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Schneider MM, Hollinger B, Zimmerer A, Nietschke R, Michaely H, Migliorini F, Maffulli N, Burkhart KJ. Ossification of the posterior capitellum: description of a new pathology and its radiological appearance. Arch Orthop Trauma Surg 2023; 143:4019-4029. [PMID: 36399163 PMCID: PMC10293325 DOI: 10.1007/s00402-022-04689-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Boxer elbow and handball goalkeeper elbow are causes of impingement characterized by osteophytes formation at the olecranon and coronoid tip as well as their corresponding fossae. Herein, we present another distinct pathology in these patients: the formation of an exostosis at the posterolateral aspect of the elbow. METHODS Between April 2016 and May 2020, 12 athletes with boxer elbow and handball goalkeeper elbow (mean age of 22 years) suffering from elbow pain were enrolled in the present study. Plain radiography, magnetic resonance imaging (MRI), and computer tomography (CT) scans were used to evaluate the bone conformation of the posterolateral aspect of the elbow. Assessment and staging of the ossification was performed by two independent fellowship-trained elbow surgeons. RESULTS Bone marrow edema of the posterior aspect of the elbow at the origin of the anconeus muscle was initially detected in MRI scans. With the progression of the condition, imaging revealed an ossification posterior to the capitellum with bony bridges. In the advanced stage of the disease, the exostoses was unstable as the ossification had no adherence to the posterior capitellum during surgical excision. Plain radiographs are limited in their ability to detect the condition, whereas MRI and CT scans allow to identify a signal enhancement at the posterolateral aspect of the elbow. CONCLUSION In patients without history of elbow trauma, bony irregularities of the posterior aspect of the capitellum may indicate ossification of the posterolateral aspect of the elbow, most likely caused by repetitive hyperextensions.
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Affiliation(s)
- M M Schneider
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Germany.
- University Witten/Herdecke, Witten, Germany.
| | - B Hollinger
- Abteilung Sportorthopädie, Orthopädische Klinik Markgröningen, Markgröningen, Germany
| | - A Zimmerer
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Germany
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - R Nietschke
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - H Michaely
- MVZ Radiologie Karlsruhe, Karlsruhe, Germany
| | - F Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany
| | - N Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
- Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, England, UK
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, England, UK
| | - K J Burkhart
- Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Germany
- University of Cologne, Cologne, Germany
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Abstract
Distal triceps ruptures are uncommon, usually caused by a fall on an outstretched hand or a direct blow. Factors linked to injury include eccentric loading of a contracting triceps, anabolic steroid use, weightlifting, and traumatic laceration. Risk factors include local steroid injection, hyperparathyroidism, and olecranon bursitis. Initial diagnosis can be complicated by pain and swelling, and a palpable defect is not always present. Plain radiographs can be helpful. MRI confirms the diagnosis and directs treatment. Incomplete tears can be treated nonsurgically; complete tears are best managed surgically. Good to excellent restoration of function has been shown with surgical repair.
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Kholinne E, Al-Ramadhan H, Bahkley AM, Alalwan MQ, Jeon IH. MRI overestimates the full-thickness tear of distal triceps tendon rupture. J Orthop Surg (Hong Kong) 2019; 26:2309499018778364. [PMID: 29871547 DOI: 10.1177/2309499018778364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Injury to the distal triceps brachii tendon is rare. Imaging radiographs are used to confirm the findings of physical examination, classify the extent of injury, and guide treatment. Magnetic resonance imaging (MRI) is considered the gold standard of diagnostic imaging. However, no previous study has reported on the accuracy of differentiation between partial- and full-thickness triceps tendon tears. Our study's aim was to define the accuracy of MRI in differentiating partial- from full-thickness tear of the distal triceps tendon. We hypothesized that MRI has low accuracy in differentiating partial- from full-thickness tears. METHODS A total of eight patients with nine triceps tendon tears underwent surgical repair from 2011 to 2015. MRI of the elbows were retrospectively reviewed for the presence and type of tear, tendon involvement, and location of the tear, and later correlated with surgical findings. RESULTS Of the three surgically confirmed complete tears, MRI correctly reported a complete tear in all patients. Of the six partial tears confirmed at surgery, MRI correctly identified four tears. In two cases, MRI described a complete tear, but only a partial tear was noted at surgery. CONCLUSION False-positive MRI assessment of distal triceps injury is not rare. Surgeons should rely on clinical examination in assessing distal triceps tendon injury, with imaging studies providing an adjunctive role in the diagnosis and decision-making.
