Medicine and Health Sciences Commons^™

Periprosthetic Joint Infection Increases The Risk Of One-Year Mortality., Benjamin Zmistowski, Joseph A. Karam, M.D., Joel B Durinka, David S Casper, Md, Javad Parvizi Md

Rothman Institute Faculty Papers

BACKGROUND: Periprosthetic joint infection continues to potentially complicate an otherwise successful joint replacement. The treatment of this infection often requires multiple surgical procedures associated with increased complications and morbidity. This study examined the relationship between periprosthetic joint infection and mortality and aimed to determine the effect of periprosthetic joint infection on mortality and any predictors of mortality in patients with periprosthetic joint infection.

METHODS: Four hundred and thirty-six patients with at least one surgical intervention secondary to confirmed periprosthetic joint infection were compared with 2342 patients undergoing revision arthroplasty for aseptic failure. The incidence of mortality at thirty days, ninety …

Locking Compression Plate In Musculoskeletal Oncology'a Nriend In Need', Masood Umer, Kashif Abbas, Shahid Khan, Haroon Ur Rashid

Department of Surgery

Abstract

BACKGROUND:

We are presenting our experience in the use of locking compression plate (LCP) after juxta-articular oncological resections in addition to its use in pathologic fracture.

METHODS:

A retrospective audit of skeletal reconstruction using LCP in 25 cases of long bone tumors was performed from 2008 to 2010. Reconstruction following limb salvage surgery was done in 17 patients and internal fixation of pathological fracture was done in 8 patients. All patients were available for > 12 months of follow-up, and thus assessed for union at the resected ends.

RESULTS:

There were 8 males and 17 females in the study. The …

Periprosthetic Knee Infection: Ten Strategies That Work., Javad Parvizi, Md, Priscilla Ku Cavanaugh, Claudio Diaz-Ledezma

Department of Orthopaedic Surgery Faculty Papers

Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). The demand for TKA is rapidly increasing, resulting in a subsequent increase in infections involving knee prosthesis. Despite the existence of common management practices, the best approach for several aspects in the management of periprosthetic knee infection remains controversial. This review examines the current understanding in the management of the following aspects of PJI: preoperative risk stratification, preoperative antibiotics, preoperative skin preparation, outpatient diagnosis, assessing for infection in revision cases, improving culture utility, irrigation and debridement, one and two-stage revision, and patient prognostic information. …

Oncology Section Task Force On Breast Cancer Outcomes: Scapular Assessment, Mary Insana Fisher, Pamela K. Levangie

Physical Therapy Faculty Publications

Background: Functional deficits and changes in scapular mechanics following breast cancer (BC) treatments have been documented. Scapular assessment is important when examining the shoulder in survivors of breast cancer to document the need for or effectiveness of physical therapy intervention. The Oncology Section Task Force on Breast Cancer Outcomes sought to identify scapular examination tools that can be recommended for routine use in individuals treated for BC.

Methods: A systematic review of the literature on scapular measures was conducted. Relevant studies were examined for psychometric properties and clinical usefulness. Each method was given a recommendation score based on the Breast …

Oncology Section Task Force On Breast Cancer Outcomes: An Introduction To The Edge Task Force And Clinical Measures Of Upper Extremity Function, Pamela K. Levangie, Mary Insana Fisher

Physical Therapy Faculty Publications

With the proliferation of outcome measures in the literature, many of which lack documentation of sufficient psychometric properties to justify use, it is difficult to document patient change or demonstrate effectiveness of interventions. The goal of the Section on Research’s EDGE (Evaluation Database to Guide Effectiveness) Task Force is to facilitate identification of valid and reliable tests and measures that reflect clinically important outcomes and are responsive to change for standard use across selected patient groups. This paper lays the groundwork for understanding the work of the Oncology Section’s Breast Cancer EDGE Task Force on clinical measures of shoulder function …

Unplanned Readmission After Total Joint Arthroplasty: Rates, Reasons, And Risk Factors., Benjamin Zmistowski, Camilo Restrepo, Jordan Hess, Darius Adibi, Soltan Cangoz, Javad Parvizi

Rothman Institute Faculty Papers

BACKGROUND: There has been a major and alarming increase in readmission rates following total joint arthroplasty. With proposed changes in reimbursement policy, increased rates of unplanned readmission following arthroplasty will penalize providers. In particular, it has been proposed that specific complications-so-called "zero-tolerance" complications-are unacceptable and that their treatment will not qualify for reimbursement. The purpose of this study was to identify the incidence, causes, and risk factors for readmission following total joint arthroplasty.

