overhead pain, and pain with acceleration. Exam-
ination findings include positive clunktest, positive
grind test, and positive O’Brien’s test. Treatment is sur-
gery if conservative therapies fail.- Bennett lesionis a region of mineralization at the
posterior-inferior glenoid rim. This ossification is
unique in throwing athletes and often associated with
rotator cuff injuries or instability. Symptoms are usu-
ally related to secondary shoulder pathology and diag-
nosis is made with CT scan. Conservative treatment is
favored over surgical intervention (De Maeseneer et al,
1998). - Osteochondritis dissecans (OCD) of the humeral
capitellum is often due to repetitive valgus stress at
radiocapitallar joint. Symptoms include lateral elbow
pain associated with throwing and possibly clicking
and or locking. Crepitus and limited extension may
be found on examination and loose bodies may be
seen on plain films. Fractures, avascular necrosis, and
accessory centers of ossification have been reported
to be associated with OCD (Takahara et al, 1998).
Treatment includes rest, ice, NSAIDs and possibly
surgery. - Ulnar collateral ligament injury often occurs in
throwing athletes from repetitive valgus stress. This
stress can cause medial elbow instability and pain.
Physical examination findings include decreased
extension, and laxity and pain with valgus stressing.
Plain films may be negative. Ultrasound and MRI can
assist with diagnosis (Sasaki et al, 2002). Treatment
includes rest, ice, and NSAIDs. Indications for sur-
gery include chronic instability, failed conservative
treatment, or complete 3rd degree tear. - Ulnar neuritiscan result from direct trauma, or repet-
itive overuse. Symptoms include pain at medial
elbow, paresthesias throughout arm greatest at 4th and
5th digits. Examination includes pain reproduced with
cubital tunnel pressure, positive Tinel’s sign, and
distal hand weakness. Treatment includes rest, range
of motion(ROM) exercises, and rarely surgery for
failed conservative therapy. - Little league elbowresults form repetitive throwing in
a skeletally immature athlete, injuring the growth
plate. Symptoms include medial elbow pain greatest
with throwing. Examination is significant for medial
elbow tenderness. Treatment includes rest and throw-
ing modifications. - Commotio cordisis dysrrhythmia or cardiac arrest
occurring after a direct blow to the chest. Numerous
cases of batters hit by a baseball causing sudden death
have heightened awareness and controversy for safer
and softer baseball use (Curfman, 1998; Janda et al,
1998). Chest protectors may also be utilized for better
prevention (Viano et al, 2000).- Head injuriesoccur often in baseball due to wild
pitches, swinging bats, and hit baseballs often striking
fans or spectators. The most common mechanism of
injury is direct ball impact to players in the field
(Pasrernack, Veenema, and Callahan, 1996).
- Head injuriesoccur often in baseball due to wild
ASSOCIATED INJURIES- Oral canceris a concern in many baseball players
using chewing tobacco. Education should be directed
toward prevention. - Abdominal injurieshave been reported from sliding,
collisions, falls, and direct impact of the baseball.
Common injuries to the abdomen include muscular
contusion, rectus sheath hematoma, and spleen and
renal damage. Careful evaluation including computed
tomography(CT) scanning is often necessary to work
up abdominal injuries (Riviello and Young, 2000). - Aneurysm of mid axillary arteryis rare but has been
reported in baseball players and should be considered
in the differential diagnosis of a throwing athlete with
hand pain and/or paresthesias. This injury can cause
embolization to the arm or hand and may be due to the
forceful downward displacement of the humeral head
or pectoralis minor tendon, damaging the intima in
throwing athletes. Treatment is often surgical revascu-
larization (Ishitobi et al, 2001; Todd et al, 1998).
EQUIPMENT- Baseball equipment includes batting helmets, athletic
supporters with cups, cleats, batting gloves, alu-
minum, or wooden bats, and mouth guards. - Position specific equipment include mask, chest,
throat, and shin protectors for catchers; toe guards for
batters and catchers; forearm batting protectors; and
gloves or mitts for different fielding positions. - Recently health care professionals have proposed the
implementation of softer baseballs in Little League
Baseball to reduce the risk of injury.
REHABILITATION- Rehabilitation for a baseball player or throwing ath-
lete is often injury specific. Physical therapy should
include rehabilitation of the large lower body muscle
groups and the smaller muscle groups of the upper
extremity. Strengthening often needs to be directed at
the rotator cuff and scapular stabilizing muscles. - The phases of rehabilitation include the acute, recovery,
and maintenance phases. The acute phase concentrates
462 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS