Radial Head Lag: A Possible Biomechanical Mechanism for Osteochondritis Dissecans of the Capitellum in Baseball Pitchers

2021 ◽  
Vol 49 (12) ◽  
pp. 3226-3233
Author(s):  
Dani Rotman ◽  
Jae-Man Kwak ◽  
Jorge Rojas Lievano ◽  
Alexander Hooke ◽  
Christopher L. Camp ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Radial Head ◽  
Video Camera ◽  
Head Motion ◽  
Joint Motion ◽  
Elbow Extension ◽  
Valgus Stress ◽  
Active Motion ◽  
Baseball Pitchers ◽  
Elbow Motion

Background: Osteochondritis dissecans (OCD) of the capitellum is common in throwing athletes and is believed to result from repetitive overloading on the radiocapitellar (RC) joint, although the cause and mechanism remain unclear. The torsional forces (moments) generated by the triceps during elbow extension pull only on the ulna; therefore, the radial head moves passively across the capitellum and is effectively “dragged along” by the ulna. Any laxity in the proximal radioulnar joint could lead to asynchronous motion between the radius and ulna, resulting in the radial head lagging behind the coronoid and possibly malarticulating with the capitellum during such motion. Hypothesis: Radial head motion on the capitellum lags behind ulnohumeral joint motion during simulated throwing. Study Design: Controlled laboratory study. Methods: A total of 8 cadaveric elbows were tested under simulated throwing, including active extension of the elbow generated by pulling of the triceps under valgus stress, as well as during passive extension under valgus stress to serve as a reference. Ulnohumeral motion was tracked using a video camera. Radial head motion was tracked using an intra-articular, thin-film pressure sensor mounted on the capitellum, and the longitudinal movement of the center of force (COF) of the radial head was measured. Radial head motion was compared between passive and active motion for each 10° of elbow extension from 90° to 20°. Results: Elbow motion during simulated active extension reached an angular velocity of 366 deg/s. Radial head motion during simulated active extension significantly lagged compared with its motion during passive extension at every elbow extension angle examined between 70° and 20° ( P < .001). The maximal lag reached a mean of 4 mm (range, 2-7 mm). In other words, RC and ulnohumeral motion were asynchronous during simulated throwing. Conclusion: This study describes a novel phenomenon: motion of the radial head across the capitellum during rapid extension, such as in baseball pitching, lags behind that seen during passive elbow motion. According to a new proposed theory of OCD lesion development, this lag should result in RC incongruency and elevated shear forces on the capitellum due to edge loading. Clinical Relevance: We propose a new biomechanical explanation for OCD of the capitellum in baseball pitchers: radial head lag. Understanding this process is the first step in efforts to prevent this common injury.

The Effectiveness of a Hinged Elbow Orthosis in Medial Collateral Ligament Injuries: An In Vitro Biomechanical Study

2019 ◽  
Vol 47 (12) ◽  
pp. 2827-2835
Author(s):  
Ranita H.K. Manocha ◽  
James A. Johnson ◽  
Graham J.W. King
Keyword(s):  
Medial Collateral Ligament ◽  
Muscle Activation ◽  
Mechanical Stability ◽  
Biomechanical Study ◽  
Return To Play ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Active Motion ◽  
Early Return

Background: Medial collateral ligament (MCL) injuries are common after elbow trauma and in overhead throwing athletes. A hinged elbow orthosis (HEO) is often used to protect the elbow from valgus stress early after injury and during early return to play. However, there is minimal evidence regarding the efficacy of these orthoses in controlling instability and their influence on long-term clinical outcomes. Purpose: (1) To quantify the effect of an HEO on elbow stability after simulated MCL injury. (2) To determine whether arm position, forearm rotation, and muscle activation influence the effectiveness of an HEO. Study Design: Controlled laboratory study. Methods: Seven cadaveric upper extremity specimens were tested in a custom simulator that enabled elbow motion via computer-controlled actuators and motors attached to relevant tendons. Specimens were examined in 2 arm positions (dependent, valgus) and 2 forearm positions (pronation, supination) during passive and simulated active elbow flexion while unbraced and then while braced with an HEO. Testing was performed in intact elbows and repeated after simulated MCL injury. An electromagnetic tracking device measured valgus angulation as an indicator of elbow stability. Results: When the arm was dependent, the HEO increased valgus angle with the forearm in pronation (+1.0°± 0.2°, P = .003) and supination (+1.5°± 0.0°, P = .006) during active motion. It had no significant effect on elbow stability during passive motion. In the valgus position, the HEO had no effect on elbow stability during passive or active motion in pronation and supination. With the arm in the valgus position with the HEO, muscle activation reduced instability during pronation (–10.3°± 2.5°, P = .006) but not supination ( P = .61). Conclusion: In this in vitro study, this HEO did not enhance mechanical stability when the arm was in the valgus and dependent positions after MCL injury. Clinical Relevance: After MCL injury, an HEO likely does not provide mechanical elbow stability during rehabilitative exercises or when the elbow is subjected to valgus stress such as occurs during throwing.

scholarly journals Limiting the Pitch Count in Youth Baseball Pitchers Decreases Elbow Pain

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198910
Author(s):  
Tetsuya Matsuura ◽  
Yuki Takata ◽  
Toshiyuki Iwame ◽  
Jyoji Iwase ◽  
Kenji Yokoyama ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Stress Test ◽  
Daily Maximum ◽  
Test Results ◽  
Level Of Evidence ◽  
Valgus Stress ◽  
Radiographic Images ◽  
Elbow Pain ◽  
Youth Baseball ◽  
Baseball Pitchers

Background: Reducing the number of pitches thrown is regarded as the most effective way to prevent throwing injuries in youth baseball pitchers. However, few studies have compared the effectiveness of limiting the pitch count versus the limiting the number of innings pitched in terms of elbow injuries. Hypothesis: We hypothesized that, compared with inning limits, pitch count limits would lead to greater decreases in elbow pain, range of motion deficits, positive moving valgus stress test results, and the risk of capitellar osteochondritis dissecans (OCD). Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively reviewed baseball pitchers aged 8 to 12 years in 2017 and 2018. Inning and pitch count limits in games were set to a daily maximum of 7 innings in 2017 and 70 pitches in 2018. Elbow pain, range of motion, and moving valgus stress test results were evaluated. The presence of capitellar OCD was assessed on ultrasonographic and radiographic images. Results: A total of 352 pitchers in 2017 and 367 pitchers in 2018 participated. The mean pitch count per game was lower in the pitch count limit (CL) group (52.5 ± 16.0) than in the inning limit (IL) group (98.2 ± 19.5) ( P < .001). Compared with the IL group, the CL group had significantly lower rates of elbow pain (40.9% vs 31.9%, respectively; P = .01) and reduced flexion (19.0% vs 10.6%, respectively; P = .001). Multivariate analysis revealed a significant association between elbow pain and age in both the IL and the CL groups ( P < .0001 and P = .02, respectively) and between OCD and elbow pain in the CL group ( P = .04). Conclusion: A pitch count limit of ≤70 pitches per day for baseball pitchers ≤12 years could be more protective against elbow pain and reduced flexion than a limit of ≤7 innings per day, but it may not be effective for reducing the risk of capitellar OCD.

scholarly journals Pilot report: non-operative treatment of Mayo Type II olecranon fractures in any-age adult patient

2017 ◽  
Vol 9 (4) ◽  
pp. 285-291 ◽  
Author(s):  
Matthew D. Putnam ◽  
Christy M. Christophersen ◽  
Julie E. Adams
Keyword(s):  
Supportive Care ◽  
Operative Treatment ◽  
Type Ii ◽  
Post Injury ◽  
Active Motion ◽  
Non Union ◽  
The Mean ◽  
Elbow Motion ◽  
Olecranon Fractures

Background We report on the non-operative treatment of Mayo Type II olecranon fractures. Methods Fourteen isolated Mayo Type II olecranon fractures were treated non-operatively, followed to discharge, and retrospectively reviewed. Treatment was splinting in extension followed by protected active motion beginning 3 weeks to 4 weeks post-injury. Mayo Elbow Performance Index (MEPI) and Shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were available in 86% and 64% of cases, respectively. Follow-up radiographs were obtained. Results At discharge, the mean (SD) MEPI score was 95 (5). The mean (SD) elbow motion arc was 121° (21°). One patient re-fractured his elbow after discharge by falling on the ice. He recovered after open reduction and internal fixation. One patient (documented Marfan syndrome) developed an asymptomatic non-union. Excepting the patient who fell, no patient received additional care. Conclusions In this pilot report, Mayo Type II olecranon fractures were treated non-operatively to discharge. Good to excellent results were obtained in all patients according to the MEPI. Supportive care of these fractures should be comparatively studied. A downside risk to providing supportive care for these fractures was not identified.

scholarly journals Radial head fractures

2019 ◽  
Vol 12 (3) ◽  
pp. 212-223 ◽  
Author(s):  
RP van Riet ◽  
MPJ van den Bekerom ◽  
A Van Tongel ◽  
C Spross ◽  
R Barco ◽  
...  
Keyword(s):  
Radial Head ◽  
Long Term Results ◽  
Valgus Stress ◽  
Proximal Ulna ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Radial Head Replacement ◽  
Treatment Type ◽  
Radial Head Resection ◽  
Type 3

