Volume 32, Issue 5, Pages (May 2016)

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Volume 32, Issue 5, Pages 762-771 (May 2016) The Impact of Fatigue on Baseball Pitching Mechanics in Adolescent Male Pitchers Brandon J. Erickson, M.D., Terrance Sgori, B.S., Peter N. Chalmers, M.D., Patrick Vignona, B.S., Matthew Lesniak, B.S., Charles A. Bush-Joseph, M.D., Nikhil N. Verma, M.D., Anthony A. Romeo, M.D. Arthroscopy Volume 32, Issue 5, Pages 762-771 (May 2016) DOI: 10.1016/j.arthro.2015.11.051 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Testing protocol. Arthroscopy 2016 32, 762-771DOI: (10.1016/j.arthro.2015.11.051) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Survey completed by all pitchers before participating in the throwing program. (BMI, body mass index.) Arthroscopy 2016 32, 762-771DOI: (10.1016/j.arthro.2015.11.051) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Mean fatigue (blue) and pain (green) scores by pitch number. Both scores were rated on a scale from 0 to 10, with higher scores denoting more fatigue and more pain. Both significantly increased with pitch number (P < .001 and P = .001, respectively). Error bars show 1 standard deviation. Arthroscopy 2016 32, 762-771DOI: (10.1016/j.arthro.2015.11.051) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Mean velocity (in miles per hour) by pitch number. Velocity significantly decreased with increasing pitch number (P < .001). Error bars show 1 standard deviation. Arthroscopy 2016 32, 762-771DOI: (10.1016/j.arthro.2015.11.051) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Mean knee flexion angle at ball release (in degrees) by pitch number. Knee flexion at ball release significantly increased with pitch number (P = .008). Error bars show 1 standard deviation. Arthroscopy 2016 32, 762-771DOI: (10.1016/j.arthro.2015.11.051) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 Mean elbow flexion angle at ball release (in degrees) by pitch number. Elbow flexion at ball release did not significantly differ with pitch number (P > .096). Error bars show 1 standard deviation. Arthroscopy 2016 32, 762-771DOI: (10.1016/j.arthro.2015.11.051) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 Percentage of pitchers showing separation of rotation within hips and shoulders, by pitch number. Hip-to-shoulder separation significantly decreased with pitch number (P < .001). Error bars show 1 standard deviation. Arthroscopy 2016 32, 762-771DOI: (10.1016/j.arthro.2015.11.051) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 (A, B) Still images of one pitcher included in this study showing (A) closed and (B) open hip-to-shoulder separation at front-foot contact. The circles indicate the position of the lead shoulder at front-foot contact. (C, D) Cartoons showing (C) closed and (D) open hip-to-shoulder separation at front-foot contact. The arrows indicate the position of the lead shoulder at front-foot contact. Notice the closed versus open position. Arthroscopy 2016 32, 762-771DOI: (10.1016/j.arthro.2015.11.051) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions