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 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.

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.

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 Baseball Players Exhibit Symptoms of Posttraumatic Stress Disorder After Ulnar Collateral Ligament Rupture (124)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0026
Author(s):  
Frank Alexander ◽  
Forrest Anderson ◽  
Matthew Anderson ◽  
Michelle Spataro ◽  
Kira Skaggs ◽  
...  
Keyword(s):  
High School ◽  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Ulnar Collateral Ligament ◽  
School Level ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Event Scale ◽  
Minor League

Objectives: The significant psychological impact and prevalence of posttraumatic stress disorder (PTSD) have been thoroughly documented in multiple investigations of patients after anterior cruciate ligament ruptures, but this has not yet been assessed in patients after ulnar collateral ligament (UCL) rupture. Our hypothesis is that symptoms of PTSD are present among baseball players after UCL injury. Methods: Baseball players, from the high school to minor league baseball level who had suffered an acute UCL rupture were recruited at a tertiary care center. Patients completed the Horowitz Impact of Event Scale - Revised (IES-R) to analyze for PTSD symptomatology. Results: A total of 24 patients were enrolled. The mean patient age was 19.2 years (range 15-24 years). Twenty patients (83.3%) were pitchers; 12 pitched exclusively. Six patients surveyed played at the high school level (25%), 15 in college (62.5%), and 3 at the minor league level (12.5%). 100% of patients were male. Over 91% of patients experienced symptoms of intrusion, 87.5% displayed avoidance symptoms, and 79.2% had symptoms of hyperarousal. Twelve patients (50%) scored >24 on the IES-R (PTSD is a clinical concern). 6 patients (25%) reached the threshold for a probable diagnosis of PTSD (³33 on the IES-R). Conclusions: Following UCL rupture, athletes experience substantial emotional trauma, and a significant proportion of patients experience symptoms severe enough to warrant a diagnosis of PTSD.

scholarly journals The impact of distance and the crow hop on medial elbow stress during an interval throwing program

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0034
Author(s):  
Austin Cross ◽  
Grace Smith ◽  
Caleb Gulledge ◽  
Dylan Koolmees ◽  
Vasilios Moutzouros ◽  
...  
Keyword(s):  
High School ◽  
Ligament Reconstruction ◽  
Ulnar Collateral Ligament ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Standard Interval ◽  
Rehabilitation Programs ◽  
Ball Velocity ◽  
The Impact ◽  
Ulnar Collateral Ligament Reconstruction

Objectives: Rehabilitation programs following ulnar collateral ligament reconstruction include an interval throwing program in order to gradually increase stress and prevent excessive elbow valgus loads. These programs often instruct players to use the crow hop, even at short distances, in order to reduce stress on the reconstructed ligament. The purpose of the study was to evaluate the impact of the crow hop on medial elbow stress at various distances of an interval throwing program. Methods: High school and college-aged baseball players were recruited for this study. Players threw at distances of 30, 45, 60, 90, 120, 150, and 180 feet. At each distance, participants made 3 throws while using a crow hop and 3 throws without using a crow hop with the instruction to throw on an arc. A wearable device recorded elbow torque, arm slot, arm speed, and shoulder rotation. Ball velocity was measured using radar gun. Results: A total of 20 players participated in this study. Overall elbow torque at each distance was 12.9, 20.5, 26.3, 31.9, 34.7, 36.1, and 37.1 Nm, respectively. There was no difference in elbow stress for throws with a crow hop compared to throws without a crow hop at any distance of throwing (p > 0.05). There was no difference in elbow torque for throws at 150 feet compared to 120 feet (p = 0.10) or 150 feet compared to 180 feet (p = 0.83); however, there were significant increases in elbow torque between every other throwing distance (p < 0.05). Conclusions: Medial elbow torque significantly increases at greater throwing distances of a standard interval throwing program, although the effect becomes less pronounced at longer distances as players maximize effort. The crow hop does not affect medial elbow torque at any distance of throwing.

Baseball Players With an Ulnar Collateral Ligament Tear Display Increased Nondominant Arm Humeral Torsion Compared With Healthy Baseball Players

2016 ◽  
Vol 45 (1) ◽  
pp. 144-149 ◽  
Author(s):  
Casey J. Meyer ◽  
J. Craig Garrison ◽  
John E. Conway
Keyword(s):  
Ulnar Collateral Ligament ◽  
Protective Mechanism ◽  
Shoulder Injuries ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Elbow Injury ◽  
Significant Difference ◽  
Humeral Torsion ◽  
The Mean ◽  
The Relationship

