Download Kambiz Behzadi, M.D. -- Orthopedic Medicine/Surgery in Livermore

Kambiz Behzadi, M.D
Sports Medicine and Arthroscopy
Webster Orthopedic Medical Group
Valley Care Hospital
Baseball Injuries
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America’s National Pastime
50% participants under age 12
Non-contact/Safe Sport
US Consumer Product Safety Commission:
900,000 Injuries/year
35% Require ER visits
1973-1981 183 baseball fatalities
40% of fatalities in 5-14 year age
Throwing, Hitting, Sliding, Catching,
Fielding
Biomechanics of Throwing
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Synchronous Progression
of body movements: legs>trunks->upper
extremities->propulsion of
ball
Mobility vs. Stability
Static Restraints (Bone and
Ligaments) and Dynamic
Restraints (Muscles) allow
balance between mobility
and stability
Repetitious act of
throwing: Overuse
Syndrome
Throwing Mechanism
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Windup
Early Cocking
Late Cocking
Acceleration
Follow-Through
Windup
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Balance Phase
Proper Body
alignment and
weight shift
Kinetic Energy is
stored
All segments of
body contribute to
the throw
Cocking
Early and Late
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Legs extend
Shoulder abducted
and externally
rotated
Large Torques at
Elbow and
Shoulder
Shoulder Instability
Elbow Instability
Acceleration
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Internal rotation
Ends with ball release
Deceleration of body
of arm
Acceleration
Follow-Through
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Energy not
transferred to the
ball must be
absorbed by arm
and body
Shoulder Injuries
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Basic Anatomy
Labrum
Glenohumeral
Ligaments
Rotator Cuff
Muscles
Shoulder Injuries
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Shoulder is an inherently
unstable Joint
Repetition of Throwing
Stress on anterior/front
ligaments Microtrauma
instability Tears of
Labrum, Ligaments, and
Rotator Cuff tendons.
Adolescent Shoulder Injuries
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Physeal Growth Plate
Capsular Ligaments
stronger than Growth
Plate
Little League
Shoulder
Stress Fracture of
Growth Plate
Elbow Injuries
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Repetitive Chronic Stresses
Young Throwers more Elbow than
Shoulder injuries
Little League Elbow a group of
pathologic entities
Elbow Injuries
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Medial Tension
Injuries
Lateral
Compression
Injuries
Elbow Injuries
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Medial Tension
Injuries
Most Common
Pain, decreased
distance and speed
Stress Fracture of
Medial Epicondylar
Physis/Growth
Plate
Elbow Injuries
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Kids Elbows have
several growth
plates
Medial Epicondyle
Growth Plate most
commonly injured
Repetitive
Valgus/Open Book
stress on inside
aspect of elbow
Medial Ligament Injuries
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More prevalent in mature throwers
Insidious microtrauma
Tommy John Procedure
Lateral Compression Injuries
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13 to 16 years
Compression forces on
outside aspect of elbow
Disruption of blood supply to
Growth Centers
Microfracture>>Fragmentation
Osteonecrosis
Dead Bone
Vascular Compromise
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Thoracic Outlet Syndrome
Effort Thrombosis
Hand Ischemia
Head & Neck Injuries
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High Number of Head and
Neck Injuries in Baseball
Half of fatalities from Head
and Neck injuries
170,000 injuries to face
annually
Common in 5 to 14 year age
group
Leading cause of youth
sports related head injuries?
Head & Neck Injuries
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Ball Impact
Collision trauma
Sliding accidents
50% of eye injuries from being hit
by a pitch while batting
Teeth, Jaw, facial bones, nose,
orbit and skull fractures from
being hit with ball
Ocular Injuries
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Lid lacerations
Vitreous hemorrhage
Retinal detachment
Optic nerve damage
Blindness
Head & Neck
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Head first sliding
Quadriplegia
Head first sliding
Head Trauma
Epidural Hematoma
Subdural Hematoma
Activity should be
disallowed?
Head and Neck Trauma
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Head and Neck Stabilized
until integrity of spine
established
Contusions, Concussions,
Skull Fractures, Epidural
and Subdural Hematomas,
Spinal Fractures
Loss of consciousness,
Sensory change, Motor
deficits, Neck stiffness,
Altered mental status need
careful neurological exam
Head and Face Protection
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Facial and Ocular
injuries are Preventable
Total Head and Face
protection a
Requirement?
Polycarbonate Face
Guards
Improved energy
absorbing capabilities
of head gear
Hitting
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Most batting
injuries result from
being hit by a pitch
Soft tissue injuries
and fractures at
site of impact
Uncontrolled swing
Direct impact with
ball handle
Batting Injuries
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Patella Dislocation:
Dislocation of the
knee cap of the
trailing leg, when
foot fixed into the
ground with cleats
Batting Injuries
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Fractures in the
hand
Carpal Bones
Centrifugal force of
the swing bat
overcomes
grasping power
Hook of Hamate
fracture
Sliding
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Vertical Stance to
Horizontal Stance
Head first vs. Feet
first
40% to 70% of all
softball injuries at
sliding
Sliding
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Sheer force (Abrasions / Contusions)
Deceleration against base
1.ankle and hand fractures
2.ankle and hand ligament injuries
3.knee ligament injuries
Collision injuries with fielder (head injuries,
fractures, sprains)
Rapid acceleration from standing (hamstring
pulls)
Sliding
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Significant impact body against
ground or base
Illegalization of sliding
Use of base running helmets
Proper sliding technique
Improved conditioning
Recessed bases
Breakaway bases
Sliding
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Head first disallowed
Ankle injuries less frequent at home
plate ( run over, not into the base)
Recessing 2 and 3 as in home?
Janda et al: significant prevention of
sliding injuries with use of
breakaway bases
Sliding
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633 games on breakaway base fields
627 games on stationary base fields
2 injuries on breakaway base fields
45 injuries on stationary base fields
One injury per 316 games
One injury per 14 games
Save 2 billion/year
acute care medical costs
Catching
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Chronic repetitive
impact->>Digital
ischemia/loss of
blood supply>>pain/cold
intolerance
Collisions with
runner, ball, bat
Meniscal tears in
older catchers from
squatting
Catching
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Predisposed to vascular injuries in
the gloved hand
Digital ischemia in the index finger of
the catching hand– by angiogram
Hand padding
Improved mitt design
Proper technique
Proper equipment
Fielding
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Collisions with players
or ballpark fence
(head injuries,
fractures, sprains
Ball trauma from
uncaught balls (head
injuries and fractures)
Explosive bursts of
muscle activity
(muscle strains)
Summary
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Baseball a fun and
challenging sport
Not particularly
dangerous sport
Substantial number of
injuries due to large
participation
Understanding
mechanisms of injury
helpful in preventing
injuries