scholarly journals Clinical Value of an Acute Popping Sensation in Throwing Athletes With Medial Elbow Pain for Ulnar Collateral Ligament Injury

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989327
Author(s):  
Rik J. Molenaars ◽  
Michel P.J. van den Bekerom ◽  
Mark R. Nazal ◽  
Denise Eygendaal ◽  
Luke S. Oh
Keyword(s):  
Likelihood Ratio ◽  
Injury Severity ◽  
Positive Likelihood Ratio ◽  
Ulnar Collateral Ligament ◽  
Senior Author ◽  
Low Grade ◽  
High Grade ◽  
Full Thickness ◽  
Collateral Ligament ◽  
Elbow Pain

Background: Throwing athletes sustaining an ulnar collateral ligament (UCL) injury may recall a popping sensation originating from the medial elbow at the time of injury. There are no studies available that inform clinicians how to utilize this salient anamnestic information and what amount of diagnostic weight to afford to it. Purpose: To assess the diagnostic value of a popping sensation for significant UCL injury in throwing athletes who sustained an injury causing medial elbow pain. Study Design: Cohort study (prognosis); Level of evidence, 3. Methods: A total of 207 consecutive patients with throwing-related medial elbow pain were evaluated for UCL injury by the senior author between 2011 and 2016. The presence or absence of a popping sensation was routinely reported by the senior author. Magnetic resonance imaging was evaluated for UCL injury severity and classified into intact, edema/low-grade partial-, high-grade partial-, and full-thickness tears. Results: The overall frequency of a pop was 26%. The proportion of patients who reported a pop significantly increased with UCL tear severity ( P < .001), from 13% in patients with low-grade UCL injuries to 26% in patients with high-grade partial-thickness tears and 51% in patients with full-thickness tears. The positive likelihood ratio, negative likelihood ratio, and odds ratio of a popping sensation for significant UCL injury were 3.2, 0.7, and 4.4 ( P < .001), respectively ( P < .001). A pop was not associated with either distal or proximal UCL tears ( P ≥ .999). Conclusion: A popping sensation at the time of injury in throwing athletes with medial elbow pain was associated with UCL injury severity. When a throwing athlete reports a pop, this should moderately increase a clinician’s suspicion for a significant UCL injury. Conversely, absence of a pop should not substantially decrease suspicion for significant UCL injury. The findings of this study allow for the clinical interpretation of the salient anamnestic finding of a pop at the time of injury, which can be used for diagnostic purposes as well as patient counseling. This study provides reference foundation for future studies of predictive and diagnostic factors for UCL injury in throwing athletes.

scholarly journals Effectiveness of contrast-enhanced ultrasound for detecting the staging and grading of bladder cancer: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Xinyue Ge ◽  
Zhong-Kai Lan ◽  
Jing Chen ◽  
Shang-Yong Zhu
Keyword(s):  
Bladder Cancer ◽  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Positive Likelihood Ratio ◽  
Cochrane Library ◽  
Forest Plot ◽  
Low Grade ◽  
High Grade ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced

Aim: The study retrospectively analysed the accuracy of preoperative contrast-enhanced ultrasound (CEUS) in differenti-ating stage Ta-T1 or low-grade bladder cancer (BC) from stage T2 or high-grade bladder cancer. Material and methods: We systematically searched the literature indexed in PubMed, Embase, and the Cochrane Library for original diagnostic articles of bladder cancer. The diagnostic accuracy of CEUS was compared with cystoscopy and/or transurethral resection of bladder tumors (TURBT). The bivariate logistic regression model was used for data pooling, couple forest plot, diagnostic odds ratio (DOR) and summary receiver operating characteristic (SROC). Results: Five studies met the selection criteria; the overall number of reported bladder cancers patients were 436. The pooled-sensitivity (P-SEN), pooled-specificity (P-SPE), pooled-positive likelihood ratio (PLR+), pooled-negative likelihood ratio (PLR−), DOR, and area under the SROC curve were 94.0% (95%CI: 85%–98%), 90% (95%CI: 83%–95%), 9.5 (95%CI: 5.1–17.6), 0.06 (95%CI: 0.02–0.17), 147 (95%CI: 35–612) and 97% (95% CI: 95%–98%) respectively. Conclusion: CEUS reaches a high efficiency in discriminating Ta-T1 or low-grade bladder cancer from stage T2 or high-grade bladder cancer. It can be a promising method in patients to distinguish T staging and grading of bladder cancer because of its high sensitivity, specificity and diagnostic accuracy.

