When I joined the 1974 Los Angeles Dodgers, right-handed pitcher, Andy Messersmith, and I became friends. While in the dugout or traveling, we talked baseball. While eating, I noticed that Andy had difficulty bending his pitching elbow sufficiently to feed himself.

Andy said that not only could he not bend his pitching elbow sufficiently to easily feed himself, he could not brush his teeth, comb his hair, wash his face and so on. I compared his pitching elbow's flexion angle with his non-pitching elbow. His flexion angles differed dramatically. I suggested that we scientifically investigate this difference. Andy agreed to visit me at Michigan State University after the season.

a. Methodology

On January 15, 1975, Andy and I presented ourselves to Professor Bert M. Bez MD, the Chairman of the Division of Anesthesia in MSU's College of Osteopathic Medicine. To prevent muscle action interference, Professor Bez bi-laterally anesthetized our brachial plexuses. (At the brachial plexus, cervical nerves' five (C5), six (C6), seven (C7), eight (C8) and thoracic nerve one (T1) intertwine to form the arm's radial, median, ulnar, musculocutaneous and axillary nerves. The brachial plexus lies beneath the clavicle's middle and the scapula's coracoid process.)

Using the Subclavian Perivascular Technique, Professor Bez bi-laterally administered 20cc of a 1% solution of Lidocaine (Xylocaine). Lidocaine anesthetized the motor nerves that stimulate the elbow flexors and extensors. Without muscle action, only skeletal structures could limit elbow flexion and extension.

An Olin Heath Center Radiographic technician placed our arms into the proper X-ray positions and forcefully fully extended and flexed our elbows. Another technician captured Anterior/Posterior (A/P) and Medial/Lateral (M/L) views of our forcefully extended elbows and a Medial/Lateral (M/L) view of our forcefully flexed elbows.

b. Analyzing X-Rays

1. A/P Extended Elbow Measurements and Evaluations

The original X-rays permitted direct measurements. However, because the technician could not completely extend or flex our pitching elbows, some elbow structures did not contact the X-ray plates. Therefore, parallax error may cause some incorrect measurements.

To analyze forcefully extended elbows' Anterior/Posterior views, I:
1. measured the humeral mid-shaft width and cortex depth,
2. evaluated the medial epicondyle,
3. evaluated the trochlea/olecranon process articular surfaces,
4. evaluated the olecranon fossa,
5. evaluated the capitulum/radial head articular surfaces,
6. evaluated the lateral epicondyle,
7. measured and evaluated the radial head,
8. measured the radial tuberosity,
9. measured the radial mid-shaft width and cortex depth and
10. measured the ulnar mid-shaft width and cortex depth.

a) Mike Marshall

1) Non-Pitching Elbow

My humeral mid-shaft measured one inch wide with the cortex one-quarter inch thick. My medial epicondyle showed normal trabeculae and mineralization and a smooth, uninterrupted surface. The articular surfaces of my trochlea/olecranon process joint appeared even-spaced, smooth and uninterrupted. My olecranon fossa showed normal trabeculae and mineralization and no abnormalities. The articular surfaces of my capitulum/radial head joint appeared even-spaced, smooth and uninterrupted. My lateral epicondyle showed normal trabeculae and mineralization and a smooth, uninterrupted surface. My radial head measured one inch wide with normal trabeculae and mineralization. My radial tuberosity measured thirteen-sixteenths inch wide with normal trabeculae and mineralization and a smooth, uninterrupted surface. My radial mid-shaft measured three-quarters inch wide with the cortex one-eighth inch thick. My ulnar mid-shaft measured five-eighths inch wide with the cortex one-eighth inch thick.

2) Pitching Elbow

My humeral mid-shaft measured one and one-eighth inches wide with the cortex three-eighth inch thick. My medial epicondyle showed slightly abnormal trabeculae and considerably increased mineralization, especially proximally, but a smooth, uninterrupted surface. The articular surfaces of my trochlea/olecranon process joint appeared even-spaced, smooth and uninterrupted. My olecranon fossa showed normal trabeculae and mineralization with no abnormalities. The articular surfaces of my capitulum/radial head joint appeared even-spaced, smooth and uninterrupted. My lateral epicondyle showed normal trabeculae and mineralization and a smooth, uninterrupted surface. My radial head measured one inch wide with normal trabeculae and mineralization. My radial tuberosity measured thirteen-sixteenth inch wide with normal trabeculae and mineralization and a smooth, uninterrupted surface. My radial mid-shaft measured thirteen-sixteenth inch wide with the cortex one-eighth inch thick. My ulnar mid-shaft measured five-eighth inch wide with the cortex three-sixteenth inch thick.

