Evidence of Subclinical Medial Collateral Ligament Injury and Posteromedial Impingement in Professional Baseball Players

Kooima, Cynthia; Anderson, Kyle; Craig, Joseph V.; Teeter, Douglas M.; Holsbeeck, Marnix van

doi:10.1177/0363546503262646

Cited by 74 publications

(64 citation statements)

References 11 publications

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“…Asymptomatic elite-level throwers may have baseline progressive, adaptive changes in the UCL on imaging studies that may not correlate with the future risk of injuries. 21,24,25 Wright et al 41 used plain radiographs to examine a cohort of 56 asymptomatic professional baseball pitchers and found that degenerative changes developed over time, but these changes did not correlate to the time spent on the Major League Baseball disabled list or risk of future injuries. In addition, it is difficult for plain radio-graphs to accurately assess the structural integrity of the UCL or detect any associated soft tissue injuries.…”

Section: Discussionmentioning

confidence: 99%

Stress Sonography of the Ulnar Collateral Ligament of the Elbow in Professional Baseball Pitchers

et al. 2014

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Background An injury to the ulnar collateral ligament (UCL) of the elbow is potentially career threatening for elite baseball pitchers. Stress ultrasound (US) of the elbow allows for evaluation of both the UCL and the ulnohumeral joint space at rest and with stress. Hypothesis Stress US can identify morphological and functional UCL changes and may predict the risk of a UCL injury in elite pitchers. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 368 asymptomatic professional baseball pitchers underwent preseason stress US of their dominant and non-dominant elbows over a 10-year period (2002-2012). Stress US examinations were performed in 30° of flexion at rest and with 150 N of valgus stress by a single musculoskeletal radiologist. Ligament thickness, ulnohumeral joint space width, and ligament abnormalities (hypoechoic foci and calcifications) were documented. Results There were 736 stress US studies. The mean UCL thickness in the dominant elbow (6.15 mm) was significantly greater than that in the nondominant elbow (4.82 mm) (P < .0001). The mean stressed ulnohumeral joint space width in the dominant elbow (4.56 mm) was significantly greater than that in the nondominant elbow (3.72 mm) (P < .02). In the dominant arm, hypoechoic foci and calcifications were both significantly more prevalent (28.0% vs 3.5% and 24.9% vs 1.6%, respectively; P < .001). In the 12 players who incurred a UCL injury, there were nonsignificant (P > .05) increases in baseline ligament thickness, ulnohumeral joint space gapping with stress, and incidence of hypoechoic foci and calcifications. More than 1 stress US examination was performed in 131 players, with a mean increase of 0.78 mm in joint space gapping with subsequent evaluations. Conclusion Stress US indicates that the UCL in the dominant elbow of elite pitchers is thicker, is more likely to have hypoechoic foci and/or calcifications, and has increased laxity with valgus stress over time.

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Section: Discussionmentioning

confidence: 99%

Stress Sonography of the Ulnar Collateral Ligament of the Elbow in Professional Baseball Pitchers

et al. 2014

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“…6 All images were read by the same board-certified, fellowship-trained, musculoskeletal radiologist (N.S.M.) who was blinded to all participant data including the throwing limb.…”

Section: Methodsmentioning

confidence: 99%

Magnetic Resonance Imaging of the Throwing Elbow in the Uninjured, High School–Aged Baseball Pitcher

et al. 2011

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Background Tissue adaptations in response to pitching are an expected finding during magnetic resonance imaging (MRI) evaluation of the throwing elbow of adult pitchers. These changes are considered normal in the absence of symptom complaints. It is unclear when during the playing career these tissue adaptations are initiated. Hypothesis Abnormalities in the appearance of the throwing elbow compared with the nonthrowing elbow would be visible during MRI assessment of this asymptomatic population of high school–aged throwers. Study Design Cross-sectional study; Level of evidence, 3. Methods Twenty-three uninjured, asymptomatic male high school–aged baseball pitchers (mean age, 16 years) with no history of elbow injury were recruited for the study. Participants had a minimum of 3 years’ experience with pitching as their primary position (mean experience, 6 years). Bilateral elbow MRI examinations were performed using a standardized protocol including fast spin-echo proton-density (axial and coronal), T1-weighted (sagittal), and T2-weighted fat-saturated (axial, sagittal, and coronal) sequences. Osteoarticular, ligamentous, musculotendinous, and neural structures were evaluated and compared bilaterally. The images were reviewed by a musculoskeletal radiologist who was blinded to all the gathered data on these athletes, including limb dominance. Results Three participants (13%) had no abnormalities. Fifteen individuals (65%) had asymmetrical anterior band ulnar collateral ligament thickening, including 4 individuals who also had mild sublime tubercle/anteromedial facet edema. Fourteen participants (61%) had posteromedial subchondral sclerosis of the ulnotrochlear articulation, including 8 (35%) with a posteromedial ulnotrochlear osteophyte, and 4 (17%) with mild posteromedial ulnotrochlear chondromalacia. Ten individuals (43%) had multiple abnormal findings in the throwing elbow. Conclusion Thickening of the anterior band of the ulnar collateral ligament and posteromedial subchondral sclerosis of the trochlea are common findings in the high school–aged pitcher and may be considered normal clinical findings in the absence of symptom complaints. Other changes in tissue appearance of the throwing elbow are uncommon in this age group and should be regarded with a higher level of caution when evaluating for the presence of injury. An understanding of the MRI appearance of the uninjured youth pitcher is necessary for clinicians to distinguish between normal adaptations and the presence of injury.

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“…The mechanism of ulnar collateral ligament injury involves forceful valgus stress during overhead throwing, medial stretching of the soft tissue, and posterior impingement [9,23]. The anterior bundle of the ulnar collateral ligament can be observed using high-resolution ultrasound.…”

Section: Ulnar Collateral Ligament Injurymentioning

confidence: 99%

Application of Ultrasound and Ultrasound-Guided Intervention for Evaluating Elbow Joint Pathologies

Lin

Chen

2012

Journal of Medical Ultrasound

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Evidence of Subclinical Medial Collateral Ligament Injury and Posteromedial Impingement in Professional Baseball Players

Abstract: This study demonstrates a high rate of abnormal magnetic resonance imaging findings in asymptomatic throwers' elbows. These baseline findings must be considered when magnetic resonance imaging is being used as a factor in treatment decisions.

Cited by 74 publications

References 11 publications

Stress Sonography of the Ulnar Collateral Ligament of the Elbow in Professional Baseball Pitchers

Stress Sonography of the Ulnar Collateral Ligament of the Elbow in Professional Baseball Pitchers

Magnetic Resonance Imaging of the Throwing Elbow in the Uninjured, High School–Aged Baseball Pitcher

Application of Ultrasound and Ultrasound-Guided Intervention for Evaluating Elbow Joint Pathologies

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