KINETIC ARM CASE STUDY: Use of External Dynamic Arm Stabilizer with a Collegiate Baseball Player with Glenohumeral Labrum Tear

Crimson Publishers 

Wings to the Research Case Report 

Use of External Dynamic Arm Stabilizer  

with a Collegiate Baseball Player with a  

Glenohumeral Labrum Tear 

ISSN: 2577-1914 

Cage SA1*, Jacobsen AP2,3, Skowron P2,3, Wang A2,3, Trail LE1,3 and Hodges C3 

1The University of Texas at Tyler, USA 

2The University of Texas Health Science Center at Tyler, USA 

3UT Health East Texas, USA 

Abstract 

Glenohumeral labrum tears are a relatively common injury experienced by overhead athletes, particularly  

baseball players. Labrum tears have the potential to lead to time lost from sport, along with loss of financial  

compensation. There is a need for reports that detail non-operative interventions for glenohumeral  

labrum tears that allow for a safe and expedient return to activity. In this report, we present the case of a  

collegiate baseball player with a glenohumeral labrum tear who underwent five weeks of treatment and  

*Corresponding author: Cage SA, The  University of Texas at Tyler, USA 

Submission: July 27, 2023 

Published: August 11, 2023 

Volume 9 - Issue 5 

How to cite this article: Cage SA*,  Jacobsen AP, Skowron P, Wang A, Trail LE  and Hodges C. Use of External Dynamic  Arm Stabilizer with a Collegiate  Baseball Player with a Glenohumeral  Labrum Tear. Res Inves Sports Med. 9(5),  RISM.000722. 2023.  

DOI: 10.31031/RISM.2023.09.000722 

Copyright@ Cage SA. This article is  distributed under the terms of the Creative  Commons Attribution 4.0 International  License, which permits unrestricted use  and redistribution provided that the  original author and source are credited. 

rehabilitation for his injury. To return to play for post-season competitions, the patient made use of an  external dynamic arm stabilizer to provide support and attenuate force when throwing and swinging. This  appears to be the first case study detailing the use of an external dynamic arm stabilizer in conjunction  with rehabilitation and treatment to align with a patient’s goal of a safe, expedited return to participation.

Introduction 

It has been well documented that the glenohumeral joint and surrounding shoulder  complex undergo a large amount of force when a baseball is being thrown [1,2]. When exposed  to these forces, there is an increased risk of ligamentous and musculoskeletal structures  of the shoulder, and microtrauma has been documented at the shoulder as well [1,2]. In  baseball players, the glenohumeral labrum is a structure that causes particular concern  when considering potential shoulder pathologies [3,4]. A study researching baseball players  who had undergone labrum repair surgery found that on average, players took 315 days to  return to full participation [5]. As individuals reach elite college and professional levels, this  amount of time lost from injury may be associated with a risk of loss of future earnings and  other financial compensations [6]. In this case report, we present the details of the use of an  external dynamic arm stabilizer in a collegiate baseball player with an anterior glenohumeral  labrum tear to expedite return to participation. To the authors’ knowledge, there has not been  a published report describing the use of a dynamic arm stabilizer for enhancing a baseball  player’s return to sports-related activities. 

Case History 

A 22-year-old collegiate male baseball player reported to the athletic training staff  immediately after attempting to slide into a base. The patient stated that once his hand met the  base, he felt his right shoulder shift anteriorly. After feeling the shift, the patient felt a sharp  pain in the anterior aspect of his shoulder, along with diffuse weakness. When the patient  attempted to throw a ball in the next half inning, he was unable to throw and the patient was  removed from the competition. 

Initial presentation 

Evaluation in the team dugout revealed weakness with shoulder abduction, flexion and  external rotation. Tenderness to palpation was noted along the proximal long head of the  

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biceps tendon and the posterior aspect of the shoulder capsule.  Anterior Apprehension, Jobe’s Relocation and Empty Can tests  were all positive. The differential diagnosis at this time consisted of  an anterior glenohumeral subluxation, glenohumeral labrum tear,  and biceps tendon sprain. The team physician was contacted to set  an appointment for further evaluation. 

