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Review
. 2023 Apr;16(4):115-122.
doi: 10.1007/s12178-022-09800-4. Epub 2022 Dec 27.

Factors that Increase Elbow Stress in the Throwing Athlete: a Systematic Review of Biomechanical and Motion Analysis Studies of Baseball Pitching and Throwing

Jacob J Triplet  1 , Joshua R Labott  1 , Devin P Leland  1 , Adnan Cheema  1 , Sara E Till  1 , Kenton R Kaufman  1 , Christopher L Camp  2
Affiliations
Review

Factors that Increase Elbow Stress in the Throwing Athlete: a Systematic Review of Biomechanical and Motion Analysis Studies of Baseball Pitching and Throwing

Jacob J Triplet et al. Curr Rev Musculoskelet Med. 2023 Apr.

Abstract

Purpose of review: Elbow pain poses a unique challenge in the throwing athlete. Due to the high levels of elbow stress during the throwing motion, elbow injuries are common in throwers of all ages. There are several postulated factors believed to contribute increased stress to the throwing elbow. A detailed review of the published biomechanical studies evaluating the stresses experienced by the throwing elbow is needed. Here, we review these biomechanical studies to extrapolate the contributing factors that increase stress, the modifications that may reduce such stress, and the post-injury rehabilitation that optimizes outcomes and reduces recurrence.

Recent findings: The biomechanical forces on the elbow have been further investigated delineated in recent work. Rotational malalignment of the shoulder, including both GIRD and decreased adduction, increases torque experienced by the elbow during pitching motions. Exact interactions between lower extremity, lumbopelvic or trunk rotation, and elbow forces during throwing remain uncertain with mixed results in recent literature. Pitch types may influence elbow stresses although delivery mechanism and distance thrown do not. Several biomechanical factors influence the stresses imparted on the throwing elbow. Throwing volume, proper throwing mechanics, and appropriate rehabilitation are likely to be to be the most influential on mitigating unnecessary stresses imparted to the elbow in the throwing athlete. A proper understanding of these factors may reduce the occurrence of these injuries in this population. Moreover, an understanding of proper rehabilitation following injury may ensure optimized results and reduce recurrence.

Keywords: Biomechanics; Elbow; Throwing athlete; Valgus moment; Varus moment.

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Conflict of interest statement

Christopher L. Camp has received personal fees and non-financial support from Arthrex, personal fees and non-financial support from Zimmer Biomet, non-financial support from Stryker Corporation, and personal fees from Gemini Inc. Jacob J. Triplet has received personal fees from Medtronic USA Inc. Adnan Cheema has received personal fees from ConvaTec Inc. Kenton R. Kaufman reports editorial or governing board position on Gait and Posture, Prosthetics, and Orthotics International. Joshua R. Labott, Devin P. Leland, Sara E. Till declare that they have no conflict of interest.

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