Reliability of sonographic measurements of the ulnar collateral ligament: a multi-rater prospective study.

Background: The use of sonography is a cost-effective and reliable method to evaluate upper extremity superficial tissue structural integrity and pathology. Establishing the measurement reliability of widely used diagnostic ultrasound evaluation for musculoskeletal assessment is paramount enhance accurate clinical evaluations. The objective of this study was to establish the inter-rater and intra-rater reliability of select ulnar collateral ligament (UCL) thickness measures at two distinct anatomical locations in intercollegiate baseball athletes using ultrasound imaging (USI). Methods: This was a prospective cohort study conducted in a university research laboratory and included a total of 17 NCAA Division I baseball athletes (age 20.4 ± 1.43, height = 183.63 cm ± 6.27 cm, mass = 89.28 kg ± 8.24 kg). Two trained clinicians measured UCL mid-substance and apex thickness in the throwing extremity, prospectively, on 5 occasions at 1-month intervals during rest. Intraclass correlation coefficients (ICCs) (model 3,3), associated standard error of measurement, and 95% minimal detectable change in thickness were derived. Results: Intrarater reliability estimates for operator 1 were 0.90-0.98 (mid-substance) and 0.91-0.99 (apex). Operator 2's values were 0.92-0.97 and 0.93-0.99, respectively. The standard error of measurement (SEM) ranged from 0.045-0.071 cm (mid-substance) and 0.023-0.067 cm (apex). The minimal detectable difference (MDD95) was 0.12-0.20 cm (mid-substance) and 0.07-0.19 cm (apex). Interrater reliability was 0.86-0.96 (mid-substance) and 0.79-0.98 (apex); most ICCs were >0.90. Measurement of UCL thickness at two locations demonstrated very good to excellent reliability with high precision. Using this protocol, two evaluators can obtain consistent UCL measurement at two positions. This finding has significant implications for the clinical evaluation of superficial tissue pathology of the same individual by two experienced practitioners.

Ultrasound Imaging of Quadriceps Tendon in a Recreational Golfer.

The patient was a 69-year-old recreational golfer who injured his right . While walking between the 9th and 18th holes, he slipped on pine straw. Ultrasound images of the quadriceps tendon post-injury revealed a full-thickness tear of the Quadriceps tendon, Rectus Femoris and Vastus intermedius. The diagnosis was confirmed through MRI arthrogram imaging. The hypoechoic finding in the ultrasound exam demonstrated the imaging to be as precise in diagnosing a full thickness tear as the MRI. The patient underwent surgical repair of the Quadriceps Tendon and is currently progressing in rehabilitation.

Ultrasound Imaging of Ulnar Collateral Ligament Injury.

The patient was an 18-year-old collegiate baseball pitcher who injured his right throwing elbow during an overhead slider pitch. As a part of a study, preinjury ultrasound images of the throwing arm were obtained 2 weeks prior to the injury. One day postinjury, repeat ultrasound imaging of the medial elbow was performed. The attending team physician ordered a magnetic resonance arthrogram 2 days after injury, which confirmed the presence of a complete tear of the ulnar collateral ligament. J Orthop Sports Phys Ther 2016;46(12):1086. doi:10.2519/jospt.2016.0420.