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Hanna AJ, Popper HR, Sonnier JH, Erickson BJ, Jack RA, Cohen SB. The Utility of Stress Ultrasound in Identifying Risk Factors for Elbow Ulnar Collateral Ligament Tear: A Longitudinal Study of 203 Professional Baseball Players. Am J Sports Med 2024; 52:1060-1067. [PMID: 38406885 DOI: 10.1177/03635465241230049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Injuries to the medial ulnar collateral ligament (UCL) are common among baseball pitchers due to repetitive stress on the soft tissue stabilizers of the elbow during pitching. Dynamic stress ultrasound (SUS) can be used to evaluate the UCL and ulnohumeral joint to identify anatomic risk factors of those who will require UCL reconstruction (UCLR). PURPOSE To determine whether any adaptive or morphological changes detectable on SUS can predict injury to the UCL in professional baseball pitchers. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 203 professional baseball pitchers who underwent SUS at preseason training sessions over the course of 18 years were categorized into 1 of 2 groups: those without a history of shoulder, arm, elbow, or forearm surgery or injuries (healthy cohort; n = 184) and those who underwent UCLR the same season as SUS (UCLR cohort; n = 19). Ligament thickness, joint spacing, and laxity were compared. An additional matched cohort analysis was conducted using 10 players from each group to detect differences in the progression of UCL and ulnohumeral joint measures in the year before injury. RESULTS The UCLR cohort, when compared with the healthy cohort, had higher relative (ie, nondominant-side measurements subtracted from dominant-side measurements) resting ulnohumeral joint space (median, 0.50 vs 0.20 mm, respectively; P = .006) and higher rates of hypoechoic foci (57.9% vs 30.4%, respectively; P = .030). Players of both groups had similar dominant UCL thickness (P = .161), ulnohumeral joint space at rest (P = .321), space under stress (P = .498), and laxity (P = .796). Groups did not differ in terms of relative UCL thickness, ulnohumeral joint space under stress, or relative laxity. In the year before UCL injury, the UCLR cohort, compared with the matched healthy cohort, had a greater increase in mean dominant UCL thickness (0.94 vs -0.60 mm, respectively; P = .038) and a greater increase in relative median UCL thickness (1.35 vs -0.35 mm, respectively; P = .045). Players in the healthy cohort were statistically older than those in the UCLR cohort (23 vs 22 years, respectively; P = .004). No differences in ulnohumeral stress spacing or laxity were detected. CONCLUSION SUS of players who underwent UCLR demonstrated a progressive increase in UCL thickness over 1 year, higher rates of hypoechoic foci, and increased ulnohumeral rest space compared with SUS of uninjured players.
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Affiliation(s)
- Adeeb Jacob Hanna
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Hannah R Popper
- Department of Orthopaedic Surgery, Jefferson Health New Jersey, Stratford, New Jersey, USA
| | - John Hayden Sonnier
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Brandon J Erickson
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Robert A Jack
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Steven B Cohen
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
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Hanna AJ, Sonnier JH, Fliegel BE, Erickson BJ, Jack RA, Cohen SB. Dynamic Stress Ultrasound Assessment of Professional Baseball Players' Elbows After Ulnar Collateral Ligament Reconstruction. Am J Sports Med 2024; 52:1053-1059. [PMID: 38353117 DOI: 10.1177/03635465241227436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND There is a paucity of data analyzing dynamic stress ultrasound (SUS) findings in elite pitchers who have undergone ulnar collateral ligament (UCL) reconstruction (UCLR) and returned to sport. PURPOSE To identify longitudinal, perioperative changes in the elbows of professional baseball pitchers who have undergone UCLR and to compare these findings with a matched cohort of healthy pitchers. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study used prospectively collected data from dynamic elbow SUS analyses of professional baseball pitchers within a single Major League Baseball organization. Pitchers were divided into 2 cohorts: a UCLR cohort and healthy cohort. The UCLR cohort eligibility included availability of (1) SUS from preseason of injury/UCLR and (2) SUS from ≥2 years after surgery. These players were 1:1 matched to players with no history of upper extremity injury to form the healthy cohort. Ligament thickness and ulnohumeral joint space at rest and under stress were directly measured. Joint laxity was calculated by subtracting joint space at rest from joint space under stress. The term "relative" was used to describe calculated differences where nondominant measurements were subtracted from dominant-side measurements. RESULTS Eight pitchers were included in the UCLR group and matched to 8 healthy pitchers (mean age at initial SUS examination, 19.6 years). At a minimum follow-up of 2 years, there were no significant differences between groups in terms of relative or dominant arm rest space, stress space, or laxity. Longitudinally (final measurements - baseline measurements), the mean relative ulnohumeral rest space decreased in the UCLR group and increased in the healthy group (-0.36 mm vs +0.50 mm; P = .032). The finding of increased UCL thickness in the UCLR group was expected, as UCL grafts are typically thicker than native ligaments. CONCLUSION Ulnhohumeral joint stability was achieved after UCLR as indicated by similar rest space, stress space, and joint laxity in dominant arms compared with a matched healthy cohort. A significant decrease in relative rest space after UCLR may represent the achievement of stability in surgery patients. Alternatively, the increase in ulnohumeral rest space seen in the healthy cohort may represent adaptive changes from pitching at a professional level.
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Affiliation(s)
- Adeeb Jacob Hanna
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
| | | | - Brian E Fliegel
- Department of Orthopaedic Surgery, Jefferson Health New Jersey, Stratford, New Jersey, USA
| | | | - Robert A Jack
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Steven B Cohen
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
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Yoon ES, Pishgar F, Dines J, Mintz DN. Characterizing focal muscle signal on MRI in flexor-pronator muscles' status post ulnar collateral ligament reconstruction. Skeletal Radiol 2024; 53:293-297. [PMID: 37428190 DOI: 10.1007/s00256-023-04388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Focal high signal is commonly seen about the flexor pronator mass on MRI in some patients after ulnar collateral ligament (UCL) reconstruction of the elbow. The etiology of this high signal is unclear and not described in literature. The hypothesis is that the edema we see on post-operative MRI is related to palmaris longus graft harvest rather than secondary to other causes of muscle edema such as denervation or muscle strain. METHODS AND MATERIALS An IRB waiver-approved, retrospective search of our radiology database was conducted using the keywords "ucl," "elbow," and "reconstruction" between 1/01/2012 and 1/01/2022, with search parameters set as MRI for exam type. The images were reviewed to evaluate for high signal at the flexor pronator mass by a junior and a senior musculoskeletal radiologist. The surgical notes were then reviewed in electronic medical record system to see which graft was used for the UCL reconstruction. RESULTS The cohort comprised of 33 patients (1 female/32males, 14-51 years old) who had undergone UCL reconstructions. Four patients were excluded from the study secondary to the surgical note not specifying which graft was used. The surgical and imaging dates were also recorded with the largest time gap of 7 years between the surgery and imaging. Seventeen of the 29 patients had palmaris longus harvested from the ipsilateral arm, 1 patient had palmaris longus harvested from the contralateral arm, 2 patients had an internal brace, and 9 patients had a hamstring graft. Seventeen out of 17 (100%) patients with ipsilateral palmaris longus graft demonstrated focal edema at the flexor pronator mass while 0/12 of the patients without the palmaris longus graft showed the focal edema seen by its counterparts. CONCLUSION High signal which is commonly seen at the flexor pronator mass in patient status most UCL reconstruction of the elbow is secondary to the palmaris longus harvest rather than other etiologies such as muscle strain, retear, or trauma.
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Affiliation(s)
| | | | - Josh Dines
- Hospital for Special Surgery, New York, NY, USA
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Hanna AJ, Sonnier JH, Fliegel BE, Sherman MB, Ciccotti MG, Jack RA, Cohen SB. Association Between Draft Order and Stress Sonography of the Ulnar Collateral Ligament of the Elbow in Professional Baseball Pitchers: An 18-Year Study. Am J Sports Med 2024; 52:224-231. [PMID: 38164663 DOI: 10.1177/03635465231210292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND The Major League Baseball (MLB) draft is a common route for players to enter professional baseball in the United States. Players taken in earlier rounds are typically higher-performing players. When looking at pitchers specifically, higher performance at the amateur level may be associated with an increased frequency of adaptive change in the throwing elbow. PURPOSE To determine whether pitchers taken in earlier rounds of the MLB draft have a greater frequency or extent of pathological change in the elbow, as measured by dynamic stress ultrasound. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Dynamic stress ultrasounds (SUSs) were performed over 18 years on the dominant and nondominant arms of 651 professional pitchers. The 383 drafted players were grouped according to the round in which they were drafted (rounds 1-5, 6-10, 11-20, 21+). Groups were compared with respect to "relative" ulnar collateral ligament (UCL) thickness (dominant-nondominant), relative ulnohumeral joint laxity (joint space distance under stress minus joint space at rest), and the presence of pathology (calcifications, tears, hypoechoic foci, osteophytes). In addition, a subgroup analysis was done to compare the progression of SUS findings over 3 years in players for which data were available. RESULTS Draft round groups did not differ by age, number of previous spring training, or handedness. Comparing baseline measurements, there was no significant relationship between draft round and relative UCL thickness (P = .932), relative laxity (P = .996), or presence of pathology detectable on SUS (P = .642). However, increased relative UCL thickness was significantly associated with the presence of pathology on SUS (odds ratio, 1.45; 95% CI, 1.26-1.69; P < .001). Longitudinally, there was no significant relationship between draft round and 3-year progression of relative laxity, relative UCL thickness, or clinical progression of pathology. CONCLUSION Higher-performing pitchers are drafted earlier in the MLB draft. This may be attributable to peak pitch velocity, in-game performance, visibility gained during player showcases, or any number of other sport-specific variables. However, despite this, there was no significant relationship between draft round and adaptive changes to the elbow or specific properties of the UCL on stress ultrasound.
