scholarly journals Changes in Medial Elbow Joint Space When Elbow Valgus Stress Is Applied at Different Limb Positions and Loads In Vivo

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110459
Author(s):  
Kanta Yoshioka ◽  
Kanta Matsuzawa ◽  
Tomoya Ikuta ◽  
Sae Maruyama ◽  
Mutsuaki Edama
Keyword(s):  
Repeated Measures ◽  
Elbow Joint ◽  
Ulnar Collateral Ligament ◽  
Elbow Flexion ◽  
Sports Injury ◽  
Joint Space ◽  
Muscle Contractions ◽  
Collateral Ligament ◽  
Valgus Stress

Background: Ulnar collateral ligament (UCL) injury is a common sports injury among overhead-throwing athletes and causes medial elbow pain and instability. UCL injury is generally diagnosed based on symptoms, physical findings, and image evaluation. To standardize the method for evaluating elbow valgus instability, more information is needed regarding changes in the medial elbow joint space (JS) in healthy elbows. Purpose/Hypothesis: The purpose of this study was to measure the JS during the application of elbow valgus stress at different elbow flexion angles and loads and to clarify the presence of defensive muscle contractions during elbow valgus stress. It was hypothesized that the JS will differ according to different limb positions and loads and that defensive contractions will occur when elbow valgus stress is >90 N. Study Design: Controlled laboratory study. Methods: Elbow joints on the nondominant side were examined in 20 healthy male university students (mean age, 21 ± 0.2 years) at 30°, 60°, and 90° of elbow flexion. To create valgus stress on the elbow, loads of 30, 60, 90, 120, and 150 N were applied with a Telos stress device and with gravity stress on the forearm. The medial JS was measured ultrasonographically during the application of elbow valgus stress. Electrodes were attached to the pronator teres muscle, and defensive muscle contractions were measured using electromyography during the application of elbow valgus stress. Repeated-measures analysis of variance and paired t tests were used to compare the JS at each elbow angle and each valgus stress load, and the Bonferroni method was used as a post hoc test. Results: At 30° of elbow flexion, the JS was significantly higher at 30 N versus 0 N and at 60 N versus 0 or 30 N ( P ≤ .018 for all). At 60° of flexion, the JS was significantly higher at 30 N versus 0 N, at 60 N versus 0 and 30 N, and at 90 N versus 0, 30, and 60 N ( P ≤ .024 for all). At 90° of elbow flexion, the JS was significantly higher at 30 N versus 0 N and at 60 N versus 0 and 30 N ( P ≤ .028 for all). Defensive muscle contraction did not occur at any elbow flexion angles at elbow valgus stress ≤60 N. Conclusion: The lack of muscular contraction at elbow valgus stress ≤60 N may reflect the function of the medial collateral ligament. Clinical Relevance: Elbow valgus stress ≤60 N allows for the evaluation of the joint opening.

Medial Elbow Joint Laxity in Professional Baseball Pitchers

1998 ◽  
Vol 26 (3) ◽  
pp. 420-424 ◽  
Author(s):  
Todd S. Ellenbecker ◽  
Angelo J. Mattalino ◽  
Erik A. Elam ◽  
Roger A. Caplinger
Keyword(s):  
Elbow Joint ◽  
Joint Space Width ◽  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Professional Baseball ◽  
Stress Radiography ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Baseball Pitchers ◽  
Space Width

Injuries to the ulnar collateral ligament frequently occur in throwing athletes because of large, repetitive valgus stresses to the elbow during the cocking and acceleration phases of throwing. Identification of injury to this ligament is important in evaluating the throwing elbow. The purpose of this study was to determine whether differences in medial elbow laxity exist between the dominant and nondominant extremities in uninjured baseball pitchers. Forty uninjured professional baseball pitchers were tested bilaterally with a Telos GA-IIE stress radiography device. Joint space width between the trochlea of the humerus and the coronoid process of the ulna was measured on anteroposterior radiographs obtained with no stress applied and with a 15-daN valgus stress. Results showed significant differences between the medial joint space opening of the dominant and nondominant elbows with no stress applied. With stress, the dominant elbow opened 1.20 0.97 mm, while the nondominant elbow opened 0.88 0.55 mm. A significantly greater difference in medial joint space opening between the stressed and unstressed elbows was measured in the dominant elbow compared with the nondominant elbow (0.32 0.42 mm). This study identifies increased medial elbow laxity in the dominant arm in uninjured pitchers.

