1
|
Gorti B, Stephenson C, Sethi M, Gross K, Ramos M, Seshadri D, Drummond CK. Overarm Training Tolerance: A Pilot Study on the Use of Muscle Oxygen Saturation as a Biomarker. SENSORS (BASEL, SWITZERLAND) 2024; 24:4710. [PMID: 39066108 PMCID: PMC11280755 DOI: 10.3390/s24144710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 07/14/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Ulnar collateral ligament (UCL) tears occur due to the prolonged exposure and overworking of joint stresses, resulting in decreased strength in the flexion and extension of the elbow. Current rehabilitation approaches for UCL tears involve subjective assessments (pain scales) and objective measures such as monitoring joint angles and range of motion. The main goal of this study is to find out if using wearable near-infrared spectroscopy technology can help measure digital biomarkers like muscle oxygen levels and heart rate. These measurements could then be applied to athletes who have been injured. Specifically, measuring muscle oxygen levels will help us understand how well the muscles are using oxygen. This can indicate improvements in how the muscles are healing and growing new blood vessels after reconstructive surgery. Previous research studies demonstrated that there remains an unmet clinical need to measure biomarkers to provide continuous, internal data on muscle physiology during the rehabilitation process. This study's findings can benefit team physicians, sports scientists, athletic trainers, and athletes in the identification of biomarkers to assist in clinical decisions for optimizing training regimens for athletes that perform overarm movements; the research suggests pathways for possible earlier detection, and thus earlier intervention for injury prevention.
Collapse
Affiliation(s)
- Bhargav Gorti
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (C.S.); (M.S.); (K.G.); (M.R.)
| | - Connor Stephenson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (C.S.); (M.S.); (K.G.); (M.R.)
| | - Maia Sethi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (C.S.); (M.S.); (K.G.); (M.R.)
| | - KaiLi Gross
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (C.S.); (M.S.); (K.G.); (M.R.)
| | - Mikaela Ramos
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (C.S.); (M.S.); (K.G.); (M.R.)
| | - Dhruv Seshadri
- Department of Biomedical Engineering, Lehigh University, Bethlehem, PA 18015, USA;
| | - Colin K. Drummond
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (C.S.); (M.S.); (K.G.); (M.R.)
| |
Collapse
|
2
|
Watts V GJ, Tai R, Joshi G, Garwood E, Saha D. Reinjury Following Return to Play. Semin Musculoskelet Radiol 2024; 28:154-164. [PMID: 38484768 DOI: 10.1055/s-0043-1778022] [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: 03/19/2024]
Abstract
Radiologists are frequently called on for guidance regarding return to play (RTP) for athletes and active individuals after sustaining a musculoskeletal injury. Avoidance of reinjury is of particular importance throughout the rehabilitative process and following resumption of competitive activity. Understanding reinjury risk estimation, imaging patterns, and correlation of clinical and surgical findings will help prepare the radiologist to identify reinjuries correctly on diagnostic imaging studies and optimize management for a safe RTP.
Collapse
Affiliation(s)
- George J Watts V
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
| | - Ryan Tai
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
| | - Ganesh Joshi
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
| | - Elisabeth Garwood
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
| | - Debajyoti Saha
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
| |
Collapse
|
3
|
Hanna AJ, Popper HR, Sonnier JH, Erickson BJ, Jack RA, Cohen SB. The Utility of Stress Ultrasound in Identifying Risk Factors for Elbow Ulnar Collateral Ligament Tear: A Longitudinal Study of 203 Professional Baseball Players. Am J Sports Med 2024; 52:1060-1067. [PMID: 38406885 DOI: 10.1177/03635465241230049] [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] [Indexed: 02/27/2024]
Abstract
BACKGROUND Injuries to the medial ulnar collateral ligament (UCL) are common among baseball pitchers due to repetitive stress on the soft tissue stabilizers of the elbow during pitching. Dynamic stress ultrasound (SUS) can be used to evaluate the UCL and ulnohumeral joint to identify anatomic risk factors of those who will require UCL reconstruction (UCLR). PURPOSE To determine whether any adaptive or morphological changes detectable on SUS can predict injury to the UCL in professional baseball pitchers. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 203 professional baseball pitchers who underwent SUS at preseason training sessions over the course of 18 years were categorized into 1 of 2 groups: those without a history of shoulder, arm, elbow, or forearm surgery or injuries (healthy cohort; n = 184) and those who underwent UCLR the same season as SUS (UCLR cohort; n = 19). Ligament thickness, joint spacing, and laxity were compared. An additional matched cohort analysis was conducted using 10 players from each group to detect differences in the progression of UCL and ulnohumeral joint measures in the year before injury. RESULTS The UCLR cohort, when compared with the healthy cohort, had higher relative (ie, nondominant-side measurements subtracted from dominant-side measurements) resting ulnohumeral joint space (median, 0.50 vs 0.20 mm, respectively; P = .006) and higher rates of hypoechoic foci (57.9% vs 30.4%, respectively; P = .030). Players of both groups had similar dominant UCL thickness (P = .161), ulnohumeral joint space at rest (P = .321), space under stress (P = .498), and laxity (P = .796). Groups did not differ in terms of relative UCL thickness, ulnohumeral joint space under stress, or relative laxity. In the year before UCL injury, the UCLR cohort, compared with the matched healthy cohort, had a greater increase in mean dominant UCL thickness (0.94 vs -0.60 mm, respectively; P = .038) and a greater increase in relative median UCL thickness (1.35 vs -0.35 mm, respectively; P = .045). Players in the healthy cohort were statistically older than those in the UCLR cohort (23 vs 22 years, respectively; P = .004). No differences in ulnohumeral stress spacing or laxity were detected. CONCLUSION SUS of players who underwent UCLR demonstrated a progressive increase in UCL thickness over 1 year, higher rates of hypoechoic foci, and increased ulnohumeral rest space compared with SUS of uninjured players.
Collapse
Affiliation(s)
- Adeeb Jacob Hanna
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Hannah R Popper
- Department of Orthopaedic Surgery, Jefferson Health New Jersey, Stratford, New Jersey, USA
| | - John Hayden Sonnier
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Brandon J Erickson
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Robert A Jack
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Steven B Cohen
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina MD, García-Pérez-de-Sevilla G, Martín-Pérez S, González-de-la-Flor Á. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon 2024; 70:101629. [PMID: 37716840 DOI: 10.1016/j.disamonth.2023.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.
