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Nimura A, Shimura H, Hoshika S, Fukai A, Akita K. Elbow anatomy in perspective of joint capsule and surrounding aponeuroses: a narrative review. JSES Int 2024; 8:654-660. [PMID: 38707559 PMCID: PMC11064712 DOI: 10.1016/j.jseint.2024.01.006] [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] [Indexed: 05/07/2024] Open
Abstract
Background Because of the proximity of several ligaments, aponeuroses, and capsule in the limited area of the elbow joint, the precise anatomy is difficult to understand. In the current narrative review, we focused on two anatomical perspectives: the capsular attachment and structures consisting of ligaments. Methods Based on the previously performed studies regarding the elbow anatomy, a narrative review was prepared in terms of the capsular attachment and structures consisting of ligaments. Results At the tip of the coronoid process, the joint capsule attaches roughly 6 mm distal to its tip with 6-12 mm length. On the lateral epicondyle of the humerus, the capsular attachment at the anterior part of the extensor carpi radialis brevis origin is narrower than the one distal to it. A single interpretation of the lateral collateral ligament is the capsulo-aponeurotic membrane, which is composed of the joint capsule intermingling with the supinator aponeurosis. The anterior bundle of the ulnar collateral ligament could be interpreted as the grossly separated collagenous structure from the tendinous complex, which is composed of the tendinous septum between the flexor digitorum superficialis and pronator teres muscle, the medial part of the brachialis muscle, and deep aponeurosis of the flexor digitorum superficialis muscle. Discussion Based on these perspectives, ligaments could function as a "static-dynamic" stabilizer rather than a simple static one.
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Affiliation(s)
- Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Haruhiko Shimura
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shota Hoshika
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsuhiro Fukai
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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Roubea I, Korakakis V. Rehabilitation following ulnar collateral ligament injury of the elbow in a female acrobatic athlete: A case report. J Bodyw Mov Ther 2024; 38:329-338. [PMID: 38763577 DOI: 10.1016/j.jbmt.2024.01.031] [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] [Received: 05/21/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND The mechanism of injury and the conservative rehabilitation of the ulnar collateral ligament of the elbow (UCL) are well studied and reported in overhead athletes, while research on gymnastic athletes is sparse. Evidence suggests exercise as the mainstay in UCL injury rehabilitation. With this report, we aimed to provide a complete rehabilitation protocol following a partial UCL tear of an acrobatic athlete, where exercise and adjunct treatments, such as manual therapy, were used in a progressive staged rehabilitation. CASE DESCRIPTION A 16-year-old female acrobatic athlete was diagnosed with partial tear of the anterior band of UCL. The rehabilitation included progressive exercise loading in conjunction with manual therapy for 10 sessions in 8 weeks. Pain, UCL special tests, the Disabilities of Arm, Shoulder and Hand Score Questionnaire (DASH), and the Upper Limb Functional Index (ULFI) were assessed and administered at baseline and at 3, 6, 10 weeks, and 3 months. RESULTS Improvement in all outcome measures was noted at the 3-month follow-up indicating a substantial reduction in pain and disability, and an increase in stability of the elbow joint. Return to training was achieved at 8 weeks from the initial visit, while return to sport at the pre-injury level was achieved at 3 months. CONCLUSION Progressive exercise loading along with the addition of manual therapy is an effective intervention for the rehabilitation and return to sport following a partial UCL tear. A progressive staged rehabilitation guideline for acrobatic athletes with UCL injuries has been provided to be used and guide clinical practice. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Iliana Roubea
- Physiotherapy Department, University of West Attica, Egaleo, Athens, Greece; Hellenic Orthopaedic Manipulative Therapy Education (HOMT Edu), Athens, Greece.
