Neck Range of Motion Prognostic Factors in Association to Shoulder and Elbow Injuries in Professional Baseball Pitchers

Garrett S Bullock; Charles A Thigpen; Hannah Zhao; Laurie Devaney; Daniel Kline; Thomas J Noonan; Michael J Kissenberth; Ellen Shanley

doi:10.1016/j.jse.2024.08.026

Neck Range of Motion Prognostic Factors in Association to Shoulder and Elbow Injuries in Professional Baseball Pitchers

J Shoulder Elbow Surg. 2024 Oct 11:S1058-2746(24)00724-9. doi: 10.1016/j.jse.2024.08.026. Online ahead of print.

Authors

Garrett S Bullock¹, Charles A Thigpen², Hannah Zhao³, Laurie Devaney⁴, Daniel Kline², Thomas J Noonan⁵, Michael J Kissenberth⁶, Ellen Shanley³

Affiliations

¹ Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA. Electronic address: garrettbullock@gmail.com.
² ATI Physical Therapy, Greenville, SC, USA.
³ Doctor of Physical Therapy Program, Duke University School of Medicine, Durham, NC, USA.
⁴ Department of Kinesiology, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, USA.
⁵ Department of Orthopaedic Surgery, University of Colorado School of Medicine, Boulder, CO, USA; University of Colorado Health, Steadman Hawkins Clinic, Englewood, CO, USA.
⁶ Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.

PMID: 39396612
DOI: 10.1016/j.jse.2024.08.026

Abstract

Background: Authors have observed an association between cervical spine mobility and arm injury risk in baseball player; however, there is a need to assess the generalizability of cervical measurement data. Assessing the downstream of associations of cervical dysfunction on shoulder and elbow injuries can inform clinical interventions to help reduce future arm injuries. The purpose of this study was to assess the generalizability of neck range of motion measures as arm injury prognostic factors in professional baseball pitchers.

Methods: A prospective cohort of professional baseball pitchers in one Major League Baseball Organization was performed. Pitchers underwent pre-season neck range of motion including cervical flexion, extension, rotation, lateral flexion, and the flexion-rotation test (CFRT) and were followed for the season. The outcome was the occurrence of shoulder or elbow injury. A Cox proportional hazards analysis was performed and reported as hazard ratios (HR) with 95% confidence intervals (95% CI).

Results: A total of 88 pitchers were included (Age: 24.2 (2.4); Left-Handed: 21 (23%); Fastball Velocity: 92.3 (1.8)), with 15,942 athlete exposure days collected over the season. Pitcher neck range of motion was assessed (Flexion: 64 (10); Extension: 69 (11); Difference in Lateral Flexion: -1 (7); Difference in Neck Rotation: -2 (9); Difference in CFRT: -1 (7)). A total of 20 arm injuries (Shoulder: 9 (10%); Elbow: 11 (13%); Combined Rate: 1.3 (95% CI: 0.7, 1.7) per 1000 exposure days) were suffered by pitchers during the season. For every degree increase in the difference in dominant (rotating to dominant shoulder) versus non-dominant (rotating to non-dominant shoulder) neck rotation, there was a four-fold increase in arm injury hazard (HR: 4.0 (95% CI: 1.1, 13.9), p = 0.031). No other neck measurements demonstrated prognostic value.

Conclusions: A deficit in dominant versus non-dominant neck rotation was prognostic for pitching arm injury. However, the cervical rotation test did not have prognostic value in this sample. Further research is required to assess the generalizability and scalability of neck range of motion assessment in relation to baseball shoulder and elbow injuries across different competition levels.

Keywords: Cervical; Clinical Factors; Elbow; Injury Prevention; Injury Risk; Shoulder.