the app, or this is a smaller room, a little bit more intimate, so if you want to ask your questions via the microphones as well. I'm just going to start, Beamer, just a question, just from a translational standpoint. So in a very elegant study that you did, how does it alter what you do? What kind of recommendations do you give these throwers? Yeah, so I think just in terms of, you know, obviously we're not pitching coaches, but I think pitchers that are able to, you know, harness that ipsilateral trunk tilt, it gives them a longer moment arm to then be able to generate more force by redirecting it towards that other side of the contralateral trunk tilt. So I think that's an adaptive strategy that the pro pitchers kind of seem to learn along the way, and you can do that without increasing force on the shoulder and elbow based off of our study. I mean, you might have less force, so it may be protective to the shoulder and elbow. We don't know that. That's beyond the scope of our paper. We didn't look at injury risk, but there may be some kinematic factors going on and some mechanical factors that can help increase velocity safely since that's all the rage nowadays without generating more force on the shoulder and elbow, which could be beneficial from an injury risk perspective. More studies need to be done, though, to make that claim. So Joe, so both prophylactically assessing patients, or athletes rather, the come-in throwers, looking at where they're at, maybe modifying to some degree, and or post-operatively, you know, a return to play, thinking about it as well. It might be much easier to do that and to modify from a mechanical standpoint, pitching mechanics in a younger athlete, you know, as opposed to a professional pitcher that's more set in his or her, you know, ways. Absolutely. Absolutely. And we see such a, that one slide with the high school pitchers, there was such wider variability in the amount of trunk tilt, just kind of demonstrating the different mechanical expertise or lack thereof in the high school pitchers. So there certainly are areas to potentially modify mechanics at a younger age and help those pitchers along the road. Great. We have a question from the audience for Dr. Ebens. The question is, why would you not consider repair of the bony avulsion of the sublime tubercle? Yeah, so in part, obviously it matters the amount of displacement of the fragment. And for a lot of these, they were just displaced only a millimeter or two. And I think in the grand scheme of how tolerant the elbow can be in terms of shortening of the UCL over time and kind of just contracting, it didn't seem to be necessary. People didn't lose stability to the elbow. And we've seen it for sure, you know, in managing kids over the years where we tolerated, you know, two centimeters of displacement on a media epicondyle that they still had good function of their elbow with that amount of displacement as well. So in terms of the specific amount of displacement that you used, you know, your recommendation from an algorithm standpoint? Yeah. I mean, I suppose in the setting, with the times where we saw displacement that would make me curious enough to try to put perhaps maybe like a threaded K wire into one of these little fragments, it was usually in those complex settings where they had also the media epicondyle injured and there was a much bigger injury pattern. For these throwers, where there are all those simple injuries, where they're just like the little tiny avulsions, they're relatively small pieces that you probably just fragment trying to fix it. Dr. Couture, in terms of the, you know, certainly an excellent study, you emphasize the idea of the lateral wall and getting the lateral wall to heal, which is important. What were some of the criteria you used in terms of determining this athlete needed to be operated on rather than going through your non-operative protocol? Okay. Thank you. So we emphasize the lateral wall, but we check the size of the OCD. So we calculate the size of the OCD over the 100 millimeters. So we have to do the surgery, but under the 100 millimeters, so just doing a conservative treatment. So it depends on the timing of the players. So he have to do the last game of the college or the last game of the high school. So we recommend to do the, reserve the throwing. So it depends on the situation of the players. Yeah. Eric, one other question, Eric, in terms of getting back when you treated them non-operatively, just your timeframe in terms of starting, tossing, and return to play. Yeah. So, yeah, that actually didn't vary too much across the board where the kids that were treated in a cast for that roughly four weeks, then came out of the cast, had some evidence of union kind of at that visit, then started just kind of, we don't usually send people to physical therapy at that moment. There was the three that kind of ultimately ended up there, but probably for another four weeks, they were just allowed to be out of the cast, no throwing, with the understanding that they're still children and who knows what they're doing. And in the end, the process became at that eight week visit, union is identified, and then you could start doing a throwing program and working at them from there. And I mean, honestly, we talk about it being, you know, a two to three month process of working up from a velocity and distance, and I'm sure none of them actually follow it, but officially that's what they do. You're looking at clinical radiographic evidence, and then you're sort of using that eight, 10 week period to start. Yeah, yeah, exactly. Well, that's great. So, we're going to move on to the, thank you for those great papers. We're going to move on to the next part of the...

pitching mechanics

injury prevention

trunk tilt

force generation

shoulder strain