METHODS: An institutional arthroplasty database was utilized to identify those patients undergoing total knee or hip arthroplasty from January 2004 through December 2008. A total of 10,633 …

Predictors Of Perioperative Blood Loss In Total Joint Arthroplasty., Jai Hyung Park, Mohammad R Rasouli, S M Javad Mortazavi, Anthony T Tokarski, Mitchell G Maltenfort, Javad Parvizi

Rothman Institute Faculty Papers

UNLABELLED: UPDATE The print version of this article has errors that have been corrected in the online version of this article. In the Materials and Methods section, the sentence that reads as "During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with a hemoglobin level of no less than 11 mg/dL or a hematocrit level of at least 33%." in the print version now reads as "During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with …

Common Peroneal Nerve Palsy Following Total Knee Arthroplasty: Prognostic Factors And Course Of Recovery., Jai Hyung Park, Md, Camilo Restrepo, Md, Robert Norton, Md, Steven Mandel, Md, Peter F. Sharkey, Md, Javad Parvizi, Md

Department of Orthopaedic Surgery Faculty Papers

Common peroneal nerve palsy (CPNP) is a serious complication following total knee arthroplasty (TKA). There is little information regarding the clinical course and prognostic factors for recovery. Between January 2000 and December 2008, 44 patients (0.53%) developed CPNP following TKA and were matched to 100 control patients based on year of surgery, type of surgery and surgeon. Regression analysis was performed to identify prognostic factors for recovery. A significant difference was seen in CPNP patients who were on average younger (62.1 years) and had higher BMI (34.5 kg/m(2)) than those who did not have nerve palsy (67.5 years and 31.8 …

Allograft Reconstruction For Digital Nerve Loss., John S Taras, Nirav Amin, Nimit Patel, Lucy A Mccabe

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: To investigate the outcomes of digital nerve repairs using processed nerve allograft for defects measuring 30 mm or less.

METHODS: Seventeen patients with 21 digital nerve lacerations in the hand underwent reconstruction with processed nerve allograft. Outcome data for 14 patients with 18 digital nerve lacerations were available for analysis. Postoperative outcome data were recorded at a minimum of 12 months and an average of 15 months. The average nerve gap measured 11 mm (range, 5-30 mm). Outcome measures included postoperative sensory examination as assessed by Semmes-Weinstein monofilaments and static and moving 2-point discrimination. Pain was graded using a …

Do Ceramic Femoral Heads Reduce Taper Fretting Corrosion In Hip Arthroplasty? A Retrieval Study., Steven M Kurtz, Sevi B Kocagöz, Josa A Hanzlik, Richard J Underwood, Jeremy L Gilbert, Daniel W Macdonald, Gwo-Chin Lee, Michael A Mont, Matthew J Kraay, Gregg R Klein, Javad Parvizi, Clare M Rimnac

Rothman Institute Faculty Papers

BACKGROUND: Previous studies regarding modular head-neck taper corrosion were largely based on cobalt chrome (CoCr) alloy femoral heads. Less is known about head-neck taper corrosion with ceramic femoral heads.

QUESTIONS/PURPOSES: We asked (1) whether ceramic heads resulted in less taper corrosion than CoCr heads; (2) what device and patient factors influence taper fretting corrosion; and (3) whether the mechanism of taper fretting corrosion in ceramic heads differs from that in CoCr heads.

METHODS: One hundred femoral head-stem pairs were analyzed for evidence of fretting and corrosion using a visual scoring technique based on the severity and extent of fretting and …

Patients With Atrial Fibrillation Undergoing Total Joint Arthroplasty Increase Hospital Burden., Vinay K Aggarwal, Eric H Tischler, Zachary D Post, Ian Kane, Fabio R Orozco, Alvin Ong

Rothman Institute Faculty Papers

BACKGROUND: More than 3 million people in the United States have atrial fibrillation, most of whom are being managed with anticoagulation therapy for life. The goal of the present study was to examine the effect of chronic anticoagulation therapy on patients with atrial fibrillation who undergo total joint arthroplasty.

