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Stevens KJ, Chaudhari AS, Kuhn KJ. Differences in Anatomic Adaptation and Injury Patterns Related to Valgus Extension Overload in Overhead Throwing Athletes. Diagnostics (Basel) 2024; 14:217. [PMID: 38275464 PMCID: PMC10814069 DOI: 10.3390/diagnostics14020217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
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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Affiliation(s)
- Kathryn J. Stevens
- Department of Radiology, Stanford University Medical Center, Palo Alto, CA 94304, USA;
| | - Akshay S. Chaudhari
- Department of Radiology, Stanford University Medical Center, Palo Alto, CA 94304, USA;
| | - Karin J. Kuhn
- MAPMG: Mid-Atlantic Permanente Medical Group, Rockville, MD 20852, USA;
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Goes PK, Flores DV, Damer A, Huang BK. Shoulder and Elbow Injuries in Adult Overhead Throwers: Imaging Review. Radiographics 2023; 43:e230094. [PMID: 37917538 DOI: 10.1148/rg.230094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Overhead throwing, particularly in baseball, subjects the shoulder and elbow to various unique injuries. Capsular contracture following repetitive external rotation shifts the humeral head posterosuperiorly, predisposing to glenohumeral internal rotation deficit (GIRD), Bennett, posterosuperior internal impingement (PSI), and superior labrum anterior-posterior (SLAP) lesions. GIRD represents loss of internal rotation at the expense of external rotation. Bennett lesion represents ossification of the posteroinferior glenohumeral ligament due to repetitive traction. PSI manifests with humeral head cysts and "kissing" tears of the posterosuperior cuff and labrum. Scapular dysfunction contributes to symptoms of PSI and predisposes to labral or rotator cuff disease. "Peel-back" or SLAP lesions occur when torsional forces detach the biceps-labral anchor from the glenoid. Finally, disorders of the anterior capsule, latissimus dorsi, teres major, and subscapularis are well recognized in overhead throwers. At the elbow, injuries typically involve the medial-sided structures. The ulnar collateral ligament (UCL) is the primary static restraint to valgus stress and can be thickened, attenuated, ossified, and/or partially or completely torn. Medial epicondylitis can occur with tendinosis, partial tear, or complete rupture of the flexor-pronator mass and can accompany UCL tears and ulnar neuropathy. Posteromedial impingement (PMI) and valgus extension overload syndrome are related entities that follow abundant valgus forces during late cocking or acceleration, and deceleration. These valgus stresses wedge the olecranon into the olecranon fossa, leading to PMI, osteophytes, and intra-articular bodies. Other osseous manifestations include olecranon stress fracture and cortical thickening of the humeral shaft. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Paola Kuenzer Goes
- From the Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA Diagnostic Imaging, São Paulo, Brazil (P.K.G.); Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottowa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Dyan V Flores
- From the Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA Diagnostic Imaging, São Paulo, Brazil (P.K.G.); Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottowa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Alameen Damer
- From the Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA Diagnostic Imaging, São Paulo, Brazil (P.K.G.); Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottowa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Brady K Huang
- From the Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA Diagnostic Imaging, São Paulo, Brazil (P.K.G.); Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottowa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
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Outcomes following arthroscopic posteromedial osteophyte resection and risk of future ulnar collateral ligament reconstruction. J Shoulder Elbow Surg 2023; 32:141-149. [PMID: 36167288 DOI: 10.1016/j.jse.2022.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/24/2022] [Accepted: 08/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Despite successful return-to-sport (RTS) outcomes after posteromedial osteophyte resection, one possible consequence of osteophyte removal is increased stress on the ulnar collateral ligament (UCL), leading to a UCL injury. It is currently unknown how often overhead athletes who undergo isolated posteromedial osteophyte resection subsequently require UCL reconstruction (UCLR). Therefore, the purpose of this study was to report outcomes following arthroscopic resection of posteromedial osteophytes in overhead athletes and determine whether overhead athletes who underwent arthroscopic posteromedial osteophyte resection for posteromedial impingement went on to require UCL surgery. We hypothesized that there would be a high rate of RTS following osteophyte resection and that players who underwent arthroscopic posteromedial osteophyte resection would have a >10% risk of requiring subsequent UCLR or UCL repair. MATERIALS AND METHODS All patients who underwent elbow arthroscopy from 2010-2020 at a single institution were reviewed. Patients were included if they underwent isolated arthroscopic posteromedial osteophyte resection without concomitant UCL surgery, were overhead athletes at the onset of posteromedial impingement symptoms, and had no history of elbow surgery. Primary outcomes included RTS rate, complications, and subsequent shoulder and/or elbow injury and surgery, as well as several patient-reported outcome measures (Kerlan-Jobe Orthopaedic Clinic score, Timmerman-Andrews elbow score, and Conway-Jobe score). RESULTS Overall, 36 overhead athletes were evaluated at 5.1 ± 3.4 years postoperatively, including 28 baseball pitchers, 3 baseball catchers, 3 softball players, 1 tennis player, and 1 volleyball player. Of the overhead athletes, 77% were able to RTS; the mean Kerlan-Jobe Orthopaedic Clinic and satisfaction scores were 70 and 75, respectively; and 89% of athletes had either excellent (73%) or good (16%) Conway-Jobe scores at long-term follow-up. Subsequent UCLR was required in 18% of baseball pitchers (n = 5) at a median of 13 months postoperatively. Of the 5 UCLRs, 3 were performed shortly after posteromedial osteophyte resection (6, 7, and 13 months postoperatively) whereas the other 2 were performed at 6.2 and 7.5 years postoperatively. CONCLUSION Following arthroscopic posteromedial osteophyte resection, 77% of athletes were able to RTS. Baseball pitchers who undergo arthroscopic resection of posteromedial osteophytes for posteromedial impingement have an 18% risk of subsequent UCLR.
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Piraino AB, Davis BM. The Management of Valgus Extension Overload Syndrome Experienced with Hitting in a High School Baseball Player: A Case Report. Int J Sports Phys Ther 2022; 17:1156-1169. [PMID: 36237658 PMCID: PMC9528722 DOI: 10.26603/001c.38168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/27/2022] [Indexed: 11/05/2022] Open
Abstract
Background Valgus extension overload syndrome (VEOS) of the elbow is a condition associated with overhead athletes. However, the non-surgical management of these individuals is not well documented. Purpose To discuss the unique presentation, management, and outcomes of an adolescent baseball player with a chronic history of VEOS experienced during hitting. Case Description A 15-year-old right-handed high school baseball catcher presented with a six-month history of right-sided ulnar elbow pain. Elbow MRI w/ contrast was consistent with VEOS. The initial examination demonstrated excessive resting right-sided humeral external rotation compared to his left. Valgus stress testing in the subject's hitting position reproduced symptoms, which were alleviated with retest while correcting excessive humeral external rotation. Weakness of the humeral internal rotators and stiffness/shortness of the posterior shoulder were found and thought to relate to the humeral contribution to his elbow movement dysfunction. Rehabilitation emphasized addressing impairments contributing to excessive humeral external rotation with reintegration into batting. Outcomes After five weeks of physical therapy, the subject returned to soft toss hitting at approximately 75% velocity for the first time since symptom onset, without pain. At seven months after discharge, a phone conversation confirmed that the subject had returned to baseball without limitations. Discussion Despite the concept of 'regional interdependence', common proximal impairments are often assumed to contribute to elbow pain without a clear biomechanical rationale. Future research demonstrating the specific biomechanical effects of the shoulder on the elbow is needed, in addition to more accessible examination strategies to assess their relationship. Level of Evidence 5.
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Affiliation(s)
- Andrew B Piraino
- Houston Methodist Clear Lake Orthopedics & Sports Medicine, Friendswood, TX, USA; University of Southern California Division of Biokinesiology and Physical Therapy, Los Angeles, CA, USA
| | - Brent M Davis
- Houston Methodist Clear Lake Orthopedics & Sports Medicine, Friendswood, TX, USA
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Bowers RL, Lourie GM, Griffith TB. Diagnosis and Treatment of Posteromedial Elbow Impingement in the Throwing Athlete. Curr Rev Musculoskelet Med 2022; 15:513-520. [PMID: 36006592 PMCID: PMC9789259 DOI: 10.1007/s12178-022-09789-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Posteromedial elbow impingement is a common pathological entity in the throwing athlete. The posteromedial articulation of the elbow is a significant stabilizer to medial elbow forces and valgus stress noted during repetitive throwing. This current review investigates recent literature regarding the relevant anatomy, diagnosis, and treatment of posteromedial impingement in the thrower. RECENT FINDINGS Improvements in advanced imaging have provided accurate and detailed diagnostic capability for the assessment of the throwers' elbow. After failure of conservative measures, arthroscopic treatment of posteromedial elbow impingement with posteromedial osteophyte removal has demonstrated excellent outcomes with a reliable return to play in the competitive thrower. In addition to a thorough history and physical examination, MRI, MR arthrogram, CT, and dynamic ultrasound imaging modalities are useful in the assessment of a presumed diagnosis of posteromedial impingement. Arthroscopic decompression with posteromedial osteophyte removal provides effective clinical results and return to play. The surgeon should be careful to avoid creating medial ulnar collateral instability by means of over-resection of the posteromedial olecranon.
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Affiliation(s)
- R. L. Bowers
- Atlanta Braves Baseball Club, Emory Sports Medicine Center, Emory University School of Medicine, 21 Ortho Lane, Atlanta, GA 30329 USA
| | - G. M. Lourie
- Atlanta Braves Baseball Club, The Hand and Upper Extremity Center of Georgia, Atlanta, GA USA
| | - T. B. Griffith
- Atlanta Braves Baseball Club, Peachtree Orthopaedics, Atlanta, GA USA
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Looney AM, Bovill JD, Huffman SS, Najarian RG. Routine diagnostic arthroscopy with elbow ulnar collateral ligament reconstruction does not reduce the need for future valgus extension overload-related surgeries: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:e22-e36. [PMID: 34478864 DOI: 10.1016/j.jse.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Valgus extension overload syndrome (VEOS) most commonly affects overhead athletes and consists of a constellation of conditions involving the medial, posterior, and lateral elbow, with the most widely discussed being ulnar collateral ligament (UCL) injuries. Many athletes with UCL tears also have findings consistent with other VEOS conditions, though these are not consistently symptomatic. Given the high rate of concomitant pathology, many authors have recommended performing arthroscopy at the time of UCL reconstruction (UCLR) to diagnose and address concomitant VEOS pathology; however, it is not known if this practice actually leads to a reduction in subsequent surgeries for VEOS conditions following index UCLR. The purpose of this systematic review and meta-analysis was to determine if performing routine diagnostic arthroscopy (RDA) in patients undergoing UCLR was associated with a lower incidence of future VEOS-related surgery. METHODS This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the primary outcome of interest being the likelihood of needing future surgery to address VEOS conditions with or without RDA at the time of index UCLR. The proportion and incidence rate of subsequent VEOS-related surgeries following UCLR with and without RDA were compared in mixed effects models. RESULTS There were 25 eligible studies from an initial 1335 systematically identified articles, with results for 2118 UCLR cases. Among these, there were a total of 94 reported VEOS-related surgeries. The proportion of subsequent VEOS-related surgeries was lower when UCLR was performed with RDA (0.40%, 95% CI 0.00%-3.51%) than without (1.16%, 95% CI 0.03%-3.25%), but the difference was not significant (P = .584). The incidence rate of VEOS-related surgeries was 0.16 (95% CI 0.00-0.95) per 100 person-years with RDA and 0.14 (95% CI 0.00-0.55) per 100 person-years without RDA (P = .942). CONCLUSION RDA preceding UCLR does not significantly reduce the proportion or rate of subsequent surgery for other VEOS conditions. There has been a decrease in RDA utilization with UCLR over time for athletes with torn/incompetent UCLs but otherwise no known symptomatic VEOS conditions, and this trend appears to be justified based on these findings.
