Evaluating Changes in Shear Modulus of Elbow Ulnar Collateral Ligament in Overhead Throwing Athletes Over the Course of a Competitive Season

2018 ◽  
Vol 1 (4) ◽  
Author(s):  
Seyedali Sadeghi ◽  
Che-Yu Lin ◽  
Dov A. Bader ◽  
Daniel H. Cortes
Keyword(s):  
Mechanical Properties ◽  
Shear Modulus ◽  
Ulnar Collateral Ligament ◽  
College Level ◽  
Clinical Tool ◽  
Collateral Ligament ◽  
Time Points ◽  
Competitive Season ◽  
Repetitive Loading ◽  
Overhead Throwing

The anterior band of the ulnar collateral ligament (UCL) is commonly subjected to repetitive stress in overhead-throwing athletes, causing high subfailure strain and change in mechanical properties of the ligament. Understanding the change in UCL mechanical properties after repetitive loading can help to evaluate the health status of UCL. The objective of this study was to evaluate changes in UCL shear modulus in overhead-throwing, Division I college-level athletes over the course of a competitive season using ultrasound shear wave elastography (SWE). The proposed protocol quantified changes in shear modulus of UCL in 17 baseball players at preseason and season-end time points as well as in five football quarterbacks at preseason, midseason, and season-end time points. The highest shear modulus values were obtained in the nondominant arm at preseason time points in both groups of athletes. The average UCL shear modulus at the season-end decreased by 39.35% and 37.96% compared to the preseason values in dominant and nondominant arms, respectively. This study shows that SWE could quantify changes in the shear modulus of the UCL after repetitive loading, suggesting that it could be a useful clinical tool for evaluating the risk of UCL injury. Further research on injured overhead-throwing athletes is warranted.

scholarly journals Ultrasound Shear Wave Elastography of the Elbow Ulnar Collateral Ligament: Reliability Test and a Preliminary Case Study in a Baseball Pitcher

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Che-Yu Lin ◽  
Seyedali Sadeghi ◽  
Dov A. Bader ◽  
Daniel H. Cortes
Keyword(s):  
Mechanical Properties ◽  
Shear Modulus ◽  
Shear Wave ◽  
Ulnar Collateral Ligament ◽  
Reliability Test ◽  
Collateral Ligament ◽  
Cronbach’S Alpha ◽  
Cronbach's Alpha ◽  
Baseball Pitcher

Overhead throwing athletes are at high risk of the elbow ulnar collateral ligament (UCL) injury, and there is a need for clinical tools to objectively diagnose severity of injury and monitor recovery. Mechanical properties of ligaments can potentially be used as biomarkers of UCL health. The objectives of this study are to evaluate the reliability of shear wave ultrasound elastography (SWE) for quantifying UCL shear modulus in 16 healthy nonthrowing individuals and use this technique to evaluate the difference in UCL shear modulus between the injured and uninjured elbows in a baseball pitcher with UCL tear. In the reliability test, the UCL shear modulus of both elbows of each participant was evaluated by SWE for five trials. The same procedures were repeated on two different days. The intra-day and day-to-day reliabilities were determined by the five measurements on the first day and two averages on the two days, respectively. In the case study, each elbow of the baseball pitcher with UCL tear was tested for five trials, and the average was calculated. The intra-day (intraclass correlation coefficient (ICC) = 0.715, Cronbach's alpha = 0.926) and day-to-day (ICC = 0.948, Cronbach's alpha = 0.955) reliabilities were found to be good. There was no difference between both sides. In the case study, the UCL shear modulus of the injured elbow (186.45 kPa) was much lower than that of the uninjured elbow (879.59 kPa). This study shows that SWE could be a reliable tool for quantifying the mechanical properties and health status of the UCL.

scholarly journals Adolescent Pitcher Fatigue: Ulnar Collateral Ligament Stress, Flexor-Pronator Mass Energy Depletion, and Correlation to Pitch Count

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0024
Author(s):  
Manuel Schubert ◽  
Tariq Awan ◽  
Aaron Sciascia ◽  
Emily Pacheco ◽  
Jennifer DeMink ◽  
...  
Keyword(s):  
Grip Strength ◽  
Muscle Glycogen ◽  
Repeated Measures ◽  
Statistical Significance ◽  
Ulnar Collateral Ligament ◽  
Glycogen Storage ◽  
Collateral Ligament ◽  
Time Points ◽  
Subjective Fatigue ◽  
Forearm Flexor