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Affiliation(s)
- Adeeb J Hanna
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - John H Sonnier
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Brian E Fliegel
- Department of Orthopaedic Surgery, Jefferson Health New Jersey, Stratford, New Jersey, USA
| | - Matthew B Sherman
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Michael G Ciccotti
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Robert A Jack
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Steven B Cohen
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
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Alzouhayli K, Schilaty ND, Wei Y, Hooke AW, Sellon JL, Bates NA. Shear wave elastography demonstrates different material properties between the medial collateral ligament and anterolateral ligament. Clin Biomech (Bristol, Avon) 2024; 111:106155. [PMID: 38043170 PMCID: PMC10872362 DOI: 10.1016/j.clinbiomech.2023.106155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Anterolateral ligament and medial collateral ligament injuries could happen concomitantly with anterior cruciate ligament ruptures. The anterolateral ligament is injured more often than the medial collateral ligament during concomitant anterior cruciate ligament ruptures although it offers less restraint to knee movement. Comparing the material properties of the medial collateral ligament and anterolateral ligament helps improve our understanding of their structure-function relationship and injury risk before the onset of injury. METHODS Eight cadaveric lower extremity specimens were prepared and mechanically tested to failure in a laboratory setting using a hydraulic platform. Measurements of surface strains of superficial surface of each medial collateral ligament and anterolateral ligament specimen were found using three-dimensional digital image correlation. Ligament stiffness was found using ultrasound shear-wave elastography. t-tests were used to assess for significant differences in strain, stress, Young's modulus, and stiffness in the two ligaments. FINDINGS The medial collateral ligament exhibited greater ultimate failure strain along its longitudinal axis (p = 0.03) and Young's modulus (p < 0.0018) than the anterolateral ligament. Conversely, the anterolateral ligament exhibited greater ultimate failure stress than the medial collateral ligament (p < 0.0001). Medial collateral ligament failure occurred mostly in the proximal aspect of the ligament, while most anterolateral ligament failure occurred in the distal or midsubstance aspect (P = 0.04). INTERPRETATION Despite both being ligamentous structures, the medial collateral ligament and anterolateral ligament exhibited separate material properties during ultimate failure testing. The weaker material properties of the anterolateral ligament likely contribute to higher rates of concomitant injury with anterior cruciate ligament ruptures.
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Affiliation(s)
- Kenan Alzouhayli
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Ohio State University College of Medicine, Columbus, OH, USA
| | - Nathan D Schilaty
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Yi Wei
- Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
| | | | - Jacob L Sellon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nathaniel A Bates
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Noriego D, Carrera A, Tubbs RS, Guibernau J, San Millán M, Iwanaga J, Cateura A, Sañudo J, Reina F. The lateral ulnar collateral ligament: Anatomical and structural study for clinical application in the diagnosis and treatment of elbow lateral ligament injuries. Clin Anat 2023; 36:866-874. [PMID: 36509693 DOI: 10.1002/ca.23991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
The lateral ulnar collateral ligament (LUCL) is considered one of the main stabilizers of the elbow. However, its anatomical description is not well established. Imaging techniques do not always have agreed upon parameters for the study of this ligament. Therefore, herein, we studied the macro and microanatomy of the LUCL to establish its morphological and morphometric characteristics more precisely. Fifty-five fresh-frozen human elbows underwent dissection of the lateral collateral ligament. Morphological characteristics were studied in detail. Ultrasound (US) and magnetic resonance (MR) were done before dissection. Two specimens were selected for PGP 9.5 S immunohistochemistry. Ten additional elbows were analyzed by E12 sheet plastination. LUCL was identified in all specimens and clearly defined by E12 semi-thin sections. It fused with the common extensor tendon and the radial ligament. The total length of the LUCL was 48.50 mm at 90°, 46.76 mm at maximum flexion and 44.10 mm at complete extension. Three morphological insertion variants were identified. Both US and MR identified the LUCL in all cases. It was hypoechoic in the middle and distal third in 85%. The LUCL was hypointense on MR in 95%. Free nerve endings were present on histology. The LUCL is closely related to the anular ligament. It is stretched during flexion and supination. US and MR can reliably identify its fibers. Anatomical data are relevant to the surgeon who repairs the ligaments of the elbow. Also, to the radiologist and pain physician who interpret imaging and treat patients with pain syndromes of the elbow.
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Affiliation(s)
- Diana Noriego
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain
- Department of Orthopedic Surgery, University Hospital Dr. Trueta, Girona, Spain
| | - Anna Carrera
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Jorge Guibernau
- IDIBGI Girona Biomedical Research Center, Girona, Spain
- Department of Radiology, Salut Empordà Hospital Foundation, Figueres, Spain
| | - Marta San Millán
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Aïda Cateura
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain
| | - Jose Sañudo
- Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Reina
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain
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Lobb NJ, Lu Z, Long E, Chow K, Michener LA. Sonographic morphological and qualitative deficits in the elbow ulnar collateral ligament and ulnohumeral joint in throwing arms of asymptomatic collegiate baseball pitchers. Skeletal Radiol 2023; 52:31-37. [PMID: 35864196 DOI: 10.1007/s00256-022-04116-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The ulnar collateral ligament (UCL) supports the medial elbow against valgus torque and is commonly injured in baseball pitchers. Changes in UCL morphology and pathology occur with long-term pitching, with more severe findings at higher competition levels. We examined the bilateral differences and the relationship between UCL morphology, pathology, and ulnohumeral joint laxity in asymptomatic collegiate pitchers using ultrasound. MATERIALS AND METHODS Division I college pitchers (n = 41) underwent ultrasound scans of their bilateral medial elbows, both at rest and in a valgus-stressed position. The presence of enthesopathy, calcifications, and degeneration was assessed qualitatively. UCL thickness and ulnohumeral joint gap were measured with online calipers. The bilateral differences were analyzed using paired t-tests and chi-square analysis, and the relationships between thickness, gapping, and degenerative changes were analyzed using regression analyses. RESULTS The throwing arm demonstrated greater distal UCL thickness (mean difference (MD) = 0.2 mm (95%CI = 0.1-0.3), p < 0.01), resting and stressed gap (MD = 0.3 mm (95%CI = 0.0-0.7), p = 0.04; MD = 0.4 (95%CI = 0.0-0.9), p = 0.02), and greater prevalence of degeneration and enthesopathy (p = 0.03) compared bilaterally. Enthesopathy and calcifications predicted increased distal UCL thickness (p = 0.04; p = 0.02). Degenerative scores predicted increased stressed-resting ulnohumeral joint gap (p < 0.01). CONCLUSION In the throwing arms of collegiate pitchers, ultrasound demonstrated UCL thickening, enthesopathy/intra-ligamentous calcification, and greater laxity of the ulnohumeral joint relative to the non-throwing arm. Degeneration of the UCL, not thickness, was related to greater elbow joint gapping. This study demonstrates the utility of ultrasound for examining sonographic characteristics of the UCL in a sample of college pitchers.
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Affiliation(s)
- Nicholas J Lobb
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar Street, CHP 155, Los Angeles, CA, 90089, USA.
| | - Ziang Lu
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Emma Long
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar Street, CHP 155, Los Angeles, CA, 90089, USA
| | - Kira Chow
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar Street, CHP 155, Los Angeles, CA, 90089, USA
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Torniainen J, Ristaniemi A, Sarin JK, Prakash M, Afara IO, Finnilä MAJ, Stenroth L, Korhonen RK, Töyräs J. Near infrared spectroscopic evaluation of biochemical and crimp properties of knee joint ligaments and patellar tendon. PLoS One 2022; 17:e0263280. [PMID: 35157708 PMCID: PMC8843223 DOI: 10.1371/journal.pone.0263280] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/16/2022] [Indexed: 11/22/2022] Open
Abstract
Knee ligaments and tendons play an important role in stabilizing and controlling the motions of the knee. Injuries to the ligaments can lead to abnormal mechanical loading of the other supporting tissues (e.g., cartilage and meniscus) and even osteoarthritis. While the condition of knee ligaments can be examined during arthroscopic repair procedures, the arthroscopic evaluation suffers from subjectivity and poor repeatability. Near infrared spectroscopy (NIRS) is capable of non-destructively quantifying the composition and structure of collagen-rich connective tissues, such as articular cartilage and meniscus. Despite the similarities, NIRS-based evaluation of ligament composition has not been previously attempted. In this study, ligaments and patellar tendon of ten bovine stifle joints were measured with NIRS, followed by chemical and histological reference analysis. The relationship between the reference properties of the tissue and NIR spectra was investigated using partial least squares regression. NIRS was found to be sensitive towards the water (R2CV = .65) and collagen (R2CV = .57) contents, while elastin, proteoglycans, and the internal crimp structure remained undetectable. As collagen largely determines the mechanical response of ligaments, we conclude that NIRS demonstrates potential for quantitative evaluation of knee ligaments.