The shape and size of the radial head is highly variable but correlates to the contralateral side. The radial head is a secondary stabilizer to valgus stress and provides lateral stability. The modified Mason–Hotchkiss classification is the most commonly used and describes three types, depending on the number of fragments and their displacement. Type 1 fractures are typically treated conservatively. Surgical reduction and fixation are recommended for type 2 fractures, if there is a mechanical block to motion. This can be done arthroscopically or open. Controversy exists for two-part fractures with >2 mm and <5 mm displacement, without a mechanical bloc as good results have been published with conservative treatment. Type 3 fractures are often treated with radial head replacement. Although radial head resection is also an option as long-term results have been shown to be favourable. Radial head arthroplasty is recommended in type 3 fractures with ligamentous injury or proximal ulna fractures. Failure of primary radial head replacement may be due to several factors. Identification of the cause of failure is essential. Failed radial head arthroplasty can be treated by implant removal alone, interposition arthroplasty, revision radial head replacement either as a single stage or two-stage procedure.

Accuracy and Precision of a Control System for an Elbow Joint Simulator

2008 ◽  
Author(s):  
Patrick J. Schimoler ◽  
Jeffrey S. Vipperman ◽  
Laurel Kuxhaus ◽  
Daniel D. Budny ◽  
Angela M. Flamm ◽  
...  
Keyword(s):  
Control System ◽  
Soft Tissue ◽  
Radial Head ◽  
Elbow Joint ◽  
Joint Motion ◽  
Joint Mechanics ◽  
Scientific Investigations ◽  
Accuracy And Precision ◽  
Control Schemes ◽  
Joint Implants

Joint motion simulators (JMS’s) have been developed for many applications enabling the repeatable testing of prostheses, scientific investigations of joint mechanics and the study of surgical procedures.[1–4] Although Morrey has reported that radial head implants have lower post-operative satisfaction than other joint implants[5] and Dunning has examined several issues with radial heads, many problems remain.[6] It is therefore beneficial to develop a simulator capable of evaluating radial head implants. A robust simulator can also provide the ability to test soft tissue strains at the elbow and compare control schemes that may elucidate the body’s means of controlling multiaxial multimuscle systems.

Changes in Camera Visibility Affect Measured Marker Motion

2007 ◽  
Author(s):  
Laurel Kuxhaus ◽  
Patrick J. Schimoler ◽  
Jeffrey S. Vipperman ◽  
Mark E. Baratz ◽  
Mark Carl Miller
Keyword(s):  
Image Reconstruction ◽  
Motion Analysis ◽  
Large Volume ◽  
Radial Head ◽  
The Body ◽  
Reconstruction Process ◽  
Anatomical Constraints ◽  
Elbow Motion

Motion analysis is an important tool for biomechanical studies and its accuracy and reliability for large-volume applications, such as gait labs, is well-established. Previous work has offered a comparison of commercially available systems.[1] No work to date has quantified the error in position of a given tracking marker caused by its removal from the view of one or more cameras, either by obstruction or by the data being removed during the image reconstruction process. This issue is critical to the tracking of extremely fine movements such as the travel of the radial head on the capitellum during elbow motion. Due to anatomical constraints, markers must frequently be placed a distance away from the body of interest and must be smaller than those conventionally used in gross motion analysis. The nature of the motion may not permit all cameras to view all markers all of the time. For example, a specimen may itself obstruct a camera’s view during certain motions.

Articular Surface Area of the Coronoid Process and Radial Head in Elbow Extension: Surface Ratio in Cadavers and a Computed Tomography Study In Vivo

2010 ◽  
Vol 35 (7) ◽  
pp. 1120-1125 ◽  
Author(s):  
Seong-Ho Shin ◽  
In-Ho Jeon ◽  
Hyo-Jin Kim ◽  
Matthew McCullough ◽  
Jae-Hyuck Yi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surface Area ◽  
Radial Head ◽  
Articular Surface ◽  
Coronoid Process ◽  
Elbow Extension

Closed Reduction and Percutaneous Pinning of Fractures of the Proximal Phalanx

2001 ◽  
Vol 26 (1) ◽  
pp. 45-49 ◽  
Author(s):  
E. E. HORNBACH ◽  
M. S. COHEN
Keyword(s):  
Flexor Tendon ◽  
Proximal Phalanx ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Joint Motion ◽  
Percutaneous Pinning ◽  
Kirschner Wires ◽  
Rotational Deformity ◽  
Active Motion ◽  
Total Active Motion

This study reports the results of 12 unstable extraarticular fractures of the proximal phalanx treated with transarticular intramedullary Kirschner wires. Early proximal interphalangeal joint motion was allowed and all patients achieved uneventful union, with an average total active motion of 265°. Objective physical assessment revealed one significant flexion contracture, one flexor tendon adhesion and one significant rotational deformity. Excellent results were observed in ten of the 12 patients.

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