Differences in Shoulder Internal Rotation Strength Between Baseball Players With Ulnar Collateral Ligament Reconstruction and Healthy Controls

Sean M Kennedy; Philip Sheedy; Brooks Klein; Mason F Gist; Joseph P Hannon; John E Conway; Kalyssa Creed; J Craig Garrison

doi:10.1177/23259671211065025

Differences in Shoulder Internal Rotation Strength Between Baseball Players With Ulnar Collateral Ligament Reconstruction and Healthy Controls

Orthop J Sports Med. 2022 Jan 7;10(1):23259671211065025. doi: 10.1177/23259671211065025. eCollection 2022 Jan.

Authors

Sean M Kennedy¹, Philip Sheedy², Brooks Klein³, Mason F Gist², Joseph P Hannon^{2

4}, John E Conway⁵, Kalyssa Creed², J Craig Garrison⁶

Affiliations

¹ Memorial Hermann Health, IRONMAN Sports Medicine Institute, Houston, Texas, USA.
² Texas Health Sports Medicine, Fort Worth, Texas, USA.
³ Chicago White Sox, Chicago, Illinois, USA.
⁴ St Louis Children's Hospital, Young Athlete Center, St Louis, Missouri, USA.
⁵ Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
⁶ Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA.

Abstract

Background: Studies have indicated decreased shoulder internal rotation (IR) and external rotation (ER) strength in the throwing limb of baseball players after ulnar collateral ligament injury. There is limited evidence on the recovery of shoulder rotation strength after primary ulnar collateral ligament reconstruction (UCLR).

Hypothesis: At the time of return to throwing, baseball players who underwent UCLR would demonstrate decreased IR and ER shoulder strength in the throwing arm as compared with healthy baseball players.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: Male competitive high school and collegiate baseball athletes participated in this study. Athletes who underwent UCLR were compared with healthy controls who were matched by age, height, weight, and position. Bilateral isometric shoulder ER and IR strength was measured using a handheld dynamometer for all participants at the time of initial evaluation (UCLR group) and throughout the course of a season (healthy group). Independent t tests were run to calculate mean differences in ER and IR shoulder strength between the groups, with significance set at P < .05.

Results: A total of 86 baseball athletes participated in this study (43 UCLR group, 43 healthy group). At the time of return to throwing (mean ± SD, 194 ± 30 days postoperatively), the 2 groups demonstrated no significant differences in nonthrowing arm ER or IR strength (P = .143 and .994, respectively). No significant difference was found between groups for throwing arm ER strength (P = .921); however, the UCLR group demonstrated significantly less throwing arm IR strength than the healthy group (144.2 ± 27.8 vs 157.6 ± 27.1 N; P = .023).

Conclusion: The results of this study demonstrate that throwing arm rotator cuff strength may not fully recover before the initiation of a return-to-throwing program after UCLR. These data provide a potential framework for clinicians to assist in the management and exercise prescription of the baseball athlete after UCLR and before medical release and the initiation of a return-to-throwing program.

Keywords: UCL; baseball; elbow; rotator cuff.