Multimodality Imaging of the Painful Elbow

Gustas, Cristy; Lee, Kenneth S.

doi:10.1016/j.rcl.2016.04.005

Cited by 13 publications

(5 citation statements)

References 108 publications

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“…Early biomechanical studies established that the UCL functions as the primary stabilizer at the elbow during the majority of the throwing motion [8,24]. In the setting of repetitive microtrauma, progressive UCL injury, and resultant valgus instability, the biomechanical distribution of forces at the elbow is altered [25,26], resulting in predictable injury patterns at the elbow that can be readily diagnosed at imaging [15,16]. This alteration in force distribution also likely contributes to the soft tissue and osseous adaptations seen at the elbow, as well as early and progressive degenerative changes with continued play.…”

Section: Discussionmentioning

confidence: 99%

“…MRI/MRA examinations were interpreted by an experienced musculoskeletal radiologist with over 20 years of experience and a musculoskeletal radiology fellow. A consensus interpretation was rendered for each subject regarding the presence or absence of specific anatomic adaptations and injury patterns related to medial tension overload, lateral compressive forces, and posteromedial shear forces in the setting of VEO that have been previously described in the literature [15,16] (Table 1).…”

Section: Retrospective Review Of Mri/mra Imagesmentioning

confidence: 99%

“…Elbow injuries occurring in the setting of VEO demonstrate predictable patterns in terms of clinical presentation and imaging findings [15,16]. Due to underlying anatomic differences in skeletally immature versus mature throwing athletes, these patterns manifest differently.…”

Section: Introductionmentioning

confidence: 99%

“…Due to underlying anatomic differences in skeletally immature versus mature throwing athletes, these patterns manifest differently. Pediatric athletes have open growth plates that are softer and weaker than the ligaments and tendons inserting into them, and therefore demonstrate a propensity for apophyseal, osteochondral, and stress injuries [17][18][19], whereas adult athletes with closed growth plates are at greater risk for soft tissue injury and progressive degenerative change [15,20,21].…”

Section: Introductionmentioning

confidence: 99%

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Differences in Anatomic Adaptation and Injury Patterns Related to Valgus Extension Overload in Overhead Throwing Athletes

Stevens,

Chaudhari,

Kuhn

2024

Diagnostics

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The purpose of our study was to determine differences in adaptative and injury patterns in the elbow related to valgus extension overload (VEO) in overhead throwing athletes by age. A total of 86 overhead throwing athletes and 23 controls underwent MRI or MR arthrography (MRA) of the elbow. Throwing athletes were divided by age into three groups: ≤16 years (26 subjects), 17–19 years (25 subjects), and ≥20 years (35 subjects). Consensus interpretation of each MRI was performed, with measurements of ulnar collateral ligament (UCL) thickness and subchondral sclerosis at the radial head, humeral trochlea, and olecranon process. A higher frequency of apophyseal and stress injuries was seen in adolescent athletes and increased incidence of soft tissue injuries was observed in older athletes. Early adaptive and degenerative changes were observed with high frequency independent of age. Significant differences were observed between athletes and controls for UCL thickness (p < 0.001) and subchondral sclerosis at the radial head (p < 0.001), humeral trochlea (p < 0.001), and olecranon process (p < 0.001). Significant differences based on athlete age were observed for UCL thickness (p < 0.001) and subchondral sclerosis at the olecranon process (p = 0.002). Our study highlights differences in anatomic adaptations related to VEO at the elbow between overhead throwing athletes and control subjects, as well as across age in throwing athletes.

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Section: Discussionmentioning

confidence: 99%

Section: Retrospective Review Of Mri/mra Imagesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Differences in Anatomic Adaptation and Injury Patterns Related to Valgus Extension Overload in Overhead Throwing Athletes

Stevens,

Chaudhari,

Kuhn

2024

Diagnostics

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“…Multiple imaging modalities can be applied for the diagnosis of elbow instability [ 11 ]. Magnetic resonance imaging (MRI) has been established as gold standard for diagnosing soft tissue injuries of the elbow [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic rod technique compared to stress ultrasound in the dynamic evaluation of lateral ligament instabilities of the elbow

Plath

Otto

Förch

et al. 2022

Arch Orthop Trauma Surg

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Introduction The purpose was to compare the arthroscopic rod technique to stress ultrasound in the dynamic assessment of lateral elbow instabilities. Materials and methods Fifteen elbows of eight specimen with a mean age of 66.4 ± 13.3 years were assessed in a prone position following a defined dissection setup. After evaluation of the native status, an arthroscopic dissection of the radial collateral ligament (RCL) or lateral ulnar collateral ligament (LUCL), and finally of entire capsuloligamentous structures was performed. Three raters examined each state (native, RCL or LUCL lesion, complete lesion) with the arthroscopic rod technique in 90° flexion and with stress ultrasound in 30 and 90° flexion. The intra-class correlation coefficient (ICC) was calculated to assess the interrater reliability as well as test–retest reliability for each testing modality (arthroscopy and ultrasound). Results The arthroscopic rod technique showed a superior interrater and test–retest reliability of 0.953 and 0.959 (P < 0.001), respectively, when compared to stress ultrasound with an ICC of 0.4 and 0.611 (P < 0.001). A joint space opening during arthroscopy of > 6 mm humero-ulnar or > 7 mm humero-radial was indicative for a lateral collateral ligament lesion. However, a differentiation between an isolated RCL or LUCL tear was not possible. A lateral joint opening of ≥ 9 mm was only observed in complete tears of the lateral capsuloligamentous complex. Conclusions The arthroscopic rod technique showed a superior interrater and test–retest reliability when compared to stress ultrasound. Arthroscopic assessment for radial elbow instability was found to be reliable and reproducible. A joint gapping ≥ 9 mm in the arthroscopic evaluation is a sign for a complete insufficiency of the radial capsuloligamentous complex. However, it is not possible to precisely distinguish between a lesion of the RCL or LUCL by arthroscopy. On the basis of our results, dynamic ultrasound testing may be inappropriate to objectify lateral elbow instability.

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