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Affiliation(s)
- Austin M Looney
- Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, DC, USA.
| | - John D Bovill
- School of Medicine, Georgetown University, Washington, DC, USA
| | | | - Robert G Najarian
- Department of Orthopaedic Surgery, Inova Fairfax Hospital, Falls Church, VA, USA
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Reliable Pain Relief But Variable Return to Play After Arthroscopic Elbow Debridement in Baseball Players. Arthrosc Sports Med Rehabil 2021; 3:e1295-e1299. [PMID: 34712966 PMCID: PMC8527256 DOI: 10.1016/j.asmr.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/20/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose We sought to determine the rate of return to play (RTP) in baseball players following arthroscopic elbow debridement for the management of the symptomatic elbow. Methods A retrospective case series with prospectively collected data via questionnaire was conducted on all baseball players who underwent an arthroscopic elbow debridement, from July, 15, 2004 to November 1, 2017. A postoperative questionnaire was released at an average 7.25 year follow-up. Data collected included age, gender, laterality, preoperative diagnosis, range of motion, duration and characterization of symptoms, visual analog scale (VAS) pain score, complications, level of play, and RTP. Results Follow-up data were available on 18 baseball players. Average age was 19.7 years (range 16-24). Seventeen were pitchers, and 1 was a catcher. Level of play included 12 collegiate athletes, 2 high school athletes, 2 recreational athletes, 1 minor league athletes, and 1 major league athlete. Rate of RTP was 61% (11/18) with 6 returning to a greater level and 5 to an equal level. The length of time to RTP following surgery was most commonly within 6-8 months (44.4%, 8/18). Mean VAS pain score improved from 6.9 to 0.75 (P = <.001). 27.8% (5/18) had repeat surgery secondary to recurrent/persistent stiffness or heterotopic ossification. 77.8% (14/18) of patients rated their final outcome as either “very satisfied” (9/18), or “satisfied” (5/18). Conclusions Pain can reliably be relieved following arthroscopic elbow debridement in baseball players. Although patient satisfaction may be high, patients do not always return to their previous level of play. Patients must be counseled on the risk of limited postoperative athletic capacity before the time of surgery. Level of Evidence Level IV, therapeutic case series.
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8
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Ciccotti MC, Ciccotti MG. Ulnar Collateral Ligament Evaluation and Diagnostics. Clin Sports Med 2020; 39:503-522. [DOI: 10.1016/j.csm.2020.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Ciccotti MC, Ciccotti MG. Exam and Imaging of the Throwing Elbow. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2020.150732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Imaging of the post-operative medial elbow in the overhead thrower: common and abnormal findings after ulnar collateral ligament reconstruction and ulnar nerve transposition. Skeletal Radiol 2019; 48:1843-1860. [PMID: 31203406 DOI: 10.1007/s00256-019-03246-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 02/02/2023]
Abstract
Ulnar collateral ligament (UCL) reconstruction is now being performed more commonly and on younger patients than in prior decades. As a result, radiologists will increasingly be asked to evaluate elbow imaging of patients presenting with pain who have had UCL reconstruction. It is essential for radiologists to understand the normal and abnormal imaging appearances after UCL reconstruction and ulnar nerve transposition, which is also commonly performed in overhead-throwing athletes. Doing so will allow radiologists to provide accurate interpretations that appropriately guide patient management.
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Abstract
PURPOSE OF REVIEW Injury to the ulnar collateral ligament is the most common, significant injury affecting the medial elbow of the overhead athlete. However, there are many other significant sources of pathology that should be considered. This review seeks to present a broad range of conditions that providers should consider when evaluating the overhead athlete with medial elbow pain. RECENT FINDINGS Recent biomechanical studies have deepened understanding of the anatomy and function of the anterior bundle of the ulnar collateral ligament germane to the overhead athlete. Orthobiologics hold potential for expanding the role of non-operative treatment for ulnar collateral ligament injuries. In addition to injury to the ulnar collateral ligament, providers should be prepared to diagnose and treat valgus extension overload, proximal olecranon stress fracture, ulnar nerve pathology, common flexor - pronator mass injury, and, in adolescents, medial epicondylar avulsion, when managing medial elbow pain in the overhead athlete.