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Affiliation(s)
- Jari Torniainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- * E-mail:
| | - Aapo Ristaniemi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Jaakko K. Sarin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- Department of Medical Physics, Medical Imaging Center, Pirkanmaa Hospital District, Tampere, Finland
| | - Mithilesh Prakash
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Isaac O. Afara
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Mikko A. J. Finnilä
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Rami K. Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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Jung HS, Lee JS, Kim JY, Baek SH, Lee GY, Choi JH. Analysis of Fracture Characteristic and Medial Collateral Ligament Injury Relationships in Terrible Triad Elbow Injuries. J Hand Surg Am 2021; 46:713.e1-713.e9. [PMID: 33795153 DOI: 10.1016/j.jhsa.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 11/09/2020] [Accepted: 01/20/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The objectives of this study were to identify the relationship between fracture characteristics and medial collateral ligament (MCL) injuries in terrible triad injuries of the elbow. METHODS Between 2010 and 2018, 60 patients who underwent surgery for terrible triad elbow injuries were retrospectively reviewed. Using magnetic resonance imaging (MRI) assessments, patients were stratified into those who had intact or low-grade partial MCL tears (low-grade MRI-MCL group) and those who had high-grade partial or full-thickness MCL tears (high-grade MRI-MCL group). We also analyzed patients according to whether they underwent MCL repair surgery. Fractures of the radial head were assessed according to Mason's classification system and measurements of fracture fragment arc on axial cuts. Fractures of the coronoid processes were assessed according to the system of Regan and Morrey and measurements of coronoid process volumes. RESULTS Patients in the high-grade MRI-MCL group (28 patients) had a more comminuted and higher fragment arc of radial head fractures than those in the low-grade MRI-MCL group (32 patients) (143º ± 45º vs 119º ± 31º). However, the volume of coronoid fracture fragments was smaller in the high-grade MRI-MCL than in the low-grade MRI-MCL group (359 ± 325 mm3 vs 722 ± 448 mm3). The MCL repair group (22 patients) also had a more comminuted and higher fragment arc in radial head fractures (153º ± 44º vs 117º ± 31º) and a smaller coronoid process fracture volume (236 ± 224 mm3 vs 735 ± 419 mm3) than the non-MCL repair group (38 patients). CONCLUSIONS Our results demonstrated that high-grade MCL injuries are associated with comminuted and larger-sized radial head fractures, as well as smaller-sized coronoid process fractures in terrible triad injuries. In making a decision regarding surgical treatment, these fracture characteristics could help to predict the severity for MCL injury in terrible triad injuries. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
| | - Jae Sung Lee
- Department of Orthopaedic Surgery, Seoul, Korea.
| | | | - Suk Ho Baek
- Department of Orthopaedic Surgery, Seoul, Korea
| | | | - Jin Hwa Choi
- Department of Radiation Oncology, Medical Center of Chung-Ang University School of Medicine, Seoul, Korea
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Edmonds EW, Mitchell BC. Coronal Lateral Collateral Ligament Sign: Response. Am J Sports Med 2021; 49:NP54-NP55. [PMID: 34347550 DOI: 10.1177/03635465211030209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Prein TK, Brogren E, Dahlin LB, Søe NH, Brorson S. [Ulnar collateral ligament injury to the thumb]. Ugeskr Laeger 2021; 183:V01210085. [PMID: 34356007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Instability of the ulnar collateral ligament (UCL) is disabling and can occur at any age as an acute or chronic condition. A medical history and objective examination together with the radiological findings are sufficient to make the diagnosis in the majority of cases. Otherwise, an ultrasound or MRI scan should be considered for the acute and chronic injuries, respectively. The partial injuries are treated non-surgically with immobilisation of the metacarpophalangeal joint, while the complete ruptures require surgery, which is summarised in this review. Chronic UCL injuries with symptomatic osteoarthritis are treated with arthrodesis.
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Kim YS, Kim ST, Lee KH, Ahn JM, Gong HS. Radiocapitellar incongruity of the radial head in magnetic resonance imaging correlates with pathologic changes of the lateral elbow stabilizers in lateral epicondylitis. PLoS One 2021; 16:e0254037. [PMID: 34234369 PMCID: PMC8263266 DOI: 10.1371/journal.pone.0254037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Post-traumatic posterolateral rotatory instability (PLRI) can be shown as radiocapitellar incongruity or posterior translation (PT) of the radial head in magnetic resonance imaging (MRI). We aimed to evaluate whether PT correlated with pathologic changes of lateral elbow stabilizers in patients with lateral epicondylitis. MATERIALS AND METHODS In MRIs of 160 patients with lateral epicondylitis, we measured PT of the radial head in the sagittal images. We qualitatively graded five lesions of the lateral elbow structures that included common extensor tendon (CET) lesion (grade 1-3), lateral collateral ligament complex (LCLC) insufficiency (grade 0-2), and absence or presence of bone marrow signal change, osteochondral lesion, and calcification. We analyzed whether the PT correlated with pathologic changes of the lateral elbow stabilizers and evaluated the diagnostic value of the PT for severe lesions. RESULTS The average PT was 1.9 mm. The PT correlated with both the CET lesion (p < 0.001) and LCLC insufficiency (p < 0.001). The optimal cutoff values of the PT for grade 3 CET lesion and grade 2 LCLC lesion were 2.6 and 2.8 mm, respectively. When potential PLRI was defined as the PT of > 3.4mm as suggested for post-traumatic PLRI, 21 patients had potential PLRI. The positive predictive values of the PT > 3.4mm were 76% for grade 3 CET lesions and 67% for grade 2 LCLC insufficiency. CONCLUSION This study demonstrates that PT of the radial head correlates with pathological changes of the lateral elbow stabilizers. As radiocapitellar incongruity is easy to measure quantitatively, it can be used for screening potential PLRI in patients with lateral epicondylitis.
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Affiliation(s)
- Yeun Soo Kim
- Department of Orthopedic Surgery, National Police Hospital, Seoul, Republic of Korea
| | - Sung Taeck Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kyoung Hwan Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- * E-mail:
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Moore BJ, Iafrate JL, Kakar S, Wisniewski SJ, Murthy NS, Smith J. Accuracy of Ultrasound Compared to Magnetic Resonance Imaging in the Diagnosis of Thumb Ulnar Collateral Ligament Injuries: A Prospective Case Series. J Ultrasound Med 2021; 40:1251-1257. [PMID: 32930402 DOI: 10.1002/jum.15491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/19/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
This prospective case series compared the accuracy of ultrasound (US) to magnetic resonance imaging (MRI) in differentiating complete displaced (CD) thumb ulnar collateral ligament (UCL) tears from nondisplaced injuries in 10 patients with suspected traumatic thumb UCL injuries. Ultrasound identified 100% (2 of 2) of MRI-documented CD tears, both of which were further confirmed during surgical repair. Ultrasound identified the absence of CD tears in the remaining 8 patients. Although MRI is the reference standard imaging modality for characterizing thumb UCL injuries, ultrasound should be considered an accurate, cost-effective, and alternative imaging modality to differentiate surgical versus nonsurgical thumb UCL injuries.
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Affiliation(s)
- Brittany J Moore
- Departments of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Julia L Iafrate
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, New York, USA
| | - Sanjeev Kakar
- Departments of Orthopedics, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen J Wisniewski
- Departments of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Naveen S Murthy
- Departments of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jay Smith
- Departments of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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Aguirre-Rodríguez VH, Valdés-Montor JF, Valero-González FS, Santa-María-Gasca NE, Gómez-Pérez MG, Sánchez-Silva MC, Zúñiga-Isaac C, Pérez-Mora HE, Mejía-Terrazas GE. [Prevalence of injury of the medial collateral ligament of the knee assessed by magnetic resonance]. Acta Ortop Mex 2021; 35:271-275. [PMID: 34921537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The medial collateral ligament (MCL) is one of the main stabilizers of the knee, but its injury occurs in conjunction with other ligaments. OBJECTIVE To determine the prevalence of MCL lesions by magnetic resonance imaging, their degrees and associated lesions in our institution. MATERIAL AND METHODS Retrospective study from January to April 2018 where KNEE MRIs were evaluated where the MCL lesion was presented to evaluate the degree and type of associated injuries. RESULTS We included 368 studies, prevalence of isolated MCL lesion of 3.07%, grade I and grade II, prevalence of concomitant MCL lesions was 17.66% grade I (75%), grade II (15%) and grade III (3%). Associated injuries were medial meniscus injury (46.15%), anterior cruciate ligament injury (30.7%), isolated bone contusion (18.46%), chodral injuries (37.58%), medial vastus injury (14.51%), patellar medial retinacular injury (14.51%), vastus lateral injury (9.23%), posterior cruciate ligament injury (6.15%), lateral meniscus injury (4.61%), iliotibial band tenosynovitis (4.61%), medial facet avulsion fracture (3.07%), Pes Anserine tenosynovitis (3.07%). CONCLUSION Prevalence of 17.66% of the MCL injuries in our hospital by magnetic resonance, the first 2 degrees predominate, with a wide spectrum of associated knee injuries.
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Affiliation(s)
| | - J F Valdés-Montor
- Alta Especialidad en Reconstrucción Articular de Hombro y Codo, ULSA-HAP. México
| | | | | | - M G Gómez-Pérez
- Resonancia Magnética del Hospital Ángeles del Pedregal. México
| | - M C Sánchez-Silva
- Alta Especialidad en Medicina de Resonancia Magnética de Cuerpo Completo. UNAM-HAP. México
| | - C Zúñiga-Isaac
- Alta Especialidad en Medicina de Resonancia Magnética de Cuerpo Completo. UNAM-HAP. México
| | - H E Pérez-Mora
- Alta Especialidad en Medicina de Resonancia Magnética de Cuerpo Completo. UNAM-HAP. México
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Moraux A, Bianchi S, Le Corroller T. Anterolateral knee pain related to thrombosed lateral patellar retinaculum veins: Unusual anterolateral pain of the knee. J Clin Ultrasound 2020; 48:275-278. [PMID: 32237145 DOI: 10.1002/jcu.22835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/25/2020] [Accepted: 03/05/2020] [Indexed: 06/11/2023]
Abstract
We describe the ultrasound (US) features of venous thrombosis involving the lateral patellar retinaculum (LPR) veins presenting as anterolateral knee pain. Four male patients, aged 16 to 35 years, were referred for lateropatellar pain with focal tenderness. In two cases, physical examination also demonstrated soft tissue swelling at the anterolateral aspect of the knee. In all four cases, US showed subcutaneous fat edema surrounding a thrombosis involving the LPR veins. Magnetic resonance imaging performed before US in one patient revealed only nonspecific subcutaneous fat edema and was therefore unable to make the correct diagnosis of LPR venous thrombosis.