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Affiliation(s)
- Erica Kholinne
- 1 Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.,2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Hassan Al-Ramadhan
- 2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | | | - Malak Q Alalwan
- 3 College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - In-Ho Jeon
- 2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
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Dubin JM, Rojas JL, Borade AU, Familiari F, McFarland EG. Isolated complete ulnar collateral ligament tear of the elbow in a gymnast: does it need surgery? PHYSICIAN SPORTSMED 2019; 47:242-246. [PMID: 30827129 DOI: 10.1080/00913847.2019.1589104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ulnar collateral ligament (UCL) tears can occur from trauma or chronic overuse, and the treatment depends on the type of sport the patient plays and the severity of symptoms. Overuse UCL injuries are most commonly due to micro-trauma in overhead athletes such as baseball players, softball players, and tennis players. Acute complete UCL tears in athletes due to trauma are less common but generally operative treatment is recommended. In gymnastics, elbow dislocations are more common than isolated UCL injuries, and there is sparse literature on the success of non-operative treatment of isolated UCL injuries in this group of athletes. In this case report, we report a high-level competitive gymnast with an UCL tear and a partial tear of the forearm flexor mass, which was confirmed by a thorough careful physical examination and magnetic resonance imaging. The patient was treated non-operatively and successfully returned to gymnastics without symptoms. This case supports the suggestion that UCL tears of the elbow can be treated successfully in some gymnasts without surgery, and that treatment should be individualized in this group of athletes.
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Affiliation(s)
- Justin M Dubin
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University , Baltimore , MD , USA
| | - Jorge L Rojas
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University , Baltimore , MD , USA
| | - Amrut U Borade
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University , Baltimore , MD , USA
| | - Filippo Familiari
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University , Baltimore , MD , USA
| | - Edward G McFarland
- The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University , Baltimore , MD , USA
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Mirzayan R, Acevedo DC, Sodl JF, Yian EH, Navarro RA, Anakwenze O, Singh A. Operative Management of Acute Triceps Tendon Ruptures: Review of 184 Cases. Am J Sports Med 2018; 46:1451-1458. [PMID: 29578750 DOI: 10.1177/0363546518757426] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Distal triceps tendon ruptures are rare. The authors present a series of 184 surgically treated, acute, traumatic triceps tendon avulsions and compare the complications between those treated with anchors (A) versus transosseous (TO) suture repair. HYPOTHESIS No difference exists in the retear rate between TO and A repairs. Study Designed: Cohort study; Level of evidence, 3. METHODS All patients who underwent an open primary repair of a traumatic triceps tendon avulsion within 90 days of injury, between 2007 and 2015, were retrospectively reviewed. Surgeries were performed within a multisurgeon (75 surgeons), multicenter (14 centers), community-based integrated health care system. Patient demographic information, type of repair, complications, and time from surgery to release from medical care were recorded. RESULTS 184 triceps tears in 181 patients met the inclusion criteria. The mean age was 49 years (range, 15-83 years). There were 169 males. The most common mechanisms of injury were fall (56.5%) and weight lifting (19%). Mean time from injury to surgery was 19 days (range, 1-90 days); in 74.5% of cases, surgery was performed in 3 weeks or less. There were 105 TO and 73 A repairs. No significant difference was found between the two groups in the mean age ( P = .18), sex ( P = .51), completeness of tears ( P = .74), tourniquet time ( P = .455), and prevalence of smokers ( P = .64). Significant differences were noted between TO and A repairs in terms of reruptures (6.7% vs 0%, respectively; P = .0244), overall reoperation rate (9.5% vs 1.4%; P = .026), and release from medical care (4.3 vs 3.4 months; P = .0014), but no difference was seen in infection rate (3.8% vs 0%; P = .092). No difference was noted in release from medical care in patients who underwent surgery 3 weeks or less after injury compared with those undergoing surgery more than 3 weeks after injury (3.90 vs 4.09 months, respectively; P = .911). CONCLUSION Primary repair of triceps ruptures with TO fixation has a significantly higher rerupture rate, higher reoperation rate, and longer release from medical care than does repair with A fixation. Implementation of suture anchors in triceps repairs offers a lower complication rate and earlier release from medical care.