| | - Vasileios Korakakis
- Hellenic Orthopaedic Manipulative Therapy Education (HOMT Edu), Athens, Greece; Department of Health Sciences, School of Life Sciences and Health Sciences, PhD in Physiotherapy Program, University of Nicosia, Cyprus
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McHugh MP, Mullaney MJ. Does High Medial Elbow Stress During Pitching Compromise the Dynamic Stabilizers of The Elbow? Int J Sports Phys Ther 2023; 18:949-957. [PMID: 37547846 PMCID: PMC10399083 DOI: 10.26603/001c.81596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/07/2023] [Indexed: 08/08/2023] Open
Abstract
Background The flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) are thought to provide dynamic stability to the medial elbow, with a lesser contribution from the pronator teres (PT). Hypothesis/Purpose The purpose of this study was to determine if baseball pitchers with higher valgus elbow torque experience greater FCU and FDS strength loss. Study Design Controlled Laboratory Study. Methods A pilot study was performed to determine if middle and ring finger flexion strength tests preferentially activated the FCU and FDS versus the PT (10 men age 36±12 yr). EMG amplitudes, expressed as percent of maximal voluntary contraction (MVC) were compared between tests and muscles. In a field study of college baseball pitchers, middle finger, ring finger and grip strength were tested prior to, immediately after, and one day after 14 pitching performances in 10 pitchers (21±2 yr). Elbow valgus torque was measured from an inertial measurement unit, housed in a compression sleeve and pitchers were categorized as having high or low valgus torque. Results For the pilot study EMG activations were 74% FDS, 66% FCU and 35% PT for the middle finger test (muscle effect p=0.032) and 93% FCU, 61% FDS and 23% PT for the ring finger test (muscle effect p=0.005). In the field study, pitchers with high valgus torque showed marked post-game middle finger fatigue (88% of baseline) and incomplete recovery the following day (95%), while pitchers with low valgus torque showed no strength loss (107% post game, 106% a day later; group x time p=0.022). Results were similar for ring finger strength (high torque: 94% post game 96% a day later; low torque: 114% post game 107% a day later; group x time p=0.048). By contrast, grip strength was not different between pitchers with high versus low valgus torque (p=0.143). Conclusion High medial elbow stress during pitching fatigues the dynamic stabilizers of the medial elbow. Level of Evidence Level 3©The Author(s).
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Otto A, Muench LN, Mehl J, Baldino JB, Murphy M, Obopilwe E, Cote MP, Scheiderer B, Imhoff AB, Mazzocca AD, Siebenlist S. Dual Bracing for Ulnar Collateral Ligament Injuries Restores Native Valgus Laxity and Native Medial Joint Gapping of the Elbow. Orthop J Sports Med 2023; 11:23259671231179179. [PMID: 37378277 PMCID: PMC10291402 DOI: 10.1177/23259671231179179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 02/26/2023] [Indexed: 06/29/2023] Open
Abstract
Background Despite growing evidence on the role of the posterior ulnar collateral ligament (pUCL) in elbow stability, current ligament bracing techniques are mainly focused on the anterior ulnar collateral ligament (aUCL). A dual-bracing technique combines the repair of the pUCL and aUCL with a suture augmentation of both bundles. Purpose To biomechanically assess a dual-bracing approach addressing aUCL and pUCL for humeral-sided complete UCL lesions to restore medial elbow laxity without overconstraining. Study Design Controlled laboratory study. Methods A total of 21 unpaired human elbows (11 right, 10 left; 57.19 ± 11.7 years) were randomized into 3 groups to compare dual bracing with aUCL suture augmentation and aUCL graft reconstruction. Laxity testing was performed with 25 N applied 12 cm distal to the elbow joint for 30 seconds at randomized flexion angles (0°, 30°, 60°, 90°, and 120°) for the native condition and then for each surgical technique. A calibrated motion capture system was used for assessment, allowing the 3-dimensional displacement during the complete valgus stress cycle between the optical trackers to be quantified as joint gap and laxity. The repaired constructs were then cyclically tested through a materials testing machine starting with 20 N for 200 cycles at a rate of 0.5 Hz. The load was increased stepwise by 10 N for 200 cycles until displacement reached 5.0 mm or complete failure occurred. Results Dual bracing and aUCL bracing resulted in significantly (P = .045) less joint gapping at 120° of flexion compared with aUCL reconstruction. No significant differences in valgus laxity were found among the surgical techniques. Within each technique, there were no significant differences between the native and the postoperative state in valgus laxity and joint gapping. No significant differences between the techniques were observed in cycles to failure and failure load. Conclusion Dual bracing restored native valgus joint laxity and medial joint gapping without overconstraining and provided similar primary stability regarding failure outcomes as established techniques. Furthermore, it was able to restore joint gapping in 120° of flexion significantly better than aUCL reconstruction. Clinical Relevance This study provides biomechanical data on the dual-bracing approach that may help surgeons to consider this new method of addressing acute humeral UCL lesions.