Collapse
Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol , Universidade da Coruña, 15403 Ferrol, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Sara Mogedano-Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Sebastián Martín-Pérez
- Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife 38300, Spain
| | | |
Collapse
|
5
|
Vomer RP, Montero DP, Shapiro S, York E, Memon S, Fungwe C, Pujalte GGA. From Dugout to the Mound: A Tale of Platelet-Rich Performance. Cureus 2023; 15:e50600. [PMID: 38222189 PMCID: PMC10788149 DOI: 10.7759/cureus.50600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Ulnar collateral ligament (UCL) tears of the elbow are prevalent injuries among throwing athletes and are associated with excessive or repeated valgus forces at the elbow. We present the case of an 18-year-old male baseball pitcher with an 18-month history of progressive right elbow pain, notably worsened during his fastball pitching. Clinical assessment revealed tenderness with dynamic stressing of the right UCL. Imaging analyses, including magnetic resonance imaging (MRI) and dynamic ultrasound, confirmed a high-grade partial tear of the UCL at its origin. Non-operative management was pursued, which included an ultrasound-guided platelet-rich plasma (PRP) injection and intensive physical therapy. Follow-up evaluations at six and 12 weeks demonstrated a noteworthy improvement in subjective pain descriptions and structural healing of the UCL. After the patient completed a therapy and rehabilitation program, throwing activities at full strength were able to be resumed. This case underscores the potential efficacy of conservative approaches in handling UCL tears with the inclusion of PRP as a viable treatment option.
Collapse
Affiliation(s)
- Rock P Vomer
- Department of Family Medicine, Avance Care, Raleigh, USA
- Department of Family Medicine, Mayo Clinic, Jacksonville, USA
| | - Daniel P Montero
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, USA
| | - Shane Shapiro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, USA
| | - Emma York
- Department of Family Medicine, Prisma Health University of South Carolina, Columbia, USA
| | - Sara Memon
- Department of Family Medicine, Mayo Clinic, Jacksonville, USA
| | - Chris Fungwe
- Department of Family Medicine, Avance Care, Raleigh, USA
| | - George G A Pujalte
- Departments of Family Medicine and Orthopedics and Sports Medicine, Mayo Clinic, Jacksonville, USA
| |
Collapse
|
6
|
Kerzner B, Kaplan DJ, Khan ZA, Smith SR, Obioha OA, Jawanda H, Jackson GR, Gopinatth V, Sivasundaram L, Verma NN. Ulnar Collateral Ligament Internal Bracing Repair Technique for High-Grade Partial Proximal Tears in the Throwing Athlete. Arthrosc Tech 2023; 12:e1225-e1232. [PMID: 37533907 PMCID: PMC10391346 DOI: 10.1016/j.eats.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/17/2023] [Indexed: 08/04/2023] Open
Abstract
The use of ulnar collateral ligament (UCL) repair with concomitant internal bracing for throwing athletes is a viable treatment option, but must take into account tear location, ligament quality, the expected length of the athlete's career, desire to advance to the next level of competition, and age. There has been increased interest in repair of UCL injuries in overhead athletes due to advancements in surgical technique, as well as improved technologies of anchor and suture material. In addition, return to sport can be accelerated compared to reconstruction. In this Technical Note, we demonstrate an ulnar collateral ligament repair technique, with internal bracing augmentation for high-grade partial proximal tears in the throwing athlete that is reliable, strong, and easily reproducible.
Collapse
Affiliation(s)
- Benjamin Kerzner
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Daniel J. Kaplan
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Zeeshan A. Khan
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shelby R. Smith
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Obianuju A. Obioha
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Harry Jawanda
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Garrett R. Jackson
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Varun Gopinatth
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Lakshmanan Sivasundaram
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N. Verma
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| |
Collapse
|
7
|
Rothermich MA, Pharr ZK, Mundy AC, Fleisig GS, Mussell EA, Ryan MK, Bernier HM, Ostrander B, Slowik JS, Emblom BA, Cain EL, Dugas JR. Clinical Outcomes of Ulnar Collateral Ligament Surgery in Nonthrowing Athletes. Am J Sports Med 2022; 50:3368-3373. [PMID: 36112993 DOI: 10.1177/03635465221120654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ulnar collateral ligament (UCL) surgery continues to demonstrate excellent clinical outcomes and a high return-to-play (RTP) rate with a low complication rate. Recent studies have demonstrated similar clinical outcomes for baseball players who have undergone either UCL reconstruction or UCL repair. In comparison, few studies have assessed the clinical outcomes of UCL surgery for nonthrowing athletes. PURPOSE/HYPOTHESIS The primary objective of this study is to provide clinical outcomes of UCL surgery performed in nonthrowing athletes at a single institution with a minimum 2-year follow-up. Our hypothesis was that these patients would have similar clinical outcomes, complication rates, and RTP rates when compared with throwing athletes. LEVEL OF EVIDENCE Case series; Level of evidence, 4. METHODS From our longitudinal elbow registry, 40 nonthrowing athletes were identified who underwent UCL surgery (repair or reconstruction) between 2011 and 2019. Participant characteristics were recorded: age, sex, laterality, arm dominance, sport, level of competition, and type of surgery (UCL repair or reconstruction). Outcomes included RTP rate and average time, American Shoulder and Elbow Surgeons (ASES) scores, and complications. RESULTS From the 40 patients eligible for inclusion in this study with a minimum 2-year follow-up, 37 (93%) were successfully contacted: 16 male (43%) and 21 female (57%). Mean ± standard deviation age at the time of surgery was 18.0 ± 3.7 years. From the 37 technical procedures, 28 (76%) were UCL repairs and 9 (24%) were UCL reconstructions. For these patients, 15 (41%) had partial tears, 20 (54%) had complete tears, 1 (3%) had a medial epicondyle avulsion, and 1 (3%) had an unspecified pathology. Sports included football (n = 11), gymnastics (11), cheerleading (7), wrestling (4), volleyball (2), basketball (1), and acrobatics (1). Quarterbacks were excluded from the football patients, as quarterbacks are throwing athletes. Level of competition included high school (n = 26), college (8), professional (2), and youth sports (1). The RTP rate was 93% (26/28) at a mean 7.4 months for UCL repair and 100% (9/9) at a mean 10.0 months for UCL reconstruction. Mean ASES scores were 94.4 and 98.7 for UCL repair and reconstruction, respectively. Complications were low, with 2 patients in the UCL repair group requiring ulnar nerve transposition for ulnar nerve paresthesia. CONCLUSION In nonthrowing athletes, patients undergoing UCL repair and UCL reconstruction show favorable outcomes at minimum 2-year follow-up. RTP and clinical outcomes are consistent with previous studies in baseball players as well as a parallel ongoing study conducted on non-baseball throwing athletes.
Collapse
Affiliation(s)
| | - Zachary K Pharr
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Andrew C Mundy
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Glenn S Fleisig
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Eric A Mussell
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Michael K Ryan
- Andrews Sports Medicine & Orthopaedic Center, Birmingham, Alabama, USA
| | | | - Brook Ostrander
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | | | - Benton A Emblom
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - E Lyle Cain
- Andrews Sports Medicine & Orthopaedic Center, Birmingham, Alabama, USA
| | - Jeffrey R Dugas
- Andrews Sports Medicine & Orthopaedic Center, Birmingham, Alabama, USA
| |
Collapse
|
8
|
Zaremski JL. Elbow Ulnar Collateral Ligament Injuries in Overhead Athletes: An Infographic Summary. Sports Health 2022; 14:527-529. [PMID: 35549483 PMCID: PMC9214910 DOI: 10.1177/19417381221098622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ulnar collateral ligament (UCL) injuries of the elbow are common in throwing athletes. Given that the UCL's primary function is to provide valgus stability during the deceleration phase of throwing, injury to the UCL will render throwing difficult to nearly impossible.15 Injuries will occur more so in the sports of baseball, softball, and javlineers participating in track and field.5,10,14 Data has indicated that valgus torque reaches 64 N-m and proximal forces as high as 1000 N to prevent elbow distraction. Further, angular velocity across elbow may reach 1900-2480 degrees/second.6,8 Imaging modalities that have the greatest accuracy for diagnosis include magnetic resonance imaging (MRI), MRI-arthrogram, and stress ultrasonography.2,3,11,12 Treatment of UCL injury depends on multiple factors. These include if the injury is a partial tear or complete tear and the location (distal versus proximal) of the partial tear.7 Further, complete tears, as well as partial distal tears, are more likely to undergo surgical intervention.1,13 Treatment decision-making is primarily dependent on following factors: location, severity, if the patient is a throwing athlete, and if the patient is in his or her last year of his/her throwing career due to the length of the rehabilitation process if surgery is pursued.15 Return-to-play success rates when treated conservatively vary from anywhere from 42% to 100%. Conservative treatment includes rest, rehabilitation, platelet-rich plasma injections, and a throwing program.4 Surgical treatment has evolved significantly with various reconstructive techniques and (when indicated) surgical repair with internal bracing. Return-to-play rates are high, ranging from 80% to 95% with low complication rates, but rehabilitation for reconstruction can range from 12-18 months or longer. Therefore, patients must be made aware of the commitment to the rehabilitation process if electing to undergo surgical reconstruction.9.
Collapse
Affiliation(s)
- Jason L Zaremski
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL
| |
Collapse
|
9
|
Hadley CJ, Rao S, Erickson BJ, Cohen SB, Dodson CC, Ciccotti MG, Romeo AA. Ulnar collateral ligament reconstruction in javelin throwers: an analysis of return to play rates and patient outcomes. J Shoulder Elbow Surg 2022; 31:488-494. [PMID: 34687920 DOI: 10.1016/j.jse.2021.10.003] [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: 02/12/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although results after ulnar collateral ligament reconstruction (UCLR) in baseball players have been well documented, the literature is replete regarding the outcomes after UCLR in javelin throwers. PURPOSE To report outcomes after UCLR in javelin throwers. HYPOTHESIS UCLR in javelin throwers will result in a high rate of return to play similar to that of previously published studies from athletes of other sports. METHODS All patients who were identified preoperatively as javelin throwers and underwent UCLR between 2011 and 2017 with a minimum 2-year follow-up were eligible for inclusion. Patients were assessed with the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score, Timmerman-Andrews Elbow score, Conway-Jobe score, patient satisfaction, return to sport rate questionnaire, and the occurrence of any postoperative complications. RESULTS Eighteen patients met the inclusion criteria. Complete follow-up was available in 16 (88.9%) patients. The average age at surgery was 21.2 ± 2.0 (range, 18.6-24.9) years. At the final follow-up, the average Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score and Timmerman-Andrews Elbow score were 77.3 (range, 18.7-98.4) and 91.8 (range, 70.0-100.0), respectively. Outcomes on the Conway-Jobe scale were as follows: excellent (n = 6; 37.5%), good (n = 4; 25%), fair (n = 6; 37.5%). Ten (62.5%) patients returned to play at an average of 12.2 ± 3.6 (range, 6.0-18.0) months after surgery. Two (12.5%) patients sustained a shoulder injury postoperatively; however, neither required surgery. CONCLUSION UCLR in javelin throwers results in good outcomes with a low rate of reinjury/reoperation. However, the return to play rate (62.5%) and good/excellent outcomes per the Conway-Jobe scale (68.8%) are lower than what has been previously reported in baseball players and javelin throwers. Further investigation regarding outcomes in javelin throwers after UCLR is warranted.
