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.

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.

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.

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.

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.

scholarly journals Relationship between ulnar collateral ligament thickness and joint hypermobility in young adults

2021 ◽  
Vol 2 (2) ◽  
pp. 24-29
Author(s):  
Peter R. Reuter ◽  
Arie J. van Duijn ◽  
Kaylee R. Fichthorn ◽  
Lacy Mroz
Keyword(s):  
Undergraduate Students ◽  
Elbow Joint ◽  
Ulnar Collateral Ligament ◽  
Joint Hypermobility ◽  
Ultrasound Images ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Cross Sectional ◽  
Significant Difference ◽  
Joint Gapping

Joint hypermobility is largely understood as a dysfunction of collagen fibers within connective tissues, allowing for a range of motion markedly increased over validated normal values. The ulnar collateral ligament (UCL) of the elbow provides stability to the elbow during valgus stress and, thus, has great significance in overhead throwing sports due to its susceptibility to injury. Our cross-sectional study explored the relationship between the length and width of the anterior bundle of the ulnar collateral ligament of the elbow and joint hypermobility. Two hundred and eighty-four undergraduate students completed a Beighton score assessment. Ultrasound images of the participants’ UCL were obtained in both arms at rest and under gravity induced valgus force. Sixty-one participants reported hypermobility in at least one elbow joint, and hypermobility in one elbow joint was correlated with hypermobility in the other. There were moderate correlations between UCL thickness and joint gapping between left and right elbow joints. However, there was no significant difference in UCL anterior bundle thickness or medial elbow joint gapping at rest or under valgus stress between those with and without hypermobile elbow joints. The thickness of the anterior bundle of the UCL and humeroulnar joint gap at rest moderately correlates to corresponding thickness and width under valgus stress. There is no significant difference in UCL anterior bundle thickness or joint width in people with elbow hypermobility and those without.

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.

scholarly journals Direct Comparison of Modified Jobe and Docking Ulnar Collateral Ligament Reconstruction at Midterm Follow-up

2018 ◽  
Vol 47 (1) ◽  
pp. 144-150 ◽  
Author(s):  
Justin W. Arner ◽  
Edward S. Chang ◽  
Stephen Bayer ◽  
James P. Bradley
Keyword(s):  
Reconstructive Surgical Procedures ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Shoulder Injuries ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Overhead Athletes ◽  
Additional Surgery ◽  
Significant Difference

Background: The modified Jobe and docking techniques are the 2 most commonly employed techniques for ulnar collateral ligament (UCL) reconstruction among overhead athletes. However, no study has directly compared these techniques performed by a single surgeon. Current comparisons of these techniques have relied solely on systematic reviews and biomechanical studies. Hypothesis: There will be no difference in outcomes or return to play between the modified Jobe and docking techniques in elbow UCL reconstruction surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-five modified Jobe and 26 docking UCL-reconstructive surgical procedures were performed by a single surgeon, each with a minimum 2-year follow-up. Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway Scale, years played, sex, handedness, sport, position, palmaris versus gracilis graft type, concomitant or future arm/shoulder injuries, and need for additional surgery were compared between the groups. Patients who underwent future shoulder or elbow surgery, no matter the cause, were included. Results: No difference was seen between the modified Jobe and docking reconstruction cases in regard to KJOC scores (mean ± SD: 78.4 ± 19.5 vs 72.0 ± 26.0, P = .44), Conway Scale (return to play, any level: 84% vs 82%, P = .61), years played (14.7 ± 6.2 vs 15.2 ± 5.8, P = .52), sex ( P = .67), handedness ( P ≥ .999), sport ( P = .44), position ( P = .60), level of competition ( P = .59), and future surgery (12% vs 4%, P = .35). Palmaris graft type had significantly higher KJOC scores than hamstring grafts (82.3 ± 20.0 vs 57.9 ± 21.2, P = .001). The mean follow-up was 6.1 years in the modified Jobe group and 7.3 years in the docking group (mean = 6.7, P = .47). Conclusion: The modified Jobe and docking techniques are both suitable surgical options for elbow UCL reconstruction. There was no statistically significant difference between the techniques in regard to return to play, KJOC score, or need for subsequent surgery at 6.7-year follow-up. This is the first direct clinical comparison of these 2 techniques by a single surgeon at midterm follow-up.

scholarly journals Performance and Return to Sport After Thumb Ulnar Collateral Ligament Surgery in National Football League Players

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 487-493 ◽  
Author(s):  
Kyle R. Sochacki ◽  
Robert A. Jack ◽  
Richard Nauert ◽  
Shari R. Liberman ◽  
Patrick C. McCulloch ◽  
...  
Keyword(s):  
National Football League ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
High Rate ◽  
Collateral Ligament ◽  
Postoperative Performance ◽  
Paired Samples ◽  
Significant Difference ◽  
Postoperative Time ◽  
And Performance

Background: Acute ruptures of the ulnar collateral ligament (UCL) of the thumb are common injuries in sports. Surgical repair of complete tears has yielded excellent results in elite athletes. Methods: National Football League (NFL) players who underwent thumb UCL surgery and matched controls were identified. Demographic and performance data were collected. Performance scores were calculated using a standardized scoring system. Return to sport (RTS) in the NFL was defined as playing in at least 1 NFL game after thumb UCL surgery. Comparisons between case and control groups and preoperative and postoperative time points were made using paired-samples Student t tests. Results: Twenty-three players were identified (mean age: 28.8 ± 3.4 years and mean experience in the NFL: 5.9 ± 3.4 years). Twenty-two players (95.7%) were able to return to sport in the NFL at an average of 132.2 ± 126.1 days. The overall 1-year NFL career survival rate of players undergoing thumb UCL surgery was 87.0%. There was not a statistically significant decrease in games per season and career length for any position following surgery. No positions had a significant difference in postoperative performance when compared with preoperative performance, and there was no significant performance difference postoperatively when compared with matched controls. Conclusions: There is a high rate of RTS in the NFL following thumb UCL surgery. Players who underwent thumb UCL surgery played in a similar number of games per season and had similar career lengths in the NFL as controls. No position group had any significant postoperative performance score differences when compared with postindex matched controls.

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