Relationship of Ulnar Collateral Ligament Strain to Amount of Medial Olecranon Osteotomy

2001 ◽  
Vol 29 (6) ◽  
pp. 716-721 ◽  
Author(s):  
James R. Andrews ◽  
Erik J. H. Heggland ◽  
Glenn S. Fleisig ◽  
Nigel Zheng
Keyword(s):  
At Risk ◽  
Repeated Measures ◽  
Small Sample Size ◽  
Tensile Force ◽  
Ulnar Collateral Ligament ◽  
Small Sample ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Ligament Strain

Athletes at risk for valgus extension overload are also at risk for tears of the anterior bundle of the ulnar collateral ligament. Some athletes develop ligament tears after procedures for valgus extension overload such as posteromedial olecranon osteotomy. The amount of posteromedial olecranon that can be resected before ulnar collateral ligament strain, and risk of injury, increases is unknown. We dissected and mounted five fresh-frozen human cadaveric elbows to allow strain gauge monitoring of the ulnar collateral ligament with varying valgus stress, elbow flexion angle, and medial osteotomy. The average strain to failure was 11.96% ± 6.51%, corresponding to a load of 347.71 ± 46.42 N. The maximum tensile force recorded at failure was 416.24 N. Three-way repeated-measures analysis of variance revealed no significant change in strain with change in the amount of osteotomy for a given applied load and angle of flexion. On the basis of these data, we conclude that the effect of medial olecranon osteotomy on ulnar collateral ligament strain may be small. Small sample size, elderly specimens, and the variables inherent in the experimental setup and mathematical modeling make it difficult to extrapolate these results to in vivo behavior of the anterior ulnar collateral ligament. Further work is needed before definitive guidelines for olecranon osteotomy can be formulated.

Medial Elbow Instability Resulting From Partial Tears of the Ulnar Collateral Ligament: Stress Ultrasound in a Cadaveric Model

2020 ◽  
Vol 48 (11) ◽  
pp. 2613-2620
Author(s):  
Michael C. Ciccotti ◽  
Sommer Hammoud ◽  
Christopher C. Dodson ◽  
Steven B. Cohen ◽  
Levon N. Nazarian ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Nonoperative Treatment ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Diagnostic Modality ◽  
Partial Tear ◽  
Partial Tears ◽  
Early Reconstruction ◽  
Anterior Posterior

Background: There is consensus that most complete ulnar collateral ligament (UCL) injuries in throwers would benefit from surgical intervention. Optimal treatment for partial UCL tears remains controversial. Stress ultrasonography has become a well-accepted diagnostic modality for assessing UCL injury. Hypothesis: Partial UCL tears will result in an intermediate increase in ulnohumeral joint space gapping as compared with that of an intact UCL and a complete UCL tear, but the degree of joint space gapping will vary by anatomic location of the partial tear. Study Design: Controlled laboratory study. Methods: Twenty-one cadaveric elbows were divided into 7 groups representing different anatomic locations of UCL partial tears. Partial tears were simulated by cutting 50% of the measured width of the UCL at 6 locations: distal anterior/posterior, midsubstance anterior/posterior, and proximal anterior/posterior. A seventh partial tear was created by partially elevating the undersurface of the distal UCL to simulate the radiographic “T-sign.” Valgus stress (15 daN) was applied to each cadaveric elbow at 30° of flexion using a standardized device. Each specimen was tested intact, partially torn, and completely torn. At each state, joint space was measured using stress ultrasonography, and the difference in joint space from unstressed to stressed (delta) was recorded. Results: There were 10 right and 11 left upper extremity specimens. The mean delta was 0.58 mm for the intact state and <0.75 mm in all groups. Both distal partial tear groups had mean deltas <0.75 mm, similar to intact elbows. Proximal tears and the T-sign demonstrated intermediate deltas (0.99-1.23 mm). Midsubstance partial tears demonstrated the largest deltas (1.57-2.03 mm), similar to those of the complete tears. All complete tear groups had a mean delta >1.5 mm (1.54-3.03 mm). Conclusion: These findings suggest that partial tears introduce a spectrum of instability from functionally intact to completely torn. As a result, some may be biomechanically amenable to nonoperative treatment, while others would be indicated for early reconstruction. Further research into the biological and biomechanical determinants of nonoperative treatment failure will assist with more precise treatment recommendations. Clinical Relevance: Describing the biomechanical consequences of different, clinically significant partial UCL tears potentially allows more precise recommendations for operative and nonoperative treatment.