Unusual Cause of Lateral Elbow Pain: A Case Report of Anconeus Muscle Contusion

2019 ◽  
Vol 34 (2) ◽  
pp. 102-104
Author(s):  
Muhsin E Uluc ◽  
Atilla H Cilengir ◽  
Cemal Kazimoglu ◽  
Özgür Tosun
Keyword(s):  
Case Report ◽  
Elbow Joint ◽  
Rare Case ◽  
Ulnar Collateral Ligament ◽  
Joint Capsule ◽  
Coronoid Process ◽  
Collateral Ligament ◽  
Elbow Pain ◽  
Lateral Elbow Pain ◽  
Lateral Elbow

The anconeus muscle is a small and minor functioning muscle located at the posterolateral elbow region. It helps forearm extension and tightening of the joint capsule. Despite its limited functions, pathologies of the anconeus muscle can mimic other abnormalities of the elbow joint. Here, we report a rare case of a traumatic anconeus muscle contusion in a 15-year-old boy due to falling during dance. MRI showed contusion in the anconeus muscle, as well as strain in the ulnar collateral ligament and edema in the coronoid process of the ulna. To our knowledge, this is the first described case of traumatic anconeus muscle contusion in the literature. The presence of long-lasting lateral elbow pain in trauma cases without fracture should alert clinicians to consider anconeus muscle abnormalities. MRI is the best modality for diagnosis in these cases.

scholarly journals Trends in Sports-Related Elbow Ulnar Collateral Ligament Injuries

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773129 ◽  
Author(s):  
Jason L. Zaremski ◽  
JoAnna McClelland ◽  
Heather K. Vincent ◽  
MaryBeth Horodyski
Keyword(s):  
Odds Ratio ◽  
Injury Severity ◽  
Ulnar Collateral Ligament ◽  
International Classification Of Diseases ◽  
Collateral Ligament ◽  
Surgical Interventions ◽  
Injury Management ◽  
Nonsurgical Management ◽  
Older Athletes ◽  
Partial Tears

Background: Elbow ulnar collateral ligament (UCL) injuries are common, particularly in adolescent athletes playing overhead sports. While the incidence and outcomes of surgical UCL injuries are well documented, the nonsurgical UCL injury patterns and injury management in this population are not yet known. Purpose/Hypothesis: The purpose of this study was to retrospectively assess the injury severity and subsequent management of UCL injuries among competitive athletes aged 11 to 22 years. We hypothesized that nonsurgical UCL injuries would occur more frequently in younger athletes compared with older athletes. Study Design: Descriptive epidemiological study. Methods: Electronic medical records (using International Classification of Diseases, 9th Revision and 10th Revision and Current Procedural Terminology codes) and keyword searches were used to identify all patients with sports-related UCL injuries between January 2000 and April 2016. A total of 136 records were included. Patients were stratified into 3 age brackets (age 11-13 years, n = 17; age 14-16 years, n = 49; age 17-22 years, n = 70). There were no prior elbow surgical interventions. The main outcome measures included the frequency and severity of UCL injuries and injury management (surgical, nonsurgical). Independent variables included age, UCL injuries per year, and sport classification. Results: There were 53 surgical and 83 nonsurgical UCL injuries. The number of nonsurgical cases increased 9-fold from 2000-2008 to 2009-2016. The UCL injuries were distributed as follows: 60 sprains, 39 partial tears, 36 ruptures, and 1 rerupture. Moreover, 7% of sprains, 51% of partial tears, and 78% of ruptures underwent UCL reconstruction. Nonsurgical management was most common in the youngest athletes (age 11-13 years, 100.0% of total injuries; age 14-16 years, 71.4% of total injuries; and age 17-22 years, 44.3% of total injuries) ( P = .007). UCL injury volume was most commonly associated with javelin (odds ratio, 6.69; 95% CI, 0.72-61.62; P = .07) and baseball (odds ratio, 1.55; 95% CI, 0.69-3.51; P = .32). Conclusion: Younger athletes sustained less severe UCL injuries more often than older athletes. Participation in javelin and baseball was associated with a greater likelihood of UCL injuries based on our dataset. This is the first study to provide data on the volume of nonsurgical UCL injuries among athletes in various sports.

