The Role of Ultrasound in the Evaluation of Elbow Medial Ulnar Collateral Ligament Injuries in Throwing Athletes

PURPOSE OF REVIEW

Although ultrasound (US) imaging is commonly used to evaluate the elbow medial ulnar collateral ligament (mUCL) in throwing athletes, significant technical heterogeneity exists in the published literature and in practice. This has resulted in variable and often ambiguous US diagnostic criteria for mUCL injury. This review summarizes the literature on sonographic evaluation of the mUCL and outlines recommendations for consistent descriptive terminology, as well as future clinical and research applications.

RECENT FINDINGS

Both acute and chronic throwing loads in overhead athletes cause the mUCL to become thicker and more lax on stress testing, and these changes tend to revert after a period of prolonged rest. Stress US (SUS) can aid in the diagnosis of mUCL tears and may help identify athletes at risk of mUCL injury. Variability exists in terminology, elbow flexion angle, amount of stress applied, and technique of stress testing. Recent studies have suggested an injured elbow stress delta (SD-change in ulnohumeral joint (UHJ) space with valgus stress) of 2.4 mm and a stress delta difference (SDD-side-side difference in SD) of 1 mm each denote abnormal UHJ laxity due to mUCL injury. US imaging is a powerful and widely accessible tool in the evaluation elbow mUCL injuries. Sonologists should consider how their US techniques compare with published methods and use caution when applying diagnostic criteria outside of those circumstances. Currently, an SD of 2.4 mm and an SDD of 1 mm provide the best diagnostic accuracy for mUCL tears requiring surgery. Finally, preliminary work suggests that shear wave elastography may be helpful in evaluating the biomechanical properties of the mUCL, but additional research is needed.

Prevalence and burden of overuse injuries in elite junior handball

AIM

To record overuse injuries among male junior handball players throughout a handball season.

DESIGN

Prospective cohort study.

METHODS

Ten Norwegian junior male handball teams (145 players aged 16-18 years) were followed for one 10-month season. All players were sent the Oslo Sports Trauma Research Center Overuse Injury Questionaire every second week to record overuse injuries located in the shoulder, elbow, lower back and knee. The relative burden of overuse injuries was calculated in each anatomical area represented, defined as the proportion of the total cumulative severity score.

RESULTS

The average prevalence of all overuse injury problems was 39% (95% CI 29% to 49%) across all anatomical areas. The average prevalence of substantial overuse injury problems, defined as those leading to moderate or large reductions in training volume or sports performance, or to complete inability to participate, was 15% (95% CI 13% to 17%). Over the duration of the study, the cumulative incidence of overuse injury problems was 91% (133 players). Shoulder problems were the most prevalent (average prevalence 17%, 95% CI 16% to 19%), whereas knee problems had the greatest relative burden.

CONCLUSION

Overuse injuries, particularly in the shoulder and knee, have a substantial impact on junior handball players' training participation and performance. Interventions to prevent overuse injuries among male junior handball players should focus on these areas.

Understanding and evaluating shoulder pain in the throwing athlete

Shoulder pain in the throwing athlete can present at any age and in any level of sport and can lead to dysfunction. A thorough evaluation of the throwing athlete can often determine the cause of symptoms, which is frequently multifactorial. Although the pathophysiology leading to pain in the shoulder of the throwing athlete is not entirely known, nonoperative modalities remain the mainstay of treatment. In general, surgical intervention should be reserved as a last resort. Effective treatment often requires collaboration among trainers, players, physicians, and therapists to determine an appropriate course of action.

Anterior shoulder capsular tears in professional baseball players

BACKGROUND

Tearing of the anterior capsule of the shoulder is a rare but debilitating injury for throwing athletes. However, there is very little in the literature to guide its diagnosis and treatment. In this case series, we outline our experience with anterior capsular tears of the shoulder in professional baseball players.

METHODS

Five professional baseball players were diagnosed with midsubstance tears of their anterior capsule. A trial of rest and rehabilitation failed in all patients, and they eventually underwent surgery. These patients were retrospectively reviewed. The presenting symptoms and findings were documented, and outcomes were assessed by the player's ability to return to play.

RESULTS

The mean age was 33.5 years (range, 31-37 years), and all patients presented with anterior shoulder pain and the inability to throw. No patient had an acute traumatic injury. Magnetic resonance imaging provided the correct diagnosis in 4 patients, and the diagnosis was made with diagnostic arthroscopy in the fifth. Three underwent arthroscopic repair, and 2 underwent open repair of the anterior capsule. Of the 5 players, 4 (80%) returned to their preinjury level by a mean of 13.3 months (range, 8-18 months).

CONCLUSIONS

Anterior capsular tears can occur in older throwing athletes. Surgical repair, whether arthroscopic or open, can yield good results in most patients.