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Garcia GH, Gowd AK, Cabarcas BC, Liu JN, Meyer JR, White GM, Romeo AA, Verma NN. Magnetic Resonance Imaging Findings of the Asymptomatic Elbow Predict Injuries and Surgery in Major League Baseball Pitchers. Orthop J Sports Med 2019; 7:2325967118818413. [PMID: 30729142 PMCID: PMC6354307 DOI: 10.1177/2325967118818413] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background: Repetitive pitching produces significant stress on the elbow that may result in structural abnormalities discernable on magnetic resonance imaging (MRI) without causing symptoms. Purpose: To determine whether there exists an association between subclinical MRI findings in asymptomatic elbows of Major League Baseball (MLB) players and future placement on the disabled list (DL) or future operative procedure. Study Design: Cohort study; Level of evidence, 3. Methods: MRI scans of the elbows of professional-level baseball pitchers, taken during routine presigning imaging at a single organization from 2005 to 2017, were retrospectively reviewed. Publicly available databases were queried to exclude pitchers with an injury before the earliest session of elbow MRI. Three blinded reviewers reviewed all MRI scans independently to evaluate for the presence of chondral damage to the joint, loose bodies, ulnar collateral ligament (UCL) heterogeneity or tears, flexor pronator mass defects, and signs of posteromedial (PM) impingement. Binary imaging findings were related to future placement on the DL for elbow complaints and future elbow surgery. Results: A total of 41 pitchers had asymptomatic MRI findings with no prior DL placement. For players who eventually went on the DL, there were a statistically greater number of players with UCL heterogeneity (P = .021), humeral-sided partial UCL tears (P = .031), and PM impingement (P = .004) on preinjury MRI compared with players who remained healthy. PM impingement was related to future elbow-related surgery (P = .003). Pitchers with UCL heterogeneity were associated with reduced career strike zone percentage, innings pitched, and fastball percentage (P < .05 for all). Conclusion: UCL heterogeneity, PM impingement, and humeral-sided partial tears were correlated with future DL placement for elbow-related reasons in MLB pitchers. Asymptomatic PM impingement may be a precursor to future surgery.
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Affiliation(s)
| | - Anirudh K Gowd
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brandon C Cabarcas
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - John R Meyer
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory M White
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Anthony A Romeo
- Department of Orthopaedics, Rothman Institute, New York, New York, USA
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Long N, He S, Wu S, Huang F. [Research progress of posteromedial rotatory instability of the elbow]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:505-510. [PMID: 29806312 DOI: 10.7507/1002-1892.201710101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To summarize the research progress in posteromedial rotatory instability (PMRI) of the elbow joint. Methods The recent researches about the management of PMRI of the elbow joint from the aspects of pathological anatomy, biomechanics, diagnosis, and therapy were analyzed and summarized. Results The most important factors related to PMRI of the elbow joint are lateral collateral ligament complex (LCLC) lesion, posterior bundle of the medial collateral ligament complex (MCLC) lesion, and anteromedial coronoid fracture. Clinical physical examination include varus and valgus stress test of the elbow joint. X-ray examination, computed tomography, particularly three-dimensional reconstruction, are particularly useful to diagnose the fracture. Also MRI, arthroscopy, and dynamic ultrasound can assistantly evaluate the affiliated injury of the parenchyma. It is important to repair and reconstruct LCLC and MCLC and fix coronoid process fracture for recovering stability of the elbow joint. There are such ways to repair ligament injury as in situ repairation and functional reconstruction, which include direct suturation, borehole repairation, wire anchor repairation, and transplantation repairation etc. The methods for fixation of coronal fracture include screw fixation, plate fixation, unabsorbable suture fixation, and arthroscopy technology. Conclusion It is crucial that recovering the stability of the elbow joint and early functional exercise for the treatment of PMRI. Individual treatment is favorable to protect soft tissue, reduce surgical complications, and improve the functional recovery and the quality of life.
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Affiliation(s)
- Nengji Long
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Shukun He
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Shizhou Wu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuguo Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Hilgersom NFJ, Molenaars RJ, van den Bekerom MPJ, Eygendaal D, Doornberg JN. Review of Poehling et al (1989) on elbow arthroscopy: a new technique. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nocerino EA, Cucchi D, Arrigoni P, Brioschi M, Fusi C, Genovese EA, Messina C, Randelli P, Masciocchi C, Aliprandi A. Acute and overuse elbow trauma: radio-orthopaedics overview. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:124-137. [PMID: 29350642 PMCID: PMC6179073 DOI: 10.23750/abm.v89i1-s.7016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
Abstract
Summary. The correct management of acute, subacute and overuse-related elbow pathologies represents a challenging diagnostic and therapeutic problem. While major trauma frequently requires a rapid surgical intervention, subluxation and minor trauma allow taking more time for diagnostics and planning the correct elective treatment after careful clinical and radiological investigation. In these conditions, communication between orthopaedic surgeon and radiologist allow to create a detailed radiology report, tailored to the patient’s and surgeon’s needs and optimal to plan proper management. Imaging technique as X-Ray, CT, US, MRI, CTA and MRA all belong to the radiologist’s portfolio in elbow diagnostics. Detailed knowledge of elbow pathology and its classification and of the possibilities and limits of each imaging technique is of crucial importance to reach the correct diagnosis efficiently. The aim of this review is to present the most frequent elbow pathologies and suggest a suitable diagnostic approach for each of them. (www.actabiomedica.it)
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Matsuura T, Iwame T, Suzue N, Iwase J, Tamaki S, Yokoyama K, Sairyo K. Clinical Outcome of Arthroscopic Treatment for Posteromedial Elbow Impingement in Adolescent Baseball Players. Arthroscopy 2018; 34:105-110. [PMID: 28866343 DOI: 10.1016/j.arthro.2017.06.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/06/2017] [Accepted: 06/30/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of arthroscopic treatment in adolescent baseball players with posteromedial elbow impingement. METHODS This retrospective study evaluated the clinical outcome of arthroscopic treatment for posteromedial elbow impingement in adolescent baseball players. Patients were eligible for participation if they had undergone surgery at least 2 years earlier and excluded if they had arthritis, loose bodies, osteochondritis dissecans, ulnar collateral ligament tear, flexor/pronator injuries or medial epicondylitis, or nerve problems. Patients were also excluded if they had undergone prior elbow surgery, were younger than 13 years, or were older than 19 years. Arthroscopic treatment included debridement of posteromedial synovitis, fragment removal, and olecranon spur excision. At a mean follow-up of 26.7 (range 24-42) months, patients were evaluated based on a questionnaire, examination, and the previously reported elbow outcome score. RESULTS This retrospective study involved 15 male patients, comprising 6 pitchers, 3 catchers, and 6 fielders, of mean age 15.7 (range 14-17) years. Mean time from onset of symptoms to surgery was 4.9 (range 3-18) months. Intraoperative findings included posteromedial synovitis and olecranon spurs in all patients and fragments in 10. The elbow outcome score was considered excellent in 11 patients and good in 2, with a mean score of 92 points (maximum 100 points). The mean postoperative range of motion at the elbow was 5° to 139.7° of flexion. All patients were able to return to their previous level of play after an average of 3.4 (range 2.5-4.5) months. No patient developed medial instability that later required reconstructive surgery. CONCLUSIONS Arthroscopic debridement, excision of the olecranon spur, and removal of fragments yield reliable subjective and objective results and allow a return to baseball in adolescent patients. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Tetsuya Matsuura
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Toshiyuki Iwame
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Naoto Suzue
- Department of Orthopaedic Surgery, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Jyoji Iwase
- Department of Orthopaedic Surgery, Kochi Red Cross Hospital, Kochi, Japan
| | - Shunsuke Tamaki
- Department of Orthopaedic Surgery, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Kenji Yokoyama
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Arthroscopic treatment successfully treats posterior elbow impingement in an athletic population. Knee Surg Sports Traumatol Arthrosc 2018; 26:306-311. [PMID: 28534159 PMCID: PMC5754399 DOI: 10.1007/s00167-017-4563-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/03/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Posterior elbow impingement can cause disabling pain and limited motion during activities involving elbow extension. Less understood is whether arthroscopic treatment, compared to open surgery, can result in effective management of pain, loss of range of motion, and return athletes to previous levels of activity. This study determined whether arthroscopic debridement is a safe and effective treatment for posterior elbow impingement and whether it enables athletes to return to a previous level of function. METHODS A retrospective review of 36 consecutive patients that underwent arthroscopic debridement of the posterior elbow was performed. There were 34 male and 2 female patients, with a median age of 32 years (17-54 years). There were 7 professional athletes, 6 college athletes, and 23 high school or recreational athletes. All patients had a positive posterior impingement test for posterior pain with extension and limitations of activity. Arthroscopic debridement and additional surgical procedures were performed, and patients underwent follow-up visits at a median 51 months (range 14-81). RESULTS Significant improvements were seen in pain, motion, and function. No neurovascular complications were seen related to the arthroscopic debridement. The mean Andrews and Timmerman elbow score improved from 159 ± 27 to 193 ± 11 (p < 0.01). Thirty-five of thirty-six (97%) patients returned to their previous level of activity, including all professional athletes. CONCLUSIONS Arthroscopic management of posterior elbow impingement is safe and effective and can return patients, including professional athletes, to high-level athletic activity. Athletes with symptomatic posterior elbow impingement can be successfully and safely treated with arthroscopic debridement and typically will return to preinjury levels of activity. LEVEL OF EVIDENCE IV.
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Papaliodis DN, Conway JE. Arthroscopic and Open Treatment of Olecranon Apophyseal Injuries in the Athlete. OPER TECHN SPORT MED 2017. [DOI: 10.1053/j.otsm.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Correlation of MRI to Arthroscopy in the Elbow: Thrower's Elbow and Ulnar Collateral Ligament Injury. Sports Med Arthrosc Rev 2017; 25:191-198. [PMID: 29095397 DOI: 10.1097/jsa.0000000000000165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
One cannot overstate the importance of a thorough history and physical examination, supplemented with directed imaging, to help pinpoint the exact cause of the athlete's elbow pain. Although plain radiographs should not be overlooked, advanced imaging plays a critical role in diagnosis and management of pathology in the thrower's elbow, including computed tomography, magnetic resonance imaging, and stress ultrasound. By judiciously combining these elements, the clinician can appropriately manage these injuries in order to successfully return the athlete to their preinjury level of play.
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Abstract
Medial elbow pain is uncommon when compared with lateral elbow pain. Medial epicondylitis is an uncommon diagnosis and can be confused with other sources of pain. Overhead throwers and workers lifting heavy objects are at increased risk of medial elbow pain. Differential diagnosis includes ulnar nerve disorders, cervical radiculopathy, injured ulnar collateral ligament, altered distal triceps anatomy or joint disorders. Children with medial elbow pain have to be assessed for ‘Little League elbow’ and fractures of the medial epicondyle following a traumatic event. This paper is primarily focused on the differential diagnosis of medial elbow pain with basic recommendations on treatment strategies.
