Robert A Keller1, Nathan E Marshall2, Michael J Bey3, Hafeez Ahmed4, Courtney E Scher4, Marnix van Holsbeeck4, Vasilios Moutzouros2. 1. Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A.. Electronic address: robkeller23@gmail.com. 2. Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A. 3. Bone and Joint Center, Henry Ford Health System, Detroit, Michigan, U.S.A. 4. Department of Radiology, Henry Ford Health System, Detroit, Michigan, U.S.A.
Abstract
PURPOSE: To use ultrasound imaging to document changes over time (i.e., preseason v postseason) in the pitching elbow of high school baseball pitchers. METHODS: Twenty-two high school pitchers were prospectively followed. Pitchers were evaluated after a 2-month period of relative arm rest via preseason physical exams, dynamic ultrasound imaging of their throwing elbow, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) assessment. Players were reevaluated within 1 week of their last game. Dynamic ultrasound images were then randomized, blinded to testing time point, and evaluated by 2 fellowship-trained musculoskeletal radiologists. RESULTS: Average pitcher age was 16.9 years. Average pitches thrown was 456.5, maximum velocity 77.7 mph, games pitched 7.3, and days off between starts 6.6. From preseason to postseason, there were significant increases in ulnar collateral ligament (UCL) thickness (P = .02), ulnar nerve cross-sectional area (P = .001), UCL substance heterogeneity (P = .001), and QuickDASH scores (P = .03). In addition, there was a nonsignificant increase in loaded ulnohumeral joint space (P = .10). No pitchers had loose bodies on preseason exam, while 3 demonstrated loose bodies postseason. The increase in UCL thickness was significantly associated with the number of bullpen sessions per week (P = .01). The increase in ulnar nerve cross-sectional area was significantly associated with the number of pitches (P = .04), innings pitched (P = .01), and games pitched (P = .04). CONCLUSIONS: The stresses placed on the elbow during only one season of pitching create adaptive changes to multiple structures about the elbow including UCL heterogeneity and thickening, increased ulnohumeral joint space laxity, and enlarged ulnar nerve cross-sectional area. LEVEL OF EVIDENCE: Level II prospective observational study.
PURPOSE: To use ultrasound imaging to document changes over time (i.e., preseason v postseason) in the pitching elbow of high school baseball pitchers. METHODS: Twenty-two high school pitchers were prospectively followed. Pitchers were evaluated after a 2-month period of relative arm rest via preseason physical exams, dynamic ultrasound imaging of their throwing elbow, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) assessment. Players were reevaluated within 1 week of their last game. Dynamic ultrasound images were then randomized, blinded to testing time point, and evaluated by 2 fellowship-trained musculoskeletal radiologists. RESULTS: Average pitcher age was 16.9 years. Average pitches thrown was 456.5, maximum velocity 77.7 mph, games pitched 7.3, and days off between starts 6.6. From preseason to postseason, there were significant increases in ulnar collateral ligament (UCL) thickness (P = .02), ulnar nerve cross-sectional area (P = .001), UCL substance heterogeneity (P = .001), and QuickDASH scores (P = .03). In addition, there was a nonsignificant increase in loaded ulnohumeral joint space (P = .10). No pitchers had loose bodies on preseason exam, while 3 demonstrated loose bodies postseason. The increase in UCL thickness was significantly associated with the number of bullpen sessions per week (P = .01). The increase in ulnar nerve cross-sectional area was significantly associated with the number of pitches (P = .04), innings pitched (P = .01), and games pitched (P = .04). CONCLUSIONS: The stresses placed on the elbow during only one season of pitching create adaptive changes to multiple structures about the elbow including UCL heterogeneity and thickening, increased ulnohumeral joint space laxity, and enlarged ulnar nerve cross-sectional area. LEVEL OF EVIDENCE: Level II prospective observational study.
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Authors: Lafi S Khalil; Toufic R Jildeh; Muhammad J Abbas; Chad L Klochko; Courtney Scher; Marnix Van Holsbeeck; Stephanie J Muh; Eric C Makhni; Vasilios Moutzouros; Kelechi R Okoroha Journal: Arthrosc Sports Med Rehabil Date: 2021-10-09
Authors: Austin G Cross; Lafi S Khalil; Alexander J Swantek; Vincent A Lizzio; Alexander C Ziedas; Christopher L Camp; Peter N Chalmers; Karch Smith; Sarah E Chaides; John D Rexroth; Eric C Makhni Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2022-09-09
Authors: Lafi S Khalil; Kelechi R Okoroha; Toufic R Jildeh; Robert N Matar; Mohsin S Fidai; Joseph S Tramer; Chase Ansok; Courtney Scher; Marnix Van Holsbeeck; Eric C Makhni; Vasilios Moutzouros Journal: JSES Open Access Date: 2019-10-15