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Motor Control Training for an Amateur Baseball Pitcher with Isolated Paralysis of Trapezius: A Case Report.

Authors: Matsui K, Tachibana T, Magarey M

A case of an athlete with accessory nerve injury has not been previously reported although there have been a number of case reports and case series of non-athletes with accessory nerve injury. This case report presents a motor control intervention for an amateur baseball pitcher with isolated paralysis of the right trapezius who lost pitching control after changing his pitching technique. The subject was able to restore ball control during overhead throwing after physiotherapy.  The subject of this case report was a 20-year-old amateur male baseball pitcher, who presented with long-standing isolated paralysis of the right trapezius and a six month history of loss of ball control with shoulder pain during pitching. He was seen for a second opinion following unsuccessful conservative management and underwent physical therapy to restore his ball control during pitching. Restriction of cervical rotation range of motion and decreased position sense during shoulder abduction and external rotation were revealed in the physical examination. Proprioceptive exercise was commenced with and without visual feedback to acquire a reproducible abduction angle in the cocking phase of a baseball pitch. His pitching form was modified to ensure that his arm was being raised effectively in the cocking phase. Pitching drills that were utilized targeted motor control of the upper quarter, and were progressed in steps. Cervical joint mobilization was undertaken to allow adequate range of motion for visualization of the target while pitching.  The subject was able to return to competitive level of amateur baseball with accurate ball control. This case report demonstrates that achievement of control of a skilled upper quarter activity, such as baseball pitching, is possible with conservative management even in the presence of paralysis of trapezius, a major contributor to the movement.

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