Clinical interpretation of asymptomatic medial collateral ligament injury observed on magnetic resonance imaging in adolescent baseball players

Kenta, Tanaka; Okamoto, Yoshikazu; Makihara, Takeshi; Maehara, Kiyoshi; Yoshizawa, Toyoko; Minami, Manabu; Yamazaki, Masashi

doi:10.1007/s11604-017-0636-9

Cited by 8 publications

(8 citation statements)

References 32 publications

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“…However, it is clear that the MRI findings identified here progressed over the course of 3 years. Based on prior studies showing subclinical UCL changes on MRI in up to 53% to 65% of high school pitchers 5,22 and 34% to 87% of professional pitchers, 4,7 these structural changes will likely continue to progress in athletes involved in ongoing competition.…”

Section: Discussionmentioning

confidence: 99%

Progressive Elbow Magnetic Resonance Imaging Abnormalities in Little League Baseball Players Are Common: A 3-Year Longitudinal Evaluation

et al. 2019

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Background: Prior studies have revealed magnetic resonance imaging (MRI) evidence of elbow pathology in single-season evaluation of competitive youth baseball players. The natural history of these findings and risk factors for progression have not been reported. Purpose: To characterize the natural history of bilateral elbow MRI findings in a 3-year longitudinal study and to correlate abnormalities with prior MRI findings, throwing history, playing status, and physical examination. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective study of Little League players aged 12 to 15 years was performed. All players had preseason and postseason bilateral elbow MRI performed 3 years before this study. Players underwent repeat bilateral elbow MRI, physical examination, and detailed assessment of throwing history, playing status, and arm pain. Imaging was read by a blinded musculoskeletal radiologist and compared with prior MR images to assess for progression or resolution of previously identified pathology. Results: All 26 players who participated in the previous single-season study returned for a 3-year assessment. At the completion of the study, 15 players (58%) had dominant arm MRI pathology. Eighty percent (12/15 players) of MRI findings were new or progressive lesions. Players with postseason MRI pathology at the beginning of the study were more likely to have MRI pathology at the 3-year follow-up than players with previously normal postseason MRI ( P < .05), although 6 of the 14 players (43%) with previously normal MRI developed new pathology. Year-round play was a significant predictor of tenderness to elbow palpation ( P = .027) and positive MRI findings at 3 years ( P = .047). At the 3-year follow-up, 7 players (27%) reported having throwing elbow pain and 3 had required casting. Additionally, differences were noted in the dominant arm’s internal and external rotation in those that continued to play baseball ( P < .05). Conclusion: Dominant elbow MRI abnormalities are common in competitive Little League Baseball players. Year-round play imparts significant risk for progression of MRI pathology and physical examination abnormalities.

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Section: Discussionmentioning

confidence: 99%

Progressive Elbow Magnetic Resonance Imaging Abnormalities in Little League Baseball Players Are Common: A 3-Year Longitudinal Evaluation

et al. 2019

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“…Of the 15 articles, 11 were retrospective cohort studies, 2-4,7,8,10-12,15,17,21 and 4 were prospective cohort studies. 14,19,20,22 The studies performed by Joyner et al 7 and Bruce et al 3 comprised the same patient population; however, each article reports different aspects of diagnostic evaluations. With the exception of the study performed by Magee, 8 the patient population of each study consisted mostly of overhead athletes, primarily baseball players.…”

Section: Resultsmentioning

confidence: 99%

“…In a study evaluating 64 patients, Tanaka et al 20 examined the relationship between valgus stress ultrasound results and UCL tears diagnosed via MRI. There was no difference in relative (ipsilateral – contralateral) joint space measurements between patients with UCL tears (0.29 ± 1.06 mm) and without (0.08 ± 0.96 mm).…”

Section: Resultsmentioning

confidence: 99%

“…There was no difference in relative (ipsilateral – contralateral) joint space measurements between patients with UCL tears (0.29 ± 1.06 mm) and without (0.08 ± 0.96 mm). 20…”

