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Increased Pitch Velocity is Associated with Throwing Arm Kinetics, Injury Risk, and Ulnar Collateral Ligament Reconstruction in Adolescent, Collegiate, and Professional Baseball Pitchers: A Qualitative Systematic Review

Published:January 14, 2023DOI:https://doi.org/10.1016/j.arthro.2023.01.004

      Abstract

      Purpose

      To assess the relationship between pitch velocity and throwing arm kinetics, injury, and ulnar collateral ligament reconstruction(UCLr) among high school, collegiate, and professional baseball pitchers.

      Methods

      The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed(2008-2019), and OVID/MEDLINE(2008-2019) were queried for articles that reported on pitch velocity predicting throwing arm kinetics, injury, or UCLr. The Methodological Index for Non-randomized Studies checklist was used to evaluate the quality of all included studies. Descriptive statistics with ranges were used to quantify data where appropriate.

      Results

      A total of 24 studies examining 2,896 pitchers, with level of evidence II-V were included. Intergroup analysis noted pitch velocity was significantly correlated with elbow varus torque in high school(R

      Clair M. Are pitchers really throwing harder than ever? | MLB.com. Published August 29, 2018. Accessed October 27, 2021. https://www.mlb.com/cut4/are-pitchers-really-throwing-harder-than-ever-c292153594

      =0.36), collegiate(R

      Clair M. Are pitchers really throwing harder than ever? | MLB.com. Published August 29, 2018. Accessed October 27, 2021. https://www.mlb.com/cut4/are-pitchers-really-throwing-harder-than-ever-c292153594

      =0.29), and professional(R

      Clair M. Are pitchers really throwing harder than ever? | MLB.com. Published August 29, 2018. Accessed October 27, 2021. https://www.mlb.com/cut4/are-pitchers-really-throwing-harder-than-ever-c292153594

      =0.076) pitchers. Elbow distraction force was positively associated with ball velocity in inter-pitcher analyses of high school(R

      Clair M. Are pitchers really throwing harder than ever? | MLB.com. Published August 29, 2018. Accessed October 27, 2021. https://www.mlb.com/cut4/are-pitchers-really-throwing-harder-than-ever-c292153594

      =0.373), professional(R

      Clair M. Are pitchers really throwing harder than ever? | MLB.com. Published August 29, 2018. Accessed October 27, 2021. https://www.mlb.com/cut4/are-pitchers-really-throwing-harder-than-ever-c292153594

      =0.175), and mixed cohort evaluations(R

      Clair M. Are pitchers really throwing harder than ever? | MLB.com. Published August 29, 2018. Accessed October 27, 2021. https://www.mlb.com/cut4/are-pitchers-really-throwing-harder-than-ever-c292153594

      =0.624). Intragroup analysis demonstrated a strong association between pitch velocity and elbow varus torque(R

      Clair M. Are pitchers really throwing harder than ever? | MLB.com. Published August 29, 2018. Accessed October 27, 2021. https://www.mlb.com/cut4/are-pitchers-really-throwing-harder-than-ever-c292153594

      =0.922-0.957) and elbow distraction force(R

      Clair M. Are pitchers really throwing harder than ever? | MLB.com. Published August 29, 2018. Accessed October 27, 2021. https://www.mlb.com/cut4/are-pitchers-really-throwing-harder-than-ever-c292153594

      =0.910) in professional pitchers. Faster ball velocity was positively associated with a history of throwing arm injury(R

      Clair M. Are pitchers really throwing harder than ever? | MLB.com. Published August 29, 2018. Accessed October 27, 2021. https://www.mlb.com/cut4/are-pitchers-really-throwing-harder-than-ever-c292153594

      =0.194) in non-adult pitchers. In two studies evaluating professionals, injured pitchers had faster pitch velocity prior to injury compared to uninjured controls(p=0.014; p=0.0354). The need for UCLr was positively correlated with pitch velocity(R

      Clair M. Are pitchers really throwing harder than ever? | MLB.com. Published August 29, 2018. Accessed October 27, 2021. https://www.mlb.com/cut4/are-pitchers-really-throwing-harder-than-ever-c292153594

      =0.036) in professional pitchers. The consequences of UCL reconstruction noted little to no decrease in pitch velocity.

