Arthur R. Bartolozzi

A bilateral comparison of posterior capsule thickness and its correlation with glenohumeral range of motion and scapular upward rotation in collegiate baseball players

HYPOTHESIS We hypothesized that posterior capsule thickness (PCT) would be greater on the dominant arm compared to the non-dominant arm. We also hypothesized that PCT would negatively correlate with glenohumeral internal rotation and scapular upward rotation. In addition, PCT would positively correlate with glenohumeral external rotation. However, currently PCT has not been measured nor have correlations been identified to exist with glenohumeral and scapular motion. Therefore, the purpose of the study was to determine if the posterior capsule was hypertrophied on the dominant arm and to identify if relationships exist with glenohumeral internal rotation (IR), external rotation (ER), and scapular upward rotation (SUR). MATERIALS AND METHODS PCT was measured using a 10-MHz transducer. Glenohumeral IR and ER was measured supine using a digital inclinometer. SUR was measure at 0°, 60°, 90°, and 120° of glenohumeral abduction using a modified digital inclinometer. RESULTS PCT was greater on the dominant compared with the nondominant arm (P = .001). A negative correlation was found between PCT and IR (-0.498, P = .0001). A positive correlation was found between PCT and ER (0.450, P = .002) and between PCT and SUR at 60°, 90°, and 120° of glenohumeral abduction (0.388, P = .006; 0.327, P = .023; 0.304, P = .036, respectively). DISCUSSION This in vivo study demonstrated a hypertrophied posterior capsule and its association with GIRD, ER, and SUR. These observations suggest that PCT does occur on the throwing arm of baseball players and is linked with glenohumeral and scapular alterations. CONCLUSIONS This methodology could be used as a noninvasive screening evaluation for overhead athletes to identify those who may be at risk for shoulder injuries due to excessive capsular thickening.

Hydration status in college football players during consecutive days of twice-a-day preseason practices

Background Football players lose 3.5 to 5 kg of body weight during preseason practices because of heavy sweating. This fluid may be difficult to replace when practices occur 2 times per day on consecutive days. Hypothesis Football players are hypohydrated during twice-a-day preseason training in a hot, humid environment. Study Design Descriptive laboratory study Methods In 10 college football players, body weight was measured, and blood and urine samples were obtained before and after practices on days 2 through 8 of preseason training. Baseline samples were obtained when subjects were euhydrated. Blood samples were used to calculate plasma volume changes. Urine samples were analyzed for specific gravity, sodium, and potassium. Sweat rate was calculated. Core temperature was monitored during half- and full-padded practices. Results Mean wet bulb temperatures were 23.3°C during morning practices and 23.7°C during afternoon practices. Plasma volume was below baseline on day 2 and expanded by day 6. Urine specific gravity was higher than baseline for 12 of 20 measurements over the 8 days. It was 1.0175 ± 0.006 at baseline but subsequently ranged from 1.0214 ± 0.007 to 1.0321 ± 0.004. Mean daily urine sodium dropped from baseline to day 2 (194 ± 43 vs 43 ± 38 mmol × L-1), remaining lower on days 3, 4, and 6 (40 ± 39, 39 ± 39, and 68 ± 40 mmol × L-1, respectively). Urine potassium was lower on days 6 and 8 compared with baseline and day 3. Body weight was below baseline before and after both daily practices. Core temperature was higher in full pads; sweat rate and body weight loss were not different between half and full pads. Conclusion Body weight, plasma volume, urine specific gravity, and urine sodium indicate that football players become dehydrated by day 2 of preseason training. Urine sodium increased to near baseline by day 8; urine specific gravity was elevated. Clinical Relevance Football players struggle to maintain euhydration during preseason twice-a-day sessions.

Humeral retroversion and its association with posterior capsule thickness in collegiate baseball players

HYPOTHESIS AND BACKGROUND Baseball players commonly present with decreases in internal rotation (IR) and concurrent increases in external rotation (ER) motion. Several glenohumeral (GH) adaptations have been theorized to cause these changes in motion, including humeral retroversion (HR) and posterior capsule thickness (PCT). However, limited data exist examining the inter-relationship between HR and PCT. Therefore, the purpose of this study was to measure HR, GH IR and ER rotation, and PCT. MATERIALS AND METHODS HR and PCT were measured with an ultrasound system (Sonosite Titan; Sonosite, Bothell, WA, USA), and GH IR and ER were measured with a digital inclinometer. RESULTS The dominant arm had significantly more HR (15.6°, P = .0001) than the nondominant arm. Pearson correlation coefficients showed a significant negative relationship between HR and GH IR (-0.472, P = .001) and a significant positive relationship between HR and GH ER (0.295, P = .042). A significant positive correlation was also found between HR and PCT (0.427, P = .003). DISCUSSION This was the first study to identify a relationship between HR and PCT in addition to GH IR and ER. The identification of these multiple correlations appears to suggest that the loss of IR caused by HR may be placing additional stress on the posterior capsule during the deceleration phase of the throw, thereby causing a fibroblastic healing response. CONCLUSIONS HR has previously been identified as a positive adaptation because of the increase in ER without anterior capsule attenuation. However, this study suggests that HR may be contributing to the negative adaptation of PCT.

Stiffness Regulation and Muscle-Recruitment Strategies of the Shoulder in Response to External Rotation Perturbations

BACKGROUND The complex interactions between capsuloligamentous structures and muscle-recruitment strategies that maintain glenohumeral stability remain unclear. The purposes of the present study were to determine whether stiffness regulation and muscle-activation strategies differed under varying joint positions and levels of contraction in the shoulder and to determine the relationship between generalized joint laxity, glenohumeral joint laxity, and joint stiffness. METHODS Forty healthy, physically active subjects with a mean age (and standard deviation) of 25.2 +/- 4.6 years, a mean height of 174.7 +/- 6.7 cm, and a mean mass of 73.1 +/- 13.8 kg were tested. Shoulder stiffness and the activation of muscles (including the rotator cuff and the anterior deltoid) were measured at two levels of internal rotation torque (0% and 50% of maximum) and two joint positions (0 degrees and 90% of maximum external rotation) before and after a 5 degrees external rotation perturbation. Generalized laxity and glenohumeral joint laxity (in the anterior, posterior, and inferior directions) were also assessed. RESULTS Stiffness was 77% greater at 50% of maximum internal rotation torque than at 0% of maximum internal rotation torque (p < 0.001) but was not significantly different between joint positions (p = 0.73). From 0% to 50% of maximum internal rotation torque, preparatory and reactive recruitment of the subscapularis increased significantly more (p < 0.05) than those of the other muscles. Also, subscapularis preparatory activity was 36% greater in 0 degrees of external rotation than in 90% of maximum external rotation (p < 0.01). Generalized joint laxity (as indicated by a score of >/=4) was present in 20% of the subjects. Glenohumeral joint laxity (as indicated by a grade of >/=2) was present in the anterior, posterior, and inferior directions in 13%, 15%, and 15% of the subjects, respectively. No correlation existed between passive stiffness and generalized or glenohumeral laxity (r = -0.12 to 0.29; p = 0.08 to 0.48). CONCLUSIONS Moderate levels of muscle contraction can significantly increase glenohumeral joint stiffness and stability. Preactivation of the subscapularis appears to be the primary dynamic stabilizer with the arm in 0 degrees of external rotation. However, with the arm in 90% of maximum external rotation (the apprehension position), less subscapularis activity is observed and the maintenance of stability may shift toward other musculoskeletal structures because joint stiffness does not change. A relationship between generalized joint laxity, glenohumeral laxity, and stiffness was not observed in healthy subjects.