METHODS: We retrospectively reviewed all patients undergoing aseptic primary or revision total joint arthroplasty at our facility from March 2007 to August 2011. One hundred and sixty-one patients with atrial fibrillation (Group A) were compared with 161 matched controls (Group B). A total of 112 hips and 210 knees underwent 239 …

The Effect Of Malnutrition On Patients Undergoing Elective Joint Arthroplasty., Ronald Huang, Md, Max Greenky, Bs, Glenn J. Kerr, Md, Mathew S. Austin, Md, Javad Parvizi, Md, Frcs

Rothman Institute Faculty Papers

Malnutrition has been linked to serious complications in patients undergoing elective total joint arthroplasty (TJA). This study prospectively evaluated 2,161 patients undergoing elective TJA for malnutrition as defined by either an abnormal serum albumin or transferrin. The overall incidence of malnutrition was 8.5% (184 of 2,161) and the rate of overall complications in the malnourished group was 12% as compared to 2.9% in patients with normal parameters (P55years-old undergoing TJA and is associated with a significant increase in post-operative complications.

Understanding The Pincer - The Importance Of Reference Plane Orientation On Acetabular Rim Evaluation, Anil K. Gupta, Nozomu Inoue, Michael D. Hellman, Joshua D. Harris, Frank M. Mccormick, Shane Nho

Rothman Institute Faculty Papers

Objectives: Femoroacetabular impingement (FAI) is a common cause of young adult hip pain. FAI can result from an acetabular-sided bony lesion, or “pincer” lesion. A pincer lesion is defined as an area of linear contact between the acetabular rim and the femoral head-neck junction due to general or focal acetabular overcoverage. Three dimensional (3D) analysis of the acetabular rim morphology is essential to understand etiology and aciculate diagnosis of the of the pincer type FAI. A few studies have measured 3D geometry of the acetabular rim; in which the acetabular rim is described as a deviation from a reference plane. …

Sequential Sectioning Of The Ulnar Collateral Ligament Of The Elbow In Cadaveric Arms With Ulnohumeral Laxity Assessed By Dynamic Ultrasonography, Christopher C. Dodson, Levon N. Nazarian, Michael G. Ciccotti, Steven B. Cohen, Sommer Hammoud, Michael C. Ciccotti

Rothman Institute Faculty Papers

Objectives: Injury of the ulnar collateral ligament (UCL), whether acute or chronic, is potentially career-threatening for elite overhead throwing athletes. Dynamic ultrasound (DUS) allows for rapid, cost-effective, non-invasive, and non-radiating evaluation of the UCL and elbow joint both at rest and with applied stress. The purpose of this study was to determine the amount of cadaveric elbow valgus laxity with sequential UCL sectioning using DUS. Our objective was to quantify which portions of the UCL must be injured to cause the varying levels of laxity seen clinically on DUS testing. No prior study has used DUS to quantify valgus joint …

Aseptically Processed And Chemically Sterilized Btb Allografts For Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study., Peter A Indelicato, Michael G Ciccotti, Joel Boyd, Laurence D Higgins, Benjamin S Shaffer, C Thomas Vangsness

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: To compare the clinical outcomes of bone-patellar tendon-bone (BTB) allografts processed via a novel sterilization system with the traditional aseptically processed BTB allografts for anterior cruciate ligament (ACL) reconstruction.

METHODS: A total of 67 patients undergoing ACL reconstruction at 6 independent investigation sites were randomized into one of two intervention groups, BioCleanse-sterilized or aseptic BTB allografts. Inclusion criteria included an acute, isolated, unilateral ACL tear, and exclusion criteria included prior ACL injury, multi-ligament reconstruction, and signs of degenerative joint disease. Post-op examiners and patients were blinded to graft type. Patients were evaluated at 6, 12, and 24 months. Clinical …

Spinal Anesthesia: Should Everyone Receive A Urinary Catheter?: A Randomized, Prospective Study Of Patients Undergoing Total Hip Arthroplasty., Adam G Miller, Md, James Mckenzie, Bs, Max Greenky, Ba, Erica Shaw, Rnp, Kishor Gandhi, Md, William J Hozack, Md, Javad Parvizi, Md, Frcs

Rothman Institute Faculty Papers

BACKGROUND: The objective of this randomized prospective study was to determine whether a urinary catheter is necessary for all patients undergoing total hip arthroplasty under spinal anesthesia.