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Affiliation(s)
- Antoine Moraux
- Imagerie Médicale Jacquemars Giélée, 73 rue Jacquemars Giélée, 59000 Lille, France
- Hôpital Privé La Louvière, Ramsay Générale de Santé, 59000 Lille, France
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Li Y, Wu G, Cui S, Zhang Z, Gu X. Bilateral radial collateral ligament rupture in a shoemaker: A case report and brief literature review. Medicine (Baltimore) 2020; 99:e20126. [PMID: 32384492 PMCID: PMC7220783 DOI: 10.1097/md.0000000000020126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Rupture of the radial collateral ligament (RCL) of the index metacarpophalangeal (MCP) joint is mostly related to acute local mechanical causes, which severely affect the stability of the MCP joint. However, few cases of chronic bilateral job-related RCL injury have been reported in the literature. There is no consensus on the knowledge of the disease to date. Here, we present an extremely rare case of chronic bilateral RCL injury. PATIENT CONCERNS A 58-year-old female shoemaker presented with chief complaints of swelling and pain in the radial aspect of the MCP joint of bilateral index fingers since 2 years. There was no history of acute RCL injury. The persistent pain was aggravated while gripping, pulling, buttoning, and twisting. DIAGNOSIS Based on the combination of physical examination, X-ray, and ultrasonic and magnetic resonance imaging, the patient was diagnosed with bilateral tear of the RCLs and joint dislocation of the index MCP joint. Eventually, intra-operative findings confirmed the diagnosis. INTERVENTION The patient underwent bilateral index MCP joint fusion followed by immobilization for 6 weeks. Functional therapy was started after immobilization. OUTCOMES The patient's chief complaints were significantly alleviated after the operation. At the 12-month follow-up, the patient returned to a full level of activity as a shoemaker without any complications. CONCLUSION Compared to acute RCL rupture of the index MCP joint, occupation may play an important role in the diagnosis of chronic RCL rupture of the index MCP joint. Our report will provide more diagnostic and treatment experience to deal with this type of injury.
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Affiliation(s)
- Yueying Li
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin
| | - Guangzhi Wu
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin
| | - Shusen Cui
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin
| | - Zhan Zhang
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin
| | - Xiaosong Gu
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin
- Key Laboratory of Neuro regeneration, Ministry of Education and Jiangsu Province, Co-innovation Center of Neuro Regeneration, Nantong University, Nantong, Jiangsu, P.R. China
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Makihara T, Okamoto Y, Yoshizawa T, Tanaka K, Ogawa T, Minami M, Yamazaki M. Change in MRI findings of medial collateral ligament injury in adolescent baseball players with no clinical symptoms over time. Skeletal Radiol 2019; 48:1925-1932. [PMID: 31123766 DOI: 10.1007/s00256-019-03231-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/16/2019] [Accepted: 04/29/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Elbow screening of adolescent baseball players began in 2014 using ultrasound, palpation, and dedicated magnetic resonance imaging (MRI). We frequently encountered subjects showing MCL injury on MRI but no clinical symptoms. We assessed variations in asymptomatic MCL injury findings at follow-up MRI, and clarified the pathogenesis of these findings. MATERIALS AND METHODS Using a 0.2-T-dedicated MRI, 30 subjects with asymptomatic MCL injury at initial MRI who agreed to follow-up MRI were included. We classified the findings at repeat MRI as follows: (a) disappeared, (b) better, and (c) worse. RESULTS There were 6, 16, and 8 subjects in groups a, b, and c, respectively. The average age at follow-up was 14.0, 12.1, and 12.4 years in groups a, b, and c, respectively. There were significant differences between groups a and b and between groups a and c. Average height at follow-up of groups a, b, and c was 1.64, 1.52, and 1.57 cm, respectively, with a statistically significant difference between groups a and b. The average size of the short axis of the MCL of subjects in group a was 2.0 cm on the dominant side and 1.5 cm on the contradominant side (P < 0.04). CONCLUSION Players with asymptomatic MCL injury can continue to play baseball with no limitations, as these findings usually disappear around the age of 14.0 years, when the growth spurt occurs. This finding may be a precursor of 'adaptation', which is generally observed in high school baseball players, suggesting that the MCL adapts as growth occurs.
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Affiliation(s)
- Takeshi Makihara
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshikazu Okamoto
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Tsukuba, MD 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Tomohiro Yoshizawa
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Tsukuba, MD 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Kenta Tanaka
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Tsukuba, MD 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Takeshi Ogawa
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Tsukuba, MD 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Manabu Minami
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Tsukuba, MD 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
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Abstract
Spondyloarthritis may be increasingly present in older patients as life expectancy increases. We investigated clinical differences between early-onset and late-onset spondyloarthritis in Japan.We retrospectively reviewed 114 patients consecutively diagnosed with spondyloarthritis. The clinical course of each patient was observed for ≥1 year. We defined early-onset and late-onset spondyloarthritis as <57 or ≥57 years at a median age of this study group, respectively. We compared clinical characteristics between these 2 groups.Disease duration was significantly shorter before diagnosis in the late-onset group (P < .01). Inflammatory back pain (IBP) was significantly more common in the early-onset group (P < .01), whereas dactylitis frequency was significantly higher in the late-onset group. Significantly more patients with early-onset spondyloarthritis were human leukocyte antigen (HLA) B27-positive (P < .01). Articular synovitis, particularly of the wrist, was significantly more common on power Doppler ultrasound (PDUS) in the late-onset group (P < .01). Tenosynovitis or peritendinitis, particularly in the finger and wrist flexors were also more frequent in the late-onset group (P < .001 and P < .05, respectively). Enthesitis of the finger collateral ligament and lateral collateral ligament were significantly more common in the late-onset group (both P < .05). Multiple logistic regression analysis revealed that, comparatively, IBP was significantly and independently much more likely to occur in the early-onset group.The patients with late-onset spondyloarthritis had a lower frequency of IBP and HLA B27 and a higher frequency of dactylitis and PDUS findings in peripheral involvement.
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Affiliation(s)
- Yushiro Endo
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
| | - Keita Fujikawa
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
| | - Akinari Mizokami
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital
| | - Masanobu Mine
- Department of Rheumatology, Suga Orthopedic Hospital
| | | | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
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Abehsera E, Guerre E, Duriez P, El Rafei M, Fontaine C, Chantelot C. Ligaments injuries check-up and assessment of their healing potential in simple posterolateral elbow dislocation: about 25 cases. Eur J Orthop Surg Traumatol 2019; 29:785-792. [PMID: 30649622 DOI: 10.1007/s00590-019-02374-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/04/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Elbow dislocation can lead to instability and stiffness of the elbow. The main goal of this study was to list the initial elbow ligaments injuries caused by simple posterolateral elbow dislocations. The secondary goals were to assess ligament healing 2 months after the initial dislocation, to research a correlation between ligaments injuries and clinical course, and to search for predictive factors of instability. PATIENTS AND METHODS Patients who had simple posterolateral elbow dislocation for the first time between January 2015 and May 2016 were included. Each patient had an MRI scan of their traumatised elbow on the day of the dislocation and then again 2 months later. The assessment was performed thanks to a clinical examination and calculation of functional recovery scores. The Mann-Whitney U test was used to research a correlation between the healing of ligaments injuries and clinical course. RESULTS Twenty-five patients were included in the study. The initial MRI scans showed 70% and 54% ligament rupture, respectively, for the anterior band (ant MCL) and the posterior band (post MCL) of the medial collateral ligament (MCL), as well as 79% for the ulnar (ULCL) and 50% for the radial (RLCL) lateral collateral ligaments. The healing rate 2 months after dislocation was fairly low from 18% for the ULCL up to 41% for the anterior band of the MCL. No correlation was found between the ligament healing noticeable on MRI scans and clinical course. No elbow instability was diagnosed during the 4-month follow-up. CONCLUSION Elbow dislocation is particularly damaging for ligaments. There is no predominance on medial or lateral ligament for rupture. The low healing rate 2 months after the initial dislocation could be explained by performing a follow-up MRI scan too early.
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Affiliation(s)
- Eric Abehsera
- Service de Chirurgie Orthopédique et Traumatologique, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France.
- Service d'Orthopédie B, Chirurgie de la Main et Membre Supérieur, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France.
| | - Elvire Guerre
- Service d'Orthopédie B, Chirurgie de la Main et Membre Supérieur, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France
| | - Pauline Duriez
- Service de Chirurgie Orthopédique et Traumatologique, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France
| | - Mazen El Rafei
- Service d'Imagerie de l'Appareil Locomoteur, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France
| | - Christian Fontaine
- Service d'Orthopédie B, Chirurgie de la Main et Membre Supérieur, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France
| | - Christophe Chantelot
- Service de Chirurgie Orthopédique et Traumatologique, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France
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DeMoss A, Millard N, McIlvain G, Beckett JA, Jasko JJ, Timmons MK. Ultrasound-Assisted Assessment of Medial Elbow Stability. J Ultrasound Med 2018; 37:2769-2775. [PMID: 29655251 DOI: 10.1002/jum.14631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/02/2018] [Accepted: 02/17/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES An assessment of medial elbow stability is essential to the patient with an ulnar collateral ligament injury. Ultrasound imaging can be used to assess medial elbow stability. This study determined the effect of the elbow flexion angle on the medial elbow joint space during clinical tests of medial elbow stability. METHODS Ultrasound images of the nondominant elbow were collected during 3 tests of medial elbow stability: valgus stress test, weighted valgus test, and milking maneuver. The elbow flexion angle increased between the valgus stress test and milking maneuver. The width of the medial joint space was measured on ultrasound images collected in unstressed and stressed conditions. RESULTS Across test conditions, the medial joint width was greater in the stressed condition (mean ± SD, 3.7 ± 0.1 mm) than in the unstressed condition (2.9 ± 0.09 mm). The medial elbow joint space width was less (mean difference, 0.16 ± 0.01 mm; P = .01) in the milking maneuver position compared to the valgus stress test positions. CONCLUSIONS This study provides evidence that changes in the width of the medial elbow during clinical evaluation of the unimpaired elbow can be detected by ultrasound. Changing the elbow flexion angle did not affect the change in width of the medial elbow during valgus loading.
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Affiliation(s)
- Andrew DeMoss
- College of Health Professions, Marshall University, Huntington, West Virginia, USA
| | - Nathaniel Millard
- College of Health Professions, Marshall University, Huntington, West Virginia, USA
| | - Gary McIlvain
- College of Health Professions, Marshall University, Huntington, West Virginia, USA
| | - Joseph A Beckett
- College of Health Professions, Marshall University, Huntington, West Virginia, USA
| | - John J Jasko
- Department of Orthopedics, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Mark K Timmons
- College of Health Professions, Marshall University, Huntington, West Virginia, USA
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Draghi F, Gitto S, Bianchi S. Injuries to the Collateral Ligaments of the Metacarpophalangeal and Interphalangeal Joints: Sonographic Appearance. J Ultrasound Med 2018; 37:2117-2133. [PMID: 29480577 DOI: 10.1002/jum.14575] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/04/2017] [Accepted: 12/09/2017] [Indexed: 06/08/2023]
Abstract
Injuries to the collateral ligaments of the metacarpophalangeal (MCP) and interphalangeal (IP) joints are commonly encountered in both athletes and nonathletes. They require prompt evaluation to ensure proper management and prevent loss of joint motion and permanent disability. Imaging is often required to confirm the diagnosis and assess injury severity. This review article aims to provide physicians with guidelines for sonographic assessment of the collateral ligaments of the MCP and IP and related injuries. Sonographic features of ligament injuries ranging from sprains and partial-thickness tears to full-thickness tears are described. Specific lesions of the ulnar collateral ligament of the thumb MCP joint, such as gamekeeper's thumb, skier's thumb, and Stener lesions, are also included. In conclusion, sonography is effective in evaluating the collateral ligaments of the MCP and IP joints and related injuries and represents a valuable tool for diagnosis.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
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Hamada Y, Takai H, Satoh R, Hibino N, Ueda Y, Minamikawa Y. Swan neck deformity due to chronic radial collateral ligament injury of the little finger proximal interphalangeal joint. J Hand Surg Eur Vol 2018; 43:513-517. [PMID: 29105590 DOI: 10.1177/1753193417739248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We present seven cases of a relatively rare swan neck deformity resulting from chronic radial collateral ligament (RCL) injury of the proximal interphalangeal (PIP) joint in the little finger. All patients were middle-aged women (mean 51 years old, range 42-55), and the duration between the initial injury and surgery was 20 years (range 5-40). The chief complaint was painful snapping of the PIP joint. All patients had hyperextension and ulnar deviation of the PIP joint with mobile swan neck deformities that had not improved with conservative treatment. Radiographs revealed osteoarthritis and ulnar deviation of the PIP joints in all cases. We describe a method for reconstruction of both the palmar plate and the RCL of the affected PIP joint using a distally-based ulnar slip of flexor superficialis tendon. The prevention of PIP joint hyperextension was critical for successful resolution of symptoms; the aim of RCL augmentation was to prevent the recurrence of the deformity. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Hiroaki Takai
- 2 Department of Orthopedic Surgery, Kitajima Taoka Hospital, Japan
| | - Ryousuke Satoh
- 3 Department of Orthopedics and Hand Center, Tokushima Naruto Hospital, Japan
| | - Naohito Hibino
- 3 Department of Orthopedics and Hand Center, Tokushima Naruto Hospital, Japan
| | - Yukiko Ueda
- 4 Department of Orthopedic Surgery, Kansai Medical University Kori Hospital, Japan
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Rhyou IH, Lee JH, Kim KC, Ahn KB, Moon SC, Kim HJ, Lee JH. What Injury Mechanism and Patterns of Ligament Status Are Associated With Isolated Coronoid, Isolated Radial Head, and Combined Fractures? Clin Orthop Relat Res 2017; 475:2308-2315. [PMID: 28405856 PMCID: PMC5539024 DOI: 10.1007/s11999-017-5348-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/05/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Isolated coronoid, isolated radial head, and combined coronoid and radial head fractures are common elbow fractures, and specific ligamentous injury of each fracture configuration has been reported. However, the osseous injury mechanism related to ligament status remains unclear. QUESTIONS/PURPOSES The objectives of this study were: (1) to determine what ligamentous injury patterns (medial or lateral collateral) and bone contusion patterns (medial or lateral) are associated with isolated coronoid, isolated radial head, and combined coronoid and radial head fractures; (2) to correlate the osseous injury mechanism based on these findings with isolated coronoid, isolated radial head, and combined coronoid and radial head fractures; and (3) to determine whether isolated and combined coronoid fractures have different fracture lines through the coronoid (tip or anteromedial facet), speculated to be caused by different injury mechanisms. METHODS Between June 2007 and June 2012, 100 patients with elbow fractures were included in the cohort, with 46 of these patients being excluded owing to incongruity for our surgical indication. Finally, 54 patients with surgically treated elbow fractures who had MRI preoperatively were assessed retrospectively. There were 17 elbows with isolated coronoid fractures, 22 with isolated radial head fractures, and 15 with combined coronoid and radial head fractures. Collateral ligament injury pattern and existence of distal humerus bone contusion were reviewed on MR images. RESULTS Patients with isolated radial head fractures were at greater risk of medial collateral ligament rupture compared with patients with isolated coronoid fractures (radial head only: 15 of 22 [68%]; coronoid only: three of 17 [18%]; odds ratio [OR], 10.0; 95% CI, 2.2-46.5; p = 0.002). Patients with isolated coronoid fractures had greater risk of lateral ulnar collateral ligament ruptures (coronoid: 16 of 17 [94%]; radial head: seven of 22 [32%]; OR, 3.5; 95% CI, 3.8-333.3; p < 0.001). The presence of radial head fractures was associated with the risk of lateral bone bruising (isolated radial head fracture: 32 of 37 [86%], isolated coronoid fracture: four of 17 [24%]; OR, 29.6; 95% CI, 5.2-168.9; p < 0.001). Medial bone bruising was only detected in isolated coronoid fractures (isolated coronoid fracture: 12 of 17 [71%], others: zero of 37 [0%]). All isolated coronoid fractures involved the anteromedial facet of the coronoid (17 of 17; 100%). However, combined coronoid and radial head fractures often involved the tip (13 of 15; 87%). CONCLUSIONS Isolated coronoid fractures mostly involved the anteromedial facet of the coronoid process associated with lateral ulnar collateral ligament rupture and medial bone bruising. However, isolated radial head fractures were associated with medial collateral ligament rupture and lateral bone bruising. Combined coronoid and radial head fractures mostly involved a tip fracture of the coronoid with lateral ulnar collateral ligament rupture and lateral bone bruising. Thus surgeons may predict which ligament they should be aware of in the surgical field. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- In Hyeok Rhyou
- Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, Pohang SM Christianity Hospital, Daedo Dong 94-5, Nam Gu, Pohang, Kyeongbuk, South Korea
| | - Ji-Ho Lee
- Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, Pohang SM Christianity Hospital, Daedo Dong 94-5, Nam Gu, Pohang, Kyeongbuk, South Korea.
| | - Kyung Chul Kim
- Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, Pohang SM Christianity Hospital, Daedo Dong 94-5, Nam Gu, Pohang, Kyeongbuk, South Korea
| | - Kee Baek Ahn
- Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, Pohang SM Christianity Hospital, Daedo Dong 94-5, Nam Gu, Pohang, Kyeongbuk, South Korea
| | - Seong Cheol Moon
- Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, Pohang SM Christianity Hospital, Daedo Dong 94-5, Nam Gu, Pohang, Kyeongbuk, South Korea
| | - Hyeong Jin Kim
- Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, Pohang SM Christianity Hospital, Daedo Dong 94-5, Nam Gu, Pohang, Kyeongbuk, South Korea
| | - Jung Hyun Lee
- Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, Pohang SM Christianity Hospital, Daedo Dong 94-5, Nam Gu, Pohang, Kyeongbuk, South Korea
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Lee SJ, Lee JH, Hwang IC, Kim JK, Lee JI. Clinical outcomes of operative repair of complete rupture of the proximal interphalangeal joint collateral ligament: Comparison with non-operative treatment. Acta Orthop Traumatol Turc 2017; 51:44-48. [PMID: 28003115 PMCID: PMC6197416 DOI: 10.1016/j.aott.2016.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/10/2016] [Accepted: 04/30/2016] [Indexed: 12/02/2022]
Abstract
Objectives The purpose of this study was to compare the outcomes of non-operative treatment and operative repair of grade III injuries with complete rupture of the collateral ligament of the proximal interphalangeal (PIP) joint. Patients and methods Seventeen patients with grade III injuries with at least 6 months of follow-up were included. Seven patients underwent non-operative treatment and 10 patients underwent operative treatment. We evaluated the following clinical outcomes after treatment: 1) range of motion of the PIP and distal interphalangeal (DIP) joints, 2) joint stability, 3) pain score, and 4) amount of fusiform deformity of the PIP joint. Results There was no instability in the lateral stress test in either group. The ranges of motion of the PIP and DIP joints were not statistically different between the two groups at final follow-up. However, the ranges of motion recovered more quickly in the operative group than the non-operative group within the first 3 months after treatment. Patients in the operative group had less pain and better cosmetic appearance of the PIP joint. Conclusion Our results suggest that operative repair of the PIP collateral ligament can provide good joint stability, rapid functional recovery, and minimize fusiform deformity of the PIP joint. Level of evidence Level III, Therapeutic study.
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Affiliation(s)
- Seoung Joon Lee
- Department of Orthopedic Surgery, School of Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Jun Hee Lee
- Department of Orthopedic Surgery, School of Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - In Cheul Hwang
- Department of Orthopedic Surgery, School of Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Joon Kuk Kim
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Jung Il Lee
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea.
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Mahajan M, Tolman C, Würth B, Rhemrev SJ. Clinical evaluation vs magnetic resonance imaging of the skier's thumb: A prospective cohort of 30 patients. Eur J Radiol 2016; 85:1750-1756. [PMID: 27666612 DOI: 10.1016/j.ejrad.2016.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/05/2016] [Accepted: 07/14/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A skiers thumb, or a partial or complete rupture of the ulnar collateral ligament (UCL) is a clinical diagnosis. Swelling, pain, natural left-right difference and inexperience of a young physician can cause difficulty to correctly diagnose this injury. However, our theory is that any physician, given the correct instructions, should be able to diagnose this injury solely on clinical findings, without the necessity of additional imaging. MATERIAL AND METHODS In a large Dutch teaching hospital, physicians (residents with working experience of 6months-3years) working at the ER received instructions for physical examination. Patients >18 years, with an injury <1 week old, suspected of a true skier's thumb had an MRI reported by two independent radiologists to confirm the diagnosis. RESULTS Thirty patients were included. Seven patients had no fixed endpoint (23%), all had a complete ligamentous rupture of the UCL on MRI, of which three patients had a Stener lesion. Fifteen patients (50%) met with the criteria >35° laxity in extension of MCP/ >20° laxity in 30° flexion of the MCP. Of these, thirteen patients (81%) had a complete rupture (nine Stener lesions (56%)). One patient had a partial injury and one patient had no UCL-injury. Eight patients (27%) had inconclusive results during physical examination. Of these, two had a complete rupture (40%, 1 Stener). Three patients had a partial rupture and three patients had an intact UCL. CONCLUSION A skier's thumb can be diagnosed by any resident when correctly instructed. Additional imaging when diagnosing a skier's thumb should be reserved in cases when physical examination remains inconclusive.
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Affiliation(s)
- Mandhkani Mahajan
- Medical Center Haaglanden, Department of Surgery, Lijnbaan 32, 2512 VA The Hague, The Netherlands.
| | - Christine Tolman
- Medical Center Haaglanden, Department of Radiology, Lijnbaan 32, 2512 VA The Hague, The Netherlands.
| | - B Würth
- Medical Center Haaglanden, Department of Emergency Care, Lijnbaan 32, 2512 VA The Hague, The Netherlands.
| | - Steven J Rhemrev
- Medical Center Haaglanden, Department of Surgery, Lijnbaan 32, 2512 VA The Hague, The Netherlands.
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Karakolis T, Bhan S, Crotin RL. Injuries to young professional baseball pitchers cannot be prevented solely by restricting number of innings pitched. J Sports Med Phys Fitness 2016; 56:554-559. [PMID: 25784395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The Major League Baseball schedule is longer and more intensive than minor and amateur leagues. As a result, major league pitchers endure a considerably higher cumulative workload throughout the season. Ligament, tendon, muscle, and bone tissues in young pitchers need time to adapt to the workload a major league pitcher must endure. To mitigate the risk of overuse injury, and allow time for tissue adaptation to occur, most teams limit the number of innings a young pitcher may throw. This study examined the relationship between innings pitched and future injury in young professional baseball pitchers. METHODS All pitchers under 25 years of age that pitched at least one third of an inning in Major League Baseball during the 2002-2007 seasons were included in this study. Total innings pitched were accumulated for each season across three levels of professional baseball (Major League Baseball, and two levels of Minor Leagues). Regression analyses were preformed comparing innings pitched during a single season and difference in innings pitched over consecutive seasons to future injury, as measured by time spent on the disabled list. RESULTS No significant correlation was found between innings pitched and future injury or consecutive season innings pitched difference and future injury. No significant differences were found when pitchers were split into groups based upon consecutive season innings pitched difference cutoffs. CONCLUSIONS Based upon the evidence presented, strength and conditioning coaches, sports medicine specialists, and team trainers cannot rely solely on inning counts to accurately measure the tissue demands of professional baseball pitching. Therefore, inning limits alone cannot be used to protect young professional pitchers against the threat of injury.
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Affiliation(s)
- Thomas Karakolis
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada -
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Abstract
X-ray computed tomography has become an important tool for studying the microstructures of biological soft tissues, such as ligaments and tendons. Due to the low X-ray attenuation of such tissues, chemical contrast agents are often necessary to enhance contrast during scanning. In this article, the effects of using three different contrast agents—iodine potassium iodide solution, phosphotungstic acid and phosphomolybdic acid—are evaluated and compared. Porcine anterior cruciate ligaments, patellar tendons, medial collateral ligaments and lateral collateral ligaments were used as the basis of the study. Three samples of each of the four ligament/tendon types were each assigned a different contrast agent (giving a total of twelve samples), and the progression of that agent through the tissue was monitored by performing a scan every day for a total period of five days (giving a total of sixty scans). Since the samples were unstained on day one, they had been stained for a total of four days by the time of the final scans. The relative contrast enhancement and tissue deformation were measured. It was observed that the iodine potassium iodide solution penetrated the samples fastest and caused the least sample shrinkage on average (although significant deformation was observed by the time of the final scans), whereas the phosphomolybdic acid caused the greatest sample shrinkage. Equations describing the observed behaviour of the contrast agents, which can be used to predict optimal staining times for ligament and tendon X-ray computed tomography, are presented.
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Affiliation(s)
- Richard Balint
- School of Materials, University of Manchester, Manchester, United Kingdom
| | - Tristan Lowe
- Henry Moseley X-ray Imaging Facility, School of Materials, University of Manchester, Manchester, United Kingdom
| | - Tom Shearer
- School of Materials, University of Manchester, Manchester, United Kingdom
- School of Mathematics, University of Manchester, Manchester, United Kingdom
- * E-mail:
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Hosseini A, Qi W, Tsai TY, Liu Y, Rubash H, Li G. In vivo length change patterns of the medial and lateral collateral ligaments along the flexion path of the knee. Knee Surg Sports Traumatol Arthrosc 2015; 23:3055-61. [PMID: 25239504 PMCID: PMC4368498 DOI: 10.1007/s00167-014-3306-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 09/03/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The knowledge of the function of the collateral ligaments-i.e., superficial medial collateral ligament (sMCL), deep medial collateral ligament (dMCL) and lateral collateral ligament (LCL)-in the entire range of knee flexion is important for soft tissue balance during total knee arthroplasty (TKA). The objective of this study was to investigate the length changes of different portions (anterior, middle and posterior) of the sMCL, dMCL and LCL during in vivo weightbearing flexion from full extension to maximal knee flexion. METHODS Using a dual fluoroscopic imaging system, eight healthy knees were imaged while performing a lunge from full extension to maximal flexion. The length changes of each portion of the collateral ligaments were measured along the flexion path of the knee. RESULTS All anterior portions of the collateral ligaments were shown to have increasing length with flexion except that of the sMCL, which showed a reduction in length at high flexion. The middle portions showed minimal change in lengths except that of the sMCL, which showed a consistent reduction in length with flexion. All posterior portions showed reduction in lengths with flexion. CONCLUSIONS These data indicated that every portion of the ligaments may play important roles in knee stability at different knee flexion range. The soft tissue releasing during TKA may need to consider the function of the ligament portions along the entire flexion path including maximum flexion. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ali Hosseini
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114, USA
| | - Wei Qi
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114, USA
- Department of Orthopaedic Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Tsung-Yuan Tsai
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114, USA
| | - Yujie Liu
- Department of Orthopaedic Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Harry Rubash
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114, USA
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114, USA.
