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Elhage KG, Yedulla NR, Cross AG, Mehta N, Guo EW, Bernstein DN, Makhni E. Forearm Flexor Tendon Injury in Adolescent Athletes: Risk Factors, Treatment, and Prevention. Curr Sports Med Rep 2022; 21:443-447. [PMID: 36508600 DOI: 10.1249/jsr.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACT Injury to the flexor pronator mass is a common condition that is especially prevalent in overhead throwing athletes. The increasing incidence of these injuries has promoted considerable efforts in research to better understand the pathology, risk factors, and potential mechanisms to prevent injury in these athletes. While there are numerous intrinsic and extrinsic factors associated with injury, a common theme involves chronic overuse and microtrauma with inadequate resting intervals between performances. The purpose of this review is to discuss medial elbow injuries in young athletes with a particular focus on the flexor pronator mass.
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Affiliation(s)
| | | | | | - Nabil Mehta
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Eric W Guo
- Department of Orthopaedic Surgery, University of Michigan Medicine, Ann Arbor, MI
| | | | - Eric Makhni
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Takahashi T, Itoh S, Kida M. Availability of ultrasound screening for asymptomatic elbow injuries in judo athletes. Biomed Mater Eng 2018; 30:49-59. [PMID: 30562889 DOI: 10.3233/bme-181032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We conducted ultrasonography (US) examination for asymptomatic elbow injuries in judo athletes to confirm availability of US screening for elbow. MATERIALS AND METHODS One hundred and thirty-two black belts in judo (85 males and 47 females; mean age, 20.0 ± 1.6 years) participated in this screening. Forty-eight participants had a history of elbow injury (elbow-injury group), and 84 did not (no-elbow-injury group). All participants completed a survey in the form of a questionnaire. Subsequently, US scanning of both elbows was performed. RESULTS The maximal thickness of the medial collateral ligament of both elbows was significantly larger in the elbow-injury group than in the no-elbow-injury group. The width of the joint space was significantly larger in the right radiohumeral joint in the elbow-injury group than in the no-elbow-injury group. Combination injuries involving ligament and bone and those involving both the medial and lateral collateral ligaments were most commonly seen in both elbows in the elbow-injury group; however, these combined lesions of both elbows were also found in the no-elbow-injury group. CONCLUSIONS Because US screening can reveal abnormalities of the asymptomatic elbow, US is recommended as a complementary imaging modality that is useful for evaluation of elbow injuries in athletes.
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Affiliation(s)
- Tatsunori Takahashi
- Department of Tokyo-Judo Therapy, Faculty of the Medical Sciences, Teikyo University of Science, 2-2-1 Senju Sakuragi, Adachi-ku, Tokyo, Japan
| | - Soichiro Itoh
- Department of Inorganic Materials, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo, Japan
| | - Masakazu Kida
- Department of Orthopedic Surgery, Kawakita General Hospital, 1-7-3 Asagaya-kita, Suginami, Tokyo, Japan
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Haws BE, Stone AV, Usoro AO, Marquez-Lara A, Mannava S, Freehill MT. Optimal management of physeal elbow injuries in the skeletally immature athlete remains undefined: a systematic review. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Correlation of MRI to Arthroscopy in the Elbow: Thrower's Elbow and Ulnar Collateral Ligament Injury. Sports Med Arthrosc Rev 2017; 25:191-198. [PMID: 29095397 DOI: 10.1097/jsa.0000000000000165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
One cannot overstate the importance of a thorough history and physical examination, supplemented with directed imaging, to help pinpoint the exact cause of the athlete's elbow pain. Although plain radiographs should not be overlooked, advanced imaging plays a critical role in diagnosis and management of pathology in the thrower's elbow, including computed tomography, magnetic resonance imaging, and stress ultrasound. By judiciously combining these elements, the clinician can appropriately manage these injuries in order to successfully return the athlete to their preinjury level of play.
