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1.  THROWING INJURIES IN THE ADOLESCENT ATHLETE 
Introduction:
Adolescents ranging in age from 11–15 (early‐mid adolescence) comprise the largest percentage of baseball and softball athletes in the United States. Shoulder and elbow injuries are commonly experienced by these athletes with baseball pitchers and softball position players most likely to be injured.
Common Injuries:
Physeal injury often termed “Little League” shoulder or elbow is common and should be differentiated from soft tissue injuries such as biceps, rotator cuff, or UCL injuries. Regardless of diagnosis, rehabilitation of these athletes’ shoulder and elbow injuries provide a unique challenge given their rapidly changing physical status.
Treatment:
Common impairments include alterations in shoulder range of motion, decreased muscle performance, and poor neuromuscular control of the scapula, core, and lower extremity. A criterion based, progressive rehabilitation program is presented. Discharge from formal rehabilitation should occur only when the athlete has demonstrated a resolution of symptoms, acceptable ROM, muscle performance, and neuromuscular control while progressing through a symptom free return to sport.
Prevention of Reinjury:
Reintegration into the desired level of sport participation should be guided by the sports medicine professional with a focus on long‐term durability in sport performance as well as injury prevention. A prevention program which includes parent, coach, and athlete education, regular screening to identify those athletes at the highest risk, and monitoring athletes for the development of risk factors or warning signs of injury over the course of participation is indicated.
Level of Evidence:
5
PMCID: PMC3811729  PMID: 24175142
Adolescent; throwing injuries; youth
2.  SHOULDER RANGE OF MOTION, PITCH COUNT, AND INJURIES AMONG INTERSCHOLASTIC FEMALE SOFTBALL PITCHERS: A DESCRIPTIVE STUDY 
Background/Purpose:
Injury rates for softball players are similar to baseball players yet information regarding risk factors, pitching, and physical characteristics for high school windmill softball pitchers is limited. This information is needed to guide prevention, training, and rehabilitation efforts. The purpose of this study was to report descriptive data regarding the physical characteristics and pitching volume experienced by high school softball pitchers during one academic season. A secondary aim was to track and describe upper extremity injuries suffered by high school softball pitchers throughout the course of the 2009 season.
Methods:
Twelve uninjured female softball pitchers (13‐18y) from 5 Greenville, South Carolina high schools participated. Prior to the 2009 season, the pitchers' shoulder internal, external, total arc of rotation and horizontal adduction PROM was measured. During the 10‐week season, aggregate pitch counts (pitch volume) and occurrence of upper extremity injury were tracked for each pitcher.
Results:
Mean preseason internal, external, and total arc of rotation PROM was observed to be similar between the pitchers' dominant and non‐dominant shoulders. The PROM measures of horizontal abduction (HA) appear to demonstrate a side‐to‐side difference with less HA on the dominant arm of the pitchers who were examined. Subjects threw in an average of 10.1 games (±4.9) during the season. Six pitchers threw in 60% or more of the team's games and 3 of 12 pitchers pitched less than 25% of games. Pitchers averaged 61.8 pitches per game (±31.5) and 745.8 (±506.4) per season. Pitch count data did not appear to be different between injured and non‐injured pitchers.
Conclusions:
Knowledge of pitch volume can be used to prepare windmill softball pitchers for the seasonal stresses, guide establishment of goals when recovering from injury, or assist in training for an upcoming season. Further research is needed to examine larger samples of pitchers over multiple seasons and years.
Level of Evidence:
III
PMCID: PMC3474308  PMID: 23091788
Pitch count; shoulder; softball
3.  THE RELIABILITY OF THE VAIL SPORT TEST™ AS A MEASURE OF PHYSICAL PERFORMANCE FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION 
Purpose/Background:
The decision to return an athlete to sports following anterior cruciate ligament reconstruction can be controversial. The purposes of this study are 1) to describe a functional test (Vail Sport Test™) that includes the evaluation of muscle strength, endurance, power, and movement quality in those patients attempting to return to sports following ACL reconstruction and 2) to assess the reliability of the Vail Sport Test™.
Methods:
A prospective cohort study design. A total of 30 (12 F, 18 M) subjects (18.1±5.3 yrs) volunteered for the study. All subjects were post-operative ACL reconstruction (5.2±1.9 months) and were in the process of returning to sports. Each subject completed the Vail Sport Test™ and was videotaped from the anterior and lateral view. The videotape was then viewed and graded at two different points in time (48 hours apart) by three licensed physical therapists. Intraclass correlations (ICCs) were calculated to determine intra- and inter-rater reliability.
Results:
Intra-rater reliability was excellent with a range of .95 to 1.0. Reliability values between graders were .97 (ICC2,k) and 1.55 (SEM).
Conclusions:
The results of this study suggest that the Vail Sport Test™ has excellent reliability when the same graders scored the test using video on repeated occasions. In addition, the test was reliable between different graders.
Level of Evidence:
Level 2b
PMCID: PMC3290923  PMID: 22389868

Results 1-3 (3)