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

Abstract

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.

Biomechanical Comparison of Ulnar Collateral Ligament Repair With Internal Bracing Versus Modified Jobe Reconstruction

“…These results support the notion that an accelerated physical therapy protocol may achieve a significantly faster return to play without compromising the early integrity of the repair. While previous authors have demonstrated dominant throwing arm joint laxity and adaptive morphologic characteristics in the UCL among asymptomatic overhead athletes, 13,18 in these cases, changes in the morphologic characteristics of the UCL and subsequent joint laxity arose through adaptation and were not believed to be related to acute injury. In the case of UCL repair after acute or chronic symptomatic injury, the clinical relevance of early gap formation may be much more significant because it may affect ultimate outcomes by way of incomplete or failed healing.…”

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

“…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.…”

Sonographic Evaluation of the Plantar Heel in Asymptomatic Endurance Runners

“…Although asymptomatic structural changes have been reported in a variety of body regions, to our knowledge, no prior investigation has systematically evaluated the plantar heel region in asymptomatic runners, a group at risk for developing heel abnormalities. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Consequently, the primary purpose of this investigation was to determine the prevalence and spectrum of asymptomatic sonographically determined structural changes in the plantar fascia and plantar heel pad among experienced runners without a history of heel pain. On the basis of our preliminary observations, we hypothesized that more than 50% of asymptomatic runners would have at least 1 structural abnormality in 1 heel, as defined by the following: (1) presence of vascularization on power Doppler sonography, (2) nonuniform heterogeneous echo texture of the plantar heel pad, (3) abnormal plantar heel pad thickness (uncompressed heel pad thickness <12 or > 28 mm), 15,36 (4) abnormal plantar heel pad compressibility (heel pad compressibility index <0.45 or >0.75), 15 (5) abnormal plantar fascia thickness (>4 mm), 1 and (6) abnormal plantar fascia echo texture.…”