scholarly journals Diagnostic accuracy of computed tomography angiography (CTA) for diagnosing blunt cerebrovascular injury in trauma patients: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Charlotte C. Kik ◽  
Willem-Bart M. Slooff ◽  
Nizar Moayeri ◽  
Pim A. de Jong ◽  
Sander P. J. Muijs ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Odds Ratio ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Diagnostic Odds Ratio ◽  
Cochrane Library ◽  
Low Grade ◽  
Trauma Patients ◽  
Low Sensitivity

Abstract Objectives Previous literature showed that the diagnostic accuracy of computed tomographic angiography (CTA) is not equally comparable with that of the rarely used golden standard of digital subtraction angiography (DSA) for detecting blunt cerebrovascular injuries (BCVI) in trauma patients. However, advances in CTA technology may prove CTA to become equally accurate. This study investigated the diagnostic accuracy of CTA in detecting BCVI in comparison with DSA in trauma patients. Methods An electronic database search was performed in PubMed, EMBASE, and Cochrane Library. Summary estimates of sensitivity, specificity, positive and negative likelihood, diagnostic odds ratio, and 95% confidence intervals were determined using a bivariate random-effects model. Results Of the 3293 studies identified, 9 met the inclusion criteria. Pooled sensitivity was 64% (95% CI, 53–74%) and specificity 95% (95% CI, 87–99%) The estimated positive likelihood ratio was 11.8 (95%, 5.6–24.9), with a negative likelihood ratio of 0.38 (95%, 0.30–0.49) and a diagnostic odds ratio of 31 (95%, 17–56). Conclusion CTA has reasonable specificity but low sensitivity when compared to DSA in diagnosing any BCVI. An increase in channels to 64 slices did not yield better sensitivity. There is a risk for underdiagnosis of BCVI when only using DSA to confirm CTA-positive cases, especially in those patients with low-grade injuries. Key Points • Low sensitivity and high specificity were seen in identifying BCVI with CTA as compared to DSA. • Increased CTA detector channels (≤ 64) did not lead to higher sensitivity when detecting BCVI. • The use of CTA instead of DSA may lead to underdiagnosis and, consequently, undertreatment of BCVI.

Serious Inhalation Injuries From Military Operations in Afghanistan, Iraq, and Syria

2020 ◽  
pp. 088506662095661
Author(s):  
Michael J. Coulter ◽  
Roxanne C. Mickelson ◽  
Judy L. Dye ◽  
Kaeley B. Shannon ◽  
Art A. Ambrosio
Keyword(s):  
Injury Severity ◽  
Low Grade ◽  
High Grade ◽  
Military Operations ◽  
Post Injury ◽  
Medical Encounter ◽  
Statistical Correlations ◽  
Military Members ◽  
Medical Facilities ◽  
Facial Burn