3) Comparison

My pitching humeral mid-shaft measured one-eighth inch wider with its cortex also one-eighth inch thicker. My pitching medial epicondyle trabeculae showed slightly abnormal with the mineralization of the proximal one-half considerably increased. The cortex at my pitching ulnar mid-shaft measured one-sixteen inch thicker.

b) Andy Messersmith

1) Non-Pitching Elbow

Andy's humeral mid-shaft measured one inch wide with the cortex one-quarter inch thick. Andy's medial epicondyle showed normal trabeculae and mineralization and a smooth, uninterrupted surface. The articular surfaces of Andy's trochlea/olecranon process joint appeared even-spaced, smooth and uninterrupted. Andy's olecranon fossa showed normal trabeculae and mineralization and no abnormalities. The articular surfaces of Andy's capitulum/radial head joint appeared even-spaced, smooth and uninterrupted. Andy's lateral epicondyle showed normal trabeculae and mineralization and a smooth, uninterrupted surface. Andy's radial head measured one and one-sixteenth inch wide with normal trabeculae and mineralization. Andy's radial tuberosity measured three-quarter inch wide with normal trabeculae and mineralization and a smooth, uninterrupted surface. Andy's radius mid-shaft measured eleven-sixteenth inch wide with the cortex three-sixteenth inch thick. Andy's ulnar mid-shaft measured five-eighth inch wide with the cortex one-quarter inch thick.

2) Pitching Elbow

Andy's humeral mid-shaft measured one and one-quarter inch wide with the cortex seven-sixteenth inch thick. Andy's medial epicondyle showed abnormal trabeculae and a considerably increased mineralization in its proximal one-half, but a smooth, uninterrupted surface. However, a wide fissure appeared in the medial epicondyle/trochlear union. The articular surfaces of Andy's trochlea/olecranon process joint appeared even-spaced, smooth and uninterrupted. However, two loose pieces of cartilage lay near to the medial aspect of the trochlea/proximal ulna articular surface. Andy's olecranon fossa showed abnormal trabeculae, increased mineralization and a large calcified cartilage fragment in the fossa's center. The articular surfaces of Andy's capitulum/radial head joint had uneven spacing and a deepened hollow in the radial head. Andy's lateral epicondyle showed abnormal trabeculae and decreased mineralization around its edge, but a smooth, uninterrupted surface. Andy's radial head measured one and one-eighth inches wide with an enlarged, deformed shape, normal trabeculae and slightly increased mineralization. Andy's radial tuberosity measured three-quarter inch wide with a smooth, uninterrupted surface. Andy's radial mid-shaft measured three-quarter inch wide with the cortex one-quarter inch thick. Andy's ulnar mid-shaft measured five-eighth inch wide with the cortex three-sixteenth inch thick.

3) Comparison

Andy's pitching humeral mid-shaft measured one-quarter inch wider with its cortex three-sixteenth inch thicker. Andy's pitching medial epicondyle showed abnormal trabeculae and considerably increased mineralization in its proximal one-half. On the medial aspect of the articular surfaces of his pitching trochlea/olecranon process joint, Andy had two loose cartilage fragments. Andy had an abnormal fissure between his pitching medial epicondyle and trochlea. Andy's pitching olecranon fossa showed abnormal trabeculae, increased mineralization and a large calcified piece of cartilage or bone fragment in the center of the fossa. The articular surfaces of Andy's pitching capitulum/radial head joint abnormal trabeculae and demineralization. Andy's pitching radial head enlarged, deformed and increased its mineralization.

2. M/L Extended Elbow Measurements and Evaluations

The original X-rays permitted direct measurements. However, because the technician could not completely extend or flex our pitching elbows, some elbow structures did not contact the X-ray plates. Therefore, parallax error may cause incorrect measurements.

