Thank you for the opportunity to present and thank you to my co-authors for their great work. Next slide. So our disclosures are posted and unrelevant to this presentation. Next please. So the initiation of an interval throwing program is a crucial milestone for competitive baseball players who are returning from surgery. Next. Many factors influence this decision, including the procedure performed, the time from surgery, level of competition, as well as the time of season, the athlete's comfort level, surgeon preference and successful progression through physical therapy. Next slide. You can keep clicking. Appropriate timing of a post-surgical throwing program is crucial to ensure the safety of the athlete. In general, objective tests are strongly preferred over subjective assessments, but unfortunately there are no objective protocols currently published to guide a surgeon's decision on when an athlete is ready to initiate an initial interval throwing program after surgery or injury. Next. So the objectives of this study were the following. One to recreate a reproducible objective return to throwing rehabilitation protocol. Number two, to determine what percentage of post-surgical competitive baseball players successfully pass this protocol at the time of surgeon clearance for a throwing program. And then lastly, to determine any risk factors for not achieving a passing grade. Next. So for inclusion criteria, we chose male patients that were age 14 or older, basically high school or higher level of play with baseball as a primary sport after a single episode of dominant upper extremity surgery performed by one of two senior authors and a desire to return to baseball at the earliest opportunity. Exclusion criteria would be revision surgery, failure to comply with objective testing, a post-operative complication that would delay the timeline for rehabilitation, or inability to return for repeat testing after a failing grade. Patients completed their protocol and they were assessed by a single physical therapist with specialization and rehabilitation of baseball athletes at the time of clearance by their operating surgeon. Next slide. So our protocol, so first we assess for pain in both the shoulder and the elbow. We also assess range of motion for both the elbow and the shoulder with the benchmarks listed there in the goal column. And if the patient was able to obtain these goals at the assessment, they were given a check in the yes column. If they did not, then they were assigned to the no column and given a failing grade. Next slide. We also measure strength from an objective device, both for external rotation and internal rotation of the shoulder, as well as have the patient perform plyometric exercises, both double-handed and single-handed, and then perform the posterior shoulder endurance test, which is demonstrated in the photo below, which is a validated study for posterior shoulder musculature strength and endurance. So for data analysis, patients who pass all criteria were given a pass. Those who failed any component were retested two weeks later. The surgical procedure, level of play, objective grade, and reason for failing were recorded. And then kinematic variables were compared using a t-test, and then relative odds and risk ratios were assessed for level of play and type of surgery to assess for any risk factors for obtaining a failing grade. So for our results, we had 48 patients enrolled, mean age was 19 years. We had 43% high school patients, so 21 high school, 19 college, 8 professional. And then players attempted their protocol at about 16 weeks post-operatively. We found that three-quarters of our players, 75%, obtained a passing grade, while 25% did not. Of those who obtained a passing grade, broken down by surgery type, arthroscopic shoulder surgery, 57%, UCL reconstruction, 74%, repair, 100%. And then other elbow surgeries, so elbow arthroscopy, ulnar nerve decompression, transpositions, et cetera, 83% pass rate. All players who failed initially achieved a passing grade when they were retested two weeks later. Next slide, please. So looking at our players who passed versus those who failed, those who failed demonstrated a significantly increased elbow extension, and they also had significantly decreased maximum external rotation and internal rotation shoulder strength. No other factors reached significance when comparing the patients who passed versus those who failed. Next slide. Comparing UCL reconstruction to other procedures, since UCL reconstruction is a very hot topic in this field, these patients undergoing UCL reconstruction tended to test later in their rehabilitation process. And there were no differences for these patients compared to the others except for slightly less elbow flexion. Next slide. So looking at those who failed. So this is our table of all patients who failed. So if we break it down by level of play, click Next, please. So we had seven high school patients, four college patients, and one professional patient. And if we look at why they failed, lack of plyometric exercise in the rehabilitation program was the number one reason, followed by an insufficient posterior shoulder endurance test score. Some patients also struggled with range of motion strength, and one patient had persistent pain in his elbow. Next slide. So, again, looking at these results, so if we tease it out by level of play, we see that as the level of play increased, the rate of failing decreased. When we look at odds ratios and relative risk, nothing reached significance, though we did see an insignificant trend toward a higher odds ratio for obtaining a passing grade for those with level of play beyond college. Interestingly, those who underwent a UCL reconstruction had a slightly lower odds ratio for obtaining a passing grade. Next slide, please. So in discussion, 25% of competitive baseball players did not pass our objective protocol. Surgeons in office assessment may not accurately assess a patient's readiness to begin a throwing program. Lack of plyometric initiation was the most common reason for failing. This highlights that surgeons must educate patients and physical therapists on the importance of advancing to a higher level strengthening within their rehabilitation program. Being a professional athlete and undergoing non-UCL reconstruction elbow surgery demonstrated trends for a higher likelihood of passing, suggesting that professional athletes may have unique factors that allow them to rehabilitate more and potentially pass these protocols. Lengths and limitations, so this was a novel application of objective testing to competitive baseball players after surgery. This protocol provides a foundation for future similar studies and objective testing models. We were limited by a lack of power to determine significant findings for failing and passing risk factors, and our results could vary based on the chosen protocol. So lastly, in conclusion, next slide, post-surgical baseball athletes may be at risk for initiating an interval throwing program too soon if we do not use objective testing. Creating a reliable objective return to throw criteria is a critical step that we should strive for as a group of surgeons, and then further research is needed to confirm whether our current findings are validated and also help elucidate the best objective protocol. And last but not least, today is my wedding anniversary. My wife is here, so I just want to say thank you for all of your love and support and thank you for always understanding when I have to go do research at night or on the weekends and supporting us. So I appreciate it and thank you everyone for your attention.

interval throwing program

competitive baseball players

returning from surgery

rehabilitation protocol

objective testing