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Affiliation(s)
- Alexander Otto
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Lukas N. Muench
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Julian Mehl
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Joshua B. Baldino
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, USA
| | - Matthew Murphy
- Beaumont Orthopedic Institute Royal Oak, Royal Oak, Michigan, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, USA
| | - Mark P. Cote
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Bastian Scheiderer
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Andreas B. Imhoff
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sebastian Siebenlist
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
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Koizumi H, Oyama M, Odagiri M, Shioda N, Fujime C, Kusano N. Impact of the contraction of medial forearm muscles during grip tasks in different forearm positions on medial support at the elbow joint. J Electromyogr Kinesiol 2023; 71:102783. [PMID: 37245346 DOI: 10.1016/j.jelekin.2023.102783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/30/2023] Open
Abstract
We measured the medial joint distance (MJD), activity of muscles involved in medial elbow-joint support, and grip strength, aiming to examine the supportfunction of muscles. MJD was measured in supinated and pronated positions of the forearm of 10 participants under three conditions: at rest (R), under valgus load on the elbow joint (L), and under valgus load on the elbow joint during the grip task (L-grip). Under the L-grip condition, electromyography was performed on flexor digitorum superficialis (FDS), pronator teres (PT), flexor carpi radialis (FCR), and flexor carpi ulnaris (FCU); subsequently, normalized integrated electromyograms (NIEMG) were calculated. Under the L-grip condition, MJD was shorter in the pronated position than in the supinated position (p < 0.001); however, grip strength was lower in the pronated position. NIEMG of FDS was 90% in both positions, and those of FCR and FCU were low at 10%. However, that of PT was 3.6% in the supinated position and 40.9% in the pronated position, showing higher NIEMG in the pronated position (p < 0.001). Medial support during grip tasks was higher in the pronated position probably because PT activity compensates for the decreased FDS activity.
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Affiliation(s)
- Hiroaki Koizumi
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, Niigata, Japan; Tominaga Kusano Hospital, Niigata, Japan
| | - Mineo Oyama
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, Niigata, Japan.
| | | | | | - Chihiro Fujime
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, Niigata, Japan
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Meyer MR, Jung JP, Spear JK, Araiza IF, Galway-Witham J, Williams SA. Knuckle-walking in Sahelanthropus? Locomotor inferences from the ulnae of fossil hominins and other hominoids. J Hum Evol 2023; 179:103355. [PMID: 37003245 DOI: 10.1016/j.jhevol.2023.103355] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 04/03/2023]
Abstract
Because the ulna supports and transmits forces during movement, its morphology can signal aspects of functional adaptation. To test whether, like extant apes, some hominins habitually recruit the forelimb in locomotion, we separate the ulna shaft and ulna proximal complex for independent shape analyses via elliptical Fourier methods to identify functional signals. We examine the relative influence of locomotion, taxonomy, and body mass on ulna contours in Homo sapiens (n = 22), five species of extant apes (n = 33), two Miocene apes (Hispanopithecus and Danuvius), and 17 fossil hominin specimens including Sahelanthropus, Ardipithecus, Australopithecus, Paranthropus, and early Homo. Ulna proximal complex contours correlate with body mass but not locomotor patterns, while ulna shafts significantly correlate with locomotion. African apes' ulna shafts are more robust and curved than Asian apes and are unlike other terrestrial mammals (including other primates), curving ventrally rather than dorsally. Because this distinctive curvature is absent in orangutans and hylobatids, it is likely a function of powerful flexors engaged in wrist and hand stabilization during knuckle-walking, and not an adaptation to climbing or suspensory behavior. The OH 36 (purported Paranthropus boisei) and TM 266 (assigned to Sahelanthropus tchadensis) fossils differ from other hominins by falling within the knuckle-walking morphospace, and thus appear to show forelimb morphology consistent with terrestrial locomotion. Discriminant function analysis classifies both OH 36 and TM 266 with Pan and Gorilla with high posterior probability. Along with its associated femur, the TM 266 ulna shaft contours and its deep, keeled trochlear notch comprise a suite of traits signaling African ape-like quadrupedalism. While implications for the phylogenetic position and hominin status of S. tchadensis remain equivocal, this study supports the growing body of evidence indicating that S. tchadensis was not an obligate biped, but instead represents a late Miocene hominid with knuckle-walking adaptations.
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Affiliation(s)
- Marc R Meyer
- Department of Anthropology, Chaffey College, Rancho Cucamonga, CA 91737, USA.
