Forearm flexor injury is associated with medial ulnar collateral ligament injury in throwing athletes

Abstract

Background Elbow ulnar collateral ligament (UCL) injuries have become increasingly common in throwing athletes. The forearm flexors (FF) have been studied as biomechanical stabilizers for the medial elbow. However, there are no studies investigating the association of concomitant UCL injuries and FF injuries in throwing athletes. Objective To determine if throwing athletes with a complete UCL injury had a greater likelihood of concomitant FF injury than those with a partial UCL injury. Design Descriptive retrospective epidemiological study. Setting Academic, tertiary care medical center. Patients Throwing related UCL injuries in patients aged 12–24 years. Interventions/Methods Electronic medical records and key word searches identified all patients from January 1, 2010 to December 31, 2019. A board certified and fellowship trained musculoskeletal radiologist reviewed all advanced imaging studies. Results Fifty‐four patients (46 male, 8 female, mean age 17.1 years, SD 2.3) were included. Fifty‐four UCL injuries (21 complete ruptures, 16 proximal partial injuries, 17 distal partial injuries) were confirmed by magnetic resonance imaging (MRI). Twenty‐eight FF injuries (22 strains, 6 tears) were diagnosed with MRI and/or MRI‐arthrogram. There was a significant association between sustaining a FF injury and UCL reconstruction (UCL‐R) (X2 = [1, N = 54], = 3.97, P = .046) (15/22, 68.2%), as well as FF injury and UCL injury location (X2 = [1, N = 33], = 3.86, P = .049) (10/17, distal partial UCL injury, 58.8%). Analysis of FF injury and complete UCL tear is not significant (X2 = [1, N = 54], = 3.02, P = .08) (14/21, 66.7%). Conclusions The data indicate that FF injury is associated with UCL injury in throwing athletes. Future prospective studies should investigate causation versus correlation of FF and UCL injury in throwing athletes. The results of this study have applications to multiple sports medicine areas that include but are not limited to surgical, nonsurgical, prehabilitation, rehabilitation, and sports performance. This study reveals a strongly significant association between FF injury and concomitant UCL injury in throwing athletes.

Forearm Flexor Tendon Injury in Adolescent Athletes: Risk Factors, Treatment, and Prevention

“…The results of this study showed that three or more parameters were performed correctly in 80.7% and 64% of pitchers in the age groups of 14 to 18 years and 9 to 13 years, respectively. This study also shows that a better technique generates lower humeral internal rotation torque and a lower elbow valgus load, preventing shoulder and elbow pain in adolescent athletes (35).…”

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Ulnar Collateral Ligament Reconstruction in Female Javelin Athletes: A Case Series and Review of the Literature

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Alterations in pitching biomechanics and performance with an increasing number of pitches in baseball pitchers: A narrative review

“…Therefore, increased fatigue in the forearm flexor muscles may increase the burden imposed on the UCL, which can ultimately increase the likelihood of UCL injury. In fact, some studies have revealed the close relationship between forearm flexor injury and UCL tear in throwing athletes including baseball pitchers 51–53 . Ikezu et al 52 reported that combined UCL and flexor‐pronator muscle injuries were observed in 45 of 99 baseball players (91 pitchers and 8 fielders), of which 40 of 45 (89%) involved injury of the flexor digitorum superficialis.…”