ImageIQ and Cleveland Clinic Present Findings on Pitching Injuries and Shoulder Anatomy: Study May Help Assess Player Injury Risk

ImageIQ and Cleveland Clinic Present Findings on Pitching Injuries and Shoulder Anatomy: Study May Help Assess Player Injury Risk

CLEVELAND, OHIO – October 31, 2013 — Image IQ, Inc. announced today that findings from an orthopedic clinical study conducted by ImageIQ and Cleveland Clinic show that professional baseball pitchers with lower degrees of dominant humeral torsion, or the degree of twisting of the long arm bone running from shoulder to elbow, are more prone to severe arm and shoulder injuries. These findings, published in The American Journal of Sports Medicine, have the potential to allow players and teams to assess injury risk in the future, proactively work to prevent injuries and make better-informed player personnel decisions.
Cleveland-based ImageIQ used custom-tailored 3-dimensional clinical image and motion analysis software to quantitatively measure joint anatomy differences in the shoulders of 25 professional pitchers from computed tomography (CT) image data provided by Cleveland Clinic. The pitchers were followed for two years, and the study recorded the number of days missed from pitching activities as a measure of the severity and incidence of the players’ injuries. The study also found a trend relating lower side-to-side torsion differences with more severe upper extremity injuries.
ImageIQ, an Imaging Contract Research Organization (CRO) and spin-off company of Cleveland Clinic Innovations, provides custom-tailored imaging analytics, software engineering and visualization services for research, medical device and pharmaceutical organizations in support of preclinical and clinical research, in additional to product development.
«We were excited to work with Cleveland Clinic to bring our unique approach to orthopedic image data analysis to bear on this study,» ImageIQ CEO Tim Kulbago said. «As pitchers must strike a delicate balance between mobility and functional stability, these research findings help us better understand the connection between shoulder range-of-motion and the level of injury suffered by professional baseball players, and how to predict and protect against the most severe arm and shoulder injuries. As a member of Cleveland’s biomedical community and a life-long baseball fan, that’s great news.»
The study’s Principal Investigator, Dr. Joshua Polster, staff radiologist in the Department of Diagnostic Radiology within the Cleveland Clinic’s Imaging Institute, commented: «We found that simple measurements from standard image data sets were too limited to capture the complex interplay of 3-dimensional anatomic structures that are involved in sports injuries and other orthopedic pathologies, and we needed a more sophisticated approach. This analysis produced meaningful and reliable data for sports medicine experts and professional athletes, and will hopefully help minimize pitching injuries in professional baseball.»
This study was supported by grant funding from Major League Baseball (MLB).
About The Imaging Institute at Cleveland Clinic
Cleveland Clinic’s Imaging Institute offers a full range of radiology services for adults and children. The Institute is continuously working to provide patients the most up-to-date technological advances and innovative treatment options in diagnostic testing. The Imaging Institute is also one of the leading radiological academic centers in the world as well as one of the busiest clinical departments in the country. Each year over 1.8 million examinations are performed and interpreted by Cleveland Clinic radiologists. The Institute is composed of the Departments of Regional Radiology, Diagnostic Radiology, Nuclear Medicine and eRadiology.

Failure With Continuity in Rotator Cuff Repair “Healing”

  1. Joseph P. Iannotti, MD, PhD*,§#
+Author Affiliations

  1. *Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio

  2. Orthopaedic Surgery Section, Portland Veterans Affairs Medical Center, Portland, Oregon

  3. Department of Orthopaedic Surgery, Oregon Health and Sciences University, Portland, Oregon

  4. §Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio

  5. Henry Ford Hospital, Department of Orthopaedic Surgery, Bone and Joint Center, Detroit, Michigan

  6. Department of Radiology, Cleveland Clinic, Cleveland, Ohio

  7. Investigation performed at Cleveland Clinic, Cleveland, Ohio
  1. # Joseph P. Iannotti, MD, PhD, Department of Orthopaedic Surgery, A41, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195 (


Background: Ten to seventy percent of rotator cuff repairs form a recurrent defect after surgery. The relationship between retraction of the repaired tendon and formation of a recurrent defect is not well defined.
Purpose/Hypotheses: To measure the prevalence, timing, and magnitude of tendon retraction after rotator cuff repair and correlate these outcomes with formation of a full-thickness recurrent tendon defect on magnetic resonance imaging, as well as clinical outcomes. We hypothesized that (1) tendon retraction is a common phenomenon, although not always associated with a recurrent defect; (2) formation of a recurrent tendon defect correlates with the timing of tendon retraction; and (3) clinical outcome correlates with the magnitude of tendon retraction at 52 weeks and the formation of a recurrent tendon defect.
Study Design: Case series; Level of evidence, 4.
Methods: Fourteen patients underwent arthroscopic rotator cuff repair. Tantalum markers placed within the repaired tendons were used to assess tendon retraction by computed tomography scan at 6, 12, 26, and 52 weeks after operation. Magnetic resonance imaging was performed to assess for recurrent tendon defects. Shoulder function was evaluated using the Penn score, visual analog scale (VAS) score for pain, and isometric scapular-plane abduction strength.
Results: All rotator cuff repairs retracted away from their position of initial fixation during the first year after surgery (mean [standard deviation], 16.1 [5.3] mm; range, 5.7-23.2 mm), yet only 30% of patients formed a recurrent defect. Patients who formed a recurrent defect tended to have more tendon retraction during the first 6 weeks after surgery (9.7 [6.0] mm) than those who did not form a defect (4.1 [2.2] mm) (P = .08), but the total magnitude of tendon retraction was not significantly different between patient groups at 52 weeks. There was no significant correlation between the magnitude of tendon retraction and the Penn score (r = 0.01, P = .97) or normalized scapular abduction strength (r = −0.21, P= .58). However, patients who formed a recurrent defect tended to have lower Penn scores at 52 weeks (P = .1).
Conclusion: Early tendon retraction, but not the total magnitude, correlates with formation of a recurrent tendon defect and worse clinical outcomes. “Failure with continuity” (tendon retraction without a recurrent defect) appears to be a common phenomenon after rotator cuff repair. These data suggest that repairs should be protected in the early postoperative period and repair strategies should endeavor to mechanically and biologically augment the repair during this critical early period.



  • One or more of the authors has declared the following potential conflict of interest or source of funding: This work was supported in part by Pfizer Pharmaceuticals; the Department of Orthopedic Surgery, Cleveland Clinic; and the Department of Orthopedic Surgery, Henry Ford Hospital. Dr Derwin has received research funding and materials from Synthasome and The Musculoskeletal Transplant Foundation and was a paid consultant for CollPlant. Drs McCarron, Iannotti, and Derwin receive royalties from The Musculoskeletal Transplant Foundation. Dr Iannotti is a paid consultant and receives royalties from Tornier.