| | - Jason P Jung
- Department of Biology, California State University, San Bernardino, CA 92407, USA
| | - Jeffrey K Spear
- Center for the Study of Human Origins, Department of Anthropology, New York University, 25 Waverly Place, New York, NY 10003, USA; New York Consortium in Evolutionary Primatology, New York, NY 10024, USA
| | - Isabella Fx Araiza
- Center for the Study of Human Origins, Department of Anthropology, New York University, 25 Waverly Place, New York, NY 10003, USA; New York Consortium in Evolutionary Primatology, New York, NY 10024, USA
| | - Julia Galway-Witham
- Center for the Study of Human Origins, Department of Anthropology, New York University, 25 Waverly Place, New York, NY 10003, USA; New York Consortium in Evolutionary Primatology, New York, NY 10024, USA
| | - Scott A Williams
- Center for the Study of Human Origins, Department of Anthropology, New York University, 25 Waverly Place, New York, NY 10003, USA; New York Consortium in Evolutionary Primatology, New York, NY 10024, USA
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Masuma H, Kenmoku T, Saito K, Kawabata M, Watanabe H, Miida K, Onuma K, Sukegawa K, Tazawa R, Otake Y, Takaso M. Evaluation of flexor digitorum superficialis function in adolescent baseball players. JSES Int 2022; 7:143-146. [PMID: 36820414 PMCID: PMC9937837 DOI: 10.1016/j.jseint.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hypothesis and/or Background Increased flexor digitorum superficialis (FDS) tendon activity can be a therapeutic target for elbow disorders in adolescent baseball players. The proportion of adolescent baseball players who can use FDS independently is unknown, and which finger is most often used remains unclear. This study investigated whether adolescent baseball players intentionally used FDS on each finger. Methods Adolescent baseball players were recruited and assessed for FDS function for each finger using the standard technique. Results Sixty-nine participants (mean age: 10.4 years) were recruited. Participants numbered 33, 56, 59, and 25 on the throwing side and those numbered 28, 46, 54, and 33 on the nonthrowing side could independently flex the proximal interphalangeal joint while holding their palms in the index, middle, ring, and small fingers, respectively. When assessing both throwing and nonthrowing participants, a significant number of participants could independently flex the proximal interphalangeals of the ring and middle fingers but had difficulty with the index and small fingers (P < .001). No significant difference was noted between the throwing and nonthrowing participants in any finger (P > .05). Discussion and/or Conclusion One study reported that participating baseball players with elbow pain have more medial elbow joint space than those without pain symptoms. In another study on finger movements during pitching motion, the force of the thumb, index, middle, and ring fingers was greatest immediately before maximum external rotation. According to both reports, FDS function, especially in the index finger, can be a therapeutic target for medial-sided elbow injuries in adolescent baseball players.
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Affiliation(s)
- Hiroyoshi Masuma
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Tomonori Kenmoku
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
- Corresponding author: Tomonori Kenmoku, MD, PhD, Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0570, Japan.
| | - Kazuo Saito
- Department of Health Science, Tokyo Kasei University, Sayama, Japan
| | - Masashi Kawabata
- Department of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Hiroyuki Watanabe
- Department of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Kazumasa Miida
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kenji Onuma
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Koji Sukegawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Ryo Tazawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Yuya Otake
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University Sagamihara, Japan
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Tsubono K, Kudo R, Yokota H, Hirabayashi R, Sekine C, Maruyama S, Shagawa M, Togashi R, Yamada Y, Edama M. Changes in medial elbow joint space with differences in contraction strength of flexor-pronator muscle under elbow valgus stress. J Shoulder Elbow Surg 2022; 31:2011-2016. [PMID: 35550429 DOI: 10.1016/j.jse.2022.03.027] [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] [Received: 01/18/2022] [Revised: 03/20/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The relationship between contraction strength of the flexor-pronator muscles (FPMs) and elbow valgus braking function has not been clarified. HYPOTHESIS/PURPOSE The purpose of this study was to investigate changes in medial elbow joint space when there is a difference in contraction strength of FPMs under elbow valgus stress. METHODS Subjects were 20 healthy male university students, and the elbow joint on the nondominant hand side was used for measurements. The body position for limb measurement was sitting in a chair, with the shoulder abducted 60° and in 90° of external rotation, with 90° of elbow flexion. At first, maximum voluntary contraction (MVC) of the FPMs by grip motion was measured using a hand grip dynamometer under 60-N valgus stress. Contraction strengths of 10% MVC, 30% MVC, and 50% MVC were used. Ultrasonographic images of the medial elbow joint space (JS) were taken in the starting limb position. Using the Telos device system, load was then gradually increased by +10 N/s, and at the time of 60-N valgus stress, an image of the JS was taken. Furthermore, the subject adjusted to the set contraction strength (for about 5 sec) with 60-N valgus stress applied, and an image of the JS was taken while maintaining the set contraction strength. Each MVC condition (10% MVC, 30% MVC, and 50% MVC) was performed randomly. Three ultrasonographic images were taken within 10 seconds, and the average value of the three images was adopted as the JS. RESULTS Compared with the JS under 60-N valgus stress, the JS was significantly reduced under 60-N valgus stress + 50% MVC. No significant difference was observed between the starting limb position and 60-N valgus stress + 50% MVC. CONCLUSION FPMs may require muscle activity ≥50% MVC to brake 60-N elbow valgus stress.
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Affiliation(s)
- Kei Tsubono
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryodai Kudo
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mayuu Shagawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryoya Togashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Yuki Yamada
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.