Objective: To characterize serious inhalation injuries seen during recent military operations, and assess whether bronchoscopic severity findings were associated with clinical presentation and outcomes. Methods: Service members who suffered inhalation injuries while deployed to Iraq, Afghanistan, or Syria from 2001-2018 were identified using ICD-9 and 10 codes from the Expeditionary Medical Encounter Database (EMED), which is abstracted from patient records in forward-deployed medical facilities. Further information including demographics, mechanism of injury, mortality, total burn surface area (TBSA), degree of facial burn, total Injury Severity Score (ISS), and first post-injury bronchoscopy notes were collected. Patients were excluded with ISS less than 16 or without sufficient details regarding bronchoscopy. Injuries were grouped based on bronchoscopic Abbreviated Injury Scores (AIS) into low-grade (AIS of 1), moderate-grade (AIS of 2), or high-grade (AIS of 3 or 4). Results: 91 patients met inclusion criteria, with no significant differences in age, gender, paygrade, or service branch between degrees of injury. There were no statistical correlations between grade of injury and battle versus non-battle injury, blast versus non-blast mechanism, TBSA, or degree of facial burn. High-grade injuries had significantly higher ISS than low or moderate-grade injuries. After adjusting for ISS, the odds ratio of death was 10.4 (95% CI 1.47 to 74.53) for those with high-grade and 3.7 (95% CI 0.45 to 32.30) for those with moderate-grade compared to low-grade injuries. Conclusion: In this cohort of deployed military members with inhalation injuries, initial bronchoscopic severity findings are strongly associated with mortality even after adjusting for ISS. The AIS may be an important prognostic tool in all of those with serious inhalation injuries.

scholarly journals Medial Elbow Pain During the Return-to-Throwing Period After Ulnar Collateral Ligament Reconstruction in Pitchers

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880878
Author(s):  
Robert A. Keller ◽  
Nathan E. Marshall ◽  
Orr Limpisvasti ◽  
Anthony F. DeGiacomo ◽  
Michael Banffy ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Single Institution ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Elbow Pain ◽  
Mean Time ◽  
Control Study ◽  
Ulnar Collateral Ligament Reconstruction

Background: Ulnar collateral ligament reconstruction (UCLR) is common in the sport of baseball, particularly among pitchers. Postoperative return-to-sport protocols have many players beginning to throw at 4 to 5 months and returning to full competition between 12 and 16 months after surgery. Medial elbow pain during the return-to-throwing period often occurs and can be difficult to manage. Purpose: To evaluate the incidence of medial elbow pain and associations with outcomes and revision surgery during the return-to-throwing period after UCLR. Study Design: Case-control study; Level of evidence, 3. Methods: Between the years of 2002 and 2014, all pitchers who underwent UCLR at a single institution were identified. Charts were reviewed for incidence of medial elbow pain during return to throwing, return to sport, and subsequent operative interventions, including revision ulnar collateral ligament surgery. Results: Of a total of 616 pitchers who underwent UCLR during the study period, 317 were included in this study. Medial elbow pain was experienced by 45.1% (143 of 317), with a mean time of complaint of 9.75 months after surgery. The groups with and without pain did not differ statistically with regard to age (pain, 20.6 years; no pain, 20.9 years) or level of competition. Of those who experienced medial elbow pain, 10.5% did not return to sport; 5.6% underwent revision UCLR; and 19.6% underwent other operative procedures at the elbow. Among those who did not experience medial elbow pain when returning to throw, 8.7% did not return to sport, with only 1.7% undergoing revision UCLR and 6.9% undergoing other operative elbow procedures. Conclusion: Of the pitchers evaluated in the study, approximately half reported pain during the return-to-throwing phase after UCLR. Those who experienced medial elbow pain had a higher rate of subsequent surgical intervention.

scholarly journals Clinical utility of arterial spin labeling for preoperative grading of glioma

2018 ◽  
Vol 38 (4) ◽  
Author(s):  
Jun Fu ◽  
Linchen Li ◽  
Xinjun Wang ◽  
Min Zhang ◽  
Yan Zhang ◽  
...  
Keyword(s):  
Likelihood Ratio ◽  
Arterial Spin Labeling ◽  
Clinical Utility ◽  
Meta Analysis ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Spin Labeling ◽  
Clinical Diagnostics ◽  
Biological Behavior ◽  
Low Grade