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Borges NC, Weissengruber GE, Huber J, Kofler J. Ultrasonographic examination of the elbow region in calves and cows--normal appearance. Berl Munch Tierarztl Wochenschr 2015; 128:416-424. [PMID: 26591389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The present study describes the normal ultrasonographic appearance of the elbow region in healthy Holstein Friesian calves (n = 12) and Holstein Friesian cows (n = 12). Using 7.5 MHz linear and 5,0 MHz convex probes the ultrasonographic appearance and dimensions of the lateral collateral ligament (LCL), medial collateral ligament (MCL), joint pouch (JP), joint capsule (JC), joint space, vessels, muscles, bursa, bone surface, growth plate, articular and apophyseal cartilage were studied and measured. The exam started on the lateral aspect by identification of the LCL and continued to cranial, medial and caudal sides. The diameter of the LCL ranged between 9.2-18.6 mm in cows and 1.7-8.3 mm in calves. The caudo-lateral JP was easily imaged at the level of the humero-radio-ulnar joint caudal of the LCL, however the cranial JP was hardly or not visualized. Experimental injection of 20-40 ml of water post-mortem produced a clear distension and imaging of the joint pouch. Eleven muscles of the elbow region were distinguished in calves and seven in cows. Positive correlations were noticed between the age and the body weight (BW) with all parameters measured in calves. However, in cows, the BW correlated with the skin-bone surface distance and the thickness of the LCL only. It is concluded that ultrasonography allowed consistent imaging of the normal anatomical structures of the elbow region in calves and cows, giving reference values for the evaluation of pathological alterations.
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Chen J, Tan J, Zhang AX. In Vivo length changes of the proximal interphalangeal joint proper and accessory collateral ligaments during flexion. J Hand Surg Am 2015; 40:1130-7. [PMID: 25703864 DOI: 10.1016/j.jhsa.2014.11.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/03/2014] [Accepted: 11/04/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the length changes in proper collateral ligament (PCL) and accessory collateral ligament (ACL) during flexion of the proximal interphalangeal (PIP) joint in vivo and how portions of the PCL and ACL stabilize the PIP joint. METHODS We obtained computed tomography scans of the index, middle, and ring fingers of one hand from 6 volunteers at 0°, 30°, 60°, 90°, and full flexion of the PIP joint. Radial and ulnar PCL and ACL were measured and analyzed with computer modeling. RESULTS The data showed that during flexion the average length of the dorsal portion of the radial and ulnar PCL increased significantly and reached a maximum at 90°. The volar portion of the radial and ulnar PCL and the distal portion of the radial and ulnar ACL shortened continuously from extension to full flexion. CONCLUSIONS The proximal and middle portions of each ACL are nearly isometric, the dorsal portion of each PCL becomes taut only in flexion, and the volar portion of PCL and the distal portion of ACL become taut only in extension. The current findings indicate that the dorsal portion of PCL is the most stabilizing structure during flexion of the PIP joint, and that the volar portion of PCL and the distal portion of ACL provide the crucial lateral stability to the joint at extension. CLINICAL RELEVANCE The results may provide information relevant to the ligaments of PIP joint reconstruction and rehabilitation.
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Affiliation(s)
- Jing Chen
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
| | - Jun Tan
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Ai Xian Zhang
- Department of Internal Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Ferreira FBMD, Fernandes EDA, Silva FD, Vieira MC, Puchnick A, Fernandes ARC. A sonographic technique to evaluate the anterior bundle of the ulnar collateral ligament of the elbow: imaging features and anatomic correlation. J Ultrasound Med 2015; 34:377-384. [PMID: 25715358 DOI: 10.7863/ultra.34.3.377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The aim of this study was to test a sonographic technique used to view the anterior bundle of the ulnar collateral ligament (UCL), describe its sonographic characteristics in healthy volunteers, and verify these characteristics by determining interobserver variability and their correlations in cadavers. METHODS Sonographic studies of the anterior bundle of the UCL were performed on 48 elbows of asymptomatic healthy volunteers. The participants were examined by 3 experts, who identified the insertion sites of the anterior bundle and subjectively evaluated its echogenicity and echo texture. A sonographic examination of the anterior bundle of the UCL in a cadaveric elbow was performed, and the same aspects were evaluated. RESULTS In all cases, the anterior bundle of the UCL appeared as a triangular structure in the coronal plane and had a hyperechoic homogeneous echo texture in most of these cases. The cadaveric elbow had the same sonographic characteristics as the volunteers. CONCLUSIONS As shown by examining the interobserver variability and determining the correlation with cadaveric tissue, sonography proved to be a reliable tool for evaluating the normal aspects of the anterior bundle of the UCL.
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Affiliation(s)
- Fernando B M D Ferreira
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Eloy D A Fernandes
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Flavio D Silva
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Magno C Vieira
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Andrea Puchnick
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Artur R C Fernandes
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Abstract
OBJECTIVES Musculoskeletal sonography has emerged as an additional diagnostic tool that can be used to assess medial elbow pain and laxity in overhead throwers. It provides a dynamic, rapid, and noninvasive modality in the evaluation of ligamentous structural integrity. Many studies have demonstrated the utility of dynamic sonography for medial elbow and ulnar collateral ligament (UCL) integrity. However, evaluating the reliabilityand precision of these measurements is critical if sonography is ultimately used as a clinical diagnostic tool. The purpose of this study was to evaluate the reliability and precision of stress sonography applied to the medial elbow. METHODS We conducted a cross-sectional study during the 2011 baseball off-season. Eighteen National Collegiate Athletic Association Division I pitchers were enrolled, and 36 elbows were studied. Using sonography, the medial elbow was assessed, and measurements of the UCL length and ulnohumeral joint gapping were performed twice under two conditions (unloaded and loaded) and bilaterally. RESULTS Intraclass correlation coefficients (0.72-0.94) and standard errors of measurements (0.3-0.9 mm) for UCL length and ulnohumeral joint gapping were good to excellent. Mean differences between unloaded and loaded conditions for the dominant arms were 1.3 mm (gapping; P < .001) and 1.4 mm (UCL length; P < .001). CONCLUSIONS Medial elbow stress sonography is a reliable and precise method for detecting changes in ulnohumeral joint gapping and UCL lengthening. Ultimately, this method may provide clinicians valuable information regarding the medial elbow's response to valgus loading and may help guide treatment options.
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Affiliation(s)
- David Bica
- Brown University Alpert Medical School, Affinity Sports Medicine, East Greenwich, Rhode Island USA (D.B.); and Department of Family Medicine, Division of Sports Medicine (J.A.), and Departments of Health Education and Promotion (A.S.K.), Family Medicine (K.Y.), and Athletics (Z.W.), East Carolina University, Greenville, North Carolina USA
| | - Joseph Armen
- Brown University Alpert Medical School, Affinity Sports Medicine, East Greenwich, Rhode Island USA (D.B.); and Department of Family Medicine, Division of Sports Medicine (J.A.), and Departments of Health Education and Promotion (A.S.K.), Family Medicine (K.Y.), and Athletics (Z.W.), East Carolina University, Greenville, North Carolina USA
| | - Anthony S Kulas
- Brown University Alpert Medical School, Affinity Sports Medicine, East Greenwich, Rhode Island USA (D.B.); and Department of Family Medicine, Division of Sports Medicine (J.A.), and Departments of Health Education and Promotion (A.S.K.), Family Medicine (K.Y.), and Athletics (Z.W.), East Carolina University, Greenville, North Carolina USA
| | - Kevin Youngs
- Brown University Alpert Medical School, Affinity Sports Medicine, East Greenwich, Rhode Island USA (D.B.); and Department of Family Medicine, Division of Sports Medicine (J.A.), and Departments of Health Education and Promotion (A.S.K.), Family Medicine (K.Y.), and Athletics (Z.W.), East Carolina University, Greenville, North Carolina USA
| | - Zachary Womack
- Brown University Alpert Medical School, Affinity Sports Medicine, East Greenwich, Rhode Island USA (D.B.); and Department of Family Medicine, Division of Sports Medicine (J.A.), and Departments of Health Education and Promotion (A.S.K.), Family Medicine (K.Y.), and Athletics (Z.W.), East Carolina University, Greenville, North Carolina USA
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Farrow LD, Mahoney AP, Sheppard JE, Schickendantz MS, Taljanovic MS. Sonographic assessment of the medial ulnar collateral ligament distal ulnar attachment. J Ultrasound Med 2014; 33:1485-1490. [PMID: 25063414 DOI: 10.7863/ultra.33.8.1485] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether the long distal attachment of the medial ulnar collateral ligament (MUCL) can be delineated on sonography. METHODS We used 12 fresh-frozen cadaveric elbows for this study. We performed sonography of the elbow using a coronal-equivalent long-axis view of the MUCL. All sonographic examinations and measurements were performed by a board-certified, fellowship-trained musculoskeletal radiologist. Measurements were performed from the anteroinferior aspect of the medial epicondyle to the sublime tubercle and then from the sublime tubercle to the terminal fibers of the MUCL long ulnar attachment. We then measured the length of the MUCL from its attachment at the medial epicondyle of the humerus to the sublime tubercle and then from the sublime tubercle to the distal extent of its terminal fibers at the ulnar attachment with digital calipers. RESULTS On sonography, the average length of the MUCL from its humeral attachment to the sublime tubercle (transarticular) was 19.6 mm. The average length of the ulnar attachment was 27.9 mm. The MUCL was thickest (mediolateral dimension) at its humeral attachment and tapered as it coursed distally along the ulnar attachment. The MUCL was clearly identified on sonography and in all anatomic specimens. On gross measurement, the average lengths of the transarticular portion of the MUCL and its ulnar footprint were 21.5 and 30.2 mm, respectively. CONCLUSIONS We have successfully shown that the distal ulnar attachment of the MUCL can be visualized on high-resolution sonography. This preliminary work provides a framework for developing protocols for diagnosis of injuries to the distal ulnar collateral ligament.
