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Rachele E. Vogelpohl and Roger O. Kollock


Shoulder injury in baseball pitchers is a very common problem and has been linked to an imbalance in rotator cuff strength. Recently, the use of functional shoulder strength ratios has become more popular because they more closely resemble the actions of the shoulder during the throwing motion.


To investigate the link between preseason shoulder rotator cuff functional strength ratios and the development of shoulder pain and injury.


Prospective research design.


University human performance laboratory.


Fifteen collegiate baseball pitchers participated in this study. At the end of the baseball season, six (19.5 ± 1.8 years, 73.6 ± 2.8 inches, 198.7 ± 19.1 lbs) developed shoulder injury and were placed in the injured group, and nine (21.0 ± 1.7 years, 73.1 ± 2.3 inches, 207.9 ± 28.1 lbs) did not develop injury and were placed in the noninjured group.


Isokinetic peak torque was collected concentrically and eccentrically for both shoulder internal rotation (IR) and external rotation (ER) at 60°-s−1, 180°-s−1, and 300°-s−1.

Main Outcome Measure:

The following functional ratios were calculated from the peak torque measures: concentric ER: concentric IR; eccentric ER: eccentric IR; concentric ER: eccentric IR (cocking phase); and eccentric ER: concentric IR (acceleration phase). Analysis was conducted using an analysis of variance comparing the injured and noninjured groups. A secondary analysis was conducted using an analyses of variance on the concentric and eccentric peak torque for shoulder IR and ER between groups.


The acceleration phase functional shoulder ratio was significantly higher (p = .019) in the injured group and a concentric IR peak torque (p = .003) was significantly lower in the injured group compared with the noninjured group.


Increased acceleration phase ratios and decreased concentric IR peak torque may be linked to the development of shoulder injury during a baseball season.

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Jessica R. Fairbairn and Kellie C. Huxel Bliven

appropriate care can be provided. For example, wheelchair athletes present with unique demands and needs of their upper-extremity in daily life and sport, which may impact injury rates. It is important to know whether, how, and if sport type impacts shoulder injury rates, so appropriate steps can be

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Jereme Wilroy and Elizabeth Hibberd

are common conditions in overhead athletes. 9 – 12 Shoulder injuries in overhead athletes are frequently attributed to adaptations in physical characteristics, such as range of motion (ROM) and strength imbalances that develop secondary to the repetitive motions of the sport. These adaptations may

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Eric R. Levasseur, Kevin D. Dames, Mark A. Sutherlin, Alyson Dearie, and Sonya Comins

Key Points ▸ Identifying outcomes associated with injury could lead to injury risk stratification or prevention programs. ▸ Preseason PRO measures of shoulder function may help identify swimmers at risk for shoulder injury during a competitive season. Since 2007, United States of America Swimming

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Xin Fu, Patrick Shu-hang Yung, Chun Cheong Ma, and Hio Teng Leong

repetitive, forceful, and quick overhead movements place athletes at high risk for shoulder injury. 3 Rotator cuff tendinopathy is one of the most frequently reported shoulder injuries in overhead sports athletes, such as volleyball players (23.7%), baseball pitchers (71%), and swimmers (86%–96%). 4 – 6

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Alyssa Muething, Shellie Acocello, Kimberly A. Pritchard, Stephen F. Brockmeier, Susan A. Saliba, and Joseph M. Hart


Understanding how muscles activate in a population with a previous glenohumeral-joint (GH) injury may help clinicians understand how to build a conservative treatment plan to strengthen or activate the specific muscles in an attempt to reduce recurrent shoulder injury and development of GH laxity.


To investigate muscle-activation differences between the previously injured limb of individuals with a history of GH-joint injury and healthy matched controls during functional isometric contractions.


Case control.


University research laboratory.


17 individuals (8 women, 9 men; age 22.3 ± 2.6 y, height 172.4 ± 8.8 cm, mass 75.4 ± 16.5 kg) with previous unilateral shoulder pain and 17 (8 women, 9 men; age 22.9 ± 3.9 y, height 170.9 ± 11.3 cm, mass 73.6 ± 22.9 kg) with no history of shoulder pain or injury.


Diagnostic ultrasound measurements of the supraspinatus were completed in both resting and contracted states to assess changes in muscle thickness. Manual muscle tests (anterior deltoid, upper trapezius, infraspinatus, lower trapezius, serratus anterior) and functional isometric contractions (forward flexion, scaption, abduction) were measured using electromyography.

Main Outcome Measures:

Peak, normalized activation of each muscle and supraspinatus thickness activation ratio were compared between groups and bilaterally within groups using separate ANOVAs.


The anterior deltoid was significantly less activated during all functional isometric tasks in previously injured subjects than in healthy subjects (P = .024). In previously injured subjects, the involved limb-lower trapezius was significantly less activated during scaption and abduction tasks than the contralateral side (P = .022 and P = .031, respectively).


There were decreases in muscle activation in the anterior deltoid between previously injured and healthy people, as well as in the lower trapezius, in previously injured subjects. Understanding the source of muscle-activation deficits can help clinicians focus rehabilitation exercises on specific muscles.

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Lara Mitchinson, Amity Campbell, Damian Oldmeadow, Will Gibson, and Diana Hopper

Volleyball players are at high risk of overuse shoulder injuries, with spike biomechanics a perceived risk factor. This study compared spike kinematics between elite male volleyball players with and without a history of shoulder injuries. Height, mass, maximum jump height, passive shoulder rotation range of motion (ROM), and active trunk ROM were collected on elite players with (13) and without (11) shoulder injury history and were compared using independent samples t tests (P < .05). The average of spike kinematics at impact and range 0.1 s before and after impact during down-the-line and cross-court spike types were compared using linear mixed models in SPSS (P < .01). No differences were detected between the injured and uninjured groups. Thoracic rotation and shoulder abduction at impact and range of shoulder rotation velocity differed between spike types. The ability to tolerate the differing demands of the spike types could be used as return-to-play criteria for injured athletes.

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Aimee L. Thornton, Cailee W. McCarty, and Mollie-Jean Burgess

Clinical Scenario:

Shoulder pain is a common musculoskeletal condition that affects up to 25% of the general population. Shoulder pain can be caused by any number of underlying conditions including subacromial impingement syndrome, rotator-cuff tendinitis, and biceps tendinitis. Regardless of the specific pathology, pain is generally the number 1 symptom associated with shoulder injuries and can severely affect daily activities and quality of life of patients with these conditions. Two of the primary goals in the treatment of these conditions are reducing pain and increasing shoulder range of motion (ROM).3 Conservative treatment has traditionally included a therapeutic exercise program targeted at increasing ROM, strengthening the muscles around the joint, proprioceptive training, or some combination of those activities. In addition, these exercise programs have been supplemented with other interventions including nonsteroidal anti-inflammatory drugs, corticosteroid injections, manual therapy, activity modification, and a wide array of therapeutic modalities (eg, cryotherapy, EMS, ultrasound). Recently, low-level laser therapy (LLLT) has been used as an additional modality in the conservative management of patients with shoulder pain. However, the true effectiveness of LLLT in decreasing pain and increasing function in patients with shoulder pain is unclear.

Focused Clinical Question:

Is low-level laser therapy combined with an exercise program more effective than an exercise program alone in the treatment of adults with shoulder pain?

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Gary L. Harrelson

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Neil Curtis