Collapse
Affiliation(s)
| | - Somnath Rao
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | | | | | | | | | - Anthony A Romeo
- Shoulder, Elbow, Sports Surgery, Dupage Medical Group, Downers Grove, IL, USA
| |
Collapse
|
10
|
Carr JB, Wilson L, Sullivan SW, Poeran J, Liu J, Memtsoudis SG, Nwachukwu BU. Seasonal and monthly trends in elbow ulnar collateral ligament injuries and surgeries: a national epidemiological study. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:107-112. [PMID: 37588284 PMCID: PMC10426475 DOI: 10.1016/j.xrrt.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Monthly incidence of elbow ulnar collateral ligament (UCL) injuries and surgeries is relatively unknown. Defining seasonal peaks of UCL injuries and surgeries may identify opportunities for injury-prevention strategies. The purpose of this study is to analyze seasonal and monthly variations in UCL injuries and surgeries across the United States with emphasis on the timing of baseball season. Methods The Truven Health MarketScan database (2013-2015) was queried for patients younger than 40 years with a diagnosis code of elbow UCL sprain and a procedural code for UCL repair or reconstruction. Differences in patient characteristics were evaluated using chi-square and Mann-Whitney U-tests. Negative binomial regression models were calculated for UCL injuries and surgeries to assess monthly trends. Results UCL injuries were sustained by 13,894 patients, with 1404 (10.1%) patients having undergone surgery. The median age at first diagnosis was 17 years, and the median age of patients requiring surgery decreased from 20 to 18 years from 2013 to 2015 (P = .75). Most UCL injuries (n = 3785) and surgeries (n = 438) occurred during the spring season (March 21-June 20), and spring injuries were most likely to result in surgical management (11.6%). During the baseball season (March to September), the number of UCL injuries peaked in April/May, then declined, except for a second peak in September/October (incidence rate ratio 0.97; confidence interval 0.95, 0.99; P = .01). The number of UCL surgeries steadily increased from March (n = 116) to June (n = 152), followed by a gradual decline (incidence rate ratio 1.00; confidence interval 0.96, 1.04; P = .99). Conclusion Athletes frequently experienced UCL injuries and surgeries in the early months (April-June) of the baseball season. More emphasis should be paid to rehabilitative strategies at the beginning of a baseball season to help mitigate injury risk.
Collapse
Affiliation(s)
- James B. Carr
- Hospital for Special Surgery, Sports Medicine Institute, New York, NY, USA
| | - Lauren Wilson
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | | | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Stavros G. Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
- Department of Health Policy and Research, Weill Cornell Medical College, New York, NY, USA
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | | |
Collapse
|
11
|
Mead RN, Nelson TJ, Limpisvasti O, ElAttrache NS, Metzger MF. Biomechanical Comparison of UCL Repair Using Suspensory Fixation Versus UCL Reconstruction. Orthop J Sports Med 2021; 9:23259671211038992. [PMID: 35146033 PMCID: PMC8822040 DOI: 10.1177/23259671211038992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Medial ulnar collateral ligament (mUCL) repair is growing in popularity as a treatment for younger athletes with mUCL tears. One of the most recent techniques utilizes a collagen-coated suture tape to augment the repair. The most popular repair technique uses a screw for proximal fixation in the humerus. We present an alternative technique that uses suspensory fixation in the proximal humerus. Purpose: To biomechanically compare elbow valgus stability and load to failure of a novel alternative repair technique with suspensory fixation to an mUCL reconstruction. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen cadaveric elbows were dissected to expose the mUCL. Medial elbow stability was tested with the mUCL in an intact, deficient—either repaired or reconstructed—state. The repair technique used a suspensory fixation with suture augmentation, and the docking technique was used on all reconstructions. A 3-N·m valgus torque was applied to the elbow, and valgus rotation of the ulna was recorded via motion tracking cameras as the elbow was cycled through a full range of motion. After kinematic testing, specimens were loaded to failure at 70° of elbow flexion. Results: Both ulnar collateral ligament reconstruction and repair restored valgus stability to levels that were not statistically different from intact at all angles of flexion. There was no significant difference in the ultimate torque to failure between repaired and reconstructed mUCLs. Conclusion: There was no significant difference in the valgus strength between the mUCL repair with suspensory fixation and the mUCL reconstruction. Clinical Relevance: Suspensory fixation is an alternative method for proximal fixation in the mUCL without compromising the strength of the construct.
Collapse
Affiliation(s)
- R. Nelson Mead
- Kerlan-Jobe Orthopaedic Clinic, Los Angeles, California, USA
| | - Trevor J. Nelson
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Orr Limpisvasti
- Kerlan-Jobe Orthopaedic Clinic, Los Angeles, California, USA
| | | | - Melodie F. Metzger
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
12
|
Rothermich MA, Fleisig GS, Conte SA, Hart KM, Cain EL, Dugas JR. Short-Term Trends in Elbow Ulnar Collateral Ligament Surgery in Collegiate Baseball Players: An Analysis of 25,587 Player-Years. Orthop J Sports Med 2021; 9:23259671211016846. [PMID: 34377712 PMCID: PMC8330484 DOI: 10.1177/23259671211016846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background Trends over time in the incidence of ulnar collateral ligament (UCL) surgeries in National Collegiate Athletic Association Division I baseball players are currently unknown. Purpose/Hypothesis The purpose of this study was to evaluate the trends in UCL surgeries over 3 years in Division I baseball programs. We hypothesized that surgical injuries would be consistently high over the course of the study. Study Design Descriptive epidemiology study. Methods Athletic trainers from Division I baseball programs were invited to participate in an electronic survey over 3 seasons. A total of 155 baseball programs agreed to participate in 2017, 294 programs participated in 2018, and 296 programs participated in 2019. After each of the 3 collegiate baseball seasons, the athletic trainer from each program entered anonymous, detailed descriptive data and surgical information on injured players into a secured database. Results During the 3 years of this study, 100% of the enrolled programs successfully completed the survey (155/155 in year 1, 294/294 in year 2, and 296/296 in year 3). This registry of 745 completed surveys over 3 years represented 25,587 player-years from Division I collegiate baseball. The percentage of programs with at least 1 UCL surgery during this time was 57% in 2017, 51% in 2018, and 49% in 2019. The majority of these players were pitchers (84% overall from the 3 years). Seniors underwent a significantly lower percentage of the UCL surgeries (8% in 2017, 10% in 2018, and 13% in 2019) than did underclassmen. Surgeries were performed most often in-season and least often during the preseason. A slight majority of players undergoing surgery originated from warm-weather states, but the number of these players was never significantly higher than was the number of players from cold-weather states. Most surgeries performed each year were UCL reconstruction, but the percentage of UCL repair with ligament augmentation increased each year (10% UCL repairs in 2017, 20% in 2018, and 25% in 2019). Conclusion UCL injuries requiring surgery were found to be a major source of morbidity in Division I collegiate baseball, supporting our hypothesis. This study can serve as a baseline for tracking long-term trends in UCL surgeries in collegiate baseball.
