BLOOD FLOW ADAPTATIONS IN BASEBALL PITCHERSJesse Nelson1; Kevin Laudner, PhD, ATC1; Nick Burke, ATC1;

Noelle Selkow, PhD, ATC1; Keith Meister, MD2

1School of Kinesiology & Recreation, Illinois State University, Normal, IL; 2Texas Metroplex Institute for Sports Medicine and Orthopedics, Arlington, TX

INTRODUCTION

• There has been a recent increase in the

diagnoses of upper extremity

neurovascular injuries among baseball

players.1,2

• The repetitive nature of baseball which

causes various adaptations in shoulder

flexibility and strength may cause similar

alterations of the vascular tissue.

• An improved understanding of these

potential adaptations may aide in the

prevention, diagnosis, and treatment of

vascular pathologies among baseball

players.

PURPOSE

METHODSParticipants

• 20 professional baseball pitchers and 16

position players volunteered to

participate in this study (Table 1).

Table 1. Participant demographics.

• All participants had no recent history of

upper extremity injury or any upper

extremity surgery.

• All participants provided informed

consent prior to testing as mandated by

the university’s institutional review

board.

REFERENCES

ILLINOIS STATE UNIVERSITY

Procedures

• To determine if blood flow among

pitchers and position players changes

after a competitive baseball season.

• Following the competitive baseball

season, the pitchers had significantly

less blood flow volume when in the

provocative shoulder position (p =

0.009) (Table 1).

• There was no difference in the blood

flow of pitchers with the shoulder in a

resting position (p = 0.48) (Table 2).

• Following a competitive baseball

season, pitchers had significantly less

blood flow in a provocative position

compared to position players.

• These results should be considered in

the prevention, diagnoses, and

treatment of the various upper

extremity neurovascular pathologies

common among baseball players.

CONCLUSION

• Our results support these previous

findings and additionally show that a

further decrease in blood flow is

present among pitchers when

provocatively tested following a

single competitive season.

• Standard current methods of testing

may not show as clearly a decrease

in flow if the arm is not provoked. As

this study and prior studies have

shown, a position of rest or arm

positions of less than extremes of

abduction and external rotation, may

not elucidate the severity of the

problem in a measurable way.

Blood Flow Measurement

• Blood flow measurements were taken

at the beginning of two consecutive

competitive seasons using a Terason

t3000 M-series diagnostic ultrasound

(Teratech, Burlington, MA)

• Blood flow was measured in the

following positions:

– Standing with test arm at

participants side

– Standing with test shoulder

abducted, retracted, and externally

rotated until diminution of radial

pulse (Figure 1).

1. Rohrer MJ, Cardullo PA, Pappas AM,

Phillips DA, Wheeler HB. J Vasc Surg.

1990.

2. Duwayri YM, Emery VB, Driskill MR,

Earley JA, Wright RW, Paletta GA, Jr.,

Thompson RW. J Vasc Surg. 2011.

3. Laudner KG, Selkow NM, Burke NC,

Lynall RC, Meister K. J Shoulder Elbow

Surg. 2014.

DISCUSSION• The provocative position used in our

study is similar to the late cocked

position of the throwing motion.

• Recent research has shown that

baseball pitchers have less blood

flow than position players when the

arm is assessed in a provocative

position, but not while at rest.3

RESULTS

• We conducted separate one-way

analyses of variance tests to compare

year 1 and year 2 blood flows for both

groups using IBM SPSS Statistics 20

(p<0.05).

ILLINOIS STATE

UNIVERSITY

Statistical Analysis

Pitchers Year 1 Year 2 Difference

Resting 26.4±12.8 26.2±8.2 -0.19±15.2

Provocative* 20.7±6.7 14.7±7.3 -5.6±9.5

Position

Players

Year 1 Year 2 Difference

Resting 21.3±15.1 24.6±11.9 3.4±14.3

Provocative 15.6±7.6 12.8±4.8 -2.8±8.5

Figure 1. Blood flow measurement in

provocative position.

• The position players did not have any

changes in blood flow between years

while in either the rest (p = 0.18) or

provocative test positions (p = 0.11)

(Table 3).

Group Age (yrs) Height (cm) Mass (kg)

Pitchers 22.1±1.5 188.2±6.6 94.3±10.1

Position

Players

21.4±2.2 182.2±3.0 89.9±5.8

Table 2. Year-to-Year Changes in Pitchers Blood

Flow (mean ± standard deviation in ml/min)

*Indicates statistically significant difference over

time (p=0.009).

Table 3. Year-to-Year Changes in Position

Players Blood Flow (mean ± standard

deviation in ml/min)