To analyze our forcefully extended elbows' Medial/Lateral views, I:
1. measured olecranon fossa depth,
2. evaluated anterior capitulum articular surface,
3. measured the coranoid process and
4. measured our maximum elbow extension angles.

During maximum elbow extension, the olecranon process contacting the olecranon fossa limits the elbow's maximum extension angle. Therefore, to measure the elbow's maximum extension angle, I placed three dots on the medial/lateral extended elbows X-rays and drew lines from dot #1 through dot #2 and from dot #3 through dot #2. A compass centered on dot #2 superimposing one line measured the elbow's maximum extension angle.
1. On the humeral mid-shaft's anterior surface.
2. Where the olecranon process contacts the olecranon fossa.
3. On the ulnar mid-shaft's anterior surface.

a) Mike Marshall

1) Non-Pitching Elbow

My olecranon process penetrated one inch into its olecranon fossa. My capitulum's anterior articular surface showed normal trabeculae and mineralization and a smooth, uninterrupted surface. My coranoid process measured one and nine-sixteenth inches long and showed normal trabeculae and mineralization with a smooth, uninterrupted surface. The compass determined that my elbow's maximum extension angle is one hundred and eighty-four degrees.

2) Pitching Elbow

My olecranon process penetrated eleven-sixteenth inch into its olecranon fossa. My capitulum's anterior articular surface showed normal trabeculae and mineralization and a smooth surface interrupted only by a small, round enlargement on its anterior/superior aspect. My coranoid process measured one and five-eighth inches long and showed normal trabeculae and mineralization with a smooth, uninterrupted surface. The compass determined that my elbow's maximum extension angle is one hundred and seventy-two degrees.

3) Comparison

My pitching olecranon process penetrated five-sixteenth inch less into its olecranon fossa. My pitching capitulum's articular surface showed a small, round enlargement on its anterior/superior aspect. My pitching coranoid process measured one-eighth inch longer. Pitching decreased my elbow's maximum extension angle by twelve degrees.

b) Andy Messersmith

1) Non-Pitching Elbow

Andy's olecranon process penetrated fifteen-sixteenth inch into its olecranon fossa. Andy's capitulum's anterior articular surface had normal trabeculae and mineralization and a smooth, uninterrupted surface. Andy's coranoid process measured one and one-half inches long and showed normal trabeculae and mineralization and no abnormalities. The compass determined that Andy's elbow's maximum extension angle is one hundred and seventy-four degrees.

2) Pitching Elbow

Andy's olecranon process penetrated one and three-sixteenth inches into its olecranon process. Andy's capitulum's anterior articular surface showed normal trabeculae and mineralization and a smooth, uninterrupted surface. Andy's coranoid process measured one and seven-eighth inches long and showed abnormal trabeculae and increased mineralization with a rough, irregular surface and signs of arthritis. The compass determined that Andy's elbow's maximum extension angle is one hundred and thirty-nine degrees.

3) Comparison

Andy's pitching olecranon process penetrated three-quarter inch less into its olecranon fossa. Andy's pitching coranoid process measured three-eighth inch longer with a rough, irregular surface and signs of arthritis. Pitching decreased Andy's pitching elbow's maximum extension angle by thirty-five degrees.

3. M/L Flexed Elbow Measurements and Evaluations

The original X-rays permitted direct measurements. However, because the technician could not completely extend or flex our pitching elbows, some elbow structures did not contact the X-ray plates. Therefore, parallax error may cause incorrect measurements.

To analyze our forcefully flexed elbows' Medial/Lateral views, I:
1. measured coranoid process penetration depth,
2. measured and evaluated the olecranon process,
3. evaluated the trochlea's posterior articular surface and
4. measured our maximum elbow flexion angles.

During maximum elbow flexion, the coranoid process contacting the coranoid fossa limits the elbow's flexion range of motion. Therefore, to measure maximum elbow flexion angle, I placed three dots on the X-rays and drew a line from dot #1 through dot #2 and from dot #3 through dot #2. A compass centered on dot #2 superimposing one line measured the angle between the first line and second line.
1. On the humeral mid-shaft's anterior surface.
2. Where the coranoid process contacts the coranoid fossa.
3. On the ulnar mid-shaft's anterior surface.

a) Mike Marshall

1) Non-Pitching Elbow

My coranoid process penetrated one-eighth inch into its coranoid fossa. My olecranon process measured one and one-sixteenth inches and showed normal trabeculae and mineralization with a smooth, uninterrupted surface. My trochlea's posterior articular surface was smooth and uninterrupted. The compass determined that my elbow's maximum flexion angle is thirty-four degrees.