Evaluation and diagnosis 

The day following the injury, the patient was evaluated by  the team physician, whose exam yielded a differential diagnosis  consistent with athletic trainers. During his exam, the physician  noted the patient was lacking in active range of motion for shoulder  internal rotation, external rotation and abduction. X-rays revealed  no bony abnormalities and an MRI with contrast was ordered for  further evaluation. Eight days after the initial injury, the patient’s  MRI with contrast revealed a 180-degree anterior labrum tear.  There was no evidence of injury to the rotator cuff, joint capsule,  or other cartilaginous structures. Upon noting the extent of the  labrum tear, the team physician referred the patient for further  consultation with a sports medicine trained orthopedic surgeon.  Eleven days after the initial injury, the surgeon noted that the  patient’s strength and range of motion had begun to improve when  compared with the previous two evaluations. It recommended that  the patient attempt conservative treatment. At this time, the patient  was educated on potential return-to-play issues with glenohumeral  labrum repair in overhead athletes. The patient consented to  

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attempting a conservative course of treatment at this time, with  a plan to follow-up with the team physician every two weeks. An  additional follow-up was planned with the surgeon at six weeks  following the initial injury. 

Treatment and return to play 

Twelve days after the initial injury, the patient began a treatment  and rehabilitation program intended to decrease pain, increase  range of motion and strength at the shoulder. During the early  phases of the treatment and rehabilitation program the patient  was withheld from all baseball activities, along with weightlifting  activities that involved upper extremity exercises or having to grip  an implement. After further discussion between the athletic trainer,  team physician, and the patient, he was also prescribed a course of  meloxicam 15mg to address any lingering inflammation from the  patient’s injury. 

Week 2: Treatment during the first two weeks of conservative  management was aimed at decreasing pain and increasing blood  flow to the injured area. As such, the patient received cupping  therapy three times a week. Prior to each cupping session, the  treatment site was prepared with coconut oil, and the treatment  duration was 20-minutes. The cupping therapy treatments were  performed over the anterior and posterior deltoid, upper trapezius,  bicipital groove, and posterior shoulder capsule using plastic  pneumatic cups. Rehabilitation during this phase of treatment is  detailed in Table 1. 

Table 1: Weeks 2 of rehabilitation performed five days per week. 

*Exercise performed in conjunction with blood flow restriction at 50% maximum brachial artery outflow. 

Week 3: By the third week, the patient reported significant  improvement in pain. Thus, cupping therapy was shifted to an as  needed basis. A follow-up evaluation with the team physician and  athletic trainer yielded improvements in strength and range of  motion that indicated the ability to progress rehabilitation in terms  of volume and frequency. With the decrease in pain, the patient  

began to participate in fielding exercises while still being withheld  from throwing and hitting during practice. During weightlifting  sessions, the patient was cleared to begin upper extremity exercises  using resistance tubing provided the exercise did not place the  patient’s shoulder in an abducted and externally rotated position.  Rehabilitation during this phase of treatment is detailed in Table 2. 

Table 2: Week 3 of rehabilitation performed five days per week. 

*Exercise performed in conjunction with blood flow restriction at 50% maximum brachial artery outflow. 

Week 4: After conferring with the orthopedic surgeon, the  patient’s progress in terms of pain, strength and range of motion  

warranted the initiation of a return to throwing protocol. The patient  was also cleared to begin progressing back to hitting. During this 

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RISM.000722. 9(5).2023 

phase, the patient continued receiving cupping therapy as needed  for post activity soreness. After activity, the patient also underwent  a sequential compression treatment using the Norma Tec Pulse  

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2.0 Recovery System (HyperIce, Irvine, CA) for 30 minutes. The  intensity of rehabilitation exercises was also increased as shown  in Table 3. 

