Imaging of the Elbow in the Overhead Throwing Athlete

2003 ◽  
Vol 31 (3) ◽  
pp. 466-473 ◽  
Author(s):  
Andrew L. Chen ◽  
Thomas Youm ◽  
Bernard C. Ong ◽  
Mahvash Rafii ◽  
Andrew S. Rokito
Keyword(s):  
Functional Recovery ◽  
Return To Play ◽  
Radiographic Evaluation ◽  
Throwing Athlete ◽  
Elbow Injuries ◽  
Overhead Throwing ◽  
Patterns Of Injury

Elbow injuries in athletes who perform overhead throwing motions often present diagnostic challenges because of the undue stresses and often chronic, repetitive patterns of injury. Accurate and efficient assessment of the injured elbow is essential to maximize functional recovery and expedite return to play. Radiographic evaluation should be tailored to the specific injury suspected and requires a thorough understanding of normal anatomic relationships as well as familiarity with common injuries affecting these athletes.

Return to High-Level Throwing After Combination Infraspinatus Repair, SLAP Repair, and Release of Glenohumeral Internal Rotation Deficit

2012 ◽  
Vol 40 (11) ◽  
pp. 2536-2541 ◽  
Author(s):  
Jonathan P. Van Kleunen ◽  
Scott A. Tucker ◽  
Larry D. Field ◽  
Felix H. Savoie
Keyword(s):  
Internal Rotation ◽  
Sport Participation ◽  
Suture Anchor ◽  
Return To Play ◽  
Glenohumeral Internal Rotation Deficit ◽  
Throwing Athlete ◽  
Slap Repair ◽  
Overhead Throwing ◽  
High Level ◽  
Slap Tear

Background: The overhead-throwing athlete is a unique patient, requiring an elite, precise functional ability. Superior labral tears are quite common, and the percentage of athletes who return to play after superior labrum anterior-posterior (SLAP) repair has been variable. A tear of the infraspinatus caused by either internal impingement or tension overload may compromise this return. Hypothesis: The rate of return to a level of play similar to or greater than the preinjury level after repair of combined SLAP and infraspinatus injuries will be lower than in previous reports of SLAP repair alone. Study Design: Case series; Level of evidence, 4. Methods: In the current study, we examined a series of overhead-throwing athletes with diagnoses of both a SLAP tear and a significant (>50%) tear of the infraspinatus tendon who underwent surgical repair of both injuries. We identified 17 high-level baseball players younger than 25 years who underwent simultaneous arthroscopic repairs of a SLAP tear with a standard suture anchor technique and of an infraspinatus tear with either a free polydioxanone (PDS) suture or suture anchor between 2005 and 2008. The postoperative records of all patients were reviewed to determine their ability to return to play and their postoperative level of performance. All patients were then contacted to determine their Kerlan-Jobe Orthopaedic Clinic Overhead Athlete Shoulder and Elbow score and their current sport participation level. Results: All 17 patients in the series attempted to return to their prior sport after completion of postoperative rehabilitation. Only 6 patients (35%) were able to return to the same or a superior preinjury level of performance. Five of the remaining 11 patients returned to play at a lower level, either playing the same position or else forced to switch to another position of play because of a decline in throwing velocity. Six patients were unable to return to play. No complications or reoperations occurred in any of the patients following surgery. Conclusion: A significant (>50%) tear of the infraspinatus in combination with glenohumeral internal rotation deficit (GIRD) and SLAP tears in the throwing athlete results in a guarded prognosis in return to play at the same level. While the rates of return to play in overhead-throwing athletes with an isolated SLAP tear have historically been encouraging, the prognosis for an athlete with both a SLAP and infraspinatus tear is more guarded. These patients are not likely to return to their preinjury level of play.

scholarly journals Imaging of the Overhead Throwing Athlete

2007 ◽  
Vol 11 (1) ◽  
pp. 091-091
Author(s):  
Hugue Ouellette ◽  
Ara Kassarjian ◽  
Patrice Tétreault ◽  
William Palmer
Keyword(s):  
Throwing Athlete ◽  
Overhead Throwing

scholarly journals Ulnar Collateral Ligament Repair with Internal Brace Augmentation in Amateur Overhead Throwing Athletes