      Conclusions

      Professional baseball pitchers with faster pitch velocity may be at the highest risk of elbow injury and subsequent UCLr, potentially through the mechanism of increased distractive forces on the medial elbow complex. When a pitcher ultimately undergoes UCLr, decreases in pitching performance are unlikely, but may occur, which should encourage pitchers to caution against maximizing pitch velocity.

      Level of Evidence

      Level IV, systematic review of Level II-IV studies

      Keywords

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      References

      1. Short D. Aroldis Chapman throws fastest pitch ever recorded - MLB | NBC Sports. Published September 25, 2010. Accessed October 27, 2021. https://mlb.nbcsports.com/2010/09/25/aroldis-chapman-throws-fastest-pitch-ever-recorded/

      2. Clair M. Are pitchers really throwing harder than ever? | MLB.com. Published August 29, 2018. Accessed October 27, 2021. https://www.mlb.com/cut4/are-pitchers-really-throwing-harder-than-ever-c292153594

        • Chalmers P.N.
        • Sgroi T.
        • Riff A.J.
        • et al.
        Correlates With History of Injury in Youth and Adolescent Pitchers.
        Arthroscopy. 2015; 31: 1349-1357https://doi.org/10.1016/J.ARTHRO.2015.03.017
        • Bushnell B.D.
        • Anz A.W.
        • Noonan T.J.
        • Torry M.R.
        • Hawkins R.J.
        Association of Maximum Pitch Velocity and Elbow Injury in Professional Baseball Pitchers.
        American Journal of Sports Medicine. 2010; 38: 728-732https://doi.org/10.1177/0363546509350067
        • Chalmers P.N.
        • Erickson B.J.
        • Ball B.
        • Romeo A.A.
        • Verma N.N.
        Fastball Pitch Velocity Helps Predict Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers.
        American Journal of Sports Medicine. 2016; 44: 2130-2135https://doi.org/10.1177/0363546516634305
        • Slowik J.S.
        • Aune K.T.
        • Diffendaffer A.Z.
        • Lyle Cain E.
        • Dugas J.R.
        • Fleisig G.S.
        Fastball velocity and elbow-varus torque in professional baseball pitchers.
        J Athl Train. 2019; 54: 296-301https://doi.org/10.4085/1062-6050-558-17
        • Manzi J.E.
        • Estrada J.A.
        • Dowling B.
        • Ruzbarsky J.J.
        • Dines J.S.
        Intra- versus inter-pitcher comparisons: Associations of ball velocity with throwing-arm kinetics in professional baseball pitchers.
        J Shoulder Elbow Surg. 2021; 30: 2596-2603https://doi.org/10.1016/J.JSE.2021.04.017
        • Post E.G.
        • Laudner K.G.
        • McLoda T.A.
        • Wong R.
        • Meister K.
        Correlation of shoulder and elbow kinetics with ball velocity in collegiate baseball pitchers.
        J Athl Train. 2015; 50: 629-633https://doi.org/10.4085/1062-6040-50.1.06
        • Nicholson K.F.
        • Hulburt T.C.
        • Beck E.C.
        • Waterman B.R.
        • Bullock G.S.
        The relationship between pitch velocity and shoulder distraction force and elbow valgus torque in collegiate and high school pitchers.
        J Shoulder Elbow Surg. 2020; 29: 2661-2667https://doi.org/10.1016/j.jse.2020.04.046
        • Khalil L.S.
        • Meta F.S.
        • Tramer J.S.
        • et al.
        Elbow Torque Is Reduced in Asymptomatic College Pitchers With Elbow Laxity: A Dynamic Ultrasound Study.
        Arthroscopy. 2021; 37: 852-861https://doi.org/10.1016/J.ARTHRO.2020.12.208
        • Oyama S.
        • Yu B.
        • Blackburn J.T.
        • Padua D.A.
        • Li L.
        • Myers J.B.
        Effect of excessive contralateral trunk tilt on pitching biomechanics and performance in high school baseball pitchers.
        American Journal of Sports Medicine. 2013; 41: 2430-2438https://doi.org/10.1177/0363546513496547
        • Hurd W.J.
        • Jazayeri R.
        • Mohr K.
        • Limpisvasti O.
        • ElAttrache N.S.
        • Kaufman K.R.
        Pitch Velocity Is a Predictor of Medial Elbow Distraction Forces in the Uninjured High School-Aged Baseball Pitcher.
        Sports Health. 2012; 4: 415-418https://doi.org/10.1177/1941738112439695
        • Stodden D.F.
        • Fleisig G.S.
        • McLean S.P.
        • Andrews J.R.
        Relationship of biomechanical factors to baseball pitching velocity: Within pitcher variation.
        J Appl Biomech. 2005; 21: 44-56https://doi.org/10.1123/jab.21.1.44
        • DeFroda S.F.
        • Kriz P.K.
        • Hall A.M.
        • Zurakowski D.
        • Fadale P.D.
        Risk Stratification for Ulnar Collateral Ligament Injury in Major League Baseball Players: A Retrospective Study From 2007 to 2014.
        Orthop J Sports Med. 2016; 4https://doi.org/10.1177/2325967115627126
        • Marshall N.E.
        • Keller R.
        • Limpisvasti O.
        • Schulz B.
        • ElAttrache N.
        Major League Baseball Pitching Performance After Tommy John Surgery and the Effect of Tear Characteristics, Technique, and Graft Type.
        Am J Sports Med. 2019; 47: 713-720https://doi.org/10.1177/0363546518817750
