Ultrasound evaluation of the ulnar collateral ligament of the elbow: Which method is most reproducible?

Shukla, Mehool; Keller, Robert A.; Marshall, Nathan E.; Ahmed, Hafeez; Scher, Courtney; Moutzouros, Vasilios; Holsbeeck, Marnix van

doi:10.1007/s00256-017-2656-z

Cited by 13 publications

(6 citation statements)

References 23 publications

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“…Our study also showed that greater pitching elbow UCL thickness (3.4 15,24 although all studies reported a trend toward thicker UCLs in D arms.…”

Section: Discussionsupporting

confidence: 64%

“…Nazarian et al 15 reported mean thickness of 6.3 mm in D arms versus 5.3 mm in ND arms and Ciccotti et al 4 reported measurements of 6.15 mm in D arms versus 4.82 mm in ND arms. Although our absolute measurements were smaller, Popovic et al 20 reported mean UCL thickness of 1.68 mm in D arms and 1.21 mm in ND arms, showing that some discrepancy can be explained by different measurement techniques, 15 , 24 although all studies reported a trend toward thicker UCLs in D arms.…”

Section: Discussioncontrasting

confidence: 56%

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Professional Pitchers Display Differences in UCL Morphology and Elbow Gapping During Moving Valgus Stress Testing After UCL Reconstruction

Kissenberth

Thigpen

Bailey

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Ulnar collateral ligament (UCL) reconstruction (UCLR) of the elbow has received much attention given the rise in incidence among baseball pitchers. Stress ultrasonography has been demonstrated to be a critical evaluation tool of the UCL. No study has dynamically evaluated the ability of UCLR to restore normal kinematics. Purpose/Hypothesis: The purpose of this study was to compare ulnohumeral gapping during a moving valgus stress test as well as UCL thickness between professional pitchers with and without UCLR. We hypothesized that the ulnohumeral joint will display greater gapping and the UCL graft will be thicker in pitchers after UCLR compared with uninjured pitchers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Ultrasonography was used to measure the medial ulnohumeral joint distance and the UCL thickness of 70 asymptomatic professional baseball pitchers; 6 of the participants had a history of UCLR. Images were captured of the dominant (D) and nondominant (ND) elbows at the maximal cocking position under 2 loaded conditions within the moving valgus stress test arc: (1) gravity stress and (2) 2.5 kg (5.5 lb) of valgus force using a dynamometer. Intra- and interrater reliability of the measurements was established with intraclass correlation coefficients (ICCs). Separate mixed-model analyses of variance (D side × UCL) were used to compare the D and ND elbow variables between pitchers with and without a history of UCLR. Results: All measurements displayed good reliability according to ICCs. Pitchers with a history of UCLR demonstrated less gapping (5.6 ± 2.9 vs 4.2 ± 1.2 mm; P = .002) and greater UCL graft thickness (0.17 ± 0.07 vs 0.11 ± 0.08 mm; P = .03) compared with the native ligament in pitchers without prior UCL injury. Conclusion: Our data demonstrated that the UCLR results in a thicker, stiffer construct with less medial elbow gapping than the anatomical UCL. Using ultrasound to evaluate the UCL was a reliable, efficient, and clinically feasible method to assess UCL thickness and joint gapping in players with a history of UCLR. Future studies may consider this approach to evaluate surgical techniques and graft types for UCLR.

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“…Our study also showed that greater pitching elbow UCL thickness (3.4 15,24 although all studies reported a trend toward thicker UCLs in D arms.…”

Section: Discussionsupporting

confidence: 64%

Section: Discussioncontrasting

confidence: 56%

Professional Pitchers Display Differences in UCL Morphology and Elbow Gapping During Moving Valgus Stress Testing After UCL Reconstruction

Kissenberth

Thigpen

Bailey

et al. 2021

Orthopaedic Journal of Sports Medicine

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“… 18 , 19 , 25 The Modified Jacobson–Ward technique was used to measure the UCL. 31 Parallel cortices were used for measuring UHJS, with particular attention to omitting bone spurs.…”

Section: Methodsmentioning

confidence: 99%

Elbow Torque May be Predictive of Anatomic Adaptations to the Elbow After a Season of Collegiate Pitching: A Dynamic Ultrasound Study

