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Soft Tissue Changes Associated with Repetitive Overhead Throwing in an Adolescent Population and Their Relation to Upper Extremity Complaints

Popchak, Adam / J (2016) Soft Tissue Changes Associated with Repetitive Overhead Throwing in an Adolescent Population and Their Relation to Upper Extremity Complaints. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Shoulder and elbow pathology in the youth and adolescent pitcher has been a long standing and pervasive phenomenon. Recently there has been a dramatic rise in the incidence of adolescent throwing injuries as a result of the ever increasingly competitive environment of youth sports and the frequent involvement in year-round participation. Existing guidelines have not been universally accepted by all organizations and there are some who hold long standing beliefs on proper pitching practices that may or may not coincide with the current best evidence. Identification of real-time tendon characteristics using quantitative ultrasound (QUS) opens another avenue for discovery of specific tissue behaviors and risk factors based on objective data. This is a novel application of a technology that in the past for this population has only been used to identify existing abnormalities and bone structure but not real-time tendon changes in response to pitching. We developed a protocol to reliably measure the infraspinatus (INF) tendon that showed moderate to high intra-rater reliability and used an existing method to examine the LHB. Among healthy, uninjured youth and adolescent baseball pitchers we found significant tendon width changes that occurred within 50 pitches, with side to side differences noted in the INF tendon. No single QUS finding was significantly predictive of experiencing an upper extremity complaint, however strong trends were noted for having a larger LHB and INF tendons. Correlational analysis showed that specific strength parameters were significantly related to having a larger LHB and may be used to identify those who are greater risk. Larger INF tendons showed a tendency to have a protective effect in terms of upper extremity complaints and were shown to be significantly related to physical maturation and ball velocity. Information related to normalized strength were also determined and can serve as comparative data in the clinical setting. Application of the QUS methods may help to identify early signs of upper extremity pathology, and along with other risk factor information may be applied at the individual level to reduce the incidence of throwing related injuries.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Popchak, Adam / Jajp64@pitt.eduAJP64
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee CoChairBoninger, Michael Lboninger@upmc.eduBONINGER
Committee CoChairDelitto, Anthonydelitto@pitt.eduDELITTO
Committee MemberIrrgang, James Jirrgangjj@upmc.eduJIRRGANG
Committee MemberAbt, John Pjabt@pitt.eduJABT
Committee MemberVyas, Dharmeshvyasdr@upmc.eduDRV5
Date: 15 January 2016
Date Type: Publication
Defense Date: 21 August 2015
Approval Date: 15 January 2016
Submission Date: 19 June 2015
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 209
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Youth or adolescent, throwing, injury prevention, ultrasound imaging
Date Deposited: 15 Jan 2016 21:04
Last Modified: 19 Dec 2016 14:42


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