Collapse
Affiliation(s)
| | - Glenn S Fleisig
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Stan A Conte
- Conte Injury Analytics LLC, Scottsdale, Arizona USA
| | - Karen M Hart
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - E Lyle Cain
- American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Jeffrey R Dugas
- American Sports Medicine Institute, Birmingham, Alabama, USA
| |
Collapse
|
13
|
Solitro GF, Fattori R, Smidt K, Nguyen C, Morandi MM, Barton RS. Role of the transverse ligament of the ulnar collateral ligament of the elbow: a biomechanical study. JSES Int 2021; 5:549-553. [PMID: 34136869 PMCID: PMC8178616 DOI: 10.1016/j.jseint.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The ulnar collateral ligament (UCL) complex of the elbow plays a primary role in valgus and posteromedial stability of the elbow. The anterior oblique ligament (AOL) of the UCL is believed to provide the majority of resistance to external forces on the medial elbow. The transverse ligament (TL) of the UCL is generally thought to have minimal contribution to the elbow’s overall stability. However, recent studies have suggested a more significant role for the TL. The primary aim of this study was to identify the TL’s contribution to the stability of the elbow joint in determining the joint stiffness and neutral zone variation in internal rotation. Methods Twelve cadaveric elbows, set at a 90° flexion angle, were tested by applying an internal rotational force on the humerus to generate a medial opening torque at the level of the elbow. The specimens were preconditioned with 10 cycles of humeral internal rotation with sinusoidal torque ranging from 0 to 5 Nm. Elbow stiffness measures and joint neutral zone were first evaluated in its integrity during a final ramp loading. The test was subsequently repeated after cutting the TL at 33%, 66%, and 100% followed by the AOL in the same fashion. Results The native UCL complex joint stiffness to internal rotation measured 1.52 ± 0.51 Nm/°. The first observable change occurred with 33% sectioning of the AOL, with further sectioning of the AOL minimizing the joint stiffness to 1.26 ± 0.32 Nm/° (P = .004). A 33% resection of the TL found an initial neutral zone variation of 0.376 ± 0.23° that increased to 0.771 ± 0.41° (P < .01) at full resection. These values were marginal when compared with the full resection of the AOL for which we have found 3.69 ± 1.65° (P < .01). Conclusion The TL had no contribution to internal rotation elbow joint stiffness at a flexion angle of 90°. However, sequential sectioning of the TL was found to significantly increase the joint neutral zone when compared with the native cadaveric elbow at a flexion angle of 90°. This provides evidence toward the TL having some form of contribution to the elbow’s overall stability.
Collapse
Affiliation(s)
- Giovanni F Solitro
- Department of Orthopedic Surgery, Louisiana State University Health - Shreveport, Shreveport, LA, USA
| | - Roberto Fattori
- Clincal Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Kevin Smidt
- Department of Orthopedic Surgery, Louisiana State University Health - Shreveport, Shreveport, LA, USA
| | - Christian Nguyen
- School of Medicine, Louisiana State University Health - Shreveport, Shreveport, LA, USA
| | - Massimo Max Morandi
- Department of Orthopedic Surgery, Louisiana State University Health - Shreveport, Shreveport, LA, USA
| | - R Shane Barton
- Department of Orthopedic Surgery, Louisiana State University Health - Shreveport, Shreveport, LA, USA
| |
Collapse
|
14
|
Zaremski JL, Pazik M, Dean CW, Vijayaraghavan N, Fethiere NP, Farmer KW, Horodyski MB. Forearm flexor injury is associated with medial ulnar collateral ligament injury in throwing athletes. PM R 2021; 14:949-954. [PMID: 33743179 DOI: 10.1002/pmrj.12592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/25/2021] [Accepted: 03/08/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Elbow ulnar collateral ligament (UCL) injuries have become increasingly common in throwing athletes. The forearm flexors (FF) have been studied as biomechanical stabilizers for the medial elbow. However, there are no studies investigating the association of concomitant UCL injuries and FF injuries in throwing athletes. OBJECTIVE To determine if throwing athletes with a complete UCL injury had a greater likelihood of concomitant FF injury than those with a partial UCL injury. DESIGN Descriptive retrospective epidemiological study. SETTING Academic, tertiary care medical center. PATIENTS Throwing related UCL injuries in patients aged 12-24 years. INTERVENTIONS/METHODS Electronic medical records and key word searches identified all patients from January 1, 2010 to December 31, 2019. A board certified and fellowship trained musculoskeletal radiologist reviewed all advanced imaging studies. RESULTS Fifty-four patients (46 male, 8 female, mean age 17.1 years, SD 2.3) were included. Fifty-four UCL injuries (21 complete ruptures, 16 proximal partial injuries, 17 distal partial injuries) were confirmed by magnetic resonance imaging (MRI). Twenty-eight FF injuries (22 strains, 6 tears) were diagnosed with MRI and/or MRI-arthrogram. There was a significant association between sustaining a FF injury and UCL reconstruction (UCL-R) (X2 = [1, N = 54], = 3.97, P = .046) (15/22, 68.2%), as well as FF injury and UCL injury location (X2 = [1, N = 33], = 3.86, P = .049) (10/17, distal partial UCL injury, 58.8%). Analysis of FF injury and complete UCL tear is not significant (X2 = [1, N = 54], = 3.02, P = .08) (14/21, 66.7%). CONCLUSIONS The data indicate that FF injury is associated with UCL injury in throwing athletes. Future prospective studies should investigate causation versus correlation of FF and UCL injury in throwing athletes. The results of this study have applications to multiple sports medicine areas that include but are not limited to surgical, nonsurgical, prehabilitation, rehabilitation, and sports performance. This study reveals a strongly significant association between FF injury and concomitant UCL injury in throwing athletes.