2) Pitching Elbow

My coranoid process penetrated one-eighth of an inch into its coranoid fossa. My olecranon process measured one inch long and showed normal trabeculae and mineralization with, except for a small ridge on its superior/posterior aspect, a smooth, uninterrupted surface. My trochlea's posterior articular surface was smooth and uninterrupted. The compass determined that my elbow's maximum flexion angle is forty-six degrees.

3) Comparison

My pitching olecranon process measured one-sixteenth inch longer and showed a small ridge on its superior-posterior aspect. Pitching decreased my pitching elbow's maximum flexion angle by twelve degrees.

b) Andy Messersmith

1) Non-Pitching Elbow

Andy's coranoid process penetrated one-quarter inch into its coranoid fossa. Andy's olecranon process measured one and one-eighth inches and showed normal trabeculae and mineralization with a smooth, uninterrupted surface. Andy's trochlea's posterior articular surface was smooth and uninterrupted. Arthritis appeared throughout the articular surfaces and fossas. The compass determined that Andy's elbow's maximum flexion angle is thirty-three degrees.

2) Pitching Elbow

Andy's coranoid process penetrated one-quarter inch into its coranoid fossa. Andy's olecranon process measured one and three-eighth inches long and showed abnormal trabeculae and increased mineralization with a rough, irregular surface. Andy's trochlea's posterior articular surface showed normal trabeculae and mineralization with a rough, irregular surface. The compass determined that Andy's elbow's maximum flexion angle is sixty-six degrees.

3) Comparison

Andy's pitching olecranon process measured only one-sixteenth inch longer. However, it showed abnormal trabeculae, increased mineralization and arthritis. Andy's pitching trochlea's posterior articular surface showed a rough, irregular surface with arthritis. Pitching decreased Andy's pitching elbow's maximum flexion angle by thirty-three degrees.

c. Pitching Elbow Irregularities

1. Mike Marshall

My three sets of bi-lateral X-rays showed the following pitching arm irregularities:
1. My pitching humeral mid-shaft measured one-eighth inch wider with its cortex also one-eighth inch thicker.
2. My pitching medial epicondyle showed slightly abnormal trabeculae with the mineralization of the proximal one-half considerably increased.
3. My pitching ulna mid-shaft cortex measured one-sixteen inch thicker.
4. My pitching olecranon process penetrated into its olecranon fossa five-sixteenth inch less.
5. My pitching olecranon process measured one-sixteenth inch longer and showed a small ridge on its superior-posterior aspect.
6. My pitching elbow lost twelve degrees of maximum extension angle. 7. My pitching capitulum's articular surface showed a small, round enlargement on its anterior/superior aspect.
8. My pitching coranoid process measured one-eighth inch wider.
9. My pitching elbow lost twelve degrees of maximum flexion angle.

2. Andy Messersmith

Andy's three sets of bi-lateral X-rays showed the following pitching arm irregularities:
1. Andy's pitching humeral mid-shaft measured one-quarter inch wider and its cortex three-sixteenth inch thicker.
2. Andy's medial epicondyle showed abnormal trabeculae and considerably increased mineralization in its proximal one-half.
3. Andy's pitching trochlea/olecranon process' articular surfaces showed two loose cartilage fragments on its medial aspect.
4. An abnormal fissure showed between Andy's pitching medial epicondyle and trochlea.
5. Andy's pitching trochlea's articular surface showed a rough, irregular posterior surface with arthritis.
6. Andy's pitching olecranon fossa showed abnormal trabeculae, increased mineralization and a large calcified cartilage fragment in the fossa's center.
7. Andy's pitching olecranon process penetrated into its olecranon process three-quarter inch less.
8. Whereas Andy's pitching olecranon process measured only one-sixteenth inch longer, it showed abnormal trabeculae, increased mineralization and arthritis.
9. Andy's pitching elbow lost thirty-five degrees of maximum extension angle.
10. Andy's pitching capitulum/radial head's articular surfaces showed abnormal trabeculae and demineralization.
11. Andy's pitching radial head enlarged, deformed and increased its mineralization.
12. Andy's coranoid process measured three-eighth inch longer with a rough, irregular surface and signs of arthritis.
13. Andy's pitching elbow lost thirty-three degrees of maximum flexion angle.