        • Whiteside D.
        • Martini D.N.
        • Lepley A.S.
        • Zernicke R.F.
        • Goulet G.C.
        Predictors of ulnar collateral ligament reconstruction in major league baseball pitchers.
        American Journal of Sports Medicine. 2016; 44: 2202-2209https://doi.org/10.1177/0363546516643812
        • Keller R.A.
        • Marshall N.E.
        • Guest J.M.
        • Okoroha K.R.
        • Jung E.K.
        • Moutzouros V.
        Major League Baseball pitch velocity and pitch type associated with risk of ulnar collateral ligament injury.
        J Shoulder Elbow Surg. 2016; 25: 671-675https://doi.org/10.1016/j.jse.2015.12.027
        • Portney D.A.
        • Lazaroff J.M.
        • Buchler L.T.
        • Gryzlo S.M.
        • Saltzman M.D.
        Changes in pitching mechanics after ulnar collateral ligament reconstruction in major league baseball pitchers.
        J Shoulder Elbow Surg. 2017; 26: 1307-1315https://doi.org/10.1016/j.jse.2017.05.006
        • Fleisig G.S.
        • Diffendaffer A.Z.
        • Drogosz M.
        • Cain E.L.
        • Emblom B.A.
        • Dugas J.R.
        Baseball Pitching Biomechanics Shortly After Ulnar Collateral Ligament Repair.
        Orthop J Sports Med. 2019; 7https://doi.org/10.1177/2325967119866199
        • Lansdown D.A.
        • Feeley B.T.
        The effect of ulnar collateral ligament reconstruction on pitch velocity in Major League Baseball pitchers.
        Orthop J Sports Med. 2014; 2https://doi.org/10.1177/2325967114522592
        • Mayo B.C.
        • Miller A.
        • Patetta M.J.
        • et al.
        Preventing Tommy John Surgery: The Identification of Trends in Pitch Selection, Velocity, and Spin Rate Before Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers.
        Orthop J Sports Med. 2021; 9https://doi.org/10.1177/23259671211012364
        • Jiang J.J.
        • Leland J.M.
        Analysis of pitching velocity in major league baseball players before and after ulnar collateral ligament reconstruction.
        Am J Sports Med. 2014; 42: 880-885https://doi.org/10.1177/0363546513519072
        • McKnight B.
        • Heckmann N.D.
        • Chen X.T.
        • et al.
        Effect of Ulnar Collateral Ligament Reconstruction on Pitch Accuracy, Velocity, and Movement in Major League Baseball Pitchers.
        Orthop J Sports Med. 2020; 8https://doi.org/10.1177/2325967120968530
        • Makhni E.C.
        • Lee R.W.
        • Morrow Z.S.
        • Gualtieri A.P.
        • Gorroochurn P.
        • Ahmad C.S.
        Performance, return to competition, and reinjury after Tommy John surgery in major league baseball pitchers: A review of 147 cases.
        American Journal of Sports Medicine. 2014; 42: 1323-1332https://doi.org/10.1177/0363546514528864
        • Reiman M.P.
        • Walker M.D.
        • Peters S.
        • Kilborn E.
        • Thigpen C.A.
        • Garrigues G.E.
        Risk factors for ulnar collateral ligament injury in professional and amateur baseball players: a systematic review with meta-analysis.
        J Shoulder Elbow Surg. 2019; 28: 186-195https://doi.org/10.1016/j.jse.2018.08.018
        • Chalmers P.N.
        • English J.
        • Cushman D.M.
        • et al.
        The ulnar collateral ligament responds to stress in professional pitchers.
        J Shoulder Elbow Surg. 2021; 30: 495-503https://doi.org/10.1016/J.JSE.2020.06.027
        • Fleisig G.S.
        • Barrentine S.W.
        • Zheng N.
        • Escamilla R.F.
        • Andrews J.R.
        Kinematic and kinetic comparison of baseball pitching among various levels of development.
        J Biomech. 1999; 32: 1371-1375https://doi.org/10.1016/S0021-9290(99)00127-X
        • Dun S.
        • Fleisig G.S.
        • Loftice J.
        • Kingsley D.
        • Andrews J.R.
        The relationship between age and baseball pitching kinematics in professional baseball pitchers.
        J Biomech. 2007; 40: 265-270https://doi.org/10.1016/j.jbiomech.2006.01.008
        • Nicholson K.F.
        • Hulburt T.C.
        • Beck E.C.
        • Waterman B.R.
        • Bullock G.S.
        The relationship between pitch velocity and shoulder distraction force and elbow valgus torque in collegiate and high school pitchers.
        J Shoulder Elbow Surg. 2020; 29: 2661-2667https://doi.org/10.1016/j.jse.2020.04.046
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • et al.
        The PRISMA 2020 statement: An updated guideline for reporting systematic reviews.
        The BMJ. 2021; : 372https://doi.org/10.1136/BMJ.N71
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological index for non-randomized studies (Minors): Development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716https://doi.org/10.1046/J.1445-2197.2003.02748.X
      3. Manzi JE, Estrada JA, Dowling B, Ruzbarsky JJ, Dines JS. Intra versus Inter-Pitcher Comparisons: Associations of Ball Velocity with Throwing Arm Kinetics in Professional Baseball Pitchers. J Shoulder Elbow Surg. Published online April 28, 2021. doi:10.1016/j.jse.2021.04.017