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Piraino AB, Davis BM. The Management of Valgus Extension Overload Syndrome Experienced with Hitting in a High School Baseball Player: A Case Report. Int J Sports Phys Ther 2022; 17:1156-1169. [PMID: 36237658 PMCID: PMC9528722 DOI: 10.26603/001c.38168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/27/2022] [Indexed: 11/05/2022] Open
Abstract
Background Valgus extension overload syndrome (VEOS) of the elbow is a condition associated with overhead athletes. However, the non-surgical management of these individuals is not well documented. Purpose To discuss the unique presentation, management, and outcomes of an adolescent baseball player with a chronic history of VEOS experienced during hitting. Case Description A 15-year-old right-handed high school baseball catcher presented with a six-month history of right-sided ulnar elbow pain. Elbow MRI w/ contrast was consistent with VEOS. The initial examination demonstrated excessive resting right-sided humeral external rotation compared to his left. Valgus stress testing in the subject's hitting position reproduced symptoms, which were alleviated with retest while correcting excessive humeral external rotation. Weakness of the humeral internal rotators and stiffness/shortness of the posterior shoulder were found and thought to relate to the humeral contribution to his elbow movement dysfunction. Rehabilitation emphasized addressing impairments contributing to excessive humeral external rotation with reintegration into batting. Outcomes After five weeks of physical therapy, the subject returned to soft toss hitting at approximately 75% velocity for the first time since symptom onset, without pain. At seven months after discharge, a phone conversation confirmed that the subject had returned to baseball without limitations. Discussion Despite the concept of 'regional interdependence', common proximal impairments are often assumed to contribute to elbow pain without a clear biomechanical rationale. Future research demonstrating the specific biomechanical effects of the shoulder on the elbow is needed, in addition to more accessible examination strategies to assess their relationship. Level of Evidence 5.
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Affiliation(s)
- Andrew B Piraino
- Houston Methodist Clear Lake Orthopedics & Sports Medicine, Friendswood, TX, USA; University of Southern California Division of Biokinesiology and Physical Therapy, Los Angeles, CA, USA
| | - Brent M Davis
- Houston Methodist Clear Lake Orthopedics & Sports Medicine, Friendswood, TX, USA
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Ikezu M, Kudo S, Edama M, Ueda M, Kubo T, Hirata M, Watanuki M, Takeuchi H, Kaneiwa J, Iizuka Y, Hayashi H. Sites of flexor-pronator muscle injury and relationship between ulnar collateral ligament injury and flexor-pronator muscle injury in baseball players: a retrospective cohort study. J Shoulder Elbow Surg 2022; 31:1588-1594. [PMID: 35189370 DOI: 10.1016/j.jse.2022.01.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/07/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ulnar collateral ligament (UCL) and flexor-pronator muscle (FPM) injuries are common in baseball players. However, the sites of FPM injuries and the relationship between UCL and FPM injuries in baseball players have not been fully clarified. The purpose of this study was to identify the sites of FPM injuries and to determine the relationships of location and severity of UCL injury with the presence of FPM injuries in baseball players. METHODS UCL and FPM injuries were diagnosed using magnetic resonance imaging in 99 baseball players. The sites of FPM injuries were identified on coronal, sagittal, and axial images. UCL injury severity was classified into four grades: chronic changes, low-grade partial tear, high-grade partial tear, and complete tear. UCL injury location was classified as proximal UCL tear or distal UCL tear. All images were assessed by a musculoskeletal radiologist and an orthopedic surgeon. RESULTS Combined UCL and FPM injuries were observed in 45 of 99 players, of which 40 of 45 (89%) involved injury of the flexor digitorum superficialis (FDS). All FDS injuries were in the deep layer of the muscle belly. There was no significant difference between the severity of UCL injury and presence of FPM injuries (P = .352). There was a significant association of distal UCL tears with FPM injuries (P < .001). CONCLUSION FDS injury occurs most commonly in the muscle belly of the second and fifth digits. There may be no relationship between the severity of UCL injury and presence of FPM injury in baseball players. FPM injuries may be a contributing factor in the failure of nonoperative management of distal UCL tears in baseball players.
