Recker Andrew J, Gehrman Max D, Diaz Connor, Bullock Garrett S, Trasolini Nicholas A, Waterman Brian R
Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthrosc Sports Med Rehabil. 2023 Sep 9;5(5):100787. doi: 10.1016/j.asmr.2023.100787. eCollection 2023 Oct.
To provide a concise overview of the prevalence, diagnostic workup, management options, surgical techniques, and reported outcomes in the treatment of latissimus dorsi (LD) and teres major (TM) injuries in professional baseball pitchers.
A systematic review of studies reporting on professional baseball players who sustained LD or TM injuries was performed. Data were collected including patient presentation, injury management strategies, return-to-play (RTP) rates, time to RTP, patient-reported outcome measures, player performance after RTP, preinjury factors associated with injury, and complications.
Nine studies with 159 professional baseball players with a LD or TM injury were identified. All studies (2 retrospective cohort studies with high risk of bias and 7 case series) reported shoulder pain after pitching, and magnetic resonance imaging was performed in all cases to confirm diagnosis. Twenty-three patients underwent surgical treatment, whereas 136 patients underwent nonsurgical treatment. Overall RTP rates and performance between surgical and nonsurgical groups were similar (75% to 100% vs 75% to 93%), although the largest study reported improved performance with surgery. Two studies described a surgical technique with a posterior axillary approach and endosteal button fixation of the LD tendon. All studies reported a progressive strengthening and throwing program prior to returning to sport.
Professional baseball players who suffer a LD or TM injury have predictable clinical presentations and imaging findings. There is a high RTP rate and performance with both surgical and nonsurgical management. The heterogeneity and low level of evidence of available literature precludes comparative conclusions between treatment approaches.
IV systematic review of Level III and IV studies.
简要概述职业棒球投手中背阔肌（LD）和大圆肌（TM）损伤的患病率、诊断检查、管理选项、手术技术以及报告的治疗结果。
对报告职业棒球运动员发生LD或TM损伤的研究进行系统综述。收集的数据包括患者表现、损伤管理策略、重返比赛（RTP）率、RTP时间、患者报告的结局指标、RTP后球员表现、与损伤相关的伤前因素以及并发症。
确定了9项研究，共159名患有LD或TM损伤的职业棒球运动员。所有研究（2项有高偏倚风险的回顾性队列研究和7个病例系列）均报告了投球后肩部疼痛，所有病例均进行了磁共振成像以确诊。23例患者接受了手术治疗，而136例患者接受了非手术治疗。手术组和非手术组的总体RTP率和表现相似（75%至100%对75%至93%），尽管最大的研究报告手术可改善表现。两项研究描述了一种采用腋后入路和LD肌腱骨内膜纽扣固定的手术技术。所有研究均报告在恢复运动前有一个逐步加强和投球的计划。
患有LD或TM损伤的职业棒球运动员具有可预测的临床表现和影像学表现。手术和非手术管理的RTP率和表现都很高。现有文献的异质性和低证据水平排除了对不同治疗方法进行比较的结论。
对III级和IV级研究的IV级系统综述。
