Autologous therapies with intra-articular orthobiologic approaches have been introduced to address knee osteoarthritis (OA) patients. Among these, platelet-rich plasma (PRP) and cell-based injectable therapies obtained f...Autologous therapies with intra-articular orthobiologic approaches have been introduced to address knee osteoarthritis (OA) patients. Among these, platelet-rich plasma (PRP) and cell-based injectable therapies obtained from bone marrow or adipose tissue are gaining a significant interest in the clinical practice. PRP is currently showing the highest support, in terms of overall number of data, superiority in comparative trials, and some support from scientific societies. On the other hand, bone marrow concentrates are currently the most used approach for subchondral bone injections, and adipose-derived treatments showed promise to address more advanced OA patients otherwise less responsive to other orthobiologic injectable options.
Sports-related concussion represents a unique type of brain injury because the goal of medical care is to return the athlete safely and expeditiously to the same activity that led to the concussion. The Sport Concussion...Sports-related concussion represents a unique type of brain injury because the goal of medical care is to return the athlete safely and expeditiously to the same activity that led to the concussion. The Sport Concussion Assessment Tool has standardized assessment of concussed athletes and their return to play. Advances in brain imaging, assessment of molecular biomarkers in blood and other body fluids, and accurate wearable sensors of force and acceleration are being applied to the study of concussion in athletes. In conjunction with long-term outcome data, such technologies will continue to make athletic competition as safe as possible.
Holistic care of the baseball athlete is incomplete without attention to mental health. Baseball athletes are exposed to multiple stressors that may impact mental health negatively, but little is known about the prevalen...Holistic care of the baseball athlete is incomplete without attention to mental health. Baseball athletes are exposed to multiple stressors that may impact mental health negatively, but little is known about the prevalence of mental disorders in this population due to a paucity of research. Several barriers interfere with baseball athletes getting help when needed. Primary prevention, early intervention and screening, and timely access to specialized care are critical in keeping the baseball athlete healthy, safe, and in the game. Athletic organizations that make mental health a priority have an opportunity to destigmatize mental health concerns and transform culture.
The muscles that attach to the pubic bone (rectus abdominis, adductor longus, pectineus, and adductor brevis) constitute a harness that serves as the bedrock of core stability and underpinning the athleticism that define...The muscles that attach to the pubic bone (rectus abdominis, adductor longus, pectineus, and adductor brevis) constitute a harness that serves as the bedrock of core stability and underpinning the athleticism that defines performance in sports. Their attachment to the pubic bone is a point of weakness that, when disrupted, results in pain and a loss of athleticism. These injuries are not uncommon in baseball. A comprehensive understanding of their function and the commonality of injuries in this area is crucial for developing effective interventions aimed at enhancing athletic longevity and minimizing the risk of injury.
Spine and pelvis issues in Major League Baseball do not often get the publicity that other, more common injuries do. However, despite low incidence rates involving significant time loss, there is a very high percentage o...Spine and pelvis issues in Major League Baseball do not often get the publicity that other, more common injuries do. However, despite low incidence rates involving significant time loss, there is a very high percentage of players who report having some lumbopelvic discomfort at some point in their careers. Baseball athlete's bodies have unique clinical baseline presentations throughout the kinetic chain representing the unique demands of the game. The authors aim to outline a plan that can identify potential problematic presentations, implement an efficient and effective plan of care that will limit potential pain and injury, and maximize performance.
Foot and ankle injuries in baseball provide unique challenges to the provider. Most foot and ankle injuries (ie, ankle sprains and contusions) can be managed non-operatively using a similar approach as in other athletic...Foot and ankle injuries in baseball provide unique challenges to the provider. Most foot and ankle injuries (ie, ankle sprains and contusions) can be managed non-operatively using a similar approach as in other athletic populations, but a few unique mechanisms of injury in baseball are important to be aware of. While upper extremity injuries such as ulnar collateral ligament (UCL) tears and labral tears are extensively reported on in the literature, there is a need for further baseball-specific research on foot and ankle injuries, especially given the increasing prevalence of these injuries over the past few decades.
