Differentiation of bony and soft-tissue adaptations of the shoulder in professional baseball pitchers.

BACKGROUND: Baseball pitching places tremendous forces on the arm, which may lead to structural tissue adaptations that are represented by changes in rotational range of motion (ROM). These adaptations often include both bony and soft tissue; however, the contribution of each tissue to the change in motion is not always clinically attainable. The purposes of this study were to determine the adaptations of ROM, bone, and soft tissue bilaterally and to examine the correlation between clinical ROM and humeral retroversion (HR)-corrected ROM. We hypothesized that glenohumeral internal rotation (IR) and total motion would be decreased and glenohumeral external rotation (ER), posterior capsule thickness (PCT), and HR would be increased in the dominant arm; that HR-corrected ROM would be significantly different than clinical ROM; and that HR-corrected ROM would be correlated with total motion difference.

METHODS: Thirty professional baseball pitchers participated in this study. HR, PCT, and glenohumeral IR and ER were evaluated in the dominant and nondominant shoulders of each subject.

RESULTS: The dominant arm exhibited significantly more retroversion, ER, and PCT than the nondominant arm. The dominant arm also had significantly less IR and total motion than the nondominant arm. The total ROM difference was significantly correlated with both HR-corrected glenohumeral IR deficit and ER gain.

CONCLUSION: HR-corrected glenohumeral IR deficit and ER gain may more accurately reflect the contribution of soft-tissue changes to ROM. Unfortunately, measurement of HR is not always clinically attainable, making clinical management difficult.