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Affiliation(s)
- Masahiro Ikezu
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan; Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan.
| | - Shintarou Kudo
- Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan; AR-Ex Medical Research Center, Tokyo, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mizuho Ueda
- Department of Radiology, Saku Central Hospital, Nagano, Japan
| | - Takanori Kubo
- Department of Orthopaedic Surgery, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Masazumi Hirata
- Department of Orthopaedic Surgery, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Makoto Watanuki
- Department of Orthopaedic Surgery, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Hiroki Takeuchi
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan; AR-Ex Medical Research Center, Tokyo, Japan
| | - Jumpei Kaneiwa
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan; AR-Ex Medical Research Center, Tokyo, Japan
| | - Yasuhiko Iizuka
- Department of Radiology, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Hidetoshi Hayashi
- Department of Orthopaedic Surgery, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
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11
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Yoshioka K, Matsuzawa K, Ikuta T, Maruyama S, Edama M. Changes in Medial Elbow Joint Space When Elbow Valgus Stress Is Applied at Different Limb Positions and Loads In Vivo. Orthop J Sports Med 2021; 9:23259671211045981. [PMID: 34888388 PMCID: PMC8649105 DOI: 10.1177/23259671211045981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Ulnar collateral ligament (UCL) injury is a common sports injury among overhead-throwing athletes and causes medial elbow pain and instability. UCL injury is generally diagnosed based on symptoms, physical findings, and image evaluation. To standardize the method for evaluating elbow valgus instability, more information is needed regarding changes in the medial elbow joint space (JS) in healthy elbows. Purpose/Hypothesis: The purpose of this study was to measure the JS during the application of elbow valgus stress at different elbow flexion angles and loads and to clarify the presence of defensive muscle contractions during elbow valgus stress. It was hypothesized that the JS will differ according to different limb positions and loads and that defensive contractions will occur when elbow valgus stress is >90 N. Study Design: Controlled laboratory study. Methods: Elbow joints on the nondominant side were examined in 20 healthy male university students (mean age, 21 ± 0.2 years) at 30°, 60°, and 90° of elbow flexion. To create valgus stress on the elbow, loads of 30, 60, 90, 120, and 150 N were applied with a Telos stress device and with gravity stress on the forearm. The medial JS was measured ultrasonographically during the application of elbow valgus stress. Electrodes were attached to the pronator teres muscle, and defensive muscle contractions were measured using electromyography during the application of elbow valgus stress. Repeated-measures analysis of variance and paired t tests were used to compare the JS at each elbow angle and each valgus stress load, and the Bonferroni method was used as a post hoc test. Results: At 30° of elbow flexion, the JS was significantly higher at 30 N versus 0 N and at 60 N versus 0 or 30 N (P ≤ .018 for all). At 60° of flexion, the JS was significantly higher at 30 N versus 0 N, at 60 N versus 0 and 30 N, and at 90 N versus 0, 30, and 60 N (P ≤ .024 for all). At 90° of elbow flexion, the JS was significantly higher at 30 N versus 0 N and at 60 N versus 0 and 30 N (P ≤ .028 for all). Defensive muscle contraction did not occur at any elbow flexion angles at elbow valgus stress ≤60 N. Conclusion: The lack of muscular contraction at elbow valgus stress ≤60 N may reflect the function of the medial collateral ligament. Clinical Relevance: Elbow valgus stress ≤60 N allows for the evaluation of the joint opening.
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Affiliation(s)
- Kanta Yoshioka
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kanta Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Tomoya Ikuta
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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12
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Matsuzawa K, Edama M, Ikezu M, Otsuki T, Maruyama S, Sato N. Contributions of the Third and Fourth Digits and the Second and Fifth Digits of the Flexor Digitorum Superficialis Muscle to Elbow Valgus Stability. Orthop J Sports Med 2021; 9:23259671211026247. [PMID: 34541011 PMCID: PMC8445534 DOI: 10.1177/23259671211026247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Thiel cadavers have been reported to have lifelike flexibility and mechanical properties, but whether they are useful for measurement of the ulnohumeral joint space (JS) is unclear. The contributions of the third and fourth digits and the second and fifth digits of the flexor digitorum superficialis (FDS) to elbow valgus stability are also unknown. Purpose: To (1) clarify whether Thiel cadavers can be used for JS measurement on ultrasound and (2) identify the contributions to valgus stability of the third and fourth digits and the second and fifth digits of the FDS. Study Design: Descriptive laboratory study. Methods: In experiment 1 (12 elbows from human volunteers and 12 elbows from Thiel cadavers), valgus stress was increased gradually from 0 to 30 to 60 N, and the JS was compared on ultrasound between groups at each load. In experiment 2 (13 elbows from Thiel cadavers), specimens were divided into 2 groups, and the JS was measured for group 1 with the FDS intact, with tendinous insertions of the third and fourth digits cut (3/4-cut state), and with tendinous insertions of all fingers cut (all-cut state); and for group 2 at intact FDS, with tendinous insertions of the second and fifth digits cut (2/5-cut state), and at all-cut. Results: In experiment 1, the rate of change of the JS increased significantly with elbow valgus stress in both humans and Thiel cadavers, with no significant difference between groups. In experiment 2, the JS was significantly greater in the 3/4- and 2/5-cut states compared with the intact state at both 30 N (Δ3/4-cut vs intact = 0.23 mm [P = .01]; Δ2/5-cut vs intact = 0.32 mm [P = .02]) and 60 N (Δ3/4-cut vs intact = 0.33 mm [P = .002]; Δ2/5-cut vs intact = 0.37 mm [P = .04]). There was no significant difference in JS measurements between the 3/4- and 2/5-cut states at any load. Conclusion: Thiel cadavers showed JS changes similar to those of humans when valgus stress was applied. The third and fourth digits and the second and fifth digits of the FDS were involved in valgus stability, and there was no difference in their respective contributions. Clinical Relevance: This study may help in identifying function of the FDS based on structure.