Pitching, catching, and base-running may predispose professional baseball players to injury-particularly in the hand and wrist. In this study, we outline the diagnosis, management, and rehabilitation of commonly encounte...Pitching, catching, and base-running may predispose professional baseball players to injury-particularly in the hand and wrist. In this study, we outline the diagnosis, management, and rehabilitation of commonly encountered injuries among these high-level athletes. Wrist injuries discussed include hook of hamate fractures, extensor carpi ulnaris tendon disorders, scapholunate instability, and triangular fibrocartilage complex tears. Hand injuries discussed include thumb ulnar collateral ligament injury, flexor tendon pulley rupture, hypothenar hammer syndrome, and blisters.
While knee injuries account for just 7% of injuries in professional and collegiate baseball, they are the fourth most common cause of missed professional games. The 3 most common knee-related issues in baseball are patel...While knee injuries account for just 7% of injuries in professional and collegiate baseball, they are the fourth most common cause of missed professional games. The 3 most common knee-related issues in baseball are patellar tendinopathy, meniscus tears, and medial collateral ligament sprains. While injuries such as anterior cruciate ligament tears and patellar dislocations are less common, they are notable due to their potentially significant effect on time missed. Treatment considerations of all these pathologies are multifactorial and should include skeletal maturity, level of play, timing of season/recruiting, and long-term goals.
Core and lower extremity injuries in baseball are often overlooked and represent one-third of all injuries with hamstring strains being the most common injury in all of professional baseball. Significant time lost from p...Core and lower extremity injuries in baseball are often overlooked and represent one-third of all injuries with hamstring strains being the most common injury in all of professional baseball. Significant time lost from play may result from these injuries. Thus, it is important to assess patient-specific risk factors for injury and implement standardized return to play rehabilitation protocols in order to prevent reinjury and additional missed time.
Injuries in overhead throwers are common, and there are limited data on return to throw programs in the literature. This article outlines the criteria that baseball players should meet before initiating throwing and furt...Injuries in overhead throwers are common, and there are limited data on return to throw programs in the literature. This article outlines the criteria that baseball players should meet before initiating throwing and further describes an evidence-based throwing program that can be utilized to aid in the rehabilitation of overhead athletes and optimize chances of returning to same level of throwing. These guidelines may be used for rehabilitation after injury is treated operatively or nonoperatively.
The overhead throwing athlete possesses distinct physical traits and undergoes adaptive changes due to the repetitive nature of throwing, often resulting in significant injury to the shoulder or elbow joint. An effective...The overhead throwing athlete possesses distinct physical traits and undergoes adaptive changes due to the repetitive nature of throwing, often resulting in significant injury to the shoulder or elbow joint. An effective rehabilitation program for the throwing athlete is dependent upon an accurate evaluation that identifies the causative factors contributing to the athlete's condition. In this article, we outline the unique physiology of the thrower's shoulder and elbow, the injuries associated with these athletes and a multiphased rehabilitation approach that allows for the restoration of strength, mobility, endurance, and power essential to return to unrestricted overhead sporting activity.
Rotator cuff and biceps tendon injuries are a common source of pain and dysfunction among overhead athletes. The stress across the glenohumeral joint and its dynamic stabilizers in high level throwing leads to adaptive a...Rotator cuff and biceps tendon injuries are a common source of pain and dysfunction among overhead athletes. The stress across the glenohumeral joint and its dynamic stabilizers in high level throwing leads to adaptive anatomic changes that must be recognized and respected. Nonoperative treatment is recommended for partial rotator cuff tears and biceps tendinitis and tendinosis. Surgical treatment is indicated for persistent symptoms despite conservative treatment. For rotator cuff repairs, it is critical to avoid over-tensioning as this will lead to the loss of range of motion and lower rates for return to play.
