelve pitchers had throwing-related pain in the prior season and were currently symptom-free, while the remaining 11 pitchers had no such history of pain. Internal and external rotation ROM and muscle strength (lower trapezius, middle trapezius, rhomboids, latissimus dorsi, supraspinatus, internal rotators, external rotators) were measured bilaterally. Dominant versus nondominant differences in ROM and strength were compared between pitchers with and without throwing-related pain.
As a whole, the group of 23 pitchers had a loss of internal rotation ROM (13 degrees +/- 10 degrees , P < .001) and gain in external rotation ROM (11 degrees +/- 10 degrees , P < .001) on the dominant versus nondominant arm, with no effect on total ROM (2 degrees +/- 7 degrees loss, P = .14). There was no difference in bilateral comparison of total ROM between pitchers with and without throwing-related pain. Dominant versus nondominant muscle strength was lower (P < .05) for the pain group versus nonpain group for the middle trapezius (7% +/- 19% vs 22% +/- 12%) and supraspinatus (-4% +/- 27% vs 14% +/- 14%) and higher (P < .05) for the internal rotators (19% +/- 14% vs 6% +/- 12%).
Throwing-related pain in this population may be due to the inability of weakened posterior shoulder musculature to tolerate stress imparted on it by adaptively strengthened propulsive muscles.
Selective posterior shoulder strengthening may be indicated in rehabilitative and injury prevention programs for adolescent pitchers.
青少年棒球投手投掷相关的肩部和肘部疼痛患病率较高已被记录在案。
与没有投掷相关疼痛的投手相比，有投掷相关疼痛病史的投手优势侧肩部后方肌肉会变弱，优势侧盂肱关节总活动范围（ROM）损失更大。
对照实验室研究。
对23名青少年投手（年龄15.7±1.4岁）进行测试。12名投手在上个赛季有投掷相关疼痛且目前无症状，其余11名投手无此类疼痛病史。双侧测量内旋和外旋ROM以及肌肉力量（下斜方肌、中斜方肌、菱形肌、背阔肌、冈上肌、内旋肌、外旋肌）。比较有和没有投掷相关疼痛的投手在ROM和力量方面的优势侧与非优势侧差异。
总体而言，23名投手的优势侧与非优势侧手臂相比，内旋ROM减少（13°±10°，P <.001），外旋ROM增加（11°±10°，P <.001），对总ROM无影响（减少2°±7°，P =.14）。有和没有投掷相关疼痛的投手在总ROM的双侧比较中没有差异。疼痛组与非疼痛组相比，中斜方肌（7%±19%对22%±12%）和冈上肌（-4%±27%对14%±14%）的优势侧与非优势侧肌肉力量较低（P <.05），内旋肌的优势侧与非优势侧肌肉力量较高（P <.05）（19%±14%对6%±12%）。
该人群中与投掷相关的疼痛可能是由于肩部后方肌肉变弱，无法耐受适应性强化的推进肌肉施加在其上的压力。
在青少年投手的康复和预防损伤计划中，可能需要进行选择性的肩部后方强化训练。