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Valgus extension overload syndrome in adolescent baseball players: clinical characteristics and surgical outcomes. J Shoulder Elbow Surg 2016; 25:2048-2056. [PMID: 27765503 DOI: 10.1016/j.jse.2016.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/23/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the clinical characteristics and surgical outcomes of valgus extension overload syndrome (VEOS) in adolescent athletes. We evaluated posteromedial compartment pathology, including combined lesions, and reported the surgical outcomes in adolescent baseball players. METHODS We retrospectively reviewed the medical records of 13 male adolescent baseball players (mean age, 15.4 years) who underwent arthroscopic olecranon tip resection (n = 9) or staged operations (arthroscopic olecranon tip resection, followed by medial collateral ligament reconstruction 2 weeks later; n = 4). The shape of the tip fragment was used to classify the olecranon into 2 types: type 1, dot-like fragment (n = 3); type 2, triangular-shape fragment (n = 10). Four outcome measures were analyzed: range of motion, visual analog scale (VAS) pain score, rate of return to play, and Conway scale score. RESULTS At a mean follow-up of 3.3 years (range, 2-6 years), the mean VAS pain score decreased from 4.1 preoperatively to 1.1 postoperatively (P < .05). Preoperative mean extension and supination were 4.2° and 70.0°, which improved to 1° (P < .05) and 76.2° (P < .05), respectively. The overall rate of return to play was 85% (11 of 13). On the Conway scale, 8 of 13 patients (62%) were classified as excellent. Patients who underwent isolated arthroscopic surgery reported less pain postoperatively and achieved a higher grade on the Conway scale than patients who underwent staged operations. CONCLUSIONS Arthroscopic resection of olecranon tip yielded favorable outcomes at a minimum of 2 years of follow-up. Patients with concomitant ulnar collateral ligament insufficiency had less optimal outcomes than those with isolated posteromedial impingement.
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Hammoud S, Sgromolo N, Atanda A. The approach to elbow pain in the pediatric and adolescent throwing athlete. PHYSICIAN SPORTSMED 2014; 42:52-68. [PMID: 24565822 DOI: 10.3810/psm.2014.02.2048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Elbow pain in pediatric throwing athletes can be very concerning and challenging to diagnose. Diagnosis involves determining whether the injury is chronic or acute in nature and the anatomical location of the pain. Physicians should be aware of the sport-specific forces that predispose athletes with immature skeletons to injury and should be familiar with the common presentations of these injuries. In order to narrow the diagnosis, physicians should gather a detailed history of how and when the pain occurred in addition to performing a thorough physical exam that includes tests, such as the modified milking maneuver and the moving valgus stress test. Appropriate imaging helps physicians to confirm the diagnosis and elucidates any associated pathology in patients. In most cases, the treatment given to patients is conservative and involves rest, ice, non-steroidal anti-inflammatory drugs for pain, and an appropriate physical therapy regimen with a progressive return to play when symptoms have resolved. When patients fail to respond to conservative treatment, surgical intervention may be needed. Knowing when to refer patients for orthopedic evaluation helps athletes return to play quickly and safely.
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Affiliation(s)
- Sommer Hammoud
- Assistant Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA
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Gregory B, Nyland J. Medial elbow injury in young throwing athletes. Muscles Ligaments Tendons J 2013; 3:91-100. [PMID: 23888291 DOI: 10.11138/mltj/2013.3.2.91] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This report reviews the anatomy, overhead throwing biomechanics, injury mechanism and incidence, physical examination and diagnosis, diagnostic imaging and conservative treatment of medial elbow injuries in young throwing athletes. Based on the information a clinical management decision-making algorithm is presented.
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Affiliation(s)
- Bonnie Gregory
- Division of Sports Medicine University of Louisville, Louisville, KY
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Could forearm Kinesio Taping improve strength, force sense, and pain in baseball pitchers with medial epicondylitis? Clin J Sport Med 2012; 22:327-33. [PMID: 22584958 DOI: 10.1097/jsm.0b013e318254d7cd] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine short-term effects of applied forearm Kinesio Taping (KT) on pain, wrist flexor strength, and force sense for baseball players with medial epicondylitis (ME). DESIGN Case-control repeated measures study. SETTING Clinical sports medicine research laboratory in a medical university. PARTICIPANTS A group of 10 baseball players with ME (ME group) and another group of 17 healthy collegiate athletes (healthy group). INTERVENTION Three taping conditions were applied in both groups: (1) no taping applied, (2) placebo taping applied (PT), and (3) KT applied. MAIN OUTCOME MEASURES Three variables were measured including maximal wrist flexor strength, related/absolute force sense errors, and pain scale (pressure pain and pain tolerance) under 3 taping conditions. RESULTS No significant relationship was found either in maximal wrist flexor strength or in related force sense errors between the 2 groups with taping applied, except absolute force sense errors (P = 0.037). Both the healthy group and the ME group in absolute force sense measurement significantly decreased the errors in PT and KT conditions. Also, the tolerance of pressure pain also improved in both the healthy group and the ME group when performing PT and KT conditions. CONCLUSIONS Forearm KT may enhance absolute force sense and improve pain condition for both healthy athletes and athletes suffering from ME when placebo and KT applied. However, KT did not result in significant changes in maximal wrist flexor strength for either group.
