职业棒球投手喙肱间隙与肩胛下肌腱的慢性适应性变化
Chronic Adaptation of the Coracohumeral Space and Subscapularis Tendon in Professional Baseball Pitchers.
作者信息
Schofield Matthew R, Paul Ryan W, Buchheit Paul, Rauch Joseph, Thomas Stephen J
机构信息
Boise State University, Boise, Idaho.
Rothman Orthopaedics, Philadelphia, Pennsylvania.
出版信息
Sports Health. 2024 Aug 14:19417381241270359. doi: 10.1177/19417381241270359.
BACKGROUND
Pitchers frequently experience anterior shoulder pain, possibly associated with coracohumeral impingement; however, whether the coracohumeral distance (CHD) and/or subscapularis tendon adapt chronically (bilateral difference) due to pitching, and whether clinical measures are associated with CHD and subscapularis tendon organization have not been evaluated in professional pitchers.
HYPOTHESIS
The authors hypothesized that dominant arm CHD would be smaller than the nondominant arm, dominant subscapularis tendon would have increased spatial frequency (ie, be more disorganized), and humeral retroversion (HR) would predict CHD and subscapularis tendon organization.
LEVEL OF EVIDENCE
Level 4.
METHODS
Healthy professional baseball pitchers were recruited during their preseason physical examination. Bilateral diagnostic ultrasound measured CHD, HR, and posterior capsule thickness (PCT), and quantified subscapularis tendon organization. External rotation, neutral, and crossbody CHD was measured.
RESULTS
Overall, 52 healthy professional baseball pitchers participated. The dominant arm of pitchers demonstrated a significantly narrower CHD in all 3 positions ( < 0.01), increased scapular protraction (163 vs 156 mm; < 0.01), and increased spatial frequency of the subscapularis tendon (1.8 vs 1.6 peaks/mm; < 0.01). HR was associated with CHD in 30° of external rotation ( = 0.12; < 0.01), neutral rotation ( = 0.11; < 0.01), and the crossbody position ( = 0.28; < 0.01). PCT was associated with CHD in 30° of external rotation ( = 0.16; = 0.05). HR and CHD in 30° of external rotation was associated most strongly with subscapularis tendon organization ( = 0.11; = 0.03).
CONCLUSION
The dominant shoulder of professional pitchers presents with a smaller CHD, more scapular protraction, and more subscapularis tendon disorganization than the nondominant shoulder.
CLINICAL RELEVANCE
Professional pitchers demonstrate chronic CHD and subscapularis tendon adaptations, which may increase their risk for anterior shoulder pain and subscapularis tendon injury.
背景
投手经常经历肩部前方疼痛，可能与喙肱撞击有关；然而，由于投球，喙肱距离（CHD）和/或肩胛下肌腱是否会发生慢性适应性变化（双侧差异），以及临床测量指标是否与CHD和肩胛下肌腱结构相关，在职业投手中尚未得到评估。
假设
作者假设优势侧手臂的CHD会小于非优势侧手臂，优势侧肩胛下肌腱的空间频率会增加（即更紊乱），并且肱骨后倾（HR）可预测CHD和肩胛下肌腱结构。
证据水平
4级。
方法
在季前体检期间招募健康的职业棒球投手。通过双侧诊断性超声测量CHD、HR和后囊厚度（PCT），并对肩胛下肌腱结构进行量化。测量外旋、中立位和体侧位的CHD。
结果
共有52名健康的职业棒球投手参与。投手的优势侧手臂在所有3个位置的CHD均显著变窄（<0.01），肩胛前伸增加（163对156mm；<0.01），肩胛下肌腱的空间频率增加（1.8对1.6个峰/mm；<0.01）。HR与外旋30°时的CHD相关（=0.12；<0.01）、中立位旋转时的CHD相关（=0.11；<0.01）以及体侧位的CHD相关（=0.28；<0.01）。PCT与外旋30°时的CHD相关（=0.16；=0.05）。外旋30°时的HR和CHD与肩胛下肌腱结构的相关性最强（=0.11；=0.03）。
结论
职业投手的优势肩与非优势肩相比，CHD更小，肩胛前伸更多，肩胛下肌腱更紊乱。
临床意义
职业投手表现出慢性CHD和肩胛下肌腱适应性变化，这可能增加他们肩部前方疼痛和肩胛下肌腱损伤的风险。
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