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Affiliation(s)
- Kanta Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Division of Gross Anatomy and Morphogenesis, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masahiro Ikezu
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic, Tokyo Arthroscopy Center, Tokyo, Japan
| | - Tomofumi Otsuki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Noboru Sato
- Division of Gross Anatomy and Morphogenesis, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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13
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Shitara H, Tajika T, Kuboi T, Ichinose T, Sasaki T, Hamano N, Endo T, Kamiyama M, Miyamoto R, Nakase K, Yamamoto A, Kobayashi T, Takagishi K, Chikuda H. Pronation and palmar pinch improve the stability of the medial elbow joint space in high school baseball pitchers. J Shoulder Elbow Surg 2021; 30:2120-2126. [PMID: 33567354 DOI: 10.1016/j.jse.2020.12.022] [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] [Received: 09/07/2020] [Revised: 12/21/2020] [Accepted: 12/27/2020] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We aimed to investigate the contributions of grip, pronation, and pinch to stabilization of the medial elbow joint space; examine their relationship with muscle strength; and assess the effect of stabilization on the medial elbow joint space in baseball pitchers. METHODS In this controlled laboratory study, we measured the medial elbow joint space using ultrasound during the following conditions: unloading; loading; and loading with grip, pronation, and pinch. To evaluate changes in the medial elbow joint space as a result of various conditions, 1-way repeated-measures analysis of variance and post hoc analysis for multiple comparisons were performed. To investigate whether strong or weak muscle strength improved the medial elbow joint space during the loaded condition, Pearson correlation analysis was performed. Finally, a post hoc power analysis was performed. RESULTS We enrolled 121 pitchers. The medial elbow joint space in the loaded condition, loaded condition with full grip, and loaded condition with full pinch was significantly larger than that in the unloaded condition. The medial elbow joint space in the loaded condition with full grip, loaded condition with full pronation, and loaded condition with full palmar pinch was significantly smaller than that in the loaded condition. A post hoc power analysis showed that the power of the 1-way repeated-measures analysis of variance was 100%. The strengths of the full grip and palmar pinch were significantly correlated with a reduced gap distance of the medial elbow joint space (P < .001 for both). CONCLUSION In high school baseball pitchers, pronation and palmar pinch contraction significantly improved the gap distance of the medial elbow joint space in the loaded condition and during grip contraction. Moreover, the grip and palmar pinch strengths were significantly correlated with stabilizing effects on the medial elbow joint space.
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Affiliation(s)
- Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan.
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takuro Kuboi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takafumi Endo
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masataka Kamiyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ryosuke Miyamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kurumi Nakase
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Atsushi Yamamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsutomu Kobayashi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
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14
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Uchida S, Kazuha K, Utsunomiya H, Yamanaka Y, Sakai A. Elbow Ulnar Collateral Ligament Shoelace Repair with Internal Bracing for Treating Throwing Athletes Who Have Ulnar Collateral Ligament Instability. Arthrosc Tech 2021; 10:e1873-e1878. [PMID: 34336588 PMCID: PMC8322694 DOI: 10.1016/j.eats.2021.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/02/2021] [Indexed: 02/03/2023] Open
Abstract
This Technical Note aimed to present a surgical technique of ulnar collateral ligament (UCL) shoelace repair using suture anchors and double suture tapes in combination with internal bracing to correct UCL instability along with epiphyseal avulsion of the medial epicondyle in throwing athletes Skeletally immature throwing athletes playing baseball and softball are at a risk of sustaining medial epicondyle epiphyseal separation that can result in UCL instability, predisposing to elbow UCL disruption later. There are several surgical techniques that can restore elbow UCL function and stability. In cases where large fragments of the medial epicondyle are present in skeletally immature athletes, the residual bony fragment and the shortened, chronically injured UCL make surgical treatment quite challenging. Recent studies have shown that UCL repair with internal bracing can effectively treat acute UCL injury. However, this procedure is not ideal for restoring large disruption of the UCL such as fragmentation. Here, we present a surgical technique of UCL shoelace repair using suture anchors with double suture tapes in combination with internal bracing for correcting UCL instability concurrent with epiphyseal fragmentation of medial epicondyle in throwing athletes.