        • Fleisig G.S.
        • Andrews J.R.
        • Dillman C.J.
        • Escamilla R.F.
        Kinetics of Baseball Pitching with Implications About Injury Mechanisms.
        Am J Sports Med. 1995; 23: 233-239https://doi.org/10.1177/036354659502300218
        • Fleisig G.S.
        • Barrentine S.W.
        • Escamilla R.F.
        • Andrews J.R.
        Biomechanics of overhand throwing with implications for injuries.
        Sports Medicine. 1996; 21: 421-437https://doi.org/10.2165/00007256-199621060-00004
        • McLeod W.D.
        • Andrews J.R.
        Mechanisms of shoulder injuries.
        Phys Ther. 1986; 66: 1901-1904https://doi.org/10.1093/ptj/66.12.1901
        • Andrews J.R.
        • Carson W.G.
        • Mcleod W.D.
        Glenoid labrum tears related to the long head of the biceps.
        Am J Sports Med. 1985; 13: 337-341https://doi.org/10.1177/036354658501300508
        • Knesek M.
        • Skendzel J.G.
        • Dines J.S.
        • Altchek D.W.
        • Allen A.A.
        • Bedi A.
        Diagnosis and management of superior labral anterior posterior tears in throwing athletes.
        American Journal of Sports Medicine. 2013; 41: 444-460https://doi.org/10.1177/0363546512466067
        • Meister K.
        Injuries to the shoulder in the throwing athlete. Part one: Biomechanics/pathophysiology/classification of injury.
        American Journal of Sports Medicine. 2000; 28: 265-275https://doi.org/10.1177/03635465000280022301
        • Burkhart S.S.
        • Morgan C.D.
        • ben Kibler W.
        The disabled throwing shoulder: Spectrum of pathology part I: Pathoanatomy and biomechanics.
        Arthroscopy. 2003; 19: 404-420https://doi.org/10.1053/JARS.2003.50128
        • Escamilla R.
        • Moorman C.
        • Fleisig G.
        • Barrentine S.
        • Andrews J.
        Baseball: Kinematic and Kinetic comparisons between American and Korean professional baseball pitchers.
        Sports Biomech. 2002; 1: 213-228https://doi.org/10.1080/14763140208522798
        • Werner S.L.
        • Guido J.A.
        • Stewart G.W.
        • McNeice R.P.
        • VanDyke T.
        • Jones D.G.
        Relationships between throwing mechanics and shoulder distraction in collegiate baseball pitchers.
        J Shoulder Elbow Surg. 2007; 16: 37-42https://doi.org/10.1016/j.jse.2006.05.007
        • Sabick M.B.
        • Kim Y.K.
        • Torry M.R.
        • Keirns M.A.
        • Hawkins R.J.
        Biomechanics of the shoulder in youth baseball pitchers: Implications for the development of proximal humeral epiphysiolysis and humeral retrotorsion.
        American Journal of Sports Medicine. 2005; 33: 1716-1722https://doi.org/10.1177/0363546505275347
      4. Paulino FE, Villacis D, Ahmad C. Valgus Extension Overload in Baseball Players. undefined. Published online 2016.

