Kazuhisa Matsui1, Takashi Tachibana2, Mary Magarey3. 1. Gifu Junior College of Health Sciences, Gifu, Japan. 2. Nobuhara Hospital, Hyogo, Japan. 3. University of South Australia, North Tce Adelaide, South Australia.
Abstract
STUDY DESIGN: Case report. BACKGROUND: A case of an athlete with accessory nerve injury has not been previously reported although there have been a number of case reports and case series of non-athletes with accessory nerve injury. This case study reports motor control intervention for an amateur baseball pitcher with isolated paralysis of the right trapezius who lost pitching control after changing his pitching technique. The subject was able to restore ball control during overhead throwing after physiotherapy. CASE DESCRIPTION: The subject of this case report was a 20-year-old amateur male baseball pitcher, who presented with long-standing isolated paralysis of the right trapezius and a six month history of loss of ball control with shoulder pain during pitching. He was seen for a second opinion following unsuccessful conservative management and underwent physiotherapy to restore his ball control during pitching. Restriction of cervical rotation range of motion and decreased position sense during shoulder abduction and external rotation were revealed in the physical examination. Proprioceptive exercise was commenced with and without visual feedback to acquire a reproducible abduction angle in the cocking phase of a baseball pitch. His pitching form was modified to ensure his arm was being raised effectively in the cocking phase. Pitching drills that were utilized were targeted motor control of the upper quarter, and were progressed in steps. Cervical joint mobilization was undertaken to allow adequate range of motion for visualization of the target while pitching. OUTCOMES: His position sense and cervical range of motion were restored. His pitching control was restored with conservative therapy on by the eighth week of intervention. DISCUSSION: The subject was able to return to competitive level of amateur baseball with accurate ball control. This case report demonstrates that achievement of control of a skilled upper quarter activity, such as baseball pitching, is possible with conservative management even in the presence of paralysis of trapezius, a major contributor to the movement. LEVEL OF EVIDENCE: 4 (single case report).
STUDY DESIGN: Case report. BACKGROUND: A case of an athlete with accessory nerve injury has not been previously reported although there have been a number of case reports and case series of non-athletes with accessory nerve injury. This case study reports motor control intervention for an amateur baseball pitcher with isolated paralysis of the right trapezius who lost pitching control after changing his pitching technique. The subject was able to restore ball control during overhead throwing after physiotherapy. CASE DESCRIPTION: The subject of this case report was a 20-year-old amateur male baseball pitcher, who presented with long-standing isolated paralysis of the right trapezius and a six month history of loss of ball control with shoulder pain during pitching. He was seen for a second opinion following unsuccessful conservative management and underwent physiotherapy to restore his ball control during pitching. Restriction of cervical rotation range of motion and decreased position sense during shoulder abduction and external rotation were revealed in the physical examination. Proprioceptive exercise was commenced with and without visual feedback to acquire a reproducible abduction angle in the cocking phase of a baseball pitch. His pitching form was modified to ensure his arm was being raised effectively in the cocking phase. Pitching drills that were utilized were targeted motor control of the upper quarter, and were progressed in steps. Cervical joint mobilization was undertaken to allow adequate range of motion for visualization of the target while pitching. OUTCOMES: His position sense and cervical range of motion were restored. His pitching control was restored with conservative therapy on by the eighth week of intervention. DISCUSSION: The subject was able to return to competitive level of amateur baseball with accurate ball control. This case report demonstrates that achievement of control of a skilled upper quarter activity, such as baseball pitching, is possible with conservative management even in the presence of paralysis of trapezius, a major contributor to the movement. LEVEL OF EVIDENCE: 4 (single case report).
Authors: W Ben Kibler; Tim L Uhl; Jackson W q Maddux; Paul V Brooks; Brian Zeller; John McMullen Journal: J Shoulder Elbow Surg Date: 2002 Nov-Dec Impact factor: 3.019
Authors: Ann M Cools; Vincent Dewitte; Frederick Lanszweert; Dries Notebaert; Arne Roets; Barbara Soetens; Barbara Cagnie; Erik E Witvrouw Journal: Am J Sports Med Date: 2007-07-02 Impact factor: 6.202