Table 3: Week 4 of rehabilitation performed five days per week. 

*Exercise performed in conjunction with blood flow restriction at 50% maximum brachial artery outflow. 

As the patient began throwing and swinging, he noted that he  felt fatigue in his shoulder more rapidly than prior to the injury.  The patient also reported occasional pain in the anterior shoulder  when throwing, though the intensity of the pain was significantly  less than immediately following the injury. At this time, the athletic  trainer recommended the use of an external dynamic arm stabilizer  (The Kinetic Arm K1 BraceTM, The Perfect Arm, LLC, Chamblee  Georgia) seen in Figure 1. After wearing the arm stabilizer for one  throwing and swinging session, the patient reported a decrease  in feelings of fatigue and a decrease in episodes of pain when  throwing. Given these results, the patient agreed to using the  arm stabilizer throughout his rehabilitation process. During this  time, the patient also expressed his desire to play in his team’s  upcoming post season competitions. Through consultation with  the athletic trainer, team physician, and orthopedic surgeon, the  patient provided informed consent to accelerate his return to  participation to align with his goals. In this accelerated process,  the patient was instructed to take the minimum number of throws  and swings possible during practice to ensure he was prepared for  participation in competitions. Throughout this process, the patient  was told to report any increases in pain or prolonged soreness.  Frequency of cupping therapy was increased to three times a week  to increase blood flow and promote recovery. 

Week 5-6: The patient experienced post-activity soreness  to increase frequency, volume, and intensity of practice sessions.  The patient stated that when wearing the arm stabilizer he did  not experience any episodes of instability or pain. Ultimately, the  patient was able to compete in all four of his team’s post season  competitions with no complications. Following each competition,  the patient underwent sequential compression, followed by  cupping therapy to mitigate the effects of post-activity soreness.  At the conclusion of the patient’s season, the patient consented  to abstaining from baseball activities for a month while still  completing rehabilitation and treatment sessions. 

Week 10+: After a month of rest from baseball specific  activities, the patient resumed sport specific activities. Progression  to returning to sport specific activity was prolonged, due to the  patient being in his offseason. At this time, the patient obtained an  updated model of the external dynamic arm stabilizer (The Kinetic  Arm K2 BraceTM, The Perfect Arm, LLC, Chamblee Georgia) seen  in Figure 2. The patient initiated a maintenance rehabilitation  program at this time, consisting of the exercises listed in Table 3  being performed three times a week. Sequential compression and  cupping therapy were used when indicated due to post activity  soreness. Aside from occasional soreness, the patient has been able  to maintain an uncomplicated return to activity in preparation for  his upcoming season. 

Figure 1: Kinetic Arm K1 BraceTM. 

Figure 2: Kinetic Arm K2 BraceTM.

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RISM.000722. 9(5).2023 

Discussion and Conclusion 

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References 

This case study describes the expedited return to play of a  collegiate baseball player suffering from a glenohumeral labrum  tear. Through the combination of compliance with the rehabilitation  program and use of an external dynamic arm stabilizer, the patient  was able to participate in competitions relatively quickly following  injury. This case study is noteworthy, as it appears to be the first  publication to describe the use of an external dynamic arm stabilizer  to facilitate an uncomplicated expedited return to participation in a  baseball player suffering from a glenohumeral labrum tear. Further  research is needed to validate the use of an external dynamic arm  stabilizer for use in overhead athletes. Additionally, future studies  should focus on analyzing the amount of force attenuation that  occurs at the shoulder and elbow during overhead physical activity  when wearing an external dynamic arm stabilizer. While this paper  describes a single case study, it describes the successful use of an  external dynamic arm stabilizer for allowing a patient to return to  activity sooner than expected. The paper also includes a detailed  rehabilitation protocol that was used in conjunction with the  stabilizer. 

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