        • Wilson F.D.
        • Andrews J.R.
        • Blackburn T.A.
        • McCluskey G.
        Valgus extension overload in the pitching elbow.
        Am J Sports Med. 1983; 11: 83-88https://doi.org/10.1177/036354658301100206
        • Campbell R.E.
        • McGhee A.N.
        • Freedman K.B.
        • Tjoumakaris F.P.
        Diagnostic Imaging of Ulnar Collateral Ligament Injury: A Systematic Review.
        American Journal of Sports Medicine. 2020; 48: 2819-2827https://doi.org/10.1177/0363546520937302
      5. Fury MS, Oh LS, Linderman SE, et al. Return to Performance After Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers: A Case-Control Assessment of Advanced Analytics, Velocity, Spin Rates, and Pitch Movement. Orthop J Sports Med. 2021;9(9). doi:10.1177/23259671211035753/ASSET/IMAGES/LARGE/10.1177_23259671211035753-FIG1.JPEG

        • Ciccotti M.C.
        • Hammoud S.
        • Dodson C.C.
        • Cohen S.B.
        • Nazarian L.N.
        • Ciccotti M.G.
        Stress ultrasound evaluation of medial elbow instability in a cadaveric model.
        Am J Sports Med. 2014; 42: 2463-2469https://doi.org/10.1177/0363546514542805
        • Shukla M.
        • Keller R.
        • Marshall N.
        • et al.
        Ultrasound evaluation of the ulnar collateral ligament of the elbow: Which method is most reproducible?.
        Skeletal Radiol. 2017; 46: 1081-1085https://doi.org/10.1007/S00256-017-2656-Z
        • Park J.Y.
        • Kim H.
        • Lee J.H.
        • et al.
        Valgus stress ultrasound for medial ulnar collateral ligament injuries in athletes: is ultrasound alone enough for diagnosis?.
        J Shoulder Elbow Surg. 2020; 29: 578-586https://doi.org/10.1016/J.JSE.2019.12.005
        • Marshall R.N.
        • Elliott B.C.
        Long-axis rotation: the missing link in proximal-to-distal segmental sequencing.
        J Sports Sci. 2000; 18: 247-254https://doi.org/10.1080/026404100364983
        • Gibson B.W.
        • Webner D.
        • Huffman G.R.
        • Sennett B.J.
        Ulnar collateral ligament reconstruction in major league baseball pitchers.
        Am J Sports Med. 2007; 35: 575-581https://doi.org/10.1177/0363546506296737