Collapse
Affiliation(s)
- Jason L Zaremski
- Divisions of PM&R, Sports Medicine, & Research, Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Marissa Pazik
- Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Cooper W Dean
- Department of Radiology, University of Florida, Gainesville, Florida, USA
| | | | | | - Kevin W Farmer
- Division of Sports Medicine (Surgery), Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Mary Beth Horodyski
- Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
15
|
Ultrasound Examination Techniques for Elbow Injuries in Overhead Athletes. J Am Acad Orthop Surg 2021; 29:227-234. [PMID: 33273401 DOI: 10.5435/jaaos-d-20-00935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/17/2020] [Indexed: 02/01/2023] Open
Abstract
Elbow pain is a frequent complaint among overhead athletes. Standard evaluation of the elbow uses history and physical examination, with radiographic imaging and MRI aiding in the confirmation of diagnosis. Musculoskeletal ultrasonography (US) provides dynamic, functional assessment of tendons and ligaments in the elbow, allowing the visualization of structures under stress and motion. Stress US offers the ability to detect injuries to the ulnar collateral ligament by measuring changes in joint space under stress. The freedom of dynamic imaging means results are dependent on the skill of the US operator to obtain the most accurate and complete evaluation. US is cost efficient and portable, allowing for quick examination at the point of care. This article provides a technique guide for sports medicine specialists performing US examination of the elbow.
Collapse
|
16
|
THE NONOPERATIVE REHABILITATION OF A TRAUMATIC COMPLETE ULNAR COLLATERAL LIGAMENT TEAR OF THE ELBOW IN A HIGH SCHOOL WRESTLER: A CASE REPORT. Int J Sports Phys Ther 2020; 15:1211-1221. [PMID: 33344036 DOI: 10.26603/ijspt20201211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Injuries frequently occur in competitive wrestling, with the elbow joint representing about 25% of all injuries. Specific to the elbow, the ulnar collateral ligament (UCL) can be injured traumatically from takedowns in wrestling. In athletes with complete UCL tears, surgical management is often recommended with nonoperative management resulting in less favorable outcomes. The purpose of this case report is to present a nonoperative criterion-based rehabilitation program for a high school wrestler with a complete UCL tear of the elbow. Case Description A 17-year-old male wrestler presented to outpatient physical therapy with a complete UCL tear sustained from falling on an outstretched hand during a wrestling match. He presented with limited elbow range of motion (ROM), medial elbow instability, and weakness of the involved shoulder and forearm musculature. A three staged criterion-based rehabilitation protocol was developed for this subject based on specific criteria, including pain, elbow ROM, arm strength, and functional outcomes. Outcomes The subject was treated for nine visits over six weeks, and demonstrated improvements in all strength tests of the involved upper extremity, with elbow flexion strength improving the most by 58%. Return to sport (RTS) tests were used to assess the subject's ability to return to practice. At approximately eight weeks after initial injury, the subject was able to return to full participation in competitive wrestling with no reports of elbow pain or instability. Discussion Through the utilization of a criterion-based rehabilitation protocol for the nonoperative management of an UCL injury, this high school wrestler was able to safely progress back to wrestling without pain or instability in an accelerated time frame. Previously, no detailed rehabilitation guidelines for nonoperative management of UCL injuries in contact sports have been described. Additionally, few studies exist which report on the inclusion of RTS testing following an injury to the UCL of the elbow, as RTS testing is optimal for determining readiness for sport. Level of Evidence 4, Case Report.
Collapse
|
17
|
Reider B. Collateral Damage, Revisited. Am J Sports Med 2020; 48:2605-2607. [PMID: 32870047 DOI: 10.1177/0363546520951522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
18
|
Devaney LL, Denegar CR, Thigpen CA, Lepley AS, Edgar C, DiStefano LJ. Preseason Neck Mobility Is Associated With Throwing-Related Shoulder and Elbow Injuries, Pain, and Disability in College Baseball Pitchers. Orthop J Sports Med 2020; 8:2325967120920556. [PMID: 32523967 PMCID: PMC7235677 DOI: 10.1177/2325967120920556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Shoulder and elbow injuries in baseball pitchers, which can lead to significant pain and disability, have been on the rise at all levels of play for 3 decades. Despite anatomic and neurophysiological relationships, neck mobility has not been explored as a contributor to shoulder and elbow injuries in baseball pitchers. Hypothesis Impaired neck mobility will increase the risk of shoulder and elbow injuries in college baseball pitchers. Study Design Cohort study; Level of evidence, 2. Methods Posture, neck mobility, and shoulder passive range of motion were measured in healthy college baseball pitchers during the 2018 preseason. Time loss (days lost because of shoulder or elbow injuries) and patient-reported disability via Functional Arm Scale for Throwers (FAST) scores were used to dichotomize pitchers into injured and uninjured groups. Receiver operating characteristic curves were generated, and accuracy values and risk ratios (RRs) were calculated to assess the diagnostic utility of the physical measures. Time-to-injury analysis was conducted to assess the timing of injuries. Results A total of 49 pitchers (mean age, 19.92 ± 1.48 years; mean height, 187.04 ± 6.02 cm; mean weight, 89.14 ± 12.08 kg) completed the study. There were 10 pitchers (20.4%) who sustained a time-loss injury >7 days because of a shoulder or elbow injury. A Cervical Flexion-Rotation Test (CFRT) finding on the dominant side of ≤39° resulted in over 9 times the increased risk of time-loss injuries (RR, 9.38 [95% CI, 1.28-68.49]). Time-to-injury analysis demonstrated differences between the 2 groups (χ2 = 7.667; P = .01). Pitchers with a >39.25° finding on the CFRT played a mean 109.4 of 112 days (95% CI, 105-114) before the injury, while pitchers with ≤39.25° only played 83.6 of 112 days (95% CI, 68-99). A CFRT finding of ≤38° (RR, 3.91 [95% CI, 1.23-12.39]), cervical flexion range of motion of ≤64° (RR, 10.56 [95% CI, 1.50-74.34]), and weight of >86.9 kg (RR, 10.42 [95% CI, 1.14-213.70]) were also associated with an increased risk of patient-reported pain and disability on the FAST pitcher module. Conclusion College baseball pitchers with less neck mobility during the preseason had an increased risk of time loss and shoulder and elbow disability during the season. The predictive value of these measures as part of a risk screening profile should be further explored.