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Affiliation(s)
- Raffy Mirzayan
- Kaiser Permanente Southern California, Baldwin Park, California, USA
| | - Daniel C Acevedo
- Kaiser Permanente Southern California, Panorama City, California, USA
| | - Jeffrey F Sodl
- Kaiser Permanente Southern California, Orange County, California, USA
| | - Edward H Yian
- Kaiser Permanente Southern California, Orange County, California, USA
| | - Ronald A Navarro
- Kaiser Permanente Southern California, South Bay, California, USA
| | | | - Anshuman Singh
- Kaiser Permanente Southern California, San Diego, California, USA
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Role of Ultrasound Guided Platelet-Rich Plasma (PRP) Injection in Treatment of Lateral Epicondylitis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Qi L, Zhang YD, Yu RB, Shi HB. Magnetic Resonance Imaging of Patients With Chronic Lateral Epicondylitis: Is There a Relationship Between Magnetic Resonance Imaging Abnormalities of the Common Extensor Tendon and the Patient's Clinical Symptom? Medicine (Baltimore) 2016; 95:e2681. [PMID: 26844506 PMCID: PMC4748923 DOI: 10.1097/md.0000000000002681] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The aim of the study is to determine the inter-reliability and intra-observer reliability of magnetic resonance imaging (MRI) for lateral epicondylitis and investigate whether there is a potential relationship between MRI abnormalities of the common extensor tendon (CET) and its clinical symptom.The study group comprised 96 consecutive patients (46 men and 50 women) with a clinical diagnosis of chronic lateral epicondylitis, which were examined on 3.0 T MR. An MRI scoring system was used to grade the degree of tendinopahty. Three independent musculoskeletal radiologists, who were blinded to the patients' clinical information, scored images separately. Clinical symptoms were assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE).Of all the patients, total 96 elbows had MRI-assessed tendinopathy, including 38 (39.6%) with grade 1, 31 (32.3%) with grade 2, and 27 (28.1%) with grade 3. Inter-observer reliability and intra-observer agreement for MRI interpretation of the grades of tendinopathy was good, and a positive correlation between the grades of tendinopathy and PRTEE was determined.MRI is a reliable tool in determining radiological severity of chronical lateral epicondylitis. The severity of MR signal changes positively correlate with the patient's clinical symptom.
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Affiliation(s)
- Liang Qi
- From the Department of Radiology Liang Qi, Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhoulu, Nanjing, PR, China (Y-DZ)
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8
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Abstract
Acute triceps ruptures are an uncommon entity, occurring mainly in athletes, weight lifters (especially those taking anabolic steroids), and following elbow trauma. Accurate diagnosis is made clinically, although MRI may aid in confirmation and surgical planning. Acute ruptures are classified on an anatomic basis based on tear location and the degree of tendon involvement. Most complete tears are treated surgically in medically fit patients. Partial-thickness tears are managed according to the tear severity, functional demands, and response to conservative treatment. We favor an anatomic footprint repair of the triceps to provide optimal tendon to bone healing and, ultimately, functional outcome.
