Proximal to distal sequencing impacts on maximum shoulder joint angles and the risk of impingement in baseball pitching involving a scapular independent thoracohumeral model

• Published in: Scandinavian journal of medicine & science in sports Vol. 33; no. 8; pp. 1322 - 1334
• Main Authors: Yanai, Toshimasa, Crotin, Ryan, Du, Tanghuizi
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01-08-2023
• Subjects: Arm; Baseball; Biomechanical Phenomena; Humans; Kinematics; open kinetic chain; Pelvis; Range of Motion, Articular; Scapula; shoulder complex; Shoulder Joint; open kinetic chain; kinematics; shoulder complex
• ISSN: 0905-7188; 1600-0838
• DOI: 10.1111/sms.14374

Background
Hyperangulation of the scapulohumeral joint due to poor coordination of the scapula during throwing motion is claimed to be a major cause of internal impingement in baseball pitchers. However, evidence of injurious scapular kinematics is lacking, particularly regarding how hyperangularion actually occurs in full‐effort pitching. The purpose of this study was to describe sequential scapular motions involved in attaining maximum joint angles during pitching and the implications for internal impingement in elite baseball pitchers.
Methods
An electromagnetic goniometer system computed kinematics for pelvis, thorax, scapulae, arms, and forearms during baseball pitching in 72 pitchers. Internal impingement risk was assessed based on kinematic characteristics of internal impingement quantified in a cadaveric study.
Results
The pelvis, thorax, and scapula rotated in the proximal‐to‐distal sequence. Large forearm layback observed near the end of the cocking phase (182 ± 27°) was achieved with a submaximal scapulohumeral external rotation (98 ± 14°). In the next 0.027 ± 0.007 s, forward thoracic rotation and then scapular rotation caused increased scapulohumeral external rotation to a maximum of 113 ± 14°. Here, humeral horizontal adduction and scapula protraction occurred simultaneously preventing the humerus from lagging further behind the scapula. Only one participant reached critical hyperangulation beyond which internal impingement was reported to occur.
Conclusion
Most elite pitchers safely attained the fully cocked position, yet off‐timed recoiling of scapular protraction caused hyperangulation in full‐effort pitching. Therefore, proximal‐distal sequencing between the scapula and humerus should be evaluated to lessen the risk of internal impingement in baseball pitchers.