Michelle B. Sabick, PhD*, Michael R. Torry, PhD*,, Young-Kyu Kim, MD and Richard J. Hawkins, MD, FRCS(C)*,
From the * SteadmanHawkins Sports Medicine Foundation, Vail, Colorado, Gachon Medical School, Gil Medical Center, Inchon, South Korea, and SteadmanHawkins Clinic, Vail, Colorado
Background: Spontaneous fracture of the humeral shaft in throwers is a rare but well-known phenomenon. Although it has been hypothesized that the biomechanics of the throw cause such fractures, it is not clear how or when the fractures occur in the pitching motion.
Methods: The torque acting about the long axis of the humerus was calculated in 25 professional baseball pitchers throwing in game situations.
Results: Peak humeral axial torque reached a mean value of 92 ± 16 Nm near the time of maximum shoulder external rotation at the end of the cocking phase. This torque tended to externally rotate the distal end of the humerus relative to its proximal end. The direction of the torque was consistent with the external rotation spiral fractures of the humerus noted to occur in throwers. The magnitude of the peak humeral torque averaged 48% of the theoretical torsional strength of the humerus, suggesting that repetitive stress plays a role in humeral shaft fractures.
Conclusions: Fractures are most likely to occur near the time of maximum shoulder external rotation when humeral torque peaks. Pitchers whose elbows were more extended at stride foot contact tended to have lower peak humeral torques.
The American Journal of Sports Medicine 32:892-898 (2004)