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Affiliation(s)
- Jay D Keener
- Department of Orthopaedic Surgery, Washington University, CB# 8233, 660 South Euclid Avenue, St Louis, MO 63110, USA.
| | - Paul M Sethi
- The ONS Sports and Shoulder Service, 6 Greenwich Office Park, Greenwich, CT 06831, USA
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9
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Abstract
OBJECTIVE To elucidate mechanism of injury, nonoperative protocols, surgical techniques, rehabilitation schedules, and return to sports guidelines for partial and complete triceps tendon injuries. DATA SOURCES The PubMed and OVID databases were searched in 2010 and peer-reviewed English language articles in 2011. MAIN RESULTS After a fall on an outstretched hand, direct trauma on the elbow, or lifting against resistance, patients often present with pain and weakness of extension. Examination may reveal a palpable tendon gap, and radiographs may reveal a Flake sign. Acute partial injuries have positive outcomes with immobilization in 30-degree flexion for 4 to 6 weeks. Primary repair for complete rupture can restore normal extensor function after 3 to 4 months. Reconstruction returns normal extensor function up to 4 years. Most authors support postoperative immobilization for 2 to 3 weeks at 30- to 40-degree flexion, flexion block bracing for an additional 3 weeks, and unrestricted activity at 6 months. Athletes may be able to return to sports after 4 to 5 weeks of recovery from a partial injury, but return may be delayed if operative tendon repair is performed. CONCLUSIONS Acute partial triceps tendon injuries may be managed conservatively at first and should be repaired primarily if this fails or if presentation is delayed. Reconstruction should first use the anconeus rotation technique. If the anconeus is devitalized, the Achilles tendon may be the allograft of choice.
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10
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Rehm J, Zeifang F, Weber MA. Bildgebung des Ellenbogengelenks mit Fokus MRT. Radiologe 2014; 54:279-92; quiz 293-4. [DOI: 10.1007/s00117-013-2643-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Qi L, Zhu ZF, Li F, Wang RF. MR imaging of patients with lateral epicondylitis of the elbow: is the common extensor tendon an isolated lesion? PLoS One 2013; 8:e79498. [PMID: 24244512 PMCID: PMC3828358 DOI: 10.1371/journal.pone.0079498] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 09/22/2013] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate whether an injury of the common extensor tendon (CET) is associated with other abnormalities in the elbow joint and find the potential relationships between these imaging features by using a high-resolution magnetic resonance imaging (MRI). Methods Twenty-three patients were examined with 3.0 T MR. Two reviewers were recruited for MR images evaluation. Image features were recorded in terms of (1) the injury degree of CET; (2) associated injuries in the elbow joint. Spearman’s rank correlation analysis was performed to analyze the relationships between the injury degree of CET and associated abnormalities of the elbow joint, correlations were considered significant at p<0.05. Results Total 24 elbows in 23 patients were included. Various degrees of injuries were found in total 24 CETs (10 mild, 7 moderate and 7 severe). Associated abnormalities were detected in accompaniments of the elbow joints including ligaments, tendons, saccussynovialis and muscles. A significantly positive correlation (r = 0.877,p<0.01) was found in injuries of CET and lateral ulnar collateral ligament (LUCL). Conclusion Injury of the CET is not an isolated lesion for lateral picondylitis, which is mostly accompanied with other abnormalities, of which the LUCL injury is the most commonly seen in lateral epicondylitis, and there is a positive correlation between the injury degree in CET and LUCL.
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Affiliation(s)
- Liang Qi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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12
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Jans LB, Ditchfield M, Anna G, Jaremko JL, Verstraete KL. MR imaging findings and MR criteria for instability in osteochondritis dissecans of the elbow in children. Eur J Radiol 2012; 81:1306-10. [DOI: 10.1016/j.ejrad.2011.01.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/04/2011] [Accepted: 01/05/2011] [Indexed: 11/30/2022]
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Belentani C, Pastore D, Wangwinyuvirat M, Dirim B, Trudell DJ, Haghighi P, Resnick D. Triceps brachii tendon: anatomic-MR imaging study in cadavers with histologic correlation. Skeletal Radiol 2009; 38:171-5. [PMID: 18985338 DOI: 10.1007/s00256-008-0605-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 10/01/2008] [Accepted: 10/03/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this cadaveric study was to describe the normal MR anatomy of the triceps brachii tendon (TBT) insertion, to correlate the findings with those seen in anatomic sections and histopathologic analysis, and to review triceps tendon injuries. MATERIALS AND METHODS Twelve cadaveric elbows were used according to institution guidelines. T1-weighted spin-echo MR images were acquired in three planes. Findings on MR imaging were correlated with those derived from anatomic and histologic study. RESULTS On MR images, the TBT had a bipartite appearance as it inserted on olecranon in all specimens. The insertion of the medial head was deeper than that of the long and lateral heads and was mainly muscular at its insertion, with a small amount of the tendon blending with the muscle distally, necessitating histologic analysis to determine if there was tendon blending with the muscle at the site of insertion and if the medial head inserted together with the common tendon or as a single unit. At histopathologic analysis, the three heads of the triceps tendon had a common insertion on the olecranon. The bipartite aspect of the tendon that was identified in the MR images was not seen by histologic study, indicating that there was a union of the medial and common tendons just before they inserted into bone. CONCLUSION TBT has a bipartite appearance on MR images and inserts on olecranon as a single unit.