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Arthroscopic treatment of posterior impingement of the elbow in athletes: a medium-term follow-up in sixteen cases. J Shoulder Elbow Surg 2009; 18:279-82. [PMID: 19218052 DOI: 10.1016/j.jse.2008.10.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 09/09/2008] [Accepted: 10/14/2008] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Evaluate the effectiveness of arthroscopic treatment of posterior impingement in the athletes elbow. MATERIALS AND METHODS 16 elbows were included. An arthroscopic debridement of the posterior fossa of the elbow was performed. All Patients were evaluated preoperatively and after an average of 38 (30-53) months using range of motion, the Modified Andrews Elbow Scoring System (MAESS), VAS in rest and after provocation. RESULTS The average flexion increased from 138 degrees to 140 degrees . The extension deficit of 8 degrees preoperatively increased to a deficit of average 2 degrees (P < 0.05). The MAESS increased from average preoperative to excellent postoperative (P < 0.05). The average VAS in rest decreased from 3 to 0 and during sporting activities the VAS decreased from 7 to 2 (P < 0.05). DISCUSSION AND CONCLUSION In this series, arthroscopic debridement of the posterior fossa in athletes with posterior impingement is a procedure that showed excellent mid term results and can therefore be recommended. LEVEL OF EVIDENCE Level 4; Retrospective case series, no control group.
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Raissaki M, Apostolaki E, Karantanas AH. Imaging of sports injuries in children and adolescents. Eur J Radiol 2007; 62:86-96. [PMID: 17306491 DOI: 10.1016/j.ejrad.2007.01.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 01/16/2007] [Accepted: 01/17/2007] [Indexed: 11/21/2022]
Abstract
Sports injuries may be unique in childhood and adolescence due to the inherent weakness of the growing skeleton at specific sites, mainly the cartilaginous parts. Many injuries are predictable based on the known mechanism of injury encountered in certain sports. There are two distinct patterns of injury in sports; acute, and chronic or overuse. Imaging plays an important role in the diagnosis and management of these entities. Radiologists should be familiar with the advantages and limitations of the various imaging modalities when evaluating the injured young athlete. The present review focuses on the radiological findings and appropriate imaging approach in injuries that are typically or most commonly encountered in the skeletally immature athletes.
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Affiliation(s)
- Maria Raissaki
- Department of Radiology, Heraklion University Hospital, University of Crete, Stavrakia, Heraklion 711 10, Greece
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Abstract
The elbow is a common site of orthopaedic injury in the paediatric population. The number of these injuries continues to rise following increased levels of participation in paediatric recreational and competitive sport. Injuries to the paediatric elbow can be classified as either overuse or acute. Delineating injury patterns to the elbow in children can be challenging, given the cartilaginous composition of the distal humerus and the multiple secondary ossification centres that appear and unite with the epiphysis at defined ages. Pitching in baseball, serving in tennis, spiking in volleyball, passing in American football and launching in javelin-throwing can all produce elbow pathology by forceful valgus stress, with medial stretching, lateral compression and posterior impingement. In children and adolescents, the epiphyseal plate is weaker than the surrounding ligaments, predisposing them to epiphyseal plate injuries. On the other hand, post-pubescent or skeletally mature athletes are more prone to tendinous or ligamentous injury. Injuries may cause significant impact on the athlete, parents and healthcare system. With the exception of baseball, there are few prospective cohort studies on the epidemiological trends of childhood elbow injuries in other sports. This paper aims to describe the epidemiological trends in paediatric elbow injuries related to sports, suggests prevention strategies and discusses the scope for further research. A web-based search of existing articles pertaining to paediatric elbow injuries in sports was performed. The implications of acute and overuse injuries and the possibility of permanent damage should be understood by parents, coaches and the athletes. Proper understanding of the intrinsic and extrinsic risk factors that could lead to elbow injuries is thus required. Measures to prevent elbow injuries should include proper coaching, warm-up, officiation, legislation, medical expertise and protective gear. There are still many opportunities for prospective studies and other research projects among young athletes in various sports. Current studies will serve as a baseline for future research to assess the success of specific interventions in reducing the incidence of elbow injury in the paediatric athlete. Further epidemiological studies in various sports will help expand our knowledge and prevent potential disability and deformity in the paediatric elbow.