Comparison of the Biomechanical Profile of the Intact Ulnar Collateral Ligament with the Modified Jobe and the Docking Reconstructed Elbow

2009 ◽  
Vol 37 (5) ◽  
pp. 974-981 ◽  
Author(s):  
Michael G. Ciccotti ◽  
Sorin Siegler ◽  
John A. Kuri ◽  
John H. Thinnes ◽  
Daniel J. Murphy
Keyword(s):  
Degrees Of Freedom ◽  
Ulnar Collateral Ligament ◽  
Elbow Flexion ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Anterior Portion ◽  
Reconstructive Procedures ◽  
Kinematic Coupling ◽  
Loading System ◽  
4 Degrees Of Freedom

Background The modified Jobe and Docking techniques are commonly used to reconstruct the elbow's ulnar collateral ligament. Hypothesis Valgus laxity and kinematic coupling after these reconstructive procedures are similar to those of the native ulnar collateral ligament. Study Design Controlled laboratory study. Methods Testing was conducted on 10 pairs of cadaver elbows using a 4 degrees of freedom loading system. Subfailure valgus loads were applied to the native elbows at different flexion angles; motion and ligament elongation were measured. The elbows were then loaded to failure in valgus at 90° of flexion. The reconstructive techniques were then applied and testing was repeated. Results Only the resting length of the anterior portion of the ulnar collateral ligament anterior bundle remained isometric throughout range of motion. Valgus laxity was nearly equal for the native and reconstructed ligaments at flexion angles of 90° or higher. However, both reconstructions provided less valgus stability than the native ulnar collateral ligament at low flexion angles. Kinematic coupling decreased with increased flexion for both native and reconstructed ligaments. Conclusion The modified Jobe and Docking techniques reconstruct restraint of the native ulnar collateral ligament to valgus laxity and kinematic coupling at 90° of flexion and higher angles where peak valgus torque is experienced in the throwing elbow. Clinical Relevance Both reconstructions provide valgus stability comparable to that of the native ulnar collateral ligament at 90° and higher, helping to explain their success in treating throwing athletes. Both reconstructions provide less valgus stability than the native ulnar collateral ligament at low flexion angles, suggesting that patients undergoing ulnar collateral ligament reconstruction should be cautioned against activities that provide valgus stress at low elbow flexion angles, such as side-arm throwing. This study suggests caution against overtightening the reconstructions at the common 30° of flexion.

scholarly journals Elbow valgus stability of the transverse bundle of the ulnar collateral ligament

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mutsuaki Edama ◽  
Kanta Matsuzawa ◽  
Hirotake Yokota ◽  
Ryo Hirabayashi ◽  
Chie Sekine ◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Load Condition ◽  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Limb Position ◽  
Intact State ◽  
Significant Difference ◽  
Telos Stress Device