Objectives: There has been a rise in elbow ulnar collateral ligament (UCL) injuries in youth pitchers over recent years. With forearm flexor-pronator mass fatigue, the dynamic stability provided could be diminished placing greater stress on the UCL. Pitch count limits have been instituted in an attempt to help curtail this rise in throwing injuries, especially in youth athletes. In order to provide more objective data regarding current pitch count limits for youth pitchers, the purpose of this pilot study was to evaluate for potential fatigue of the flexor-pronator mass by assessing changes in medial elbow laxity, noninvasively characterizing changes in muscle glycogen storage within the forearm flexor-pronator mass, and evaluating changes in subjective fatigue, strength, range of motion (ROM), pitching velocity, and accuracy with increasing number of pitches thrown by 10-year-old pitchers up to their recommended 75 pitch count limit. Methods: After appropriate power analysis, male pitchers 10 years of age were recruited for the study (n=22). Pitchers threw a total of 75 pitches divided into sets of 25 pitches, with standardized periods of rest in between throws and sets to best simulate a game. Bilateral medial elbow laxity was measured by applying 10 decanewtons of valgus force with a standardized stress device and utilizing ultrasound imaging (Figures 1A-B) prior to pitching and after each pitching set. The change in medial ulnohumeral joint distance (Figure 1C) after stress was applied was calculated from baseline without stress. Relative changes in muscle glycogen storage, detected as changes in echogenicity, within the flexor carpi radialis (FCR) and the flexor digitorum superficialis (FDS)/flexor carpi ulnaris (FCU) muscles were measured non-invasively with ultrasound-based software (Figures 1D-E) and recorded as fuel percentile. Repeated measures analysis of variance and post-hoc testing were used to determine statistical significance (alpha=0.05). Results: There were no significant differences in medial elbow laxity between arms or time points. There was a trend for similar decline in FCR fuel percentile values between each arm, indicating relative decreases in glycogen storage bilaterally. However, only the throwing arm demonstrated a statistically significant decline in fuel percentile from baseline to after 75 pitches (p=0.05). There were no statistically significant differences across time points for FDS/FCU fuel percentile values. Fatigue measurements for both arms were significantly higher at all time points compared to baseline (p≤0.03). Grip strength of the dominant arm after 75 pitches was significantly decreased compared to after 25 pitches (p=0.02). There were no statistically significant changes in other strength measurements, ROM, velocity, or accuracy between all time points. Conclusions: By the recommended 75 pitch count limit in 10-year-olds, subjective fatigue and a decrease in grip strength had occurred. Furthermore, relative glycogen storage of the flexor-pronator mass of the throwing arm decreased between pitching 50 to 75 pitches, but without an increase in medial elbow gapping. This study provides a foundation and raises questions for further objective testing of physiologic changes that occur throughout increasing pitching to better guide pitch count limits and ensure the safety of young athletes

scholarly journals Outcomes after Elbow Ulnar Collateral Ligament Reconstruction with the Docking Plus Technique in 163 Athletes

2020 ◽  
Author(s):  
Marc Lubitz ◽  
Benjamin Donohue ◽  
Vadim Molla ◽  
Timothy Kremchek
Keyword(s):  
Case Series ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
High Volume ◽  
Return To Play ◽  
College Level ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Before And After ◽  
High Level

Abstract Background: This retrospective case series examined 163 athletes who underwent ulnar collateral ligament (UCL) reconstruction (UCLR) from 2015-2018. All cases were by a single surgeon at a high volume center using the Docking Plus Technique. We previously reported outcomes in 324 athletes from 2005-2014 with 88% of patients reporting a Conway score of good or excellent. Purpose/Hypothesis: The purpose of this study was to determine if patients undergoing UCLR with the docking plus technique are able to return to sport and to better characterize the athletes needing this procedure. Our hypothesis was that our cohort would largely be able to return to their previous level of play and be mostly college level pitchers. Methods: Patients who underwent UCLR at our institution from 2015-2018 were identified and surveyed. We were able to reach a total of 163 patients and they were asked for background demographic information and information about their athletic careers before and after UCLR. Results: Our results were largely similar to our previously study with 94.5% of athletes obtaining Conway scores of Good or Excellent. 95% of athletes were male, 91% played baseball, and 83% of baseball players were pitchers. 59% of athletes were in college at the time of their surgery. For 8 athletes, this was a revision procedure, 7 of the revisions were for pitchers. 5 of the 7 pitchers were able to get back to the same level or higher of competition. 98.8% of patients surveyed said they were “satisfied with the outcome of the surgery.” Conclusions: The Docking Plus Technique performed by a single surgeon at a private practice setting leads to reproducible return to play and patient satisfaction. The prototypical patient undergoing UCLR is a high level male baseball pitcher. UCL outcomes data would benefit from more prospective studies and the creation of a nationwide UCLR database to draw conclusions about technique, graft type, risk factors, and many more relevant variables.

scholarly journals Repair of the ulnar collateral ligament of the elbow with internal brace augmentation: a 5-year follow-up

2018 ◽  
Vol 11 (1) ◽  
pp. e227113 ◽  
Author(s):  
William T Wilson ◽  
Graeme P Hopper ◽  
Paul A Byrne ◽  
Gordon M MacKay
Keyword(s):  
Surgical Techniques ◽  
Ulnar Collateral Ligament ◽  
American Football ◽  
Return To Play ◽  
College Level ◽  
Collateral Ligament ◽  
Elbow Injury ◽  
Graft Harvest ◽  
Internal Brace ◽  
Return To College