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0008 ◽  
Author(s):  
Jeffrey R. Dugas ◽  
Christopher A. Looze ◽  
Christopher Michael Jones ◽  
Brian L. Walters ◽  
Marcus A. Rothermich ◽  
...  
Keyword(s):  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Time Frame ◽  
Return To Play ◽  
Overhead Athletes ◽  
Late Failure ◽  
Internal Brace ◽  
Overhead Throwing ◽  
A Prospective Study

Objectives: There has been a renewed interest in UCL repair in overhead athletes. This is largely due to greater understanding of UCL pathology, improvement in fixation technology and the extensive rehab required to return from UCL reconstruction. Initial data regarding UCL repair in overhead athletes was poor and therefore UCL repair was largely abandoned in favor of reconstruction. However, recent literature examining UCL repair with anchor only fixation demonstrated an excellent rate of return to play, reduced time to return to play and a low complication rate. Based on this promising data, we have developed a novel technique of UCL repair with internal brace augmentation that we have used in overhead throwing athletes. We performed a prospective study evaluating the outcomes of this procedure with respect to return to play, time to return to play, functional outcome score and complications. Methods: Overhead athletes undergoing UCL repair with internal brace augmentation were prospectively followed for a minimum of one year. Patients were carefully selected from those who would traditionally be considered for UCL reconstruction. Initially, patients were considered if they had an avulsion of the UCL with otherwise healthy UCL tissue and had a vested interest in shortened rehab. As the study progressed, interest in shortened rehab became a less stringent criteria. Demographic and operative data were collected at the time surgery. This data was compiled for both desciption and comparison between subgroups. Patients were then contacted 1 year postoperatively and assessed for return to play, time to return to play and KJOC scores. Complications were documented and patients having complications were detailed. Results: 66 overhead athletes underwent UCL repair with internal brace augmentation during the study period. 8 were lost to follow up, leaving 58 athletes included in the study. Average age at the time of surgery was 17.9 years old. There were 43 baseball pitchers, 8 baseball position players, 4 softball players, 2 football quaterbacks, and 1 javelin thrower. 96% (54/56) of those who desired to return to the same or higher level of competition were able to do so at an average time of 6.1 months (range 3.2-12 months). 65% of these were able to return in less than 6 months. Many of those who took longer than 6 months did so due to timing within the season. Average KJOC score was 90.2 at 1-year follow-up. 3 patients required return to the operating room, 2 of which were eventually able to return to their previous level of play. There was 1 late failure over 3 years from the index procedure. Comparative subgroup data is presented in table 1. Conclusion: UCL repair with internal brace augmentation is a viable option for overhead throwers with selected UCL pathology who wish to return to sport in a shorter time frame than allowed by traditional UCL reconstruction. [Table: see text]

Anterior Shoulder Pain in a 23-Year-Old Overhead Throwing Athlete

2017 ◽  
pp. 43-58
Author(s):  
Justin W. Griffin ◽  
John D. Higgins ◽  
Timothy S. Leroux ◽  
Anthony A. Romeo
Keyword(s):  
Shoulder Pain ◽  
Throwing Athlete ◽  
Overhead Throwing ◽  
Anterior Shoulder Pain

scholarly journals Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers

2019 ◽  
Vol 47 (5) ◽  
pp. 1103-1110 ◽  
Author(s):  
Timothy B. Griffith ◽  
Christopher S. Ahmad ◽  
Prakash Gorroochurn ◽  
John D’Angelo ◽  
Michael G. Ciccotti ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Professional Baseball ◽  
Reconstruction Technique ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Palmaris Longus ◽  
Elbow Injuries ◽  
Elbow Surgery ◽  
Baseball Pitchers

