Magnetic Resonance Imaging Predictors of Failure in the Nonoperative Management of Ulnar Collateral Ligament Injuries in Professional Baseball Pitchers

Frangiamore, Salvatore J.; Lynch, T. Sean; Vaughn, Michael D; Soloff, Lonnie; Forney, Michael C.; Styron, Joseph F.; Schickendantz, Mark S.

doi:10.1177/0363546517699832

Cited by 76 publications

(115 citation statements)

References 44 publications

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“…Notably, of the 29 patients with partial tears, 22 were proximal tears and 7 were distal tears. Distal tears resulted in a poor outcome in 100% of athletes, similar to the findings reported by Frangiamore who showed a 12.4 times greater chance of failure with nonoperative management with distal UCL tears [25]. Additionally, all 15 patients with diffuse changes reported favorable outcomes [13].…”

Section: Biologic Injectionssupporting

confidence: 75%

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Nonreconstruction Options for Treating Medial Ulnar Collateral Ligament Injuries of the Elbow in Overhead Athletes

Clark

Desai

Dines

et al. 2018

Curr Rev Musculoskelet Med

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Nonoperative options for UCL injuries include guided physical therapy and biologic augmentation with platelet-rich plasma (PRP). In some patients, repair of the UCL has shown promising return to sport rates by using modern suture and suture anchor techniques. Proximal avulsion injuries have shown the best results after repair. Currently, there is growing interest in augmentation of UCL repair with an internal brace. The treatment of UCL injuries involves complex decision making. UCL reconstruction remains the gold standard for attritional injuries and complete tears, which occur commonly in professional athletes. However, nonreconstructive options have shown promising results for simple avulsion or partial thickness UCL injuries. Future research comparing reconstructive versus nonreconstructive options is necessary.

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Section: Biologic Injectionssupporting

confidence: 75%

“…Failures were found to be 12.4 times more likely with distal UCL tears. Additionally, UCL tears comprising > 50% of the ligament failed nonoperative management in 73% of professional throwers [25].…”

Section: Physical Therapymentioning

confidence: 99%

Nonreconstruction Options for Treating Medial Ulnar Collateral Ligament Injuries of the Elbow in Overhead Athletes

Clark

Desai

Dines

et al. 2018

Curr Rev Musculoskelet Med

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“…Previously, anatomical studies reported that the FPMs had tendinous fibers merging in close proximity to the anterior bundle of the UCL (Davidson et al, ; Munshi et al, ; Frangiamore et al, ). Meanwhile, Otoshi et al () described that the PT, FCR, PL, and FDS muscles were combined together to form the common tendon at the proximal origin, and the common tendon was attached to the anterior bundle of the UCL.…”

Section: Discussionmentioning

confidence: 96%

“…Ulnar collateral ligament (UCL) injuries of the elbow joint have become common among overhead throwing athletes, particularly baseball pitchers (Fleisig and Andrews, ). Recent studies reported the failure of nonoperative management of UCL injury in overhead athletes (Rettig et al, ; Ford et al, ; Frangiamore et al, ). On the contrary, UCL reconstructions in baseball players have been proven to be an effective procedure for return to play and performance (Erickson et al, ; Osbahr et al, ; Hodgins et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the flexor‐pronator muscles (FPMs), including the flexor carpi radialis (FCR), pronator teres (PT), flexor digitorum superficial (FDS), and flexor carpi ulnaris (FCU) muscles, have also been assumed to contribute to dynamic stabilization (An et al, ; Sisto et al, ; Morrey et al, ; Digiovine et al, ; Glousman et al, ; Davidson et al, ; Hamilton et al, ; Lin et al, ; Udall et al, ; Frangiamore et al, ). However, the anatomical relationship between static and dynamic stabilizers, or how the FPMs are connected to the anterior bundle, has been rarely discussed (Davidson et al, ; Munshi et al, ; Frangiamore et al, ). Because the word “ligament” anatomically means a simple band connecting bones to bone, and is not the absolute definition, the conventional anatomical analysis based on the specific ligaments might have its limits to understand the anatomical structures for the joint stabilization.…”

Section: Introductionmentioning

confidence: 99%

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Medial elbow anatomy: A paradigm shift for UCL injury prevention and management

et al. 2019

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To improve the management outcomes and diagnostic accuracy of the ulnar collateral ligament (UCL) injury, the anatomy of the medial side of the elbow joint is necessary to be understood in terms of the periarticular surroundings rather than the specific ligaments. The aim of this study was to anatomically clarify the medial side of the elbow joint in terms of the tendinous structures and joint capsule. We conducted a descriptive anatomical study of 23 embalmed cadaveric elbows. We macroscopically analyzed the relationship between the flexor pronator muscles (FPMs) and the joint capsule in 10 elbows, histologically analyzed in 6 elbows, and observed the bone morphology through micro computed tomography in 7 elbows. The two tendinous septa (TS) were found: between the pronator teres (PT) and flexor digitorum superficial (FDS) muscles, and between the FDS and flexor carpi ulnaris (FCU) muscles. These two TS are connected to the medial part of the brachialis tendon, deep aponeurosis of the FDS, and FCU to form the tendinous complex, which linked the humeroulnar joint and could not be histologically separated from each other. Moreover, the capsule of the humeroulnar joint under the tendinous complex had attachment on the ST of 7 mm width. The two TS, the brachialis tendon, the deep FDS and FCU aponeuroses, and the joint capsule linked the humeroulnar joint. These anatomical findings could lead to a paradigm shift in the prevention, diagnosis, and treatment of UCL injuries in baseball players. Clin. Anat. 32:379–389, 2019. © 2018 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

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

Zaremski

Pazik

Dean

et al. 2021

PM&R

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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.

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Magnetic Resonance Imaging Predictors of Failure in the Nonoperative Management of Ulnar Collateral Ligament Injuries in Professional Baseball Pitchers

Abstract: In professional pitchers, distal UCL tears showed significantly higher odds of failure with nonoperative management compared with proximal tears. Thus, tear location should be considered when deciding between operative and nonoperative management.

Cited by 76 publications

References 44 publications

Nonreconstruction Options for Treating Medial Ulnar Collateral Ligament Injuries of the Elbow in Overhead Athletes

Nonreconstruction Options for Treating Medial Ulnar Collateral Ligament Injuries of the Elbow in Overhead Athletes

Medial elbow anatomy: A paradigm shift for UCL injury prevention and management

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

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