This article focuses on the history, pathoanatomy, clinical examination, management, and rehabilitation of superior labrum anterior to posterior (SLAP) tears in throwing athletes. Additionally, the authors have outlined...This article focuses on the history, pathoanatomy, clinical examination, management, and rehabilitation of superior labrum anterior to posterior (SLAP) tears in throwing athletes. Additionally, the authors have outlined how to identify and manage capsular injuries in throwing athletes. The study goes into detail about the different surgical options for SLAP lesions including the evolution of SLAP repairs and the role of biceps tenodesis in these patients.
Injury rates in baseball players reach as high as 5.8 per 1000 at the professional level. Recent data have singled out the elbow as the leading cause of injured list necessitating injuries and the costliest injury locati...Injury rates in baseball players reach as high as 5.8 per 1000 at the professional level. Recent data have singled out the elbow as the leading cause of injured list necessitating injuries and the costliest injury location in professional baseball. While the medial ulnar collateral ligament (MUCL) has gained the largest notoriety in this population, elbow injury in the thrower occurs as a spectrum of pathologies. These pathologies may encompass other injuries often resulting from or occurring in conjunction with MUCL insufficiency. These conditions include valgus extension overload syndrome, osteochondritis dissecans, olecranon stress fractures, and ulnar nerve pathology.
Ulnar collateral ligament injuries are prevalent among baseball players with an increasing incidence, especially in younger athletes. Diagnosis relies on history, examination, and MRI, with dynamic imaging playing an exp...Ulnar collateral ligament injuries are prevalent among baseball players with an increasing incidence, especially in younger athletes. Diagnosis relies on history, examination, and MRI, with dynamic imaging playing an expanding role. Nonoperative management prioritizes cessation of throwing, correcting kinetic chain deficiencies, and gradual rehabilitation. The decision between reconstruction and repair is based on tear characteristics, tissue quality, patient goals, position, and timing of injury. Primary surgery generally results in high return-to-play rates. Revision surgery has less favorable outcomes with more complications. Emerging trends include the use of hybrid reconstruction techniques for challenging cases and platelet-rich plasma to augment nonoperative care.
Major League Baseball has one of the most physically demanding schedules in professional sports. It is common for injuries to occur because of the volume of games and generally most of the injuries are from overuse and f...Major League Baseball has one of the most physically demanding schedules in professional sports. It is common for injuries to occur because of the volume of games and generally most of the injuries are from overuse and fatigue. This article will outline some injuries in baseball that sideline the athlete for some time but when treated adequately allow players to return-to-sport in the same season. Managing these injuries with established return-to-play protocols will also be detailed.
A critical aspect of the care of the baseball player involves understanding injury patterns, workload tolerance, and objective markers that can aid in identifying predisposing factors to injury. After injury, a well-stru...A critical aspect of the care of the baseball player involves understanding injury patterns, workload tolerance, and objective markers that can aid in identifying predisposing factors to injury. After injury, a well-structured rehabilitation program can return many players to the field. The greatest challenge is not only returning them to the previous level of performance but also preventing reinjury and maintaining durability. Potential factors implicated in the most common injuries include deficits in range of motion, balance, core strength, lumbopelvic control, thoracic rotation, posture, and muscle imbalance. Organizing an appropriate rehabilitation program with these factors in mind is critical.
This section is dedicated to the comprehensive evaluation of the overhead throwing athlete's elbow. The elbow provides a unique diagnostic dilemma that requires extensive knowledge and appreciation of elbow anatomy and k...This section is dedicated to the comprehensive evaluation of the overhead throwing athlete's elbow. The elbow provides a unique diagnostic dilemma that requires extensive knowledge and appreciation of elbow anatomy and kinematics, given the extreme forces seen across the elbow during the overhead throwing motion, the superficial nature of the majority of anatomic structures, and the complex interplay among bony, ligamentous, musculotendinous, and neurologic structures. The physical examination of the ulnar collateral ligament, valgus extension overload syndrome, medial and lateral epicondylitis, posterolateral rotatory instability, tendon ruptures, and compressive neuropathies will be covered.