Background: Previous work has suggested that an increase in the amount of developmentally acquired, dominant arm humeral retrotorsion (D HRT) in the thrower’s shoulder may be a potentially protective mechanism. Although the relationship between HRT and shoulder injuries has been reported, the relationship between HRT and ulnar collateral ligament (UCL) tears in baseball players is not known. Purpose: To determine whether D HRT and nondominant arm HRT (ND HRT) measurements in baseball players with a UCL tear differ statistically from a matched healthy cohort. Study Design: Case-control study; Level of evidence, 3. Methods: D HRT and ND HRT were measured in 112 male competitive high school and collegiate baseball players seen over an 18-month period from 2013 to 2015. A total of 56 participants with a clinical and magnetic resonance imaging–confirmed diagnosis of a throwing-arm UCL tear (UCLInj group) were compared with 56 healthy baseball players with no history of an elbow injury who were matched for age, experience, and position (NUCLInj group). The mean ages in the UCLInj and NUCLInj groups were 17.9 ± 2.2 and 17.6 ± 2.8 years, respectively. Using a previously validated ultrasound method, D HRT and ND HRT were measured in the supine position, and the HRT side-to-side difference (D HRT – ND HRT) was calculated. A 1-way multivariate analysis of variance was used to determine the mean statistical differences between groups ( P < .05). Results: Baseball players with a UCL tear displayed significantly more humeral torsion (ie, less retrotorsion) in their nondominant arm compared with healthy baseball players (UCLInj = 33.27° ± 10.27°, NUCLInj = 27.82° ± 10.88°; P = .007). Baseball players with a UCL tear did not display any differences in D HRT compared with healthy baseball players (UCLInj = 18.67° ± 9.41°, NUCLInj = 17.09° ± 9.92°; P = .391). Significant side-to-side differences in HRT existed between groups (UCLInj = −14.60° ± 6.72°, NUCLInj = −10.72° ± 6.88°; P = .003). Conclusion: There was a significant increase in mean nondominant arm humeral torsion (ie, less retrotorsion) in the UCL tear group, but there was no significant difference in the mean D HRT between the injured and uninjured groups. A greater HRT side-to-side difference was displayed in the UCL tear group. The extent to which a thrower has developmentally acquired both D HRT and ND HRT may affect elbow UCL tear risk. Furthermore, it is possible that the extent of genetically predisposed ND HRT may influence the throwing-related increase in D HRT.

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.

Do Outcomes or Subsequent Injuries Differ After Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Autograft?

2019 ◽  
Vol 47 (6) ◽  
pp. 1473-1479 ◽  
Author(s):  
Brandon J. Erickson ◽  
Peter N. Chalmers ◽  
John D’Angelo ◽  
Kevin Ma ◽  
Joshua S. Dines ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Performance Metrics ◽  
Group Versus ◽  
Ulnar Collateral Ligament ◽  
Professional Baseball ◽  
Hamstring Autograft ◽  
Collateral Ligament ◽  
Baseball Players ◽  
Injury Rates ◽  
Significant Difference

Background: Ulnar collateral ligament reconstruction (UCLR) is a successful procedure in professional baseball players. It is unclear whether graft choice affects results. Purpose: Determine performance and rate of return to sport (RTS) in professional baseball players after UCLR and compare performance and RTS rate, as well as injury rates, between players who underwent UCLR with hamstring versus palmaris autograft. Hypothesis: A high RTS rate exists in professional baseball players after UCLR, with no significant difference in injury rates, RTS rates, or performance specifically related to primary outcome performance variables—WHIP ([walks + hits]/innings pitched), fielding independent pitching (FIP), and wins above replacement (WAR)—between those who undergo UCLR with palmaris versus hamstring autograft. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent UCLR with hamstring autograft between 2010 and 2015 were included. Surgical details were gathered from operative reports. Players with hamstring UCLR were compared with a matched control group of players who underwent UCLR with palmaris autograft. Results: Overall, 195 players underwent UCLR with hamstring autograft. No differences in RTS rates or timing to RTS were found between the hamstring and palmaris groups. Significantly more subsequent injuries to the contralateral lower extremity were seen in the hamstring group versus the palmaris group (25 vs 13, respectively) ( P = .040). More subsequent injuries to the upper extremity were found in the palmaris group versus the hamstring group (73 vs 55, respectively), although this difference was not significant ( P = .052). No consistent differences in performance metrics upon RTS existed between hamstring and palmaris groups, although both groups significantly declined in many performance metrics after surgery. Both hamstring and palmaris groups showed a decline postoperatively in WAR (0.86 vs 0.35 and 1.23 vs 0.34, respectively) and WHIP (1.33 vs 1.44 and 1.36 vs 1.51, respectively); FIP did not decline (4.56 vs 5.27 and 4.51 vs 4.53, respectively). No significant difference in WAR, WHIP, or FIP existed between groups postoperatively. Conclusion: Baseball players who underwent UCLR with hamstring autograft were more likely to sustain a subsequent lower extremity injury, whereas those who underwent UCLR with palmaris autograft had a trend toward sustaining more upper extremity injuries. No difference in performance or RTS rates existed between groups. Both groups significantly declined in WAR and WHIP after UCLR.

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