Cite this article: EFORT Open Rev 2017;2:362-371. DOI: 10.1302/2058-5241.2.160006
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Affiliation(s)
- Raul Barco
- Shoulder & Elbow Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Samuel A Antuña
- Shoulder & Elbow Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid 28046, Spain
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Rosas S, Krill MK, Amoo-Achampong K, Kwon K, Nwachukwu BU, McCormick F. A practical, evidence-based, comprehensive (PEC) physical examination for diagnosing pathology of the long head of the biceps. J Shoulder Elbow Surg 2017; 26:1484-1492. [PMID: 28479256 PMCID: PMC6427911 DOI: 10.1016/j.jse.2017.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical examination of the shoulder joint has gained attention as clinicians aim to use an evidence-based examination of the biceps tendon, with the desire for a proper diagnosis while minimizing costly imaging procedures. The purpose of this study is to create a decision tree analysis that enables the development of a clinical algorithm for diagnosing long head of biceps (LHB) pathology. METHODS A literature review of Level I and II diagnostic studies was conducted to extract characteristics of clinical tests for LHB pathology through a systematic review of PubMed, Medline, Ovid, and Cochrane Review databases. Tests were combined in series and parallel to determine sensitivities and specificities, and positive and negative likelihood ratios were determined for each combination using a subjective pretest probability. The "gold standard" for diagnosis in all included studies was arthroscopy or arthrotomy. RESULTS The optimal testing modality was use of the uppercut test combined with the tenderness to palpation of the biceps tendon test. This combination achieved a sensitivity of 88.4% when performed in parallel and a specificity of 93.8% when performed in series. These tests used in combination optimize post-test probability accuracy greater than any single individual test. CONCLUSION Performing the uppercut test and biceps groove tenderness to palpation test together has the highest sensitivity and specificity of known physical examinations maneuvers to aid in the diagnosis of LHB pathology compared with diagnostic arthroscopy (practical, evidence-based, comprehensive examination). A decision tree analysis aides in the practical, evidence-based, comprehensive examination diagnostic accuracy post-testing based on the ordinal scale pretest probability.
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Affiliation(s)
- Samuel Rosas
- Department of Orthopedic Surgery, Baptist Health, Wake Forest University, Winston-Salem, NC, USA
| | - Michael K. Krill
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA,Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - KiHyun Kwon
- Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | | | - Frank McCormick
- Department of Orthopedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Department of Sports Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Reprint requests: Frank McCormick, MD, 330 Brookline Ave., Boston, MA02215, USA.
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Pathologies of the shoulder and elbow affecting the overhead throwing athlete. Skeletal Radiol 2017; 46:873-888. [PMID: 28299434 DOI: 10.1007/s00256-017-2627-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/02/2017] [Accepted: 03/05/2017] [Indexed: 02/08/2023]
Abstract
The overhead-throwing athlete is susceptible to a variety of predictable disease entities affecting the shoulder and elbow. While the pathophysiology and nomenclature of these diseases are ubiquitous throughout the clinical literature, this information is sparse within the radiology domain. We provide a comprehensive review of these unique injuries with accompanying imaging features in an effort to enhance the role of the radiologist during the management of the overhead thrower. When appropriately recognized and described, the imaging features aid in establishing a diagnosis and ultimately the implementation of appropriate clinical management.
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Valgus extension overload syndrome in adolescent baseball players: clinical characteristics and surgical outcomes. J Shoulder Elbow Surg 2016; 25:2048-2056. [PMID: 27765503 DOI: 10.1016/j.jse.2016.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/23/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the clinical characteristics and surgical outcomes of valgus extension overload syndrome (VEOS) in adolescent athletes. We evaluated posteromedial compartment pathology, including combined lesions, and reported the surgical outcomes in adolescent baseball players. METHODS We retrospectively reviewed the medical records of 13 male adolescent baseball players (mean age, 15.4 years) who underwent arthroscopic olecranon tip resection (n = 9) or staged operations (arthroscopic olecranon tip resection, followed by medial collateral ligament reconstruction 2 weeks later; n = 4). The shape of the tip fragment was used to classify the olecranon into 2 types: type 1, dot-like fragment (n = 3); type 2, triangular-shape fragment (n = 10). Four outcome measures were analyzed: range of motion, visual analog scale (VAS) pain score, rate of return to play, and Conway scale score. RESULTS At a mean follow-up of 3.3 years (range, 2-6 years), the mean VAS pain score decreased from 4.1 preoperatively to 1.1 postoperatively (P < .05). Preoperative mean extension and supination were 4.2° and 70.0°, which improved to 1° (P < .05) and 76.2° (P < .05), respectively. The overall rate of return to play was 85% (11 of 13). On the Conway scale, 8 of 13 patients (62%) were classified as excellent. Patients who underwent isolated arthroscopic surgery reported less pain postoperatively and achieved a higher grade on the Conway scale than patients who underwent staged operations. CONCLUSIONS Arthroscopic resection of olecranon tip yielded favorable outcomes at a minimum of 2 years of follow-up. Patients with concomitant ulnar collateral ligament insufficiency had less optimal outcomes than those with isolated posteromedial impingement.
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Abstract
Elbow pain is a frequent presenting symptom in athletes, particularly athletes who throw. The elbow can be injured as a result of acute trauma, such as a direct blow or a fall onto an outstretched hand or from chronic microtrauma. In particular, valgus extension overload during the throwing motion can precipitate a cascade of chronic injuries that can be debilitating for both casual and high-performance athletes. Prompt imaging evaluation facilitates accurate diagnosis and appropriate targeted interventions.
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Affiliation(s)
- Matthew D Bucknor
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA 94158
| | - Kathryn J Stevens
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA 94158
| | - Lynne S Steinbach
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA 94158
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Roedl JB, Gonzalez FM, Zoga AC, Morrison WB, Nevalainen MT, Ciccotti MG, Nazarian LN. Potential Utility of a Combined Approach with US and MR Arthrography to Image Medial Elbow Pain in Baseball Players. Radiology 2016; 279:827-37. [DOI: 10.1148/radiol.2015151256] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ko CC, Tai MH, Lin CH, Tzeng WS, Chen JH, Shu G, Da Wu C, Chen CKH. Posteromedial olecranon impingement of the pitching elbow: Additional findings provided by CT. Eur J Radiol 2016; 85:211-217. [PMID: 26724668 DOI: 10.1016/j.ejrad.2015.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 11/02/2015] [Accepted: 11/14/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Posteromedial olecranon impingement (PMOI) is the most common diagnosis in baseball players with throwing-induced elbow injuries. CT imaging manifestations of PMOI have seldom been previously reported. Our purpose is to investigate the additional value of CT imaging in the evaluation of PMOI. MATERIALS AND METHODS From July 2010 to December 2013, 47 baseball players with throwing-induced elbow pain received imaging studies (CT and/or MRI) of the elbow at our institution. After retrospectively reviewing the clinical records and imaging studies, 31 of the 47 players were diagnosed with PMOI by the criteria of posteromedial elbow pain with clinical consistency for PMOI and characteristic osteoarthrosis at the posteromedial ulnotrochlear articulation (posteromedial olecranon space, PMOS) detected by CT and/or MRI. The imaging modalities of these 31 players including radiography, CT, and MRI were reviewed by 2 experienced musculoskeletal radiologists. RESULTS The most common imaging manifestations of PMOI by CT or MRI include joint space narrowing, subchondral sclerosis, and osteophytes at the PMOS. CT was superior to MRI with a statistically significant (P<0.05) difference in detecting joint space narrowing, medial olecranon subluxation, as well as the number of loose bodies. In contrast, bone marrow edema and associated soft tissue injuries in PMOI are more readily observed on MRI. CONCLUSIONS CT is superior in identifying some imaging features of PMOI. Whenever PMOI is diagnosed in the pitching elbow of a baseball player, CT should be considered prior to surgical intervention as it will often provide additional information to the surgeon that may alter surgical management.
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Affiliation(s)
- Ching Chung Ko
- Department of Medical Imaging, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City 71004, Taiwan; Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan.
| | - Ming Hong Tai
- Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan.
| | - Chien Hung Lin
- Department of Medical Imaging, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City 71004, Taiwan.
| | - Wen Sheng Tzeng
- Department of Medical Imaging, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City 71004, Taiwan.
| | - Jeon Hor Chen
- Department of Radiology, I-Shou University and Eda Hospital, No. 1, Yi-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County 824, Taiwan.
| | - Ginger Shu
- Department of Medical Imaging, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City 71004, Taiwan.
| | - Chung Da Wu
- Department of Orthopaedics, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City 71004, Taiwan.
| | - Clement Kuen Huang Chen
- Department of Medical Imaging, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang District, Tainan City 71004, Taiwan.
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Reilly D, Kamineni S. The olecranon spur. J Shoulder Elbow Surg 2015; 24:980-7. [PMID: 25979555 DOI: 10.1016/j.jse.2015.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/23/2015] [Accepted: 03/07/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is very little information for today's clinician on olecranon spurs. In addition, there is some ambiguity in the literature, with the terms "olecranon spur" and "olecranon osteophyte" sometimes being used interchangeably. This review presents the current knowledge about olecranon spur anatomy, pathophysiology, clinical presentation, diagnosis, treatment options and their outcomes, as well as clarification of the terms "spur" and "osteophyte". METHODS The PubMed and Google Scholar databases were searched using the terms "olecranon spur," "olecranon traction spur," and "olecranon osteophyte." The resulting articles were used to find other manuscripts pertaining to the subject. RESULTS Very few articles were found as a result of these search criteria and were limited to a few case reports and a study investigating the postoperative outcomes of spur removal. Confusion of the terms "olecranon spur" and "olecranon osteophyte" was noted in 6 of the manuscripts. CONCLUSIONS The mechanism of olecranon spur formation has not been confirmed but seems to be similar to that of spurs at other entheses. In addition, the current literature represents a small number of patients and selects only those who required surgical intervention. Three methods of spur resection have been published, and all have good outcomes with small patient numbers and limited follow-up.
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Affiliation(s)
- Danielle Reilly
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA
| | - Srinath Kamineni
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA.
