Novel Stress Tests for Diagnosing Little League Shoulder and Determining the Timing of Return to Sports.

IF 2.4 3区 医学 Q2 ORTHOPEDICS
Orthopaedic Journal of Sports Medicine Pub Date : 2025-05-28 eCollection Date: 2025-05-01 DOI:10.1177/23259671251331055
Takahiko Uchino, Yasunori Shimamura, Taichi Saito, Ryo Nakamichi, Toshifumi Ozaki
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引用次数: 0

Abstract

Background: The primary etiology of Little League shoulder (LLS) is rotational torque caused by repetitive throwing motion. However, there are few reports on the assessment of rotational torque during physical examination.

Purpose: To investigate the usefulness of the resisted external rotation test (RERT) and the resisted internal rotation test (RIRT) in diagnosing LLS and determining the time to return to sports (RTS).

Study design: Case series (diagnosis); Level of evidence, 4.

Methods: In total, 101 patients were diagnosed with LLS by proximal humeral physeal widening on radiography and tenderness on palpation over the lateral aspect of the proximal humerus, and the RERT and the RIRT were performed. During the 2 tests, the examiner lifted the patient's elbow joint with one hand toward the humeral shaft and held the patient's wrist joint with the other hand. In the RERT/RIRT, the patient was instructed to apply a maximal force of external/internal rotation from neutral alignment. The examiner resisted the force of external/internal rotation and maintained the setting position while holding the wrist joint. These test results were positive if either or both tests elicited shoulder pain. Positive test results and their association with radiographic findings were examined. In case of positive test results, the time to achieve negative test results and the time to RTS were investigated.

Results: The RERT and RIRT were correlated with severity of LLS. The sensitivity of RERT/RIRT for LLS was 94.1%/36.6%, respectively. In RIRT, patients with advanced-stage LLS were more likely to have positive results than those with early-stage LLS (67.4% vs 10.9%; P < .001). The mean time to achieve negative RERT and RIRT results was 6.7 and 4.7 weeks, respectively (P = .01). Patients with advanced-stage LLS had a longer mean time to achieve negative RERT results than those with early-stage LLS (6.7 vs 4.7; P < .001). The time to RTS was 8.8 weeks in the group that resumed throwing after achieving negative RERT, while the group that resumed throwing before RERT became negative took 12.7 weeks (P < .001).

Conclusion: The RERT may be useful in determining the presence of LLS and when RTS can be allowed.

诊断小联盟肩部和决定重返运动时机的新型压力测试。
背景:小联盟肩(LLS)的主要病因是由重复投掷运动引起的旋转扭矩。然而,很少有关于在体检中评估旋转扭矩的报道。目的:探讨抗外旋转试验(rt)和抗内旋转试验(RIRT)在诊断LLS和确定重返运动时间(RTS)中的应用价值。研究设计:病例系列(诊断);证据等级,4级。方法:101例患者均经肱骨近端骨骺增宽及肱骨近端外侧触痛诊断为LLS,并行rrt和rrt。2次检查时,检查者一手将患者肘关节抬向肱骨轴,另一手握住患者腕关节。在rt /RIRT中,指示患者从中立位开始施加最大的外/内旋转力。检查者在握住腕关节的同时,抵抗外/内旋转的力量,保持固定位置。如果其中一项或两项测试均引起肩痛,则这些测试结果为阳性。阳性试验结果及其与放射学表现的关系进行了检查。在检测结果为阳性的情况下,研究了达到阴性检测结果的时间和RTS的时间。结果:rrt、rrt与LLS严重程度相关。rt /RIRT对LLS的敏感性分别为94.1%/36.6%。在RIRT中,晚期LLS患者比早期LLS患者更有可能出现阳性结果(67.4% vs 10.9%;P < 0.001)。达到rt阴性和rt结果的平均时间分别为6.7周和4.7周(P = 0.01)。晚期LLS患者比早期LLS患者平均获得阴性rt结果的时间更长(6.7 vs 4.7;P < 0.001)。rrt为阴性后恢复投掷的组到RTS的时间为8.8周,而在rrt为阴性前恢复投掷的组到RTS的时间为12.7周(P < 0.001)。结论:rt可能有助于确定LLS的存在以及何时允许rt。
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来源期刊
Orthopaedic Journal of Sports Medicine
Orthopaedic Journal of Sports Medicine Medicine-Orthopedics and Sports Medicine
CiteScore
4.30
自引率
7.70%
发文量
876
审稿时长
12 weeks
期刊介绍: The Orthopaedic Journal of Sports Medicine (OJSM), developed by the American Orthopaedic Society for Sports Medicine (AOSSM), is a global, peer-reviewed, open access journal that combines the interests of researchers and clinical practitioners across orthopaedic sports medicine, arthroscopy, and knee arthroplasty. Topics include original research in the areas of: -Orthopaedic Sports Medicine, including surgical and nonsurgical treatment of orthopaedic sports injuries -Arthroscopic Surgery (Shoulder/Elbow/Wrist/Hip/Knee/Ankle/Foot) -Relevant translational research -Sports traumatology/epidemiology -Knee and shoulder arthroplasty The OJSM also publishes relevant systematic reviews and meta-analyses. This journal is a member of the Committee on Publication Ethics (COPE).
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