Adaptation of the proximal humerus to physical activity: A within-subject controlled study in baseball players

Stuart J. Warden, Julio Carballido-Gamio, Keith G. Avin, Mariana Elizabeth Kersh, Robyn K. Fuchs, Roland Krug, Ryan J. Bice

Research output: Contribution to journalArticle

Abstract

The proximal humerus is a common, yet understudied site for osteoporotic fracture. The current study explored the impact of prolonged physical activity on proximal humerus bone health by comparing bone properties between the throwing and nonthrowing arms within professional baseball players. The proximal humerus in throwing arms had 28.1% (95% CI, 17.8 to 38.3%) greater bone mass compared to nonthrowing arms, as assessed using dual-energy x-ray absorptiometry. At the level of the surgical neck, computed tomography revealed 12.0% (95% CI, 8.2 to 15.8%) greater total cross-sectional area and 31.0% (95% CI, 17.8 to 44.2%) greater cortical thickness within throwing arms, which contributed to 56.8% (95% CI, 44.9 to 68.8%) greater polar moment of inertia (i.e., estimated ability to resist torsional forces) compared to nonthrowing arms. Within the humeral head and greater tubercle regions, throwing arms had 3.1% (95% CI, 1.1 to 5.1%) more trabecular bone, as assessed using high-resolution magnetic resonance imaging. Three-dimensional mapping of voxel- and vertex-wise differences between arms using statistical parametric mapping techniques revealed throwing arms had adaptation within much of the proximal diaphysis, especially the posterolateral cortex. The pattern of proximal diaphysis adaptation approximated the pattern of strain energy distribution within the proximal humerus during a fastball pitch derived from a musculoskeletal and finite element model in a representative player. These data demonstrate the adaptive ability of the proximal humerus to physical activity-related mechanical loads. It remains to be established how they translate to exercise prescription to improve bone health within the proximal humerus; however, they provide unique insight into the relationship between prolonged loading and skeletal adaptation at a clinically relevant osteoporotic site.

Original languageEnglish (US)
Pages (from-to)107-115
Number of pages9
JournalBone
Volume121
DOIs
StatePublished - Apr 1 2019

Fingerprint

Baseball
Humerus
Arm
Bone and Bones
Diaphyses
Mechanical Torsion
Humeral Head
Osteoporotic Fractures
Health
Prescriptions
Neck
Tomography
Magnetic Resonance Imaging
X-Rays

Keywords

  • Exercise
  • Internal impingement
  • Mechanoadaptation
  • Osteoporosis
  • Shoulder
  • SPM

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Physiology
  • Histology

Cite this

Warden, S. J., Carballido-Gamio, J., Avin, K. G., Kersh, M. E., Fuchs, R. K., Krug, R., & Bice, R. J. (2019). Adaptation of the proximal humerus to physical activity: A within-subject controlled study in baseball players. Bone, 121, 107-115. https://doi.org/10.1016/j.bone.2019.01.008

Adaptation of the proximal humerus to physical activity : A within-subject controlled study in baseball players. / Warden, Stuart J.; Carballido-Gamio, Julio; Avin, Keith G.; Kersh, Mariana Elizabeth; Fuchs, Robyn K.; Krug, Roland; Bice, Ryan J.

In: Bone, Vol. 121, 01.04.2019, p. 107-115.

Research output: Contribution to journalArticle

Warden, Stuart J. ; Carballido-Gamio, Julio ; Avin, Keith G. ; Kersh, Mariana Elizabeth ; Fuchs, Robyn K. ; Krug, Roland ; Bice, Ryan J. / Adaptation of the proximal humerus to physical activity : A within-subject controlled study in baseball players. In: Bone. 2019 ; Vol. 121. pp. 107-115.
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