Section: Resultsmentioning

confidence: 99%

“…There was no difference in relative (ipsilateral -contralateral) joint space measurements between patients with UCL tears (0.29 6 1.06 mm) and without (0.08 6 0.96 mm). 20 Roedl et al 15 evaluated the diagnostic accuracy of valgus stress and conventional ultrasound for UCL tears as compared with intraoperative observation. An increase in the relative ulnohumeral joint width 1.0 mm was defined as a positive valgus stress assessment.…”

Section: Ultrasoundmentioning

confidence: 99%

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Diagnostic Imaging of Ulnar Collateral Ligament Injury: A Systematic Review

et al. 2020

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Background: Ulnar collateral ligament (UCL) injuries can be debilitating in overhead athletes. Accurate diagnosis is important; however, several imaging modalities are available for the assessment of UCL injuries. Purpose: To provide a comprehensive review of published literature regarding the diagnostic capabilities of different imaging modalities for UCL tears. Methods: PubMed, Medline, and Embase were queried for peer-reviewed literature published between January 1947 and June 4, 2019, pertaining to diagnostic imaging of UCL tears. Articles assessing static and stress radiography, ultrasound, magnetic resonance imaging (MRI), MRI with arthrography (MRA), and computed tomography arthrography of the UCL were included. Studies were excluded if imaging results were not compared with intraoperative diagnosis, as intraoperative findings are generally considered the gold standard for diagnostic comparison. The articles were assessed per the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines and reviewed with the Quality Assessment of Diagnostic Accuracy Studies, version 2 (QUADAS-2) assessment. Results: The literature search yielded 2478 articles, of which 15 were included in this review. Potential bias was noted in each QUADAS-2 subsection. Multiple studies demonstrate an association between UCL tears and osseous abnormalities identified on static radiographs; however, the use of static or nonstressed radiographs is not recommended for specific evaluation of UCL injuries. Conventional ultrasound was 81% sensitive and 91% specific, as compared with 96% and 81% for stress ultrasound, respectively. The sensitivity and specificity of MRI ranged from 57% to 100% and 89% to 100%. The sensitivity of computed tomography arthrography ranged from 63% to 86%. The sensitivity and specificity of MRA ranged from 81% to 100% and 91% to 100%. Conclusion: Of the currently available imaging modalities, MRA provides the best combination of sensitivity and specificity of the evaluation of the UCL. Further research comparing ultrasound with MRA is needed.

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Normal imaging laterality on magnetic resonance imaging of the medial epicondyle of the elbow on the dominant side of adolescent male baseball players

et al. 2018

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Larger ossification and cartilage size of the medial epicondyle in the dominant elbow suggested that the medial collateral ligament to the medial epicondyle induces excessive repetitive tensile stress, but without clinical symptoms. Functional or microanatomical damage of the medial epicondyle may induce a lower ossification signal in the dominant elbow, thereby decreasing fatty bone marrow and inducing sclerotic changes.

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Clinical interpretation of asymptomatic medial collateral ligament injury observed on magnetic resonance imaging in adolescent baseball players

Abstract: 'Asymptomatic MCL injury on MRI' had little correlation to ligament dysfunction. It might represent the transition period to MCL thickening called "adaptation."

Cited by 8 publications

References 32 publications

Progressive Elbow Magnetic Resonance Imaging Abnormalities in Little League Baseball Players Are Common: A 3-Year Longitudinal Evaluation

Progressive Elbow Magnetic Resonance Imaging Abnormalities in Little League Baseball Players Are Common: A 3-Year Longitudinal Evaluation

Diagnostic Imaging of Ulnar Collateral Ligament Injury: A Systematic Review

Normal imaging laterality on magnetic resonance imaging of the medial epicondyle of the elbow on the dominant side of adolescent male baseball players

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