Collapse
Affiliation(s)
- Laurie Lee Devaney
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - Craig R Denegar
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | | | - Adam S Lepley
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Cory Edgar
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Lindsay J DiStefano
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| |
Collapse
|
19
|
The Mini-open Plication of Medial Collateral Ligament of the Elbow: A New Arthroscopically Assisted Technique. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2019. [DOI: 10.1097/bte.0000000000000176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
20
|
Biz C, Crimì A, Belluzzi E, Maschio N, Baracco R, Volpin A, Ruggieri P. Conservative Versus Surgical Management of Elbow Medial Ulnar Collateral Ligament Injury: A Systematic Review. Orthop Surg 2019; 11:974-984. [PMID: 31773896 PMCID: PMC6904592 DOI: 10.1111/os.12571] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/03/2019] [Accepted: 10/14/2019] [Indexed: 12/24/2022] Open
Abstract
Objective Several studies have been published regarding the treatment of medial ulnar collateral ligament (MUCL) injuries for professional overhead athletes. However, there is a paucity of data regarding non‐professional athletes. The aim of this systematic review was to compare the rate of outcome scores and complications of conservative versus operative treatments both in non‐professional athletes and in non‐sport‐related trauma patients with MUCL lesions. Methods A systematic review of the published literature was performed by applying the PRISMA guidelines. A search was conducted using three databases: Medline, Science Direct, and Web of Science. The keywords used were “ulnar collateral ligament injury,” “elbow,” “surgery,” and “conservative treatment”. Patients were divided into three groups: patients who underwent conservative treatment (C‐group), surgical treatment (S‐group), and surgery after a failed conservative treatment (C&S‐group). Clinical outcomes were analyzed: Disability of Arm, Shoulder and Hand (DASH), Conway scale, Carson score, and Kerlan–Jobe Orthopaedic Clinic score (KJOC). Results A total of 15 studies were included, evaluating 513 patients. Although good and excellent outcomes were found for most patients during daily and/or sport activities, independently of the type of treatment, the C‐group had better results. Excellent results were found in 98.8% of the C‐group, in 88.1% of the S‐group, and in 87.7% of the C&S‐group. The complication rate in the C‐group was statistically higher compared to the S and C&S groups (P < 0.001). However, its complication rate was higher with lower patient satisfaction. Conclusions There is insufficient evidence to establish statistically significant differences in the effects of conservative versus surgical treatments on the functional outcomes of patients with MUCL lesions. However, a period of rehabilitation therapy and the functional request of the single injured subject are useful to discern which patients genuinely require MUCL surgical repair.
Collapse
Affiliation(s)
- Carlo Biz
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Alberto Crimì
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elisa Belluzzi
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Nicola Maschio
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Riccardo Baracco
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Andrea Volpin
- Trauma and Orthopaedic Department, Royal Derby Hospital NHS Foundation Trust, Derby, UK
| | - Pietro Ruggieri
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| |
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW Primarily reported in the overhead throwing athlete, ulnar collateral ligament (UCL) injuries have been extensively studied since Dr. Frank Jobe first described his technique for ulnar collateral ligament reconstruction on professional baseball pitcher Tommy John. While the framework for our understanding of UCL injury was initially established studying the repetitive valgus loading of the throwers' elbow, other sport-related activities in non-throwing athletes can impart similar valgus stress on the medial elbow placing the UCL at risk for injury. The purpose of this review is to evaluate the current literature on UCL injury specifically in the non-throwing athlete. RECENT FINDINGS In the four decades since Dr. Jobe's seminal description of UCL reconstruction, an abundance of literature has been published on UCL injury in the throwing athlete. The evidence evaluating the UCL specifically in the non-throwing athlete, however, is quite scarce. Several small retrospective studies have demonstrated good results with high rates of return to play with focused rehabilitation and non-operative management in non-throwing athletes. Recent evidence has also demonstrated that surgical repair and/or reconstruction of the UCL in this population can produce good outcomes. The level of evidence of these published studies is low and consists primarily of case series without control groups. Further investigation is warranted to determine the optimal treatment algorithm for UCL injury in the non-throwing athlete.
Collapse
Affiliation(s)
- Nicholas Ramos
- Kerlan Jobe Institute, 6801 Park Terrace, Los Angeles, CA, 90045, USA.
| | - Orr Limpisvasti
- Kerlan Jobe Institute, 6801 Park Terrace, Los Angeles, CA, 90045, USA
| |
Collapse
|
22
|
|
23
|
Shear-wave elastography of the ulnar collateral ligament of the elbow in healthy volunteers: a pilot study. Skeletal Radiol 2019; 48:1241-1249. [PMID: 30706109 DOI: 10.1007/s00256-019-3162-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate the intra-observer repeatability of shear wave elastography in the UCL of the elbow, and to compare shear wave velocities between dominant and non-dominant arms. MATERIALS AND METHODS Twenty elbows in ten healthy volunteers were evaluated [five males, five females; mean age, 31.8 ± 10.3 years]. Shear wave velocity was measured on three separate days during the span of 1 week utilizing a linear 18-MHz transducer. Elastograms were obtained until ten ROIs were drawn, not drawing more than two ROIs on any elastogram. Elastograms were considered diagnostic if any portion of the UCL was colored in and free of boundary artifacts. Median velocity and interquartile range were recorded. A result was considered reliable if the IQR/median ratio of the ten measurements was < 0.3. RESULTS IQR/median was < 0.3 in 88% of sessions, although in 28% of sessions fewer than 60% of elastograms were diagnostic. The ICC was 0.05 (95% CI; - 0.18-0.36; poor). Repeatability coefficient (95% limits of agreement) was 1.95 m/s (95% CI; 1.61-2.37 m/s). Mean velocity in dominant arms was 5.14 ± 0.53 m/s and 5.24 ± 0.39 m/s in non-dominant (p = 0.558). CONCLUSIONS Mean shear wave velocity was similar between dominant and non-dominant arms. Although repeatability was poor as assessed by ICC, the repeatability coefficient may be a more useful indicator of clinical utility once shear wave velocities in diseased ligaments are explored. Future studies should therefore evaluate velocities in diseased ligaments and develop techniques to improve elastogram quality.