METHODS: Consecutive patients undergoing total hip arthroplasty under spinal anesthesia were randomized to treatment with or without insertion of an indwelling urinary catheter. All patients received spinal anesthesia with 15 to 30 mg of 0.5% bupivacaine. The catheter group was subjected to a standard postoperative protocol, with removal of the indwelling catheter within forty-eight hours postoperatively. The experimental group was monitored for urinary retention and, if necessary, had straight catheterization up to two …

Effect Of Early Release Of Tourniquet In Total Knee Arthroplasty, Kashif Abbas, Hasnain Raza, Masood Umer, Kamran Hafeez

Section of Orthopaedic Surgery

Objective: To evaluate whether tourniquet release intraoperatively is better than postoperative release in reducing overall blood loss, duration of surgery, duration of tourniquet, length of hospital stay, wound related complications and transfusion requirement. Study Design: Comparative study. Place and Duration of Study: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 2004 to June 2007.
Methodology: One hundred and thirty patient files were reviewed retrospectively. Patients were divided into two groups. Group-A consisted of 65 patients with early deflation of tourniquet and group-B comprised of 65 patients with the release of tourniquet after applying compressive dressing. Total blood …

Assessment Of Subacromial Space And Its Relationship With Scapular Upward Rotation In College Baseball Players., Stephen John Thomas, Charles Buz Swanik, Thomas W Kaminski, Jill S Higginson, Kathleen A Swanik, Levon N Nazarian

Department of Radiology Faculty Papers

CONTEXT: Subacromial impingement is a common injury in baseball players and has been linked to a reduction in the subacromial space. In addition, it has been suggested that decreases in scapular upward rotation will lead to decreases in the subacromial space and ultimately impingement syndrome.

OBJECTIVE: The objective of this study was to evaluate the relationship between acromiohumeral distance and scapular upward rotation in healthy college baseball players.

DESIGN: Posttest-only study design.

SETTING: Controlled laboratory setting.

PARTICIPANTS: 24 healthy college baseball players. Intervention: Participants were measured for all dependent variables at preseason.

MAIN OUTCOME MEASURES: Acromiohumeral distance at rest and …

Physical Education In West Virginia Schools: Are We Doing Enough To Generate Peak Bone Mass And Promote Skeletal Health?, Franklin D. Shuler Md, Phd, Dana Lycans, Thomas Gill Md, Ali Oliashirazi Md

Orthopaedics

Peak bone mass (PBM) is attained at 25-35 years of age, followed by a lifelong decline in bone strength. The most rapid increase in bone mass occurs between the ages of 12-17. Daily school physical education (PE) programs have been shown to produce measurable increases in PBM, but are not federally mandated. Increases in PBM can decrease the lifelong risk of osteoporosis and fractures; critical for West Virginia prevention programs. Nationally only 1 in 6 schools require PE three days per week, with 4% of elementary schools, 8% of middle schools and 2% of high schools providing daily PE. In …

Giant Cell Tumour Of The Sacrum: Function-Preserving Surgery With Extended Curettage And Ilio-Lumbar Fusion, Riaz Hussain Lakhdawala, Tashfeen Ahmad, Ather Enam

Section of Orthopaedic Surgery

Giant cell tumours of the sacrum pose a unique therapeutic challenge due to the inaccessibility of the tumour, significant intra-operative blood loss from extensive vascularity, high rate of local recurrence with conservative surgery, and loss of neurological function and mechanical instability with en-bloc excision. We present a case where successful outcome was achieved by tailoring treatment in consideration of the above issues. A 28 year old male diagnosed on biopsy to have giant cell tumour of the sacrum presented to us with low-back pain, left-sided S1 radiculopathy, ankle weakness and urinary incontinence. MRI showed a tumour involving the S1 and …

Clinical Measurement Of Patellar Tendon: Accuracy And Relationship To Surgical Tendon Dimensions., Chad Zooker, Rajeev Pandarinath, Matthew J Kraeutler, Michael G Ciccotti, Steven B. Cohen, Peter F Deluca

