Ultrasonographic characterization of the ulnar collateral ligament of normal thumbs in different age groups

OBJECTIVES: The aim of this study was to perform ultrasonographic characterization of the normal ulnar collateral ligament in different age groups and compare it in men and women and in dominant and nondominant hands. METHODS: Forty right-handed volunteers in the age groups 20-30, 31-40, 41-50, and 51-60 years without a history of trauma or surgical procedure in the studied joint were evaluated. The studied parameters were ligament length, greatest ligament thickness, ligament longitudinal section area in the longitudinal plane, distance from the aponeurosis of the adductor muscle to the metacarpal head surface and joint opening at rest and under abduction stress. RESULTS: The results indicated that the mean values of all parameters had minor variations with age, hand dominance, and gender and were slightly higher in men than in women and in the dominant hand than the nondominant hand. However, a statistically significant difference was observed between the joint opening at rest and under stress. In terms of age, there was a small but nonsignificant decrease in the values, likely because of the natural aging process. CONCLUSION: The low variability in the evaluated parameters indicates that large differences between sides or genders are not to be expected. A greater change is likely to indicate a pathological situation.

Elbow Impingement Syndrome in Athletes / 대한스포츠의학회지

Overhead athletes often suffer from elbow injuries due to repetitive throwing movements. In particular, in the baseball pitching motion, a high shear torque generated in the late corking and early acceleration stage causes tensile loads on the medial elbow and shear force on the posterior of the elbow. These repetitive movements can lead to valgus extension overload syndrome. The valgus extension overload syndrome mainly occurs in overhead athletes, and is characterized by limited elbow flexion and pain at the end of extension. It is necessary to differentiate from the stress fracture or the avulsion fracture of the olecranon which complain of posterior elbow pain through computed tomography. The treatment is primarily rehabilitation that restricts the elbow motion. If refractory or mechanical symptoms persist, arthroscopic surgery may be an effective treatment modality for the removal of the osteophytes. In the surgical field, it is desirable to reconstruct the medial collateral ligament when it is confirmed that the ligament is ruptured. Patients who underwent arthroscopic removal of olecranon osteophytes had immediate active elbow exercises and for 3 months were prohibited from pitching exercises. During this period, they were rehabilitated with the focus on strengthening muscles around the scapula, rotator cuff and shoulder. After 3 months, the pitching exercise is gradually started. Six months after the operation, the elbow strength should be restored to the level at which the game starts. Patients who underwent a combined ulnar collateral ligament reconstruction, half pitching are allowed at 6 months.

Ulnar Collateral Ligament Tear Combined with Medial Epicondylitis of the Elbow / 대한스포츠의학회지

Medial epicondylitis, also known as “golfer's elbow,” is a common overuse syndrome of the elbow and predominantly affects the origin of the common flexor tendon. We report two unique cases of medial epicondylitis complicated by chronic complete tear of the ulnar collateral ligament and common flexor tendon origin. Physical examination showed a focal huge swelling of medial epicondylar region of the dominant elbow and magnetic resonance imaging revealed complete tear of the ulnar collateral ligament and common flexor tendon and extravasation of intra-articular effusion. Satisfactory results were achieved with ulnar collateral ligament reconstruction and simultaneous repair of the common flexor tendon origin.

Gravity Valgus Stress Ultrasonographic Assessment of Ulnar Collateral Ligament Injury among Baseball Players / 대한스포츠의학회지

The purpose of this study is to evaluate the gravity valgus stress ultrasonographic findings of ulnar collateral ligament (UCL) injury among baseball players. Twenty-eight (age, 16-30; mean, 19.5 years) UCL injured players, diagnosed by magnetic resonance imaging (MRI), were examined by bilateral elbow ultrasonography. On MRI findings, partial and complete tears were 17 and 11 players, respectively. Ultrasonographic examinations were performed in 90 degree elbow flexion with gravity valgus stress, and abnormalities around UCL and ulnohumeral distance were compared with contralateral uninjured elbow. 22 of 28 (79%) players had sonographic abnormalities in injured elbow such as thickening, wavy contour of the UCL (32%), hypoechoic foci in the ligament (43%), osteophyte on trochlear or ulnar articular margin (36%), joint effusion (29%) and ossicles in or around the UCL (68%) that were the most common finding in both partial and complete tears. In all players, the ulnohumeral distance was significantly wider on the injured side than it was on the uninjured side (4.0+/-1.5 mm and 2.5+/-0.43 mm, respectively; p=0.015). Significant increased average ulnohumeral distance in injured elbow was observed with complete UCL tears compared with partial tears (5.4+/-0.9 mm and 3.1+/-0.8 mm, respectively; p=0.021) and the mean difference between injured and uninjured elbow was more significant in complete tears than partial tears (2.8+/-1.2 mm and 0.7+/-0.6 mm, respectively; p=0.012). Gravity valgus stress ultrasonography is rapid noninvasive diagnostic tool and can provide clinicians valuable information regarding the condition of the UCL and medial elbow laxity in partial and complete UCL tear players.

Does Well Maintained Graft Provide Consistent Return to Play after Medial Ulnar Collateral Ligament Reconstruction of the Elbow Joint in Elite Baseball Players?

BACKGROUND: Several studies have reported the clinical outcomes of medial ulnar collateral ligament (MUCL) reconstruction of the elbow joint in throwing athletes, including the rate of return to sports. However, little has been known about the imaging outcomes after MUCL reconstruction. The aim of this study is to report the clinical and imaging outcomes after MUCL reconstruction using figure of eight fashion in the elite and professional baseball players. METHODS: This study included 17 baseball players, who underwent MUCL reconstruction between July 2007 and May 2010. The average follow-up period was 48.6 months. Imaging assessment consisted of preoperative plain and stress radiographs, magnetic resonance imaging, and postoperative serial ultrasonography. The clinical assessments were composed of visual analogue scale (VAS) for pain, range of motion, and the Conway scale. RESULTS: The mean VAS score was 6.4 (range, 3 to 8) preoperatively and 2.2 (range, 0 to 4) postoperatively (p < 0.05). There were nine players (53%) classified as excellent who returned to sports at the same or higher level compared to preinjury. Serial ultrasonography revealed well-maintained grafts at 3 and 12 months in all of the players. Five out of 17 players showed decreased echogenecity in the common flexor tendon at 3 months, which was considered as remaining tissue swelling and resolved completely at 12 months. CONCLUSIONS: All grafts are well-maintained until 12-months based on the ultrasonographic findings, although only 53% of the players returned to preinjury level.

Ultrasonographic Serial Evaluation after Reconstruction of the Ulnar Collateral Ligament and the Common Flexor Tendon of the Elbow in a High School Female Weight Lifter / 대한정형외과학회잡지

A 16-year-old female weight-lifter with average records of 70 kg for the snatch event and 90 kg for the clean and jerk event suffered chronic ulnar collateral ligament injury, and underwent ulnar collateral ligament reconstruction. An ultrasonographic evaluation was performed at six weeks, three months, six months, nine months, and one year after the operation. The horizontal and vertical distances measured during the initial ultrasonographic examination as well as at six weeks, three months, six months, nine months, and one year after the operation were 8.4 mm, 2.0 mm, 2.6 mm, 2.8 mm, 2.7 mm, 2.7 mm, and -1.2 mm, 2.4 mm, 1.0 mm, 0.0 mm, 0.0 mm, 0.0 mm, respectively. The lifting records at one year after the operation were 65 kg for the snatch event and 90 kg for the clean and jerk event. The ultrasonographic method of serial examination was useful for evaluation of the rehabilitation program and for deciding on the time to return to competition.