Abstract Background The purpose of this study was to clarify elbow valgus stability of the transverse bundle (TB). We hypothesized that the transverse bundle is involved in elbow valgus stability. Methods Twelve elbows of six Japanese Thiel-embalmed cadavers were evaluated. The skin, subcutaneous tissue and origin of forearm flexors were removed from about 5 cm proximal to the elbow to about 5 cm distal to the elbow, and the ulnar collateral ligament was dissected (intact state). The cut state was defined as the state when the TB was cut in the middle. The joint space of the humeroulnar joint (JS) was measured in the intact state and then in the cut state. With the elbow flexed to 30°, elbow valgus stress was gradually increased to 30, 60 N using the Telos Stress Device, and the JS was measured by ultrasonography under each load condition. Paired t-testing was performed to compare the JS between the intact and cut states under each load. Results No significant difference in JS was identified between the intact and cut state at start limb position. The JS was significantly higher in the cut state than in the intact state at both 30 N and 60 N. Conclusion The findings from this study suggested that the TB may be involved in elbow valgus stability.

In Vivo Three-Dimensional Mechanical Actions of Individual Flexor-Pronator Muscles: Role in Elbow Valgus Stability

2008 ◽  
Vol 24 (4) ◽  
pp. 325-332 ◽  
Author(s):  
Jason E. Hsu ◽  
Qiyu Peng ◽  
David A. Schafer ◽  
Jason L. Koh ◽  
Gordon W. Nuber ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Ulnar Collateral Ligament ◽  
Elbow Flexion ◽  
Force Sensor ◽  
Muscle Group ◽  
Collateral Ligament ◽  
Flexor Carpi Radialis ◽  
Pronator Teres ◽  
Flexor Carpi Ulnaris

The flexor-pronator mass is thought to be the primary dynamic valgus stabilizer of the elbow and protects the ulnar collateral ligament. However, in vivo multiaxis actions of individual muscles of the flexor-pronator group and their roles in valgus stability have not been investigated quantitatively. This study tested the hypothesis that individual muscles of the flexor-pronator muscle group produce a significant varus moment that provides elbow valgus stability. The flexor carpi ulnaris, flexor carpi radialis, and pronator teres were selectively activated, and the resulting multiaxis moments at the elbow measured at 0°, 30°, 60°, and 90° of elbow flexion using a six-axis force sensor were analyzed for their role in generating varus moment and protecting the ulnar collateral ligament. Considerable off-axis moments were generated by each muscle tested. Through the range of elbow flexion, the varus moment was the major component of the multiaxis action of the flexor carpi ulnaris (p< .001). The flexor carpi radialis and pronator teres had significant actions as elbow flexors and pronators (p≤ .032); these muscles also had a significant varus contribution at 90° elbow flexion (p≤.019). The results suggest that the flexor-pronator muscle group plays an important role in valgus stability of the elbow. In particular, the flexor carpi ulnaris creates a significant varus moment, which is important in unloading and protecting the ulnar collateral ligament. Rehabilitation and strengthening of the flexor-pronator muscle group may help prevent failure of the ulnar collateral ligament and may also help compensate for a medially insufficient elbow.

Medial Elbow Joint Space Increases With Valgus Stress and Decreases When Cued to Perform A Maximal Grip Contraction

2018 ◽  
Vol 46 (5) ◽  
pp. 1114-1119 ◽  
Author(s):  
Brett S. Pexa ◽  
Eric D. Ryan ◽  
Joseph B. Myers
Keyword(s):  
Upper Extremity ◽  
Repeated Measures ◽  
Elbow Joint ◽  
Muscle Activation ◽  
Elbow Dislocation ◽  
Joint Space ◽  
Flexor Muscle ◽  
Valgus Stress ◽  
Bonferroni Adjustment