Rothman Institute Faculty Papers

Patellar tendon width and length are commonly used for preoperative planning for anterior cruciate ligament reconstruction (ACLR). In the study reported here, we assessed the accuracy of preoperative measurements made by palpation through the skin, and correlated these measurements with the actual dimensions of the tendons at surgery. Before making incisions in 53 patients undergoing ACLR with patellar tendon autograft, we measured patellar tendon length with the knee in full extension and in 90° of flexion, and tendon width with the knee in 90° of flexion. The tendon was then exposed, and its width was measured with the knee in …

Hip Fracture Surgery: Does Type Of Anesthesia Matter?, Rizwan Haroon Rashid, Adil Aijaz Shah, Amarah Shakoor, Shahryar Noordin

Department of Surgery

Background: Hip fracture surgery is a common procedure, and the geriatric population with its multiple comorbid conditions is at most at risk of developing anesthesia-related complications. Data on the impact of type anesthesia on postoperative morbidity and mortality is limited.The effects of regional and general anesthesia on postoperative outcomes need to be clearly elucidated.

Methods: In this study, all patients who underwent dynamic hip screw (DHS) fixation for intertrochanteric fractures, between January 2005 and December 2010, at the Aga Khan University Hospital, were included. Patients were divided into two groups; group A included those patients who received general anesthesia, and …

Developmental Dysplasia Of The Hip: Linkage Mapping And Whole Exome Sequencing Identify A Shared Variant In Cx3cr1 In All Affected Members Of A Large Multi-Generation Family., George J Feldman, Javad Parvizi, Mark Levenstien, Kathryn Scott, Jill A Erickson, Paolo Fortina, Marcella Devoto, Christopher L Peters

Department of Orthopaedic Surgery Faculty Papers

Developmental Dysplasia of the Hip (DDH) is a debilitating condition characterized by incomplete formation of the acetabulum leading to dislocation of the femur, suboptimal joint function, and accelerated wear of the articular cartilage resulting in arthritis. DDH affects 1 in 1000 newborns in the United States with well defined "pockets" of high prevalence in Japan, Italy and other Mediterranean countries. Although reasonably accurate for detecting gross forms of hip dysplasia, existing techniques fail to find milder forms of dysplasia. Undetected hip dysplasia is the leading cause of osteoarthritis of the hip in young individuals causing over 40% of cases in …

Common Peroneal Nerve Palsy Following Total Hip Arthroplasty: Prognostic Factors For Recovery., Jai Hyung Park, Bryan Hozack, Peter Kim, Robert Norton, Steven Mandel, Camilo Restrepo, Javad Parvizi

Rothman Institute Faculty Papers

BACKGROUND: Common peroneal nerve palsy, although rare, is a serious complication of total hip arthroplasty. Although several publications have dealt with the risk factors for peroneal nerve palsy, there is little literature regarding the time it takes for the nerve to recover and the factors that influence its recovery. The purpose of this study was to elucidate the clinical course of this injury and identify prognostic factors for recovery.

METHODS: From January 2000 to December 2007, 7969 primary and 1601 revision total hip arthroplasties were performed at our institution. Common peroneal nerve palsy developed following thirty-one (0.32%) of these procedures. …

A Home-Based Exercise Program For The Foot And Ankle To Improve Balance, Muscle Performance And Flexibility In Community Dwelling Older Adults: A Pilot Study, Laurel Long, Kurt Jackson, Lloyd L. Laubach

Physical Therapy Faculty Publications

Background and purpose: Strength and range of motion of the foot and ankle have been shown to be related to measures of balance and fall risk in older adults. The primary purpose of this pilot investigation was to evaluate the feasibility of a 6-week home-based exercise program focusing on the foot and ankle and any associated changes in balance, muscle performance and range of motion in older adults. Methods: This single-group repeated measures study involved a convenience sample of 21 healthy communitydwelling older adults age 60-90. Nineteen participants completed all phases of the testing and training. The intervention was a …

Functional And Quality-Of-Life Outcomes In Geriatric Patients With Type-Ii Dens Fracture., Alexander R Vaccaro, Christopher K Kepler, Branko Kopjar, Jens Chapman, Christopher Shaffrey, Paul Arnold, Ziya Gokaslan, Darrel Brodke, John France, Mark Dekutoski, Rick Sasso, S Tim Yoon, Christopher Bono, James Harrop, Michael G Fehlings

Rothman Institute Faculty Papers

BACKGROUND: Dens fractures are relatively common in the elderly. The treatment of Type-II dens fractures remains controversial. The aim of this multicenter prospective cohort study was to compare outcomes (assessed with use of validated clinical measures) and complications of nonsurgical and surgical treatment of Type-II dens fractures in patients sixty-five years of age or older.