Collapse
|
24
|
Vance DD, Alexander FJ, Kunkle BW, Littlefield M, Ahmad CS. Professional and Amateur Pitchers' Perspective on the Ulnar Collateral Ligament Injury Risk. Orthop J Sports Med 2019; 7:2325967119850777. [PMID: 31259185 PMCID: PMC6587394 DOI: 10.1177/2325967119850777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Medial ulnar collateral ligament (UCL) injury is increasingly prevalent in professional baseball pitchers, and significant research has been devoted to understanding the risk factors and prevention strategies associated with it. To date, no study has investigated what the players themselves believe causes and prevents the injury. Purpose To evaluate the opinions of UCL injuries among pitchers, including professional athletes. Study Design Cross-sectional study. Methods A total of 214 baseball pitchers (45 high school/college, 169 Major League Baseball [MLB]/Minor League Baseball) completed a 52-item questionnaire designed to evaluate their opinions on the cause of UCL injuries, injury prevention, and Tommy John surgery. Overall, 51 of the 214 pitchers had previously experienced a UCL injury. The frequency of the selection of each answer option was measured. Additionally, chi-square tests were used to compare (1) responses between professional and nonprofessional pitchers and (2) responses between pitchers with and without a previous UCL injury. Results Only 45% of pitchers thought that UCL injuries are avoidable in MLB. Additionally, 55% of pitchers with a UCL injury had a history of elbow injuries as an adolescent/child, compared with 18% in the uninjured group (P < .0001). Also, 72% of all surveyed pitchers agreed that fatigue over the course of a season increases the risk of UCL injuries, and the majority of pitchers agreed that inadequate rest from throwing both during the off-season (61%) and the season (59%) increases the risk of UCL injuries. Moreover, 59% of pitchers believed that a 6-man starting rotation would decrease the incidence of UCL injuries. Professional and nonprofessional pitchers significantly differed (P = .005) in the type of pitch most prone to causing UCL injuries. Conclusion Pitchers with a previous childhood elbow injury had a significantly higher incidence of UCL injuries during their adult career, suggesting possible predisposition to UCL injury and warranting further research. Fatigue and inadequate rest were of greatest concern among all pitchers for an increased risk of UCL injuries. Understanding and acknowledging the opinions that players have regarding UCL injuries are important to improve UCL education, prevention, and treatment.
Collapse
Affiliation(s)
- Danica D Vance
- Department of Orthopedic Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Frank J Alexander
- Department of Orthopedic Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Brian W Kunkle
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | | | - Christopher S Ahmad
- Department of Orthopedic Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| |
Collapse
|
25
|
Li NY, Goodman AD, Lemme NJ, Owens BD. Epidemiology of Elbow Ulnar Collateral Ligament Injuries in Throwing Versus Contact Athletes of the National Collegiate Athletic Association: Analysis of the 2009-2010 to 2013-2014 Seasons. Orthop J Sports Med 2019; 7:2325967119836428. [PMID: 31008136 PMCID: PMC6457031 DOI: 10.1177/2325967119836428] [Citation(s) in RCA: 11] [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] [Indexed: 11/18/2022] Open
Abstract
Background: The management and outcomes of elbow ulnar collateral ligament (UCL) injuries
in throwing athletes have been well investigated. However, less is known
regarding the management, severity, and outcomes of such injuries in contact
athletes. Purpose: To compare the incidence, severity, and outcomes of elbow UCL injuries
between throwing and contact athletes in collegiate sports. Study Design: Descriptive epidemiology study. Methods: Elbow UCL injuries were queried from the National Collegiate Athletic
Association (NCAA) Injury Surveillance Program between the seasons of
2009-2010 and 2013-2014 in 25 varsity sports. The rates and distribution of
injuries by mechanism, participation restriction time, and outcomes (eg,
season-ending injury, surgery) were examined. A severe injury was defined as
loss of ≥21 days from participation, a season-ending injury, or requiring a
surgical intervention. The injury frequency, incidence per 10,000
athlete-exposures (AEs), and injury proportion ratio comparing throwing and
contact athletes were calculated with 95% CIs. Results: Over the course of 5 seasons, 109 UCL injuries were recorded, for an overall
injury rate of 0.29 per 10,000 AEs. Of these injuries, 83 (76.1%) were a
result of contact and 26 (23.9%) from throwing. Men’s wrestling (1.78 per
10,000 AEs) and men’s baseball (1.12 per 10,000 AEs) sustained the highest
injury rates. A larger proportion of throwing (n = 8; 36.4%) compared with
contact (n = –7; 9.1%) (P < 0.01) injuries results in
>21 days of time loss. Additionally, more throwing-related UCL injuries
required surgery (n = 2; 11.1%) compared with contact-related injuries (n =
1; 1.3%) (P < 0.01). As a result, throwing athletes
demonstrated a significantly higher proportion of severe injuries than
contact athletes (injury proportion ratio, 4.62 [95% CI, 1.72-12.40]). Conclusion: The evaluation of athletes in 25 collegiate varsity sports across 5 seasons
found over 3 times more elbow UCL injuries in contact versus throwing
athletes. However, the number of severe injuries in throwing athletes was
significantly higher than in contact athletes. These findings demonstrate
that although elbow UCL injuries are prone to occur in both contact and
throwing athletes, their prevention, management, and outcomes must be framed
on a sport-by-sport basis.
Collapse
Affiliation(s)
- Neill Y Li
- Department of Orthopaedics, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Avi D Goodman
- Department of Orthopaedics, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Nicholas J Lemme
- Department of Orthopaedics, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Brett D Owens
- Department of Orthopaedics, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| |
Collapse
|
26
|
Quinn BL, Holman DW, Morse JR. A Pain Reporting Tool for School-Aged Baseball Pitchers. J Sch Nurs 2018; 36:212-221. [PMID: 30428751 DOI: 10.1177/1059840518812146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rates of injury to school-aged athletes are of concern to pediatric providers and can be prevented when players, coaches, and parents recognize and address pain. The aim of the present study was to evaluate the use of a pain-reporting tool. In this study, 34 baseball players aged 10-16 years reported pain surrounding 135 separate pitching experiences. Those participating in another sport on the same day as pitching rated pain intensity as significantly higher than those who did not. Approximately 19 pitches were thrown before participants noticed pain. Ice and analgesics were used appropriately to manage pain. School nurses are well positioned to discuss pain reporting and common injuries with young athletes, parents, and athletic coaches. Sharing proactive ways to elicit information about pain is suggested. Implications for future research include the study of young athlete experiences with pain and development of educational initiatives regarding the importance of reporting pain.
Collapse
Affiliation(s)
- Brenna L Quinn
- Solomont School of Nursing, University of Massachusetts Lowell, Lowell, MA, USA
| | - David W Holman
- Solomont School of Nursing, University of Massachusetts Lowell, Lowell, MA, USA
| | | |
Collapse
|