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Wright RW, Steger-May K, Klein SE. Radiographic findings in the shoulder and elbow of Major League Baseball pitchers. Am J Sports Med 2007; 35:1839-43. [PMID: 17641105 DOI: 10.1177/0363546507304493] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Changes in the dominant shoulder and elbow of professional pitchers have been noted on radiographs, magnetic resonance imaging scans, and ultrasound studies. The relationship of these findings to future injury and to time lost from play has not been identified. HYPOTHESIS Degenerative changes of the shoulder and elbow are common findings on the radiographs of asymptomatic Major League Baseball pitchers. The changes are cumulative with increased pitching. These findings are not predictive of time on the disabled list. STUDY DESIGN Cohort study (prognosis); Level of evidence, 4. METHODS Fifty-seven asymptomatic Major League Baseball pitchers participating in the St Louis Cardinals spring training camp underwent routine preseason radiographic screening of their dominant shoulder and elbow between 1986 and 1998. Radiographs were reviewed for osteophytes, cystic changes, joint-space narrowing, and loose bodies. All findings were recorded as present or absent. Public baseball records were reviewed for arm dominance, age, years of professional pitching, professional innings pitched, shoulder or elbow injury or surgery, and time on the disabled list. These factors were statistically evaluated for their possible association with findings seen on preseason radiographs. RESULTS Shoulder radiographs were available for 57 pitchers, and elbow radiographs were available for 56 pitchers. Both groups had an average age of 29 years. The average number of radiographic findings was 3 for the shoulder and 7 for the elbow. Comparing pitchers on the disabled list for a shoulder or elbow injury with those not on the disabled list demonstrated no significant difference in the age, number of seasons pitched, or number of innings pitched between the 2 groups. When individual radiographic findings were compared, no single finding was predictive of disabled list status (P >.05 in all cases). The sum of radiographic findings for the shoulder was significantly correlated with the number of innings pitched in professional baseball (Pearson correlation coefficient, 0.46; P =.0004). The elbow data showed a similar correlation (Pearson correlation coefficient, 0.38; P =.003). When select individual radiographic findings were evaluated for an association with the number of innings pitched, the presence of acromioclavicular joint findings in the shoulder and radial head osteophytes and radioulnar joint findings in the elbow increased with an increase in innings pitched (P <.05). CONCLUSION Professional pitchers develop degenerative changes over time in both the shoulder and elbow of their dominant (pitching) arm due to chronic repetitive stresses placed across the joints. These findings do not predict time spent on the Major League Baseball disabled list.
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Affiliation(s)
- Rick W Wright
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
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Frick MA. Reprint of imaging of the elbow: a review of imaging findings in acute and chronic traumatic disorders of the elbow. J Hand Ther 2007; 20:186-200; quiz 201. [PMID: 17533097 DOI: 10.1197/j.jht.2007.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Traumatic injuries of the elbow are frequent in patients of all ages but are particularly common in young children and adolescents engaged in normal play and athletic competition. Injury may result primarily due to direct trauma or may be secondary to transmission of forces through the elbow following a fall on an outstretched hand. In middle-aged and older individuals, chronic repetitive injuries tend to predominate. In all patients, radiographs remain the initial imaging study of choice. Many patients, however, may need advanced cross-sectional imaging (i.e. MRI, CT, or ultrasound) either at presentation or during the course of their treatment and follow-up. This article reviews the imaging appearance of common acute and chronic traumatic disorders of the elbow.