Background: Professional baseball pitchers are at high risk for tears of the ulnar collateral ligament (UCL) of the elbow, often requiring surgical reconstruction. Despite acceptable published return-to-play outcomes, multiple techniques and graft types have been described. Purpose: This study compares UCL reconstruction (UCLR) outcomes based on tunnel configuration and graft type. Study Design: Cohort study; Level of evidence, 3. Methods: After approval from our institutional review board and Major League Baseball (MLB), 566 professional baseball pitchers who underwent UCLR between 2010 and 2014 were identified and included. The following patient characteristics were analyzed: age, pitching role (starter vs reliever), level of play (MLB vs Minor League Baseball [MiLB]), and throwing side dominance. Surgical factors analyzed included reconstruction technique, graft type, and concomitant procedures. Primary outcome measures consisted of the ability to return to play at any level (RTP), ability to return to the same level of play (RSL), time to return, subsequent elbow injuries, and need for subsequent or revision elbow surgery. The effects of patient and surgical factors on outcomes were analyzed using multivariate linear and logistic regression modeling. Results: The RTP rate was 79.9%, and the RSL rate was 71.2%. Grafts used to reconstruct the UCL included the palmaris longus autograft (n = 361, 63.7%), the gracilis autograft (n = 135, 23.8%), and other grafts (n = 70, 12.5%). Surgical techniques utilized were the docking technique (n = 171, 30.2%), the modified Jobe technique (n = 290, 51.2%), and other techniques (n = 105, 18.6%). There were no significant differences in the time to RTP or RSL based on reconstruction technique or graft type. RTP rates were similar for the docking versus modified Jobe technique (80.1% vs 82.4%, respectively; P = .537) and for the 2 primary graft types (83.1% for palmaris longus vs 80.7% for gracilis; P = .596). The rate of subsequent elbow surgery was 10.5% for the docking technique versus 14.8% for the modified Jobe technique ( P = .203), and the rate of revision UCLR was 2.9% versus 6.2% for the docking versus modified Jobe technique, respectively ( P = .128). Significant trends toward an increasing use of the palmaris longus autograft ( P = .023) and the docking technique ( P = .006) were observed. MLB pitchers were more likely than MiLB pitchers to RTP ( P < .001) and RSL ( P < .001), but they required a longer time to return (mean difference, 35 days; P = .039) and had a higher likelihood of subsequent elbow (odds ratio [OR], 3.58 [95% CI, 2.06-6.23]; P < .001) and forearm injuries (OR, 5.70 [95% CI, 1.99-16.30]; P = .004) but not subsequent elbow surgery. No specific variables correlated with the rates of subsequent elbow surgery or revision UCLR in the multivariate analysis. The use of concomitant ulnar nerve transposition did not affect outcomes. Conclusion: Surgical outcomes in professional baseball players are not significantly influenced by UCLR technique or graft type. There was a high rate (46.3%) of subsequent throwing elbow injuries. MLB pitchers were more likely to RTP and RSL, but they had a higher frequency of subsequent elbow and forearm injuries than MiLB pitchers. Both the docking technique and the palmaris longus autograft are increasing in popularity among surgeons treating professional baseball players.

scholarly journals Radiographic evaluation of common pediatric elbow injuries

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Steven F. DeFroda ◽  
Heather Hansen ◽  
Joseph A. Gil ◽  
Ashraf H. Hawari ◽  
Aristides I. Cruz Jr.
Keyword(s):  
The Other ◽  
Radiographic Evaluation ◽  
Skeletally Immature ◽  
Radiographic Parameters ◽  
Elbow Injuries ◽  
Clinical Diagnoses ◽  
Bony Anatomy ◽  
Skeletally Immature Patient

Normal variations in anatomy in the skeletally immature patient may be mistaken for fracture or injury due to the presence of secondary centers of ossification. Variations in imaging exist from patient to patient based on sex, age, and may even vary from one extremity to the other on the same patient. Despite differences in the appearance of the bony anatomy of the elbow there are certain landmarks and relationships, which can help, distinguish normal from abnormal. We review common radiographic parameters and pitfalls associated in the evaluation of pediatric elbow imaging. We also review common clinical diagnoses in this population.

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