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Del Grande F, Aro M, Farahani SJ, Wilckens J, Cosgarea A, Carrino JA. Three-Tesla MR imaging of the elbow in non-symptomatic professional baseball pitchers. Skeletal Radiol 2015; 44:115-23. [PMID: 25296899 DOI: 10.1007/s00256-014-2018-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/03/2014] [Accepted: 09/19/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To retrospectively evaluate the qualitative and quantitative 3-T MR imaging features of the elbow in non-symptomatic professional baseball pitchers presenting as major league draft picks or trades. MATERIALS AND METHODS The Institutional Review Board (IRB) approved the HIPPA-compliant study. Informed consent was waived. Twenty-one professional non-symptomatic baseball pitchers (mean age 23, range 18 to 34 years old) underwent 3-T MR imaging of the pitching elbow. Two experienced readers independently performed qualitative (collateral ligaments, tendons, cartilage, bones, ulnar nerve, olecranon fossa, and joint fluid) and quantitative (collateral ligaments and posteromedial plica) evaluation. Descriptive statistics were calculated. RESULTS Collateral ligament thickening was seen in a high proportion, nearly half, however, without features of full thickness tearing. Tendinosis without tearing was seen in 19 % (4/21) of common extensors. Cartilage abnormalities were infrequent. Bone abnormalities manifested as edema in 24 % (5/21) and humeroulnar osteophytosis. Ulnar nerve signal and/or morphologic abnormalities were seen in a very high proportion, up to 81 % (17/21). The olceranon fat pad showed scarring features in about one third. The median ligament thicknesses in mm measured: 4.6 UCL anterior bundle, 1.8 UCL posterior bundle, 1.9 RCL, 2.5 LUCL, and 0.7 mm anular. The median plica dimensions were 5.3 by 2.2 by 2.7 mm. CONCLUSION High-resolution 3-T MR imaging frequently shows abnormalities involving the ligaments, tendons, nerves, olecranon fat pad, and bones in non-symptomatic baseball pitchers.
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Affiliation(s)
- Filippo Del Grande
- The Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 601 North Wolfe Street, Baltimore, MD, 21287, USA,
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Patel RM, Lynch TS, Amin NH, Gryzlo S, Schickendantz M. Elbow Injuries in the Throwing Athlete. JBJS Rev 2014; 2:01874474-201411000-00004. [PMID: 27490404 DOI: 10.2106/jbjs.rvw.n.00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ronak M Patel
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, OH 44125
| | - T Sean Lynch
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, OH 44125
| | - Nirav H Amin
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, OH 44125
| | - Stephen Gryzlo
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North Street Clair, Suite #1350, Chicago, IL 60611
| | - Mark Schickendantz
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, OH 44125
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Abstract
Overhead throwing activities expose the elbow to tremendous valgus stress, making athletes vulnerable to a specific constellation of injuries. Although baseball players, in particular pitchers, are the athletes affected most commonly, overhead throwing athletes in football, volleyball, tennis, and javelin tossing also are affected. The purpose of this review is to review the anatomy, biomechanics, pathophysiology, and treatment of elbow disorders related to overhead throwing athletes. Although focus is on management of ulnar collateral ligament injuries, all common pathologies are discussed.
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Affiliation(s)
- Ronak M Patel
- Sports Health, Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 5555 Transportation Boulevard, Garfield Heights, OH 44125, USA
| | - T Sean Lynch
- Sports Health, Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 5555 Transportation Boulevard, Garfield Heights, OH 44125, USA
| | - Nirav H Amin
- Sports Health, Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 5555 Transportation Boulevard, Garfield Heights, OH 44125, USA
| | - Gary Calabrese
- Sports Health, Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 5555 Transportation Boulevard, Garfield Heights, OH 44125, USA
| | - Stephen M Gryzlo
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair, #1350, Chicago, IL, USA
| | - Mark S Schickendantz
- Sports Health, Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 5555 Transportation Boulevard, Garfield Heights, OH 44125, USA.
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Abstract
BACKGROUND Recently, many studies have emphasized the importance of the comprehension of detailed functional anatomy and biomechanics of the elbow and its significant contribution in facilitating good functional outcomes of conservative and surgical treatment in the field of elbow disorders. METHODS The most common disease of elbow disorders and their treatment was reviewed. RESULTS Lateral epicondylitis of the elbow, is defined as a microscopic tear of extensor carpi radialis brevis tendon, and microscopic findings show immature reparative tissue (angiofibroblastic hyperplasia). The patient needs coordinated rehabilitation, range-of motion-exercise, stretching, and bracing in the second phase. Ninety-five percent of patients with lateral epicondylitis heal spontaneously or conservatively. The medial collateral ligament injury of the elbow is most common in the overhead-throwing athlete. Jobe's procedure, the original reconstruction technique, and its modifications in bone-tunnel creation, allow a tendon graft to be wound in a figure-eight configuration through the tunnels. Further modification of Jobe's procedure in bone-tunnel configuration reduced the total number of tunnels and facilitates easier graft tensioning. Outcomes with these reconstruction techniques have proven effective in returning high-level throwing athletes back to their sport. Arthroscopic surgery for the elbow in the throwing athlete has evolved and has proven successful results. Arthroscopic treatment includes debridement of posteromedial synovitis, loose-body removal, and excision of the olecranon spur. Posteromedial elbow impingement is also a source of disability in the overhead-throwing athlete. Twenty-five percent of these patients require a medial collateral ligament reconstruction after removal of a posteromedial bony spur. Linked and unlinked total elbow arthroplasty are successful treatment procedures for patients with rheumatoid arthritis, posttraumatic osteoarthritis, and elderly patients with comminuted distal humeral fractures and the salvage of distal humeral nonunion. Proper selection and implantation of prostheses are also important to achieve good functional outcome and longevity. CONCLUSION The success of treatment of elbow disorders depends greatly on surgical design and technique, both of which require comprehensive knowledge of detailed anatomy and biomechanics of the elbow.
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Affiliation(s)
- Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
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The current issue: clinical shoulder, knee, wrist, hip, and cost-effectiveness analysis. Arthroscopy 2011; 27:1313-6. [PMID: 21955391 DOI: 10.1016/j.arthro.2011.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 07/07/2011] [Indexed: 02/02/2023]
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