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Affiliation(s)
- Matthew A Frick
- Department of Radiology, Division of Musculoskeletal Imaging, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
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Frick MA. Imaging of the elbow: a review of imaging findings in acute and chronic traumatic disorders of the elbow. J Hand Ther 2006; 19:98-112. [PMID: 16713859 DOI: 10.1197/j.jht.2006.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Traumatic injuries of the elbow are frequent in patients of all ages but are particularly common in young children and adolescents engaged in normal play and athletic competition. Injury may result primarily due to direct trauma or may be secondary to transmission of forces through the elbow following a fall on an outstretched hand. In middle-aged and older individuals, chronic repetitive injuries tend to predominate. In all patients, radiographs remain the initial imaging study of choice. Many patients, however, may need advanced cross-sectional imaging (i.e. MRI, CT, or ultrasound) either at presentation or during the course of their treatment and follow-up. This article reviews the imaging appearance of common acute and chronic traumatic disorders of the elbow.
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Affiliation(s)
- Matthew A Frick
- Department of Radiology, Division of Musculoskeletal Imaging, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
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Banks KP, Ly JQ, Beall DP, Grayson DE, Bancroft LW, Tall MA. Overuse Injuries of the Upper Extremity in the Competitive Athlete: Magnetic Resonance Imaging Findings Associated with Repetitive Trauma. Curr Probl Diagn Radiol 2005; 34:127-42. [PMID: 16012484 DOI: 10.1067/j.cpradiol.2005.04.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Overuse injuries are a very common cause of pain in athletes, accounting for a significant loss of training time and missed competitions. Magnetic resonance imaging (MRI) is playing an increasing role in facilitating the expeditious and safe return of these individuals to their preinjury level of physical performance by allowing accurate diagnosis. Sports physicians are increasingly relying on the exquisite anatomic detail afforded by this technique to formulate diagnoses that assist with the optimal management of these athletic injuries. Some upper extremity overuse entities are well recognized; two examples are medial epicondylitis, classically appearing in baseball pitchers, and lateral epicondylitis, in tennis players. Other less well-known injuries of the upper extremity, such as intersection syndrome in rowers and distal clavicular stress fractures in weightlifters, are frequent occurrences in certain circles of athletes. The following article is a pictorial review of the MRI findings of upper extremity overuse injuries encountered in the competitive athlete, with an emphasis on the sports scenarios in which they occur. We will depict mechanisms of injury and applicable anatomy and show characteristic imaging findings. A wide range of entities are addressed, including but not limited to overuse injuries occurring in baseball, swimming, gymnastics, weightlifting, bowling, and cycling.
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Affiliation(s)
- Kevin P Banks
- Department of Radiology, Brook Army Medical Center, Fort Sam, Houston, TX, USA
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Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part I: normal anatomy, imaging technique, and osseous abnormalities. Skeletal Radiol 2004; 33:685-97. [PMID: 15480641 DOI: 10.1007/s00256-004-0853-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Revised: 07/30/2004] [Accepted: 08/03/2004] [Indexed: 02/02/2023]
Abstract
Part I of this comprehensive review on magnetic resonance imaging of the elbow discusses normal elbow anatomy and the technical factors involved in obtaining high-quality magnetic resonance images of the elbow. Part I also discusses the role of magnetic resonance imaging in evaluating patients with osseous abnormalities of the elbow. With proper patient positioning and imaging technique, magnetic resonance imaging can yield high-quality multiplanar images which are useful in evaluating the osseous structures of the elbow. Magnetic resonance imaging can detect early osteochondritis dissecans of the capitellum and can be used to evaluate the size, location, stability, and viability of the osteochondritis dissecans fragment. Magnetic resonance imaging can detect early stress injury to the proximal ulna in athletes. Magnetic resonance imaging can detect radiographically occult fractures of the elbow in both children and adults. Magnetic resonance imaging is also useful in children to further evaluate elbow fractures which are detected on plain-film radiographs.
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Affiliation(s)
- Richard Kijowski
- Department of Radiology, University of Wisconsin Hospital, Madison, Wisconsin, USA.
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