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Affiliation(s)
- Merzesh Magra
- Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, Stoke-on-Trent, England
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Kusumi T, Ishibashi Y, Tsuda E, Kusumi A, Tanaka M, Sato F, Toh S, Kijima H. Osteochondritis dissecans of the elbow: Histopathological assessment of the articular cartilage and subchondral bone with emphasis on their damage and repair. Pathol Int 2006; 56:604-12. [PMID: 16984617 DOI: 10.1111/j.1440-1827.2006.02015.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Osteochondritis dissecans (OCD) of the elbow is a localized injury of the articular cartilage and subchondral bone that is commonly seen in the young athlete. In the present study, the extent of damage and repair on the articular cartilage and subchondral bone was examined histologically using specimens of 25 osteochondral cylinders and seven loose bodies obtained from 25 young athletes who had undergone osteochondral autograft surgery. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) assays for detecting apoptotic cells and immunohistochemistry of matrix metalloproteinases (MMP) were performed on the osteochondral cylinder specimens. The histological findings of the OCD of the elbow showed that the articular cartilage exhibited degenerative change, mimicking osteoarthritis, and was markedly damaged as the lesion progressed. TUNEL-positive cells and MMP-3- and -13-expressing cells were distributed in the degenerative articular cartilage and reparative fibrocartilage tissue. Separation occurred at either the deep articular cartilage or the subchondral bone, with the former being dominant in the early OCD lesions. The present results suggest that the primary pathological changes in OCD of the elbow were due to damage of articular cartilage induced by repeated stress following degenerative and reparative process of articular cartilage and subchondral fracturing, and separation subsequently occurred on the cartilage and developed onto the subchondral bone in its advanced stages.
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Affiliation(s)
- Tomomi Kusumi
- Department of Pathology, Hirosaki University School of Medicine, Hirosaki, Japan.
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Use of conservative and sport-specific management strategies for a baseball pitcher with persistent elbow pain. J Chiropr Med 2006; 5:97-100. [DOI: 10.1016/s0899-3467(07)60141-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2004] [Revised: 09/30/2005] [Indexed: 11/22/2022] Open
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Abstract
A large number of adolescents participate in various sports. Not withstanding the methodologic problems with epidemiologic data, a large percentage of athletes sustain musculoskeletal injuries. In most instances, the athlete first presents to his or her primary care physician, who must perform the initial assessment and decide on further management. Many injuries can be managed by the primary care physician. It is important to recognize the unique characteristics of adolescent growth and development that have implications for the diagnosis and management of musculoskeletal injuries.
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Affiliation(s)
- Dilip R Patel
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, Kalamazoo Center for Medical Studies, 1000 Oakland Drive, Kalamazoo, 49008, USA.
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Nanni M, Butt S, Mansour R, Muthukumar T, Cassar-Pullicino VN, Roberts A. Stress-induced Salter-Harris I growth plate injury of the proximal tibia: first report. Skeletal Radiol 2005; 34:405-10. [PMID: 15782342 DOI: 10.1007/s00256-004-0892-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2004] [Revised: 11/22/2004] [Accepted: 11/24/2004] [Indexed: 02/02/2023]
Abstract
We describe a case of chronic Salter-Harris I injury of the proximal tibial epiphysis. To our knowledge such an injury has not been described in the English language literature. The radiological appearance can mimic chronic infection. The possibility of chronic athletic stress-related change should be considered in such scenarios to avoid a misdiagnosis.
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Affiliation(s)
- M Nanni
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK
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