Diagnostic Imaging of Ulnar Collateral Ligament Injury: A Systematic Review

2020 ◽  
Vol 48 (11) ◽  
pp. 2819-2827 ◽  
Author(s):  
Richard E. Campbell ◽  
Alexa N. McGhee ◽  
Kevin B. Freedman ◽  
Fotios P. Tjoumakaris
Keyword(s):  
Computed Tomography ◽  
Systematic Review ◽  
Diagnostic Imaging ◽  
Sensitivity And Specificity ◽  
Ulnar Collateral Ligament ◽  
Imaging Modalities ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Overhead Athletes ◽  
Imaging Results

Background: Ulnar collateral ligament (UCL) injuries can be debilitating in overhead athletes. Accurate diagnosis is important; however, several imaging modalities are available for the assessment of UCL injuries. Purpose: To provide a comprehensive review of published literature regarding the diagnostic capabilities of different imaging modalities for UCL tears. Methods: PubMed, Medline, and Embase were queried for peer-reviewed literature published between January 1947 and June 4, 2019, pertaining to diagnostic imaging of UCL tears. Articles assessing static and stress radiography, ultrasound, magnetic resonance imaging (MRI), MRI with arthrography (MRA), and computed tomography arthrography of the UCL were included. Studies were excluded if imaging results were not compared with intraoperative diagnosis, as intraoperative findings are generally considered the gold standard for diagnostic comparison. The articles were assessed per the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines and reviewed with the Quality Assessment of Diagnostic Accuracy Studies, version 2 (QUADAS-2) assessment. Results: The literature search yielded 2478 articles, of which 15 were included in this review. Potential bias was noted in each QUADAS-2 subsection. Multiple studies demonstrate an association between UCL tears and osseous abnormalities identified on static radiographs; however, the use of static or nonstressed radiographs is not recommended for specific evaluation of UCL injuries. Conventional ultrasound was 81% sensitive and 91% specific, as compared with 96% and 81% for stress ultrasound, respectively. The sensitivity and specificity of MRI ranged from 57% to 100% and 89% to 100%. The sensitivity of computed tomography arthrography ranged from 63% to 86%. The sensitivity and specificity of MRA ranged from 81% to 100% and 91% to 100%. Conclusion: Of the currently available imaging modalities, MRA provides the best combination of sensitivity and specificity of the evaluation of the UCL. Further research comparing ultrasound with MRA is needed.

scholarly journals Conservative Versus Surgical Management of Elbow Medial Ulnar Collateral Ligament Injury: A Systematic Review

2019 ◽  
Vol 11 (6) ◽  
pp. 974-984 ◽  
Author(s):  
Carlo Biz ◽  
Alberto Crimì ◽  
Elisa Belluzzi ◽  
Nicola Maschio ◽  
Riccardo Baracco ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Management ◽  
Ulnar Collateral Ligament ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Ulnar Collateral Ligament Injury

The success of return to sport after ulnar collateral ligament injury in baseball: a systematic review and meta-analysis

2018 ◽  
Vol 27 (3) ◽  
pp. 561-571 ◽  
Author(s):  
Scott D. Peters ◽  
Garrett S. Bullock ◽  
Adam P. Goode ◽  
Grant E. Garrigues ◽  
David S. Ruch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Ulnar Collateral Ligament Injury

scholarly journals Considerations of Conservative Treatment After a Partial Ulnar Collateral Ligament Injury in Overhead Athletes: A Systematic Review

2019 ◽  
Vol 11 (4) ◽  
pp. 367-374
Author(s):  
Nicole Cascia ◽  
Kelsey Picha ◽  
Carolyn M. Hettrich ◽  
Tim L. Uhl
Keyword(s):  
Systematic Review ◽  
Conservative Treatment ◽  
Study Design ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Evidence Based ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Rehabilitation Protocol ◽  
Overhead Athletes

Context: Ulnar collateral ligament (UCL) reconstructions continue to increase without consensus on an evidence-based treatment protocol for nonoperative management. Currently, there is no consensus on an effective nonoperative protocol for partial UCL injuries that uses return-to-play (RTP) rates in determining the outcome of conservative treatment. Objective: To systematically review RTP rates after conservative treatment of partial UCL injuries in overhead athletes along with descriptive components of each conservative intervention to identify an effective evidence-based nonoperative rehabilitation protocol. Data Sources: Articles in PubMed, CINAHL, MEDLINE, Academic Search Complete, and SPORTDiscus were identified in October 2018 based on the following terms: overhead athlete, ulnar collateral ligament, nonoperative treatment, and return to play. Study Selection: Seven retrospective, level 4 studies (n = 196) qualified for analysis. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Study design, level of evidence, demographics, sample size, sports involved, level of competition, grade or type of UCL diagnosis, conservative treatment components, and percentage RTP were extracted. Results: Overall, RTP rates after conservative treatment ranged between 42% and 100% (mean, 78% ± 20%). The most frequently reported components of rehabilitation protocols were (1) a period of rest, (2) stretching, (3) strengthening, and (4) a throwing program. Platelet-rich plasma injections were included in 5 (71%) of the 7 protocols with a rehabilitation period. Conclusion: Conservative treatment is a viable option for partial UCL tears in overhead athletes. A successful rehabilitation protocol includes the use of patient-reported outcomes, a sport-specific tailored treatment plan, kinetic chain strengthening, and an interval throwing program. Factors such as age, grading of tear, level of play, sport, and athlete’s perceived well-being should all be considered during treatment decisions.

Effect of Younger Starting Pitching Age on Humeral Retrotorsion in Baseball Pitchers With an Ulnar Collateral Ligament Injury

2021 ◽  
pp. 036354652199080
Author(s):  
Sean M. Kennedy ◽  
Joseph P. Hannon ◽  
John E. Conway ◽  
Kalyssa Creed ◽  
J. Craig Garrison
Keyword(s):  
Ulnar Collateral Ligament ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Significant Difference ◽  
Ulnar Collateral Ligament Injury ◽  
Baseball Pitchers ◽  
Group 2 ◽  
Group 1

Background: Increased humeral retrotorsion (HRT) has been found to be a risk factor for ulnar collateral ligament (UCL) tears in baseball players. Recent work has demonstrated the age of 11 years as a potential watershed age for HRT development. Hypothesis: In a group of baseball pitchers with UCL injuries, athletes who started pitching before the age of 10 years will demonstrate significantly more dominant limb humeral retrotorsion (DHRT) when compared with a group of baseball pitchers who reported starting pitching at 10 years or older. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 84 baseball pitchers with a diagnosed UCL injury were divided into 2 groups based upon the age at which participants began pitching: 33 players reporting a starting pitching age of 10 years or older (group 1) were compared with 51 baseball pitchers reporting a starting pitching age under 10 years (group 2). Participants’ DHRT and nondominant limb humeral retrotorsion (NDHRT) were measured using diagnostic ultrasound. Independent t tests were run to compare mean group differences of all patient data, starting pitching age, age at time of injury, DHRT, NDHRT, and humeral retrotorsion difference (HRTdiff). Results: There were no significant differences between groups with regard to age at time of injury, height, weight, or playing years’ experience. There was a statistically significant difference in the participant-reported starting pitching age. Significant differences between groups were noted for DHRT (group 1: 20.0°± 9.4°, group 2: 14.5°± 10.3°, P = .015) and for NDHRT (group 1: 38.6°± 8.8°, group 2: 32.9°± 9.5°, P = .007). No significant differences between groups were found for HRTdiff ( P = .940). Conclusion: Baseball pitchers with a UCL injury who reported a starting pitching age younger than 10 years demonstrated significantly greater DHRT and NDHRT when compared with UCL-injured baseball pitchers who reported a starting pitching age at 10 years or later. The results of this study demonstrate that a younger starting pitching age results in increased HRT in players with UCL injuries.

RADIOLOGIC CASE STUDY: Ulnar collateral ligament injury

Orthopedics ◽  
1998 ◽  
Vol 21 (7) ◽  
pp. 827-827
Author(s):  
Franklin Tan ◽  
Laurie M Lomasney ◽  
Terence C Demos
Keyword(s):  
Ulnar Collateral Ligament ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Ulnar Collateral Ligament Injury
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