Background: Previous research indicates that the amount of valgus torque placed on the elbow joint during overhead throwing is higher than the medial ulnar collateral ligament (UCL) can tolerate. Wrist and finger flexor muscle activity is hypothesized to make up for this difference, and in vitro studies that simulated activity of upper extremity musculature, specifically the flexor digitorum superficialis and flexor carpi ulnaris, support this hypothesis. Purpose: To assess the medial elbow joint space at rest, under valgus stress, and under valgus stress with finger and forearm flexor contraction by use of ultrasonography in vivo. Study Design: Controlled laboratory study. Methods: Participants were 22 healthy males with no history of elbow dislocation or UCL injury (age, 21.25 ± 1.58 years; height, 1.80 ± 0.08 m; weight, 79.43 ± 18.50 kg). Medial elbow joint space was measured by use of ultrasonography during 3 separate conditions: at rest (unloaded), under valgus load (loaded), and with a maximal grip contraction under a valgus load (loaded-contracted) in both limbs. Participants lay supine with their arm abducted 90° and elbow flexed 30° with the forearm in full supination. A handgrip dynamometer was placed in the participants’ hand to grip against during the contracted condition. Images were reduced in ImageJ to assess medial elbow joint space. A 2-way (condition × limb) repeated-measures analysis of variance and Cohen’s d effect sizes were used to assess changes in medial elbow joint space. Post hoc testing was performed with a Bonferroni adjustment to assess changes within limb and condition. Results: The medial elbow joint space was significantly larger in the loaded condition (4.91 ± 1.16 mm) compared with the unloaded condition (4.26 ± 1.23 mm, P < .001, d = 0.712) and the loaded-contracted condition (3.88 ± 0.94 mm, P < .001, d = 1.149). No significant change was found between the unloaded and loaded-contracted conditions ( P = .137). Conclusion: Medial elbow joint space increases under a valgus load and then decreases when a maximal grip contraction is performed. This indicates that wrist and finger flexor muscle contraction may assist in limiting medial elbow joint space, a result similar to findings of previous research in vitro. Clinical Relevance: Muscle activation of the upper extremity limits the medial elbow joint space, suggesting that injury prevention programs for throwing athletes should incorporate exercises for the elbow, wrist, and hand to limit excessive medial elbow joint space gapping during activities that create high valgus load.

scholarly journals Valgus Stability is Enhanced by Flexor Digitorum Superficialis Muscle Contraction of the Index and Middle Fingers

2020 ◽  
Author(s):  
Shota Hoshika ◽  
Akimoto Nimura ◽  
Norimasa Takahashi ◽  
Hiroyuki Sugaya ◽  
Keiichi Akita
Keyword(s):  
Muscle Contraction ◽  
Elbow Joint ◽  
Ulnar Collateral Ligament ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
The Difference ◽  
Flexor Digitorum ◽  
Healthy Males

Abstract Background: Flexor digitorum superficialis (FDS) muscle provides dynamic stabilization and medial elbow support for ulnar collateral ligament (UCL). The FDS contraction significantly affects the medial joint distance (MJD) through grip contraction. However, it remains unclear whether FDS activity alone contributes to medial elbow stability, or together with the activation of the flexor digitorum profundus during grip contraction, and which finger’s FDS is the main contributor to elbow stability. We investigated the resistive effects of isolated FDS contraction in individual fingers against valgus stress in the elbow joint using stress ultrasonography (US).Methods: We investigated 17 healthy males (mean age, 27 ± 5 years). Valgus stress US was performed using the Telos device, with the elbow at 30° flexion. MJD was measured for each arm during 3 separate conditions: at rest (unloaded), under valgus load (50 N) (loaded), and under valgus load with FDS contracted in individual fingers (loaded-contracted). Results: MJD was significantly longer when loaded (5.4 ± 0.4 mm) than unloaded (4.1 ± 0.2 mm, P = .007) or loaded-contracted (4.6 ± 0.3 mm, P = .003) for each finger. When loaded-contracted, MJD differed statistically between the index and ring fingers (P = .03) and between the middle and ring fingers (P = .04). However, the difference between the index and middle fingers was not statistically significant (P = .08).  Conclusions: Individual FDS contraction, particularly of the index and middle fingers contributes most to stabilization against valgus stress. Thus, injury care programs should incorporate FDS exercises of these fingers.

scholarly journals Comparison of Radiographic and Ultrasonographic Findings of Medial Elbow Laxity in High School Baseball Players

