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Circulatory disturbances in the throwing hand of baseball pitchers

Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo

Koichi Wakano

Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo

Tsuyoshi Takeda

Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo

Tsuneji Murakami

Department of Orthopedic Surgery, School of Medicine, Hiroshima University, Hiroshima, Japan

Three cases of circulatory disturbance with ulcer for mation in the pitching hand of baseball pitchers are reported. The pathophysiology was of an entirely new entity. In one case, the neurovascular bundles of the middle finger were entrapped by the proximal edges of Cleland's ligaments. In the other two cases, the blood vessels to the index and middle fingers were com pressed within the lumbrical canal. Hypertrophy of the lumbrical muscles and/or thickening of the palmar apo neurosis were responsible for the compression of the vessels. Surgical release of Cleland's ligaments or pal mar aponeurosis, including superficial transverse fiber and vertical septa, resulted in good recovery of the circulation of the involved fingers. All of the pitchers returned to professional or college league baseball with out recurrence of the ulcer.

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