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

Millard, Nathaniel; DeMoss, Andrew; McIlvain, Gary E.; Beckett, Joseph A.; Jasko, John J.; Timmons, Mark K.

doi:10.1002/jum.14779

Cited by 12 publications

(10 citation statements)

References 32 publications

(75 reference statements)

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“…Medial elbow joint space gapping under valgus stress significantly increased after 60 pitches as compared with before pitching. Millard et al 23 found that repeated wrist flexion exercise decreased the stability of the medial elbow. These 2 studies stated that fatigue of the forearm flexor muscle decreased the power of stabilization for valgus stress of the medial elbow.…”

Section: Discussionmentioning

confidence: 99%

Association Between Osteochondritis Dissecans of the Humeral Capitellum and Medial Epicondyle Lesion in Baseball Players

Kamei

Sasaki

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Osteochondritis dissecans (OCD) of the humeral capitellum occurs in adolescent overhead athletes, and medial epicondyle (ME) lesions are also common in this population. Purpose: To evaluate the association between elbow OCD and ME lesions in adolescent baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study retrospectively evaluated adolescent baseball players with unstable elbow OCD who underwent surgery between January 2000 and February 2020. Patients were excluded if they had osteoarthritis of the elbow. A total of 139 elbows were included in this study (138 male and 1 female athlete; mean ± SD age, 13.6 ± 1.5 years). The patients were first divided into 2 groups based on OCD location: a central lesion group (72 elbows) and a lateral group (67 elbows). Next, patients were divided according to OCD size into a localized group (56 elbows) and a widespread group (83 elbows). Finally, OCD lesions that were both lateral and widespread were defined as lateral-widespread (60 elbows), resulting in 5 groups. ME apophyseal fragmentation and elongation were evaluated and defined as ME lesions. We then compared the relationship between OCD and ME lesions. Results: Of the 139 elbows, 63 (45.3%) had ME lesions. The prevalence of ME lesion was higher in the lateral group than the central group (56.7% vs 34.7%; P = .009) and higher in the widespread group than the localized group (55.4% vs 30.4%; P = .004). Furthermore, the prevalence ratio of ME lesion was significantly higher in the lateral-widespread group than for other lesions (58.3% vs 35.4%; P = .007). Conclusion: In patients undergoing surgery for capitellar OCD, the presence of ME lesions was more commonly associated with lateral and widespread capitellar lesions when compared with central and localized lesions.

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Section: Discussionmentioning

confidence: 99%

Association Between Osteochondritis Dissecans of the Humeral Capitellum and Medial Epicondyle Lesion in Baseball Players

Kamei

Sasaki

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…However, a wrist flexion strength test may be a better test of flexor pronator mass strength and the potential for protection against medial elbow valgus stress. Specifically, wrist flexion fatigue (7.5% decrease in strength) has been shown to increase ultrasound measured medial elbow joint space with application of a valgus stress (28).…”

Section: Limitationsmentioning

confidence: 99%

Accelerated Muscle Recovery in Baseball Pitchers Using Phase Change Material Cooling

Mullaney¹,

McHugh²,

Kwiecien³

et al. 2020

Medicine &Amp; Science in Sports &Amp; Exercise

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The purpose of this study was to document recovery following a pitching performance and determine if prolonged post-game phase change material (PCM) cooling of the shoulder and forearm accelerates recovery. Methods: Strength, soreness and serum creatine kinase (CK) activity were assessed prior to, and on the two days following pitching performances in 16 college pitchers. Pitchers were randomized to receive either post-game PCM cooling packs on the shoulder and forearm, or no cooling (control). PCM packs were applied inside compression shirts and delivered cooling at a constant temperature of 15°C for 3 hours. Strength was assessed for shoulder internal rotation (IR), external rotation (ER), empty can test (EC) and grip. Results: Total pitch count was 60±16 for 23 PCM cooling games and 62±17 for 24 control games (P=.679). On the days following pitching IR strength (P=.006) and grip strength (P=.036) were higher in the PCM cooling group versus control. One day after pitching IR strength was 95±14% of baseline with PCM cooling versus 83±13% for control (P=.008, effect size d 0.91) and 107±9% versus 95±10% for grip strength (P=.022, effect size d 1.29). There was a trend for greater ER strength with PCM cooling (P=.091, effect size d 0.51). The EC strength was not impaired after pitching (P=.147) and was therefore unaffected by PCM cooling (P=.168). Elevations in soreness and CK were not different between treatments (Treatment by Time CK P=.139, shoulder soreness P=.885, forearm soreness P=.206). Conclusion: This is one of the first studies to document impairments in muscle function on the days following baseball pitching, and the first study showing a novel cryotherapy intervention that accelerates recovery of muscle function in baseball pitchers following a game. 2

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“…Damage to the stabilizing structures, especially the UCL, can cause instability or increase the medial joint space [1,7]. Fatigue of the dynamic stabilizers such as the wrist flexor muscle group can decrease overall stability and increase the medial joint space [8,9]. The repetitive stress of throwing begins to fatigue the flexor muscles and stretch the UCL, increasing medial elbow instability [7].…”

mentioning

confidence: 99%

“…Glousman et al [11] reported that pitchers with UCL injuries demonstrated decreased wrist flexor activity. Millard et al [9] showed that fatigue of the wrist flexors might lead to an increase in medial elbow joint space. These differences have been found in professional and collegiate baseball players, though studies on youth athletes have not been reported [2,4,10,12,13].…”

mentioning

confidence: 99%

Youth throwing athletes do not show bilateral differences in medial elbow width or flexor tendon thickness

Morrow

McIlvian

Johnson

et al. 2022

Clin Shoulder Elbow

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Background: Medial elbow laxity develops in throwing athletes due to valgus forces. Medial elbow instability in professional, collegiate, and high school athletes is well documented; however, the medial elbow of young throwing athletes has received less attention. This study investigated the medial elbow and common flexor tendon during applied elbow valgus stress of youth baseball players. Methods: The study included 15 participants. The medial elbow width and thickness of the common flexor tendon were measured on ultrasound images. Results: No significant side differences in medial elbow width or common flexor tendon were found at rest or under applied valgus stress. At rest, the medial elbow joint width was 3.34±0.94 mm on the dominant side and 3.42±0.86 mm on the non-dominant side. The dominant side increased to 3.83±1.02 mm with applied valgus stress, and the non-dominant side increased to 3.96±1.04 mm. The mean flexor tendon thickness was 3.89±0.63 mm on the dominant side and 4.02±0.70 mm on the non-dominant side. Conclusions: These findings differ from similar studies in older throwing athletes, likely because of the lack of accumulated stress on the medial elbow of youth throwing athletes. Maintaining elbow stability in young throwing athletes is a vital step to preventing injury later in their careers.

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

Cited by 12 publications

References 32 publications

Association Between Osteochondritis Dissecans of the Humeral Capitellum and Medial Epicondyle Lesion in Baseball Players

Association Between Osteochondritis Dissecans of the Humeral Capitellum and Medial Epicondyle Lesion in Baseball Players

Accelerated Muscle Recovery in Baseball Pitchers Using Phase Change Material Cooling

Youth throwing athletes do not show bilateral differences in medial elbow width or flexor tendon thickness

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