Elbow Torque Is Reduced in Asymptomatic College Pitchers With Elbow Laxity: A Dynamic Ultrasound Study

Khalil, Lafi S.; Meta, Fabien; Tramer, Joseph S.; Klochko, Chad; Scher, Courtney; Holsbeeck, Marnix van; Kolowich, Patricia A.; Makhni, Eric C.; Moutzouros, Vasilios; Okoroha, Kelechi R.

doi:10.1016/j.arthro.2020.12.208

Cited by 7 publications

(9 citation statements)

References 31 publications

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“…In a single time-point preseason analysis of this cohort of 28 collegiate pitchers, Khalil et al. 21 investigated the relationship between elbow torque and sonographic adaptations to the medial elbow. The authors found a significant relationship between greater medial elbow torque during pitching and a thicker UCL and stiffer elbow (reduced elbow laxity) on dynamic ultrasound of pitchers.…”

Section: Discussionmentioning

confidence: 99%

“…The investigators previously published their findings in this cohort of pitchers during preseason testing. 21 This follow-up study compared postseason testing with preseason testing in the cohort of pitchers who were available for follow-up. Pitchers who left their college campus to return home for the summer break, or who graduated, were unavailable to follow-up for postseason testing.…”

Section: Methodsmentioning

confidence: 99%

“…The preseason analysis, published separately, demonstrated greater than 2.5Nm difference in elbow torque among pitchers with loaded UHJS ≥4.4mm (43.9 vs 48.6, P < .001) and delta UHJS ≥1.25mm (44.2 vs 47.7, P < .001). 21 The present investigation was a postseason assessment of the same cohort of pitchers, compared with their preseason values; as such, the sample size was determined by those pitchers available for follow-up.…”

Section: Methodsmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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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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“…This study, which was designed to evaluate if dynamic US is capable of indirectly detecting a lesion of the R-LCL, distinguishing this from a tendon tear at the level of the CEO, could not confirm this hypothesis, suggesting that the λ is not a suitable parameter to evaluate this pattern of minor elbow instability. This is probably caused by the fact that US indirect signs of lateral instability, including λ, are designed to investigate U-LCL lesions and no specific protocols are designed for the R-LCL [22,[46][47][48]. Therefore, efforts should be made to develop specific diagnostic protocols to better evaluate isolated R-LCL laxity, especially in patients affected by SMILE [36].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound evaluation shows increase in laxity after partial common extensor origin detachment but not after additional lesion of the radial band of the lateral collateral ligament

Arrigoni

Cucchi

Luceri

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose The lateral elbow musculature conveys a dynamic valgus moment to the elbow, increasing joint stability. Muscular or tendinous lesions to the anterior half of the common extensor origin (CEO) may provoke a deficiency in the elbow dynamic stabilizers, regardless of their traumatic, degenerative, or iatrogenic aetiology. Furthermore, a role for the radial band of the lateral collateral ligament (R-LCL) has been postulated in the aetiology of lateral elbow pain. This study aimed to evaluate the effects of sequential lateral releases with dynamic ultrasound, evaluating its capability to detect lesions of the CEO and of the R-LCL. Methods Ultrasound investigation of the lateral compartment of the elbow was performed on nine cadaveric specimens with a 10 MHz linear probe in basal conditions, after the release of the anterior half of the CEO and after complete R-LCL release. The lateral joint line widening (λ) was the primary outcome parameter, measured as the linear distance between the humeral and radial articular surfaces. Results The release of the anterior half of the CEO significantly increased λ by 200% compared to the starting position (p = 0.0008) and the previously loaded position (p = 0.0015). Conversely, further release of the R-LCL caused only a marginal, non-significant increase in λ. Conclusions Ultrasound evaluation can detect changes related to tendon tears or muscular avulsions of the CEO and can depict lateral elbow compartmental patholaxity by assessing articular space widening while scanning under dynamic stress. However, it cannot reliably define if the R-LCL is injured. Iatrogenic damage to the CEO should be carefully avoided, since it causes a massive increase in compartmental laxity.

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“…The thickness of the mUCL has been shown to be greater in older athletes and those with more years of experience [ 39 •, 60 , 62 ]. The majority of studies comparing mUCL thickness between dominant and non-dominant elbows in throwing athletes have shown increased mUCL thickness in the dominant limb [ 36 , 39 •, 59 , 61 – 65 ]. Increased hyperechoic foci and calcifications have also been found in the throwing elbow [ 36 , 39 •, 60 ].…”

Section: Assessment Of Mucl Morphology and Change With Loadmentioning

confidence: 99%

The Role of Ultrasound in the Evaluation of Elbow Medial Ulnar Collateral Ligament Injuries in Throwing Athletes

Sutterer

Boettcher

Payne

et al. 2022

Curr Rev Musculoskelet Med

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Purpose of Review Although ultrasound (US) imaging is commonly used to evaluate the elbow medial ulnar collateral ligament (mUCL) in throwing athletes, significant technical heterogeneity exists in the published literature and in practice. This has resulted in variable and often ambiguous US diagnostic criteria for mUCL injury. This review summarizes the literature on sonographic evaluation of the mUCL and outlines recommendations for consistent descriptive terminology, as well as future clinical and research applications. Recent Findings Both acute and chronic throwing loads in overhead athletes cause the mUCL to become thicker and more lax on stress testing, and these changes tend to revert after a period of prolonged rest. Stress US (SUS) can aid in the diagnosis of mUCL tears and may help identify athletes at risk of mUCL injury. Variability exists in terminology, elbow flexion angle, amount of stress applied, and technique of stress testing. Recent studies have suggested an injured elbow stress delta (SD—change in ulnohumeral joint (UHJ) space with valgus stress) of 2.4 mm and a stress delta difference (SDD—side-side difference in SD) of 1 mm each denote abnormal UHJ laxity due to mUCL injury. Summary US imaging is a powerful and widely accessible tool in the evaluation elbow mUCL injuries. Sonologists should consider how their US techniques compare with published methods and use caution when applying diagnostic criteria outside of those circumstances. Currently, an SD of 2.4 mm and an SDD of 1 mm provide the best diagnostic accuracy for mUCL tears requiring surgery. Finally, preliminary work suggests that shear wave elastography may be helpful in evaluating the biomechanical properties of the mUCL, but additional research is needed.

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Elbow Torque Is Reduced in Asymptomatic College Pitchers With Elbow Laxity: A Dynamic Ultrasound Study

Cited by 7 publications

References 31 publications

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

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

Ultrasound evaluation shows increase in laxity after partial common extensor origin detachment but not after additional lesion of the radial band of the lateral collateral ligament

The Role of Ultrasound in the Evaluation of Elbow Medial Ulnar Collateral Ligament Injuries in Throwing Athletes

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