Khalil

Jildeh

Abbas

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To determine whether elbow torque was associated with anatomic adaptations of the medial elbow following a season of competitive pitching. Methods: Pitchers from 3 collegiate baseball teams were recruited during the preseason for participation. Before the season, pitchers were recorded throwing 5 "game-speed" fastball pitches from a standard distance off a mound while wearing a wearable sensor baseball compression sleeve that calculates elbow torque, arm speed, arm slot, and arm rotation. Participants subsequently underwent dynamic ultrasound imaging of the medial elbow, including measurements of the ulnar collateral ligament (UCL) and ulnohumeral joint space to assess elbow laxity. Following a full season of competitive pitching, all testing was repeated, and statistical analysis comparing preseason to postseason sonographic findings was performed. Results: Twenty-eight collegiate pitchers underwent preseason sonographic and kinematic testing. Nineteen pitchers were available for postseason testing. The average age (standard deviation) and playing experience was 19.9 (1.2) and 14.7 (1.5) years. Compared with preseason, there were significant increases in postseason UCL thickness (1.92 AE 0.09 vs 1.56 AE 0.09 mm, P < .01) and elbow laxity (1.77 AE 0.23 vs 1.15 AE 0.22 mm, P ¼ .028) after a season of pitching. No significant changes in pitching kinematic measurements were observed between preseason and postseason testing. Preseason pitching kinematic measurements were significantly associated with increased UCL thickness (arm slot: beta estimate e0.03 AE 0.01, P ¼ .011) and reduction in elbow laxity (elbow torque: beta estimate e0.03 AE 0.01, P ¼ .04) after a season of pitching. Pitchers with increased body weight and arm length demonstrated reduced medial elbow torque during pitching (P < .05). Conclusions: After a season of competitive pitching, adaptive changes of the medial elbow were demonstrated on dynamic ultrasound. However, the influence of pitching kinematic measurements on these adaptations are of small magnitude and unknown clinical significance. Although wearable sensor technology may have value in trending individual pitcher kinematics, no discrete threshold appears to predict the development of adaptive changes at the elbow. Level of Evidence: Level II, prospective observational study.

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“…Each image was evaluated for UCL thickness and medial UHJS distance in stressed and non-stressed examinations. UCL thickness was measured by the modified Jacobson-Ward technique, 23 whereas UHJS was measured without including bone spurs and from the superior portion of the joint with the cortices parallel. Continuous outcome measures consisted of UCL thickness and area, unloaded UHJS, loaded UHJS, and shoulder ROM measurements.…”

Section: Methodsmentioning

confidence: 99%

Do anatomic changes found in the throwing arm after a season of pitching resolve with off-season rest? A dynamic ultrasound study

et al. 2019

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HypothesisOur hypothesis was that seasonal adaptive changes in the ulnar collateral ligament (UCL), ulnohumeral joint space (UHJS), and glenohumeral internal rotation deficit (GIRD) of the pitching extremity would subsequently resolve with off-season rest.MethodsEleven collegiate pitchers underwent preseason, postseason, and off-season evaluations including physical examination; dynamic ultrasound imaging of the UCL and UHJS; and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Ultrasound images were evaluated by 2 fellowship-trained musculoskeletal radiologists.ResultsAll 11 pitchers were included in the final analysis, with an average age of 20.1 years and with 14.1 years of playing experience. After a season of pitching, we found significant increases in GIRD (P = .004) and UCL thickness (P = .033) and nonsignificant increases in both unloaded (P = .069) and loaded (P = .122) UHJS. Preseason GIRD correlated with this increase in loaded UHJS (r = 0.80, P = .003). The increase in UCL thickness was significantly greater in pitchers with GIRD greater than 10° (P < .05). After the off-season, UCL thickness returned to baseline and significant decreases were noted in both unloaded (P = .004) and loaded (P = .041) UHJS, but a progression in GIRD was found (P = .021). Pitchers with GIRD of 10° or less showed greater improvement in UHJS after the off-season (P < .05).ConclusionsThe pitching season produced adaptive changes in the throwing elbow that subsequently resolved after off-season rest. However, shoulder range-of-motion deficits were progressive and did not resolve. Ultrasound adaptations of the pitching elbow were significantly related to GIRD.

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Ultrasound evaluation of the ulnar collateral ligament of the elbow: Which method is most reproducible?

Cited by 13 publications

References 23 publications

Professional Pitchers Display Differences in UCL Morphology and Elbow Gapping During Moving Valgus Stress Testing After UCL Reconstruction

Professional Pitchers Display Differences in UCL Morphology and Elbow Gapping During Moving Valgus Stress Testing After UCL Reconstruction

Elbow Torque May be Predictive of Anatomic Adaptations to the Elbow After a Season of Collegiate Pitching: A Dynamic Ultrasound Study

Do anatomic changes found in the throwing arm after a season of pitching resolve with off-season rest? A dynamic ultrasound study

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