Magnetic Resonance Imaging Findings of the Asymptomatic Elbow Predict Injuries and Surgery in Major League Baseball Pitchers

Abstract

Background:Repetitive pitching produces significant stress on the elbow that may result in structural abnormalities discernable on magnetic resonance imaging (MRI) without causing symptoms.Purpose:To determine whether there exists an association between subclinical MRI findings in asymptomatic elbows of Major League Baseball (MLB) players and future placement on the disabled list (DL) or future operative procedure.Study Design:Cohort study; Level of evidence, 3.Methods:MRI scans of the elbows of professional-level baseball pitchers, taken during routine presigning imaging at a single organization from 2005 to 2017, were retrospectively reviewed. Publicly available databases were queried to exclude pitchers with an injury before the earliest session of elbow MRI. Three blinded reviewers reviewed all MRI scans independently to evaluate for the presence of chondral damage to the joint, loose bodies, ulnar collateral ligament (UCL) heterogeneity or tears, flexor pronator mass defects, and signs of posteromedial (PM) impingement. Binary imaging findings were related to future placement on the DL for elbow complaints and future elbow surgery.Results:A total of 41 pitchers had asymptomatic MRI findings with no prior DL placement. For players who eventually went on the DL, there were a statistically greater number of players with UCL heterogeneity (P = .021), humeral-sided partial UCL tears (P = .031), and PM impingement (P = .004) on preinjury MRI compared with players who remained healthy. PM impingement was related to future elbow-related surgery (P = .003). Pitchers with UCL heterogeneity were associated with reduced career strike zone percentage, innings pitched, and fastball percentage (P < .05 for all).Conclusion:UCL heterogeneity, PM impingement, and humeral-sided partial tears were correlated with future DL placement for elbow-related reasons in MLB pitchers. Asymptomatic PM impingement may be a precursor to future surgery.

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

“…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.…”

“…Furthermore, there is evidence to suggest that asymptomatic imaging findings in the throwing elbows of professional baseball players may be precursors to subsequent serious injury. 4 Garcia et al 4 found that in 41 asymptomatic MLB pitchers with no known prior elbow injuries, certain MRI findings, specifically UCL heterogeneity, humeral-sided partial tears, and posteromedial impingement, correlated with future inferior pitching performance, placement on the disabled list, and need for elbow surgery. The primarily medial elbow abnormalities in the current study may represent an early stage in this progression.…”

Risk factor for elbow symptom manifestation in young baseball players with asymptomatic medial elbow abnormalities: a prospective cohort study

“…Garcia et al 8 retrospectively investigated 41 Major League Baseball pitchers who had no prior injured list placement; 39% of these patients had normal findings on MRI of the elbow and 61% had abnormal findings, at a baseline assessment. The authors defined “injured” as being placed on the injured list, while the reverse case was defined as “healthy.” The authors demonstrated that MRI findings of posteromedial impingement, UCL heterogeneity, and humeral-side partial UCL tears were significantly correlated with future placement in the injured list for elbow abnormalities.…”

“…Recent studies have shown that elbow abnormalities seen on magnetic resonance imaging (MRI) were relatively common in 53.1% of young asymptomatic baseball players aged 9–13 years 6 , 65.0% of asymptomatic high school baseball players aged 15–19 years 7 , and 61.0% of asymptomatic professional baseball players 8 . These studies 6 – 8 suggest that the detection of anatomical failures in the elbow based on symptoms alone is inaccurate because although a player may be asymptomatic, there could be underlying abnormalities. Thus, the second phase of prevention involves the coexistence of elbow joint anatomical failures and an asymptomatic condition that allows unhindered throwing.…”

FEVER: The Flexed Elbow Valgus External Rotation View for MRI Evaluation of the Ulnar Collateral Ligament in Throwing Athletes—A Pilot Study in Major League Baseball Pitchers

“…MRI is the reference standard for UCL injury diagnosis. MLB protocols often include MRI screening in pitchers to help predict future performance and UCL injury risk, although such predictions from standard MRI yield variable results [15,16]. This difficulty in part relates to suboptimal rendering of the UCL on the imaging planes obtained from conventional patient positioning for elbow MRI.…”