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Affiliation(s)
- Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Fukuoka, Japan,Address correspondence to: Soshi Uchida, M.D., Ph.D., Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, 1-17-1, Hamamachi Wakamatsu Kitakyushu, Fukuoka 808-0024 Japan.
| | - Kizaki Kazuha
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Fukuoka, Japan
| | - Hajime Utsunomiya
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yoshiaki Yamanaka
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Fukuoka, Japan
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15
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Sakata J, Miyazaki T, Akeda M, Yamazaki T. Return-to-play outcomes in high school baseball players after ulnar collateral ligament injuries: dynamic contributions of flexor digitorum superficialis function. J Shoulder Elbow Surg 2021; 30:1329-1335. [PMID: 33069902 DOI: 10.1016/j.jse.2020.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ulnar collateral ligament (UCL) injuries are common in baseball pitchers. The purpose of this study was to evaluate changes to medial elbow joint laxity under valgus stress, as well as under valgus stress with flexor digitorum superficialis (FDS) contraction, and its ability to predict rehabilitation outcomes. METHODS Sixty-one UCL injuries were diagnosed. All patients were high school students who initially received rehabilitation treatment. Rates of return to play and return to the same level of play or higher (RTSP) were calculated and correlated with joint gapping under the following conditions: elbow gravity valgus stress and intra-articular ring-down artifact (RDA) at rest, elbow gravity valgus stress, and elbow gravity valgus stress with maximum FDS contraction. RESULTS The overall RTSP rate in patients receiving nonoperative treatment was 83.6% (51 of 61 patients). The RDA at rest significantly differed between the RTSP and non-RTSP groups, with an odds ratio of 17.5. This result indicated that the RDA could be a predictor of rehabilitation outcomes. Moreover, there were significant differences in the RDA under gravity valgus stress conditions with FDS contraction between the 2 groups, with an odds ratio of 98.0. Multivariate logistic regression analysis identified 1 variable (RDA under valgus stress with FDS contraction) as the most significant predictive factor for successful treatment of UCL elbow injury. CONCLUSIONS UCL injuries in high school baseball players can be successfully treated nonoperatively in most cases. Stress ultrasound with FDS muscle contraction can help predict the potential for RTSP.
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Affiliation(s)
- Jun Sakata
- Department of Rehabilitation, Toyota Memorial Hospital, Toyota, Japan.
| | - Tetsuya Miyazaki
- Department of Rehabilitation, Yokohama Sports Medical Center, Yokohama, Japan
| | - Masaki Akeda
- Department of Rehabilitation, Yokohama Sports Medical Center, Yokohama, Japan; Department of Orthopedic Sports Medicine, Yokohama Minami Kyosai Hospital, Yokohama, Japan; Department of Orthopedics, Yokohama Sports Medical Center, Yokohama, Japan
| | - Tetsuya Yamazaki
- Department of Orthopedic Sports Medicine, Yokohama Minami Kyosai Hospital, Yokohama, Japan
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16
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Matsuzawa K, Edama M, Ikezu M, Kaneko F, Hirabayashi R, Kageyama I. The origin structure of each finger in the flexor digitorum superficialis muscle. Surg Radiol Anat 2020; 43:3-10. [PMID: 32564110 DOI: 10.1007/s00276-020-02522-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The flexor digitorum superficialis muscle (FDS) is considered the most important of the forearm flexors for maintaining elbow valgus stability. However, the relationships between the origin structure of each finger of the FDS and the anterior oblique ligament (AOL) of the ulnar collateral ligament and the common tendon (CT) in the proximal part, and morphological features are unclear. The purpose of this study was to clarify the relationships between the origin structure of each finger of the FDS and the AOL and the CT, as well as to clarify the morphological features of the muscle belly of each finger of the FDS. METHODS This study examined 20 elbows. The origin of each finger was examined. Muscle mass, muscle fiber bundle length, and the pennation angle of each finger were also measured. RESULTS In all cases, the third and fourth digits originated from the radius, the anterior common tendon (ACT), and the posterior common tendon (PCT). The second and fifth digits (18 elbows) or an independent fifth digit (2 elbows) originated from the ACT, the PCT, the AOL, and other soft tissues of the elbow. Muscle mass and muscle fiber bundle length in the muscle belly of the third and fourth digits were significantly heavier and longer, respectively, than in the muscle belly of the second and fifth digits. CONCLUSION Because the second and fifth digits or an independent fifth digit originated from the AOL, their contraction may cause tension in the AOL.
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Affiliation(s)
- Kanta Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan.
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan.,Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
| | - Masahiro Ikezu
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Fumiya Kaneko
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata City, Niigata, 950-3198, Japan
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
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