d. Bi-Lateral Elbow Motion Ranges

Table 6.1: Maximum Flexion and Extension Angles

	Maximum Flexion Flexion Angle		Maximum Extension Extension Angle
	Non-Pitching Arm	Pitching Arm	Non-Pitching Arm	Pitching Arm
Marshall	34o	46o	184o	172o
Messersmith	33o	66o	174o	139o

1. Non-Pitching Elbow Motion Ranges

My non-pitching elbow's maximum flexion angle measured thirty-four degrees. Andy's non-pitching elbow's maximum flexion angle measured thirty-three degrees. My non-pitching elbow's maximum extension angle measured one hundred and eighty-four degrees. Andy's non-pitching elbow's maximum extension angle measured one hundred and seventy-four degrees.

Subtracting maximum flexion angles from maximum extension angles provides the elbow's maximum range of motion. To determine my non-pitching elbow's maximum range of motion, I subtracted forty-six degrees from one hundred and seventy-two degrees. My non-pitching elbow's range of motion is one hundred and fifty degrees. To determine Andy's non-pitching elbow's maximum range of motion, I subtracted thirty-three degrees from one hundred and seventy-four degrees. Andy non-pitching elbow's range of motion is one hundred and forty-one degrees. Our non-pitching elbows' maximum ranges of motion were essentially equal. Therefore, non-pitching elbows serve as control models.

2. Pitching Elbow Motion Ranges

My pitching elbow's maximum flexion angle measured forty-six degrees. Andy's pitching elbow's maximum flexion angle measured sixty-six degrees. Recall that Andy had difficulty feeding himself with his pitching elbow. My pitching elbow's maximum extension angle measured one hundred and seventy-two degrees. Andy's pitching elbow's maximum extension angle measured one hundred and thirty-nine degrees.

Subtracting the elbow's maximum flexion angle from the elbow's maximum extension angle provides the elbow's maximum range of motion. To determine my pitching elbow's range of motion, I subtracted forty-six degrees from one hundred and seventy-two degrees. Pitching decreased my pitching elbow's maximum range of motion by one hundred and twenty-six degrees. To determine Andy's pitching elbow's range of motion, I subtracted sixty-six degrees from one hundred and thirty-nine degrees. Pitching decreased Andy's pitching elbow's maximum range of motion by seventy-three degrees.

3. Comparing Pitching Elbow Motion Ranges

To determine how much adolescent pitching decreased my pitching elbow's range of motion, I subtracted non-pitching elbow's maximum range of motion of my one hundred and fifty degrees from my pitching elbow's maximum range of motion of one hundred and twenty-six degrees. Pitching decreased my pitching elbow's range of motion by twenty-four degrees. To determine how much adolescent pitching decreased Andy's pitching elbow's range of motion, I subtracted Andy's non-pitching elbow's maximum range of motion of one hundred and forty-one degrees from Andy's pitching elbow's maximum range of motion of seventy-three degrees. Pitching decreased Andy's pitching elbow's maximum range of motion by sixty-eight degrees.

e. Reduced Pitching Elbow Motion Range Causes

1. Reduced Maximum Flexion Angle

The brachialis muscle attaches to the coranoid process. Therefore, the coranoid process epiphysis is a traction epiphysis. With improper pitching technique, adolescents place unnecessarily high amounts of mechanical stress on their coranoid processes. Increased stresses enlarge coranoid processes. Consequently, enlarged coranoid processes contact coranoid fossas earlier and, thereby, decreases the maximum flexion angle.

2. Reduced Maximum Extension Angle

During improper pitching techniques, the olecranon process collides with the olecranon fossa. Therefore, the olecranon process epiphysis is a collision epiphysis. Repeated olecranon process/fossa collisions aggravate olecranon fossas. For protection, olecranon fossa's hyaline cartilage thicken. Thickened olecranon fossa's hyaline cartilages decrease the depth that olecranon processes penetrate and, thereby, decrease the elbow's maximum extension angle.

Coaching Adult Pitchers