The morphologic change of the ulnar collateral ligament of elbow in high school baseball pitchers, with and without symptoms, by sonography

Tajika, Tsuyoshi; Yamamoto, Atsushi; Oya, Noboru; Ichinose, Tsuyoshi; Shimoyama, Daisuke; Sasaki, Tsuyoshi; Shitara, Hitoshi; Kitagawa, Takanori; Saitô, Kenichi; Ôsawa, Takashi; Takagishi, Kenji

doi:10.1016/j.jse.2016.04.013

Cited by 28 publications

(39 citation statements)

References 19 publications

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“…The collegiate pitchers in our study demonstrated increased UCL thickness in the dominant arm relative to the nondominant arm at all 3 time points evaluated, consistently with previous studies 3, 4, 7, 16, 24. In addition, UCL thickness significantly increased throughout the season in our study.…”

Section: Discussionsupporting

confidence: 91%

Do anatomic changes found in the throwing arm after a season of pitching resolve with off-season rest? A dynamic ultrasound study

et al. 2019

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HypothesisOur hypothesis was that seasonal adaptive changes in the ulnar collateral ligament (UCL), ulnohumeral joint space (UHJS), and glenohumeral internal rotation deficit (GIRD) of the pitching extremity would subsequently resolve with off-season rest.MethodsEleven collegiate pitchers underwent preseason, postseason, and off-season evaluations including physical examination; dynamic ultrasound imaging of the UCL and UHJS; and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Ultrasound images were evaluated by 2 fellowship-trained musculoskeletal radiologists.ResultsAll 11 pitchers were included in the final analysis, with an average age of 20.1 years and with 14.1 years of playing experience. After a season of pitching, we found significant increases in GIRD (P = .004) and UCL thickness (P = .033) and nonsignificant increases in both unloaded (P = .069) and loaded (P = .122) UHJS. Preseason GIRD correlated with this increase in loaded UHJS (r = 0.80, P = .003). The increase in UCL thickness was significantly greater in pitchers with GIRD greater than 10° (P < .05). After the off-season, UCL thickness returned to baseline and significant decreases were noted in both unloaded (P = .004) and loaded (P = .041) UHJS, but a progression in GIRD was found (P = .021). Pitchers with GIRD of 10° or less showed greater improvement in UHJS after the off-season (P < .05).ConclusionsThe pitching season produced adaptive changes in the throwing elbow that subsequently resolved after off-season rest. However, shoulder range-of-motion deficits were progressive and did not resolve. Ultrasound adaptations of the pitching elbow were significantly related to GIRD.

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Section: Discussionsupporting

confidence: 91%

Do anatomic changes found in the throwing arm after a season of pitching resolve with off-season rest? A dynamic ultrasound study

et al. 2019

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“…Studies have shown an increase in the width of the medial joint space of the dominant arm. 1,2,14 Our study chose to use the nondominant arms of those who were not overhead throwing athletes. Using these participants ensured that the differences found in this study were not due to anatomic adaptations associated with repeated valgus loading but, rather, anatomic changes associated with changes in the flexion angle.…”

Section: Discussionmentioning

confidence: 99%

“…R epeated overhead throwing activity has been associated with increased medial elbow instability. [1][2][3] Waris 4 investigated the medial elbow instability of javelin throwers, and athletes with increased elbow instability were found to have an increased risk of becoming unable to participate for durations ranging from a few weeks to a year. Tajika et al 2 reported that decreased athletic performance, a decreased elbow range of motion, and greater elbow pain were associated with an increase in the width of the medial elbow joint space of high school baseball pitchers.…”

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confidence: 99%

“…The width of the medial elbow joint space during valgus stress can be an indicator of UCL laxity. 2 Diagnostic US facilitates the evaluation of the elbow and allows the patient's elbow to be repositioned during an evaluation, providing the clinician multiple views of the medial elbow in differing anatomic alignments. 8 Both US and radiography are capable of revealing the joint space at the medial elbow; however, US allows for visualization of the integrity of the UCL as well.…”

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confidence: 99%

“…[1][2][3] Periodic valgus stress has been associated with an increase in medial elbow laxity and morphologic changes to the UCL. 2 Improved understanding of the clinical tests used to assess medial elbow stability will help the clinician spot subtle changes in medial elbow stability and could prevent the occurrence of a more severe injury. The valgus test position does not stress the medial elbow while in a position similar to the throwing position.…”

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Ultrasound‐Assisted Assessment of Medial Elbow Stability

DeMoss

Millard

McIlvain

et al. 2018

J of Ultrasound Medicine

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Wrist Flexion Exercise Increases the Width of the Medial Elbow Joint Space During a Valgus Stress Test

Millard

DeMoss

McIlvain

et al. 2018

J of Ultrasound Medicine

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Objectives The medial elbow is stabilized during valgus loading by the ulnar collateral ligament, the flexor pronator mass (FPM), and the radial head. Impairment of the FPM can occur as a result of repeated wrist flexion activity. The purpose of this study was to determine the effect of repeated elbow flexion exercise on medial elbow stability. Methods Thirty volunteers were included in this study. Ultrasound images of the medial joint space of the nondominant elbow of the participants were collected during a valgus stress test. The images were collected before and immediately after a wrist flexion exercise protocol. Results The wrist flexion strength measure decreased (7.5%) after the exercise protocol (t = 3.840; P = .001). The medial elbow width increased between unstressed (mean ± SD, 2.8 ± 0.1 mm) and stressed (3.6 ± 0.1 mm) conditions (P < .001). The stress‐by‐fatigue interaction was significant (P = .048). The medial elbow width increased after fatigue (0.9 ± 0.09 mm) while remaining unchanged in the unstressed condition. Conclusions This study found an effect of repeated wrist flexion exercise on decreasing the stability of the medial elbow. Future research needs to explore the mechanisms leading to the decrease in medial elbow stability and to identify the effect of FPM fatigue on the development of medial elbow pain associated with activities.

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The morphologic change of the ulnar collateral ligament of elbow in high school baseball pitchers, with and without symptoms, by sonography

Cited by 28 publications

References 19 publications

Do anatomic changes found in the throwing arm after a season of pitching resolve with off-season rest? A dynamic ultrasound study

Do anatomic changes found in the throwing arm after a season of pitching resolve with off-season rest? A dynamic ultrasound study

Ultrasound‐Assisted Assessment of Medial Elbow Stability

Wrist Flexion Exercise Increases the Width of the Medial Elbow Joint Space During a Valgus Stress Test

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