Ultrasonography has high positive predictive value for medial epicondyle lesions among adolescent baseball players

Lee, Yan-Yuh; Yang, Tsung‐Hsun; Huang, Chi-Hsien; Huang, Yu‐Chi; Chen, Po‐Cheng; Hsu, Chia-Hao; Wang, Lin-Yi

doi:10.1007/s00167-018-5178-x

Cited by 11 publications

(6 citation statements)

References 23 publications

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“…Stress imaging using radiography is performed as one of the examinations for valgus instability, and the same method using ultrasonography, which is a useful and less-invasive technique, has been used recently. 10 , 18 , 30 , 32 The validity and reliability of stress imaging using ultrasonography are slightly similar to those of stress imaging using radiography. Lee et al showed that the ulnohumeral distance of the uninjured elbow was 4.0 ± 0.7 mm and 4.7 ± 0.6 mm in the unloaded (gravity only) and loaded conditions (5 lb), respectively, using stress radiographs.…”

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confidence: 74%

Increased medial laxity of the elbow in preadolescent baseball players with or without medial elbow apophysitis

Watanabe¹,

Masuma²,

Kenmoku³

et al. 2021

JSES International

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Background Medial elbow apophysitis is a traction apophysitis observed in the medial epicondyle of the elbow in preadolescent baseball players. The purpose of this study was to determine the relationship between medial elbow apophysitis and elbow valgus instability in preadolescent baseball players. Methods The participants were classified into a control group and an injury group; the injury group included participants diagnosed with a medial elbow injury (inclusion criteria were only symptoms of the elbow joint or positive findings on physical examinations, or both). Elbow valgus instability was assessed by measuring the differences in ulnohumeral joint gapping width, with and without gravity stress induced by weight loading of the forearm using ultrasonography. Results The control and injury groups consisted of 81 and 23 preadolescent baseball players, respectively. In the throwing elbow, valgus instability in the injury group was significantly greater than that in the control group (1.07 vs. 0.57 mm, P = .001). In the non-throwing elbow, valgus instability in the injury group was significantly greater than that in the control group (0.57 vs. 0.37 mm, P = .011). The area under the curve for valgus instability of the throwing elbow was 0.89 mm (95% confidence interval, 0.64-0.77), and the cut-off value for elbow pain appearance was 0.80 mm. Conclusion The increased elbow valgus instability in the injury group was associated with a medial elbow injury. For the elbow valgus instability of the non-throwing side in the injury group, we considered that players with medial elbow apophysitis inherently have elbow laxity.

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confidence: 74%

Increased medial laxity of the elbow in preadolescent baseball players with or without medial elbow apophysitis

Watanabe¹,

Masuma²,

Kenmoku³

et al. 2021

JSES International

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“… 33 , 34 Changes to the medial epicondyle of the throwing side also have been identified from youth to adolescent baseball players through the use of ultrasonography, radiography, or MRI. 23 , 26 , 28 , 37 Therefore, it is possible that similar adaptive changes may exist in the elbows of throwing athletes caused by the effects of repetitive throwing on the ulnar sublime tubercle. As a result, our modified technique could be an efficient surgical option in patients who have a small medial epicondyle.…”

Section: Discussionmentioning

confidence: 99%

Ulnar Collateral Ligament Reconstruction With the Modified Jobe Technique in Baseball Pitchers

Yoshida

Takenaga

Takeuchi

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Tearing and insufficiency of the ulnar collateral ligament (UCL) of the elbow result in valgus instability, which can lead to pain while throwing and decline in performance in overhead athletes. Purpose: To assess the clinical results of a modified UCL reconstruction technique using 1 bone hole in the ulna and 1 bone tunnel in the humerus in baseball players. Study Design: Case series; Level of evidence, 4. Methods: The inclusion criteria were medial elbow pain preventing effective playing, clinically medial elbow laxity, and magnetic resonance imaging results consistent with UCL injury. Patients who were engaged in other sports and in other positions in baseball except pitchers were excluded from this study. Our modified Tommy John procedure was performed via a muscle-splitting approach and an original single-bone-tunnel technique, using a suture anchor. After a minimum of 24 months, patients were evaluated using the Conway scale and the Timmerman-Andrews score. Results: Of 31 patients, 20 baseball pitchers (20 male: 5 high school, 5 collegiate, 8 nonprofessional, and 2 professional pitchers) were reviewed. The mean patient age at the time of operation was 21.9 years, and the mean postoperative follow-up period was 35.1 months (range, 24-66 months). The mean Timmerman-Andrews subjective score improved significantly from pre- to postoperatively (from 68.3 to 98.3; P < .05); the objective score also improved significantly (from 81.1 to 96.4; P = .01). No complications were detected at the latest follow-up. Overall, 19 patients were able to return to their preinjury level of sports or higher. Conclusion: UCL reconstruction with 1 bone hole in the ulna and 1 bone tunnel in the humerus demonstrated satisfactory results in baseball pitchers. Our modified technique was safe and achieved satisfactory clinical results, with a 95% rate of return to sports.

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“…A study by Lee et al showed US efficacy in the diagnosis of medial epicondyle lesions as compared with RA and MRI, with US providing a good PPV of medial epicondyle lesions. 20 Through systematic literature review, Katzer et al concluded that there are hints of a comparable diagnostic accuracy of RA and US-based diagnosis of forearm fractures in children, in addition to being less painful, time saving, and cost-effective. 18 Comparing these pediatric applications with others as well as our results, the use of US for diagnosis in the pediatric sports patient appears promising.…”

Section: Discussionmentioning

confidence: 99%

Investigation of Ultrasound as a Diagnostic Imaging Modality for Little League Shoulder

Fehr

Whealy

Liu

2021

Journal of Child Science

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Objective Ultrasound (US) is an established imaging modality in adult sports medicine but is not commonly used in the diagnosis of pediatric sports conditions, such as Little League shoulder (LLS). This study was conducted to determine the reliability of US measurement of width of the physis at the proximal humerus in diagnosed LLS and to compare US to radiography (RA) in detecting a difference between the affected (dominant) (A) and unaffected (U) shoulders. Materials and Methods Ten male baseball players diagnosed with LLS were enrolled in the study. US images of the proximal humeral physis at the greater tuberosity of both shoulders were obtained by an US-trained sports medicine physician, and the physeal width was measured. Blinded to prior measurements, a separate physician performed measurements on the stored US images. Measurements were compared with RA on the anteroposterior (AP) view for both A and U at the time of the initial visit and for A at follow-up. Results The physeal width (mm) at A and U at the initial visit averaged 5.94 ± 1.69 and 4.36 ± 1.20 respectively on RA, and 4.15 ± 1.12 and 3.40 ± 0.85 on US. Median difference of averaged US measurements between A and U at initial evaluation was 0.75 mm (p = 0.00016). A linear model showed US measurements to be predictive of RA on A (R2 = 0.51) and U (R2 = 0.48). Conclusion US was able to reliably measure the width of the proximal humeral physis and detect a difference between A and U. US correlated well with RA (standard for LLS). US should be considered by the US-trained physician for the diagnosis of LLS.

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Ultrasonography has high positive predictive value for medial epicondyle lesions among adolescent baseball players

Cited by 11 publications

References 23 publications

Increased medial laxity of the elbow in preadolescent baseball players with or without medial elbow apophysitis

Increased medial laxity of the elbow in preadolescent baseball players with or without medial elbow apophysitis

Ulnar Collateral Ligament Reconstruction With the Modified Jobe Technique in Baseball Pitchers

Investigation of Ultrasound as a Diagnostic Imaging Modality for Little League Shoulder

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