The ulnar collateral ligament (UCL) is the primary restraint to valgus angulation at the elbow. Injury to the UCL is increasingly common and can lead to instability, especially in athletes involved in overhead throwing. Conventional treatment is reconstruction using tendon autograft but performance levels are often restricted after long periods of rehabilitation. Modern surgical techniques have led to renewed interest in repair of the ligament, with the aim of restoring native anatomy. This has the benefit of retained proprioception and no graft harvest morbidity. Furthermore, augmentation of the repair with an Internal Brace protects the healing ligament, while allowing early rehabilitation and accelerated return to play. Here we present the first patient treated with this technique who achieved excellent recovery with return to college level American Football after 4 months. Five years later he has good elbow function and plays at the same level.

scholarly journals Outcomes after Elbow Ulnar Collateral Ligament Reconstruction with the Docking Plus Technique in 162 Athletes (129)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0027
Author(s):  
Marc Lubitz ◽  
Vadim Molla ◽  
Timothy Kremchek
Keyword(s):  
High School ◽  
Case Series ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
High Volume ◽  
Return To Play ◽  
College Level ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Elbow Pain

Objectives: This retrospective case series examined 162 athletes who underwent ulnar collateral ligament (UCL) reconstruction (UCLR) from 2015-2018. All cases were by a single surgeon at a high volume center using the Docking Plus Technique. We previously reported outcomes in 324 athletes from 2005-2014 with 88% of patients reporting a Conway score of good or excellent. The purpose of this study was to determine if patients undergoing UCLR with the docking plus technique are able to return to sport and to better characterize the athletes needing this procedure. Our hypothesis was that our cohort would largely be able to return to their previous level of play and be mostly college level pitchers. Methods: Patients who underwent UCLR at our institution from 2015-2018 were identified and surveyed. We were able to reach a total of 162 patients by telephone for a survey. They were surveyed for subjective and objective outcomes and for background demographic information including information about their athletic careers before and after UCLR. Results: Of our 162 respondents, 150 (93%) returned to the same level of play or higher (excellent on Conway classification). 9 did not return to competitive play (6%) while 3 returned to a lower level of play. 5 of those who did not return to competitive play had their surgery senior year of college. Most athletes were in college at the time of surgery (61%), followed by high school (32%). 2 athletes were in middle school, the rest were playing professionally. Baseball pitchers compromised the majority of our respondents (75%). Catchers were 9% of respondents and infielders/outfielders were 3% each. Other athletes participated in cheerleading, lacrosse, track, volleyball, gymnastics, wrestling, and football, though these were far less common. The mean and median ages of survey respondents was 19 (12-31). 61% described an acute “pop” leading to their elbow pain while 39% endorses no acute event but chronic elbow pain leading to presentation. Of the 61% presenting with an acute rupture, 40% endorsed an “acute on chronic,” presentation. 58% of baseball players played more than just baseball in high school while 41% had specialized in just baseball. The average return to competitive play was 12 months, with a range of 4-24. The range for pitchers was 9-24 with an average of around. Conclusions: Overall, our results mirror those of previous studies. 93% of our patients returned to the same level of competition or higher after undergoing UCLR with the docking plus technique. Most of those who did not return were college seniors who graduated. Our typical patient was a college baseball pitcher around 19 years old. Return to play with our set rehab protocol was around 1 year, though faster for non-pitchers. The docking plus technique provides reliable treatment for chronic or acute UCL tears in athletes.

scholarly journals Evaluation and management of elbow injuries in the adolescent overhead athlete

2021 ◽  
Vol 9 ◽  
pp. 205031212110033
Author(s):  
Austin M Looney ◽  
Paolo D Rigor ◽  
Blake M Bodendorfer
Keyword(s):  
Skeletal Maturity ◽  
Functional Anatomy ◽  
Ulnar Collateral Ligament ◽  
Elbow Flexion ◽  
Operative Management ◽  
Collateral Ligament ◽  
Wide Range ◽  
Elbow Injuries ◽  
Overhead Throwing ◽  
Non Operative Management

With an increased interest in youth sports, the burden of overhead throwing elbow injuries accompanying early single-sport focus has steadily risen. During the overhead throwing motion, valgus torque can reach and surpass Newton meters (N m) during the late cocking and early acceleration phases, which exceeds the tensile strength (22.7–33 N m) of the ulnar collateral ligament. While the ulnar collateral ligament serves as the primary valgus stabilizer between and degrees of elbow flexion, other structures about the elbow must contribute to stability during throwing. Depending on an athlete’s stage of skeletal maturity, certain patterns of injury are observed with mechanical failures resulting from increased medial laxity, lateral-sided compression, and posterior extension shearing forces. Together, these injury patterns represent a wide range of conditions that arise from valgus extension overload. The purpose of this article is to review common pathologies observed in the adolescent overhead throwing athlete in the context of functional anatomy, osseous development, and throwing mechanics. Operative and non-operative management and their associated outcomes will be discussed for these injuries.

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