METHODS: One hundred and fifty-nine patients with a Type-II dens fracture were enrolled in a multicenter prospective study. Subjects were treated either surgically (n = 101) or nonsurgically (n = 58) as determined by the treatment preferences of the treating physicians and the patients. The …

Single Stage Oncologic Resection And Reconstruction: A Step Toward Development Of Sarcoma Service In Resource Constrained Country, Haroon Ur Rashid, Kashif Abbas, Masood Umer

Section of Orthopaedic Surgery

Tumor free-margin surgical resection remains the single most important treatment in the curative therapy of musculoskeletal tumor of limbs. Refinements in surgical techniques have led to increased function preservation and limb salvage.
Patients and Methods: The records of patients (n = 24) who underwent microsurgical soft tissue reconstruction subsequent to resection of limb tumour during the period 2006 to 2011 were reviewed. Primary outcome i.e. uptake of the flap was evaluated. Perioperative morbidities were also noted including donor as well as recipient site complications. Assessment of Functional outcome (Musculoskeletal Tumor Society score, MSTS) local recurrence, free survival, and disease-specific …

Impact Of Unplanned Excision On Prognosis Of Patients With Extremity Soft Tissue Sarcoma, Hafiz Muhammad Umer, Masood Umer, Irfan Qadir, Nadeem Abbasi, Nehal Masood

Section of Orthopaedic Surgery

Unplanned excision of soft tissue sarcomas (STSs) outside comprehensive tumor management centers necessitates the need for wide reexcision to achieve adequate margins. We retrospectively reviewed medical records of 135 patients with STS operated at our hospital with the goal of examining outcomes, in terms of local recurrence (LR) and metastasis rate (MR), of reexcision following unplanned excision of STS and comparing results with those of first-time planned surgery. Eighty-four patients had their first-time surgery and 51 patients had come to us following unplanned excision at prereferral hospital. Mean age of all patients was 41.8 ± 21.9 years. The LR and …

Alteration In Corticospinal Excitability, Talocrural Joint Range Of Motion, And Lower Extremity Function Following Manipulation In Non-Disabled Individuals, Todd E. Davenport, Stephen F. Reischl, Somporn Sungkarat, Jason Cozby, Lisa Meyer, Beth E. Fisher

School of Pharmacy Faculty Articles

Background: Clinical outcomes of manual therapy procedures, including manipulation, have been studied. However, mechanisms underlying observed improvements remain unclear.

Objective: To determine the effect of ankle joint manipulation on corticospinal excitability, ankle dorsiflexion range of motion (DF ROM), and lower extremity functional behavior in nondisabled individuals.

Method: Six nondisabled individuals (age range: 31-50 years) received the main outcomes measurements of this study, before and after long axis distraction manipulation of the talocrural joint. Main outcomes measures were motor evoked potential (MEP) amplitude of gastrocnemius (GN) and tibialis anterior (TA) using transcranial magnetic stimulation, ankle DF ROM with the knee flexed …

Kerlan-Jobe Orthopaedic Clinic Overhead Athlete Scores In Asymptomatic Professional Baseball Pitchers., Matthew J Kraeutler, Michael G Ciccotti, Christopher C Dodson, Robert W Frederick, Brian Cammarota, Steven B. Cohen

Rothman Institute Faculty Papers

BACKGROUND: The Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score is a subjective questionnaire that has been validated and been shown to be more specific in overhead athletes than the American Shoulder and Elbow Surgeons scale. The purpose of this study was to determine a mean KJOC score and reasonable range of KJOC scores within which a healthy asymptomatic professional baseball pitcher will fall. It was hypothesized that healthy professional baseball pitchers would have very high KJOC scores.

MATERIALS AND METHODS: KJOC questionnaires were given to all healthy pitchers before the start of the season at all levels in 1 …