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Dynamic elbow ultrasound can detect early signs of UCL anatomic abnormalities
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BALTIMORE — An increase in ulnar collateral ligament thickness in young professional baseball pitchers may be an early detectable anatomic abnormality on dynamic elbow ultrasound, according to a presenter at the American Orthopaedic Society for Sport Medicine Annual Meeting, here.
“There was a trend toward greater proportion of echo textural abnormalities with increasing years of pitching experience,” Alfred Atanda, MD, said.
Atanda and colleagues performed dynamic elbow ultrasound on the dominant arm in 127 asymptomatic, professional pitchers aged 17 years to 21 years old. They divided the players into three groups based on the number of years of professional experience prior to the ultrasound: 0 years (40%), 1 year to 2 years (43%), and 3 years to 4 years (17%). All pitchers were members of the same Major League Baseball organization and had no history of major elbow injury or surgery.
The investigators measured ulnar collateral ligament (UCL) thickness at rest. Then they measure the width of the ulnohumeral joint with the elbow at 30° flexion, both at rest and with 15 pounds valgus stress using a Telos device. The researchers documented any ligament heterogeneity and calcifications.
Mean UCL thickness was 5.85 mm ± 1.22 mm in players with 0 years experience group. For players in the 1 year to 2 years group, the mean UCL thickness was 6.23 mm ± 1.32 mm, and it was 6.94 mm ± 2.12 mm for players in the 3 years to 4 years group. All of these differences were statistically significant. There was no statistically significant difference in the increase in joint space width at rest or stressed between groups. There was a higher proportion of calcifications (28.9%, 17.1% and 40%) and heterogeneity (26.7%, 26.8% and 40%) seen as the years of professional experience increased. However, Atanda said these data were not statistically significant.
“Dynamic elbow ultrasound can be used as a chronic surveillance tool to detect anatomic abnormalities in the UCL. Increased thickness may be one of the early changes that develop. There are multiple factors that may likely be associated with these abnormalities. Future prospective studies are needed to identify these factors, to determine the exact correlation of these factors to UCL injury, and also to access if these factors can be modified to decrease the risk of a future UCL injury,” Atanda said.
Reference:
Ciccotti MG, Nazarian L, Atanda A, et al. Early anatomic abnormalities of the anterior band of the ulnar collateral ligament detected on dynamic elbow ultrasound in professional baseball pitchers age 17-21. Paper #15. Presented at the American Orthopaedic Society for Sports Medicine Annual Meeting 2012. July 12-15. Baltimore.
Disclosure: Atanda has no relevant financial disclosures.
