Elbow Torque May be Predictive of Anatomic Adaptations to the Elbow After a Season of Collegiate Pitching: A Dynamic Ultrasound Study

Purpose: To determine whether elbow torque was associated with anatomic adaptations of the medial elbow following a season of competitive pitching. Methods: Pitchers from 3 collegiate baseball teams were recruited during the preseason for participation. Before the season, pitchers were recorded throwing 5 game-speed fastball pitches from a standard distance off a mound while wearing a wearable sensor baseball compression sleeve that calculates elbow torque, arm speed, arm slot, and arm rotation. Participants subsequently underwent dynamic ultrasound imaging of the medial elbow, including measurements of the ulnar collateral ligament (UCL) and ulnohumeral joint space to assess elbow laxity. Following a full season of competitive pitching, all testing was repeated, and statistical analysis comparing preseason to postseason sonographic findings was performed. Results: Twenty-eight collegiate pitchers underwent preseason sonographic and kinematic testing. Nineteen pitchers were available for postseason testing. The average age (standard deviation) and playing experience was 19.9 (1.2) and 14.7 (1.5) years. Compared with preseason, there were significant increases in postseason UCL thickness (1.92 ± 0.09 vs 1.56 ± 0.09 mm, P \u3c .01) and elbow laxity (1.77 ± 0.23 vs 1.15 ± 0.22 mm, P = .028) after a season of pitching. No significant changes in pitching kinematic measurements were observed between preseason and postseason testing. Preseason pitching kinematic measurements were significantly associated with increased UCL thickness (arm slot: beta estimate -0.03 ± 0.01, P = .011) and reduction in elbow laxity (elbow torque: beta estimate -0.03 ± 0.01, P = .04) after a season of pitching. Pitchers with increased body weight and arm length demonstrated reduced medial elbow torque during pitching (P \u3c .05). Conclusions: After a season of competitive pitching, adaptive changes of the medial elbow were demonstrated on dynamic ultrasound. However, the influence of pitching kinematic measurements on these adaptations are of small magnitude and unknown clinical significance. Although wearable sensor technology may have value in trending individual pitcher kinematics, no discrete threshold appears to predict the development of adaptive changes at the elbow. Level of Evidence: Level II, prospective observational study

Musculoskeletal ultrasonography in the diagnosis of acute crystalline synovitis

Both gout and calcium pyrophosphate deposition disease are common metabolic arthopathies, presenting not only diagnostic but also management challenges. Though histological crystal aspiration is definitive, diagnosis is commonly established through a composite of clinical features and laboratory findings. Musculoskeletal ultrasound has a contributory and growing role not only in routine disease surveillance but also in helping render a timely and specific diagnosis for patients presenting with new-onset oligoarticular arthritis in the emergency setting. In this article, we review the various general and characteristic ultrasound features of crystalline arthropathy as well as the published data in regard to sonographic performance metrics

Ultrasound evaluation of the ulnar collateral ligament of the elbow: Which method is most reproducible?

INTRODUCTION: The ulnar collateral ligament (UCL) is an important medial stabilizer of the elbow, particularly in overhead-throwing athletes. However, there is no universally accepted method for evaluating UCL thickness with ultrasound (US). OBJECTIVE: To assess reproducibility of previously published methods, as well as a modified technique, for evaluating the UCL via US. We hypothesize that a modified technique would show greater reproducibility. MATERIAL AND METHODS: Using US, the thickness of the UCL in 50 volunteers was measured by two musculoskeletal trained radiologists using two different measurement techniques. The techniques utilized were as described by Nazarian and Jacobson/Ward (JW). Technique measurements were evaluated using interclass correlation coefficients (ICC) to determine the reproducibility of each method. Twenty-eight of the subjects also underwent measurement via a modified JW technique, measured perpendicular to the ligament rather than the frame of imaging. This technique was also evaluated with ICC values. RESULTS: The ICC value for the Nazarian technique was 0.82 (very good) and 0.51 (moderate) for the JW technique. When using the modified JW technique, we found an ICC value of 0.84 (very good). Mean ligament thickness was greatest with the Nazarian technique, 6.41 mm, with the JW technique measuring 1.86 mm and the modified technique measuring 1.38 mm. CONCLUSION: US assessment of UCL thickness by all three measurement techniques are reproducible. The JW technique had less interobserver agreement when compared to the Nazarian method, whereas the modified JW technique had greater reproducibility compared to the JW technique and similar to the Nazarian technique

Pre- and Postseason Dynamic Ultrasound Evaluation of the Pitching Elbow.

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

Elbow Torque is Reduced in Asymptomatic College Pitchers with Elbow Laxity: A Dynamic Ultrasound Study

PURPOSE: To determine the relationship between medial elbow torque, as measured by wearable sensor technology, and adaptations of the medial elbow structures on dynamic ultrasound imaging in asymptomatic collegiate pitchers. METHODS: Thirty-four pitchers from NCAA DII universities were eligible for preseason testing. Exclusion criteria included age RESULTS: Final analysis included 28 pitchers with average (standard deviation) age of 20.1(1.3) years [range 18-23] and playing experience of 15.3(1.8) years [range 11-19]. Dominant UCL thickness (p CONCLUSIONS: Pitchers with increased dynamic elbow laxity were found to experience reduced medial elbow torque while pitching. Additionally, pitchers with greater UCL thickness on ultrasound were found to experience increased medial elbow torque while pitching. This study\u27s findings suggest a relationship between anatomical adaptations found on ultrasound of the pitching elbow and medial elbow torque