There were obvious differences in biological behavior and prognosis between low- and high-grade gliomas, it is of great importance for clinicians to make a right judgement for preoperative grading. We conducted a comprehensive meta-analysis to evaluate the clinical utility of arterial spin labeling for preoperative grading. We searched the PubMed, Embase, China National Knowledge Infrastructure, and Weipu electronic databases for articles published through 10 November 2017 and used ‘arterial spin-labeling’ or ‘ASL perfusion, grading’ or ‘differentiation, glioma’ or ‘glial tumor, diagnostic test’ as the search terms. A manual search of relevant original and review articles was performed to identify additional studies. The meta-analysis included nine studies. No obvious heterogeneity was found in the data in a fixed-effect model. The pooled sensitivity and specificity were 90% (95% confidence interval (CI): 0.84–0.94) and 91% (95% CI: 0.83–0.96), respectively, and the pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 10.40 (95% CI: 2.21–20.77) and 0.11 (95% CI: 0.07–0.18). The diagnostic odds ratio (DOR) was 92.47 (95% CI: 39.61–215.92). The diagnostic score was 4.53 (95% CI: 3.68–5.38). The area under the curve (AUC) was 0.94 (95% CI: 0.91–0.96). Subgroup analyses did not change the pooled results. No publication bias was found (P=0.102). The normalized maximal tumor blood flow/normal white matter ratio obtained with the arterial spin labeling technique was relatively accurate for distinguishing high/low-grade glioma. As a non-invasive procedure with favorable repeatability, this index may be useful for clinical diagnostics.

scholarly journals MAGNETIC RESONANCE IMAGING FINDINGS ASSOCIATED WITH ULNAR COLLATERAL LIGAMENT TEARS IN ADOLESCENT BASEBALL PITCHERS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0007
Author(s):  
Ben Cox ◽  
Hillary Plummer ◽  
Eric Goodrich ◽  
James Andrews ◽  
Michael Saper
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ulnar Collateral Ligament ◽  
High Grade ◽  
Type Ii ◽  
Resonance Imaging ◽  
Collateral Ligament ◽  
Plain Radiographs ◽  
Partial Tears ◽  
Baseball Pitchers

BACKGROUND: The number of ulnar collateral ligament (UCL) injuries in adolescent baseball pitchers has risen over the past 2 decades with the incidence of UCL reconstructions also increasing dramatically over that time period. The Joyner-Andrews magnetic resonance imaging (MRI) classification of UCL tears has previously been described to describe the grade and location of tears, which can aid in surgical decision-making. However, the classification of UCL tears in the at-risk adolescent population has yet to fully investigated. Improving our knowledge of these injuries is crucial to help drive targeted evidence-based treatment strategies. The purpose of this study was to examine the grade and location UCL tears using the Joyner-Andrews MRI classification in a large group of adolescent baseball pitchers. METHODS: We reviewed 225 symptomatic adolescent (aged =19 years) male baseball pitchers with UCL injuries treated by the senior author from 2007-2016. All patients had failed conservative treatment prior to evaluation. Pitchers with a prior history of elbow surgery were excluded. Plain radiographs and MRI arthrograms were evaluated for each patient to categorize the UCL injury and associated pathology. The images were reviewed by a sports medicine-trained orthopedic surgeon. UCL tear grade and location were classified using the Joyner-Andrews classification. RESULTS: The mean age at the time of evaluation was 17.2 ± 1.5 years. 56% of the patients were high school athletes. The majority (59.1%) of UCL tears were high-grade partial tears (Type II). Of those 53.4% were on the humeral side (Type II H). The least common tear types were low-grade partial tears (I) and tears in more than one location (Type IV) in 1.3% and 0.9% of patients, respectively. Plain radiographs revealed 31.4% of patients had abnormal findings; calcifications and olecranon osteophytes were present in 10% and 13% of patients, respectively and more commonly occurred in patients with Type II tears. CONCLUSIONS: The results of this study showed that the majority of adolescent baseball pitchers (59%) sustain high-grade partial tears of the UCL. These findings suggest that effective non-reconstruction options such as platelet-rich plasma and UCL repair with internal brace augmentation could be ideal alternatives to UCL reconstruction for these young patients. The high percentage of radiographic abnormalities in these patients highlights the adaptive changes about the elbow in response to the repetitive stresses experienced by the young elbow during throwing.

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