2020 ◽  
Vol 14 (1) ◽  
pp. 73-81
Author(s):  
Mikio Harada ◽  
Masatoshi Takahara ◽  
Masahiro Maruyama ◽  
Junya Sasaki ◽  
Hiroshi Satake ◽  
...  
Keyword(s):  
High School ◽  
Correlation Coefficient ◽  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Moderate Correlation ◽  
Weak Correlation ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Baseball Players ◽  
Significant Difference

Background: Although ultrasonography has been used to assess medial elbow laxity, its usefulness has not yet been confirmed. objective: The aim of this study were to assess medial elbow laxity in high school baseball players based on measurements of the medial joint space (MJS) of the elbow using ultrasonography and radiography and to investigate the correlation between these assessments. Methods: Thirty-two high school baseball players participated in this study. Fourteen players (44%) were diagnosed with Ulnar Collateral Ligament (UCL) injury. Valgus stress was applied to the elbow by gravity during ultrasonographic and radiographic assessments, and the MJS was measured. The MJS of the throwing side was compared with that of the non-throwing side, and the increase in the MJS of the throwing side was determined. The correlation between ultrasonographic and radiographic assessments was investigated and the usefulness of these assessments for the diagnosis of UCL injury was evaluated. Results: A moderate correlation was found between the ultrasonographic and radiographic assessments of the MJS of the throwing side (correlation coefficient=0.547, P=0.0009). Furthermore, a weak correlation was found for the increase in MJS (correlation coefficient=0.348, P=0.0505), although it was not significant. The comparisons of the radiographic assessments between the UCL injury and non-UCL injury groups showed a significant difference in both the MJS of the throwing side (P=0.0068) and the increase in the MJS (P=0.02), although no difference was found using ultrasonography. Conclusion: Ultrasonography, similar to radiography, is useful for assessing medial elbow laxity. While radiography is useful for diagnosing UCL injury.

scholarly journals Influence of Continuous Elbow Valgus Stress on the Medial Elbow Joint Space

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110459
Author(s):  
Tomoya Ikuta ◽  
Kanta Yoshioka ◽  
Kanta Matsuzawa ◽  
Sae Maruyama ◽  
Mutsuaki Edama
Keyword(s):  
Elbow Joint ◽  
External Rotation ◽  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Ultrasound Images ◽  
Valgus Stress ◽  
Pronator Teres ◽  
Post Hoc ◽  
Male University Students ◽  
Telos Stress Device

Background: To investigate the effect of ulnar collateral ligament stretching due to the "creep phenomenon," the effect of accumulating elbow valgus stress on ligaments must be clarified. Purpose: To evaluate the effect of continuous elbow valgus stress on the medial elbow joint space (JS). Study Design: Controlled laboratory study. Methods: The authors measured the JS of the nondominant elbow joints of 20 healthy male university students (age, 21.4 ± 0.5 years; height, 171.4 ± 6.5 cm; weight, 65.7 ± 9.1 kg). The participants were seated with their shoulder at 90° of abduction and external rotation and their elbow at 30° of flexion, and elbow valgus stress was maintained at loads of 30 and 60 N using a Telos stress device. The JS was measured on ultrasound images of the medial elbow joint with the elbow in the start limb position (0 N) and then immediately (0 seconds) and at 60, 120, 180, 240, and 300 seconds after loading. In addition, muscle activity of the pronator teres muscle during JS measurement was monitored to examine the presence or absence of defensive contraction due to pain. Analysis of variance and the Bonferroni method for post hoc testing were used for statistical analysis. Results: No participants showed defensive contractions of the pronator teres. At 30 N, JS was significantly larger 60 seconds after loading compared with immediately after loading ( P = .007). At 60 N, JS was significantly larger after 120 seconds, as the loading time of valgus stress increased, compared with immediately after loading ( P = .002). Conclusion: JS was significantly larger immediately after loading of valgus stress, with an increase in continuous elbow valgus stress after 60 seconds at 30 N and after 120 seconds at 60 N. These results suggest that a creep phenomenon may develop around the soft tissue of the elbow when loaded by a continuous valgus stress. Clinical Relevance: JS is significantly increased by continuous elbow valgus stress.

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