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Affiliation(s)
- Lutul D Farrow
- Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio USA (L.D.F., M.S.S.); Tucson Orthopedic Institute, Tucson, Arizona USA (A.P.M.); and Departments of Orthopedic Surgery (J.E.S.) and Radiology (M.S.T.), University of Arizona College of Medicine, Tucson, Arizona USA.
| | - Andrew P Mahoney
- Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio USA (L.D.F., M.S.S.); Tucson Orthopedic Institute, Tucson, Arizona USA (A.P.M.); and Departments of Orthopedic Surgery (J.E.S.) and Radiology (M.S.T.), University of Arizona College of Medicine, Tucson, Arizona USA
| | - Joseph E Sheppard
- Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio USA (L.D.F., M.S.S.); Tucson Orthopedic Institute, Tucson, Arizona USA (A.P.M.); and Departments of Orthopedic Surgery (J.E.S.) and Radiology (M.S.T.), University of Arizona College of Medicine, Tucson, Arizona USA
| | - Mark S Schickendantz
- Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio USA (L.D.F., M.S.S.); Tucson Orthopedic Institute, Tucson, Arizona USA (A.P.M.); and Departments of Orthopedic Surgery (J.E.S.) and Radiology (M.S.T.), University of Arizona College of Medicine, Tucson, Arizona USA
| | - Mihra S Taljanovic
- Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio USA (L.D.F., M.S.S.); Tucson Orthopedic Institute, Tucson, Arizona USA (A.P.M.); and Departments of Orthopedic Surgery (J.E.S.) and Radiology (M.S.T.), University of Arizona College of Medicine, Tucson, Arizona USA
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Baghdadi YMK, Morrey BF, O’Driscoll SW, Steinmann SP, Sanchez-Sotelo J. Revision allograft reconstruction of the lateral collateral ligament complex in elbows with previous failed reconstruction and persistent posterolateral rotatory instability. Clin Orthop Relat Res 2014; 472:2061-7. [PMID: 24728663 PMCID: PMC4048414 DOI: 10.1007/s11999-014-3611-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Primary reconstruction of the lateral collateral ligament complex (LCLC) using graft tissue restores elbow stability in many, but not all, elbows with acute or chronic posterolateral rotatory instability (PLRI). Revision reconstruction using a tendon allograft is occasionally considered for persistent PLRI, but the outcome of revision ligament reconstruction in this setting is largely unknown. QUESTIONS/PURPOSES We determined whether revision allograft ligament reconstruction can (1) restore the stability and (2) result in improved elbow scores for patients with persistent PLRI of the elbow after a previous failed primary reconstructive attempt and in the context of the diverse pathology being addressed. METHODS Between 2001 and 2011, 160 surgical elbow procedures were performed at our institution for the LCLC reconstruction using allograft tissue. Only patients undergoing revision allograft reconstruction of the LCLC for persistent PLRI with a previous failed primary reconstructive attempt using graft tissue and at least I year of followup were included in the study. Eleven patients (11 elbows) fulfilled our inclusion criteria and formed our study cohort. The cohort consisted of six female patients and five male patients. The mean age at the time of revision surgery was 36 years (range, 14-59 years). The revision allograft reconstruction was carried out after a mean of 3 years (range, 2.5 months to 9 years) from a failed attempted reconstruction of the LCLC. Osseous deficiency to some extent was identified in the preoperative radiographs of eight elbows. Mean followup was 5 years (range, 1-12 years). RESULTS Revision allograft reconstruction of the LCLC restored elbow stability in eight of the 11 elbows; two of the three elbows with persistent instability were operated on a third time (at 6 and 7 months after allograft revision reconstruction). For elbows with no persistent instability, the mean Mayo Elbow Performance Score at most recent followup was 83 points (range, 60-100 points), and six elbows were rated with a good or excellent result. All patients with persistent instability had some degree of preoperative bone loss. CONCLUSIONS Revision allograft reconstruction of the LCLC is an option for treating recurrent PLRI, although this is a complex and resistant problem, and nearly ½ of the patients in this cohort either had persistent instability and/or had a fair or poor elbow score. LEVEL OF EVIDENCE Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yaser M. K. Baghdadi
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
| | - Bernard F. Morrey
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
| | - Shawn W. O’Driscoll
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
| | - Scott P. Steinmann
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
| | - Joaquin Sanchez-Sotelo
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
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Lee YS, Chou YH, Chiou HJ, Lai YC. Use of sonography in assessing elbow medial collateral ligament injury after arm wrestling. J Chin Med Assoc 2014; 77:163-5. [PMID: 24331237 DOI: 10.1016/j.jcma.2013.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 06/04/2012] [Indexed: 11/24/2022] Open
Abstract
Medial collateral ligament injury is an infrequent occurrence in arm wrestlers. We report here a male patient who injured his left elbow while arm wrestling. Ultrasonography showed a medial collateral ligament tear. We assessed both elbows using ultrasonography at his 3-year follow-up visit. Dynamic ultrasonography showed a decreased gap at the ulnotrochlear joint space in his left elbow. A medial collateral ligament tear in his right elbow was also evident using ultrasonography. This case report shows the advantages of ultrasonography, especially dynamic ultrasonography, in the evaluation of elbow injury. Ultrasonography provides more information than valgus stress radiography, arthrography, and magnetic resonance imaging in the assessment of medial collateral ligament injury. In addition, the contralateral side can readily be assessed for comparison during ultrasonography.
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Affiliation(s)
- Yuh-Shan Lee
- Department of Rehabilitation, Keelung City Municipal Hospital, Keelung, Taiwan, ROC
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; National Defense Medical Center, Taipei, Taiwan, ROC.
| | - Yi-Chen Lai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; National Defense Medical Center, Taipei, Taiwan, ROC
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Song K, Dong J, Zhang Y, Chen B, Wang F, Zhao J, Ji G. Arthroscopic management of calcific tendonitis of the medial collateral ligament. Knee 2013; 20:63-5. [PMID: 22682211 DOI: 10.1016/j.knee.2012.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 04/07/2012] [Accepted: 05/13/2012] [Indexed: 02/02/2023]
Abstract
Calcific tendinitis most commonly occurs to the shoulder, but may also involve other structures of the locomotor system. It is a rare cause of knee pain. We report a 46-year-old woman with severe medial knee pain and limitation of movement in her right knee. There was a marked tenderness site at the proximal insertion of the medial collateral ligament (MCL). Flexion was able to provoke the painful symptoms in the medial knee. The involvement of differentiated diagnoses were excluded by history, laboratory and radiograph examinations, while X-ray, CT and MRI suggested calcific tendonitis of the MCL. Due to the failure of conservative treatments, we offered her arthroscopic excision of calcific deposit which was sent for biopsy. Histopathological evaluation confirmed the diagnosis of calcific tendinitis. This patient recovered shortly afterwards with immediate resolution of symptoms following excision. Thus far, calcifications involving the MCL have been documented thrice. Calcific tendonitis of the MCL diagnosed and treated by arthroscopy has not previously been reported, which can be challenging to diagnose and treat because of its rarity. Although conservative treatment appears to be frequently satisfactory, arthroscopic excision may be a better option for the refractory or severe cases.
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Affiliation(s)
- Kuangpeng Song
- Department of Orthopedics, 3rd Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
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Smith J, Sayeed YA, Finnoff JT, Levy BA, Martinoli C. The bifurcating distal biceps femoris tendon: potential pitfall in musculoskeletal sonography. J Ultrasound Med 2011; 30:1162-1166. [PMID: 21795497 DOI: 10.7863/jum.2011.30.8.1162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Keller K, Nasrilari M, Filler T, Jerosch J. The anterior tibio-talar ligament: one reason for anterior ankle impingement. Knee Surg Sports Traumatol Arthrosc 2010; 18:225-32. [PMID: 19697010 DOI: 10.1007/s00167-009-0896-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 08/01/2009] [Indexed: 11/30/2022]
Abstract
The purpose of this study was the evaluation of the ankle's anterolateral ligament structures. We documented the anatomic situation of the ankle's anterolateral ligament structures in 33 Thiel-embalmed specimens. The ligaments had been isolated. We performed measurements on both length and orientation and additionally classified the ligaments. We also conducted histologic tissue staining. We were able to document a regular appearance of a so far not well-realized structure between the talus and the tibia, present in 26 (79%) specimens. Average length of this structure was 26 mm (in 20 degrees plantarflexion). The angular orientation in relation to the ant. tibio-fibular lig. was on average 43.7 degrees. This structure could be classified as being either isolated or widespread, with a further four sub-classifications for the orientation. Histologic staining showed parallel orientated dense collagen fibers as well as elastic fibers and hyaline cartilage in different stages of proliferation. In addition, there were neural fibers in the perivascular and the soft tissue. The histologic findings proved that the structure was a ligament. Since the ant. tibio-talar lig. is constantly present in most ankle joints, it could be considered as a regular finding. Its morphology and histology show that this ligament is loaded under tension as well as under compression. This could be one reason for anterior ankle impingement.
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Affiliation(s)
- Katharina Keller
- Department for Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
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Rubino LJ, Herbenick MA, Finnan RP, Anloague PA. Chronic elbow dislocation treated with open reduction and lateral ulnar collateral ligament reconstruction. Am J Orthop (Belle Mead NJ) 2009; 38:E98-E100. [PMID: 19649353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- L Joseph Rubino
- Department of Orthopaedic Surgery, Wright State University-Boonshoft School of Medicine and Miami Valley Hospital, Dayton, OH 45409, USA.
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Abstract
BACKGROUND It is often difficult to identify the attachment sites of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament for chronic posterolateral knee injuries or during revision surgeries. Descriptions of radiographic landmarks for these attachment sites would assist in the intraoperative identification of their locations and also allow for postoperative assessment of the placement of reconstruction tunnels. HYPOTHESIS Identification of qualