Elasticity of the Scalene Muscles in Collegiate Baseball Pitchers Using Shear Wave Elastography

Diagnostic ultrasonography of upper extremity dynamic compressive neuropathies in athletes: A narrative review

PURPOSE

This narrative review identifies and summarizes current evidence for diagnostic ultrasonographic evaluation of upper extremity dynamic compressive neuropathies affecting athletes.

METHODS

Relevant literature was identified using the PubMed database and then summarized.

RESULTS

The compressive neuropathies affecting athletes we identified included: neurogenic thoracic outlet syndrome, pectoralis minor syndrome, quadrilateral space syndrome, suprascapular nerve entrapment, proximal median nerve entrapment or bicipital aponeurosis/lacertus fibrosus (lacertus syndrome), radial tunnel syndrome, and cubital tunnel syndrome. Symptoms may develop only during specific sport activity, after specific sport-related trauma, or in setting of overuse during sport. Diagnostic ultrasound strategies assessing compressive neuropathies focus on static evaluation of nerves and surrounding structures, as well as dynamic evaluation of these structures in certain degrees of shoulder abduction, elbow flexion, or forearm pronation.

CONCLUSION

Ultrasonography can be used as a diagnostic tool in assessing upper extremity dynamic compressive neuropathies. Ultrasound allows for dynamic evaluation of these rare conditions, especially for athletes who primarily develop symptoms during movement or participation in sport.

The effect of baseball grips on the hardness of the flexor digitorum superficialis

BACKGROUND

In baseball pitches, the forkball requires a special grip, pinching the ball between the second and third fingers to achieve the resulting breaking ball trajectory. We hypothesized that the forkball grip would have a substantial impact on the hardness of the flexor digitorum superficialis. The aim was to quantify and clarify the change in the hardness of the flexor digitorum superficialis due to the forkball grip.

METHODS

Twenty-one adult male subjects were recruited and instructed to perform two baseball grips with the ball: fast and forkball, and the rest without the ball. The shear wave speeds of the pronator teres, flexor carpi radialis, flexor digitorum superficialis, and flexor carpi ulnaris were measured using shear wave elastography.

RESULTS

In the forkball grip, compared with the fastball grip and the rest without the ball, the shear wave speed of the flexor digitorum superficialis was significantly higher than those of the pronator teres, flexor carpi radialis, and flexor carpi ulnaris (P<0.001), indicating that muscle hardness increased due to the forkball grip. In contrast, no significant differences were found between the conditions for the other forearm flexor-pronator muscles.

CONCLUSIONS

Quantification of muscle hardness using shear wave elastography showed that gripping a forked ball increased muscle hardness in the flexor digitorum superficialis.

Neurogenic Thoracic Outlet Syndrome: A Primer for Hand and Peripheral Nerve Surgeons

Neurogenic thoracic outlet syndrome is a complex condition and is commonly misunderstood. Historically, much of this confusion has been because of its grouping with other diagnoses that have little in common other than anatomic location. Modern understanding emphasizes the role of small unmyelinated C type pain and sympathetic fibers. Diagnosis is primarily clinical, after ruling out other common conditions. Hand therapy is usually the first-line treatment with variable success. Local anesthetic, botulinum toxins, or steroid injections can aid in diagnosis and offer short-term relief. Although surgery can yield reliable results, it is technically challenging, and the preferred surgical approach is a matter of debate. Despite limitations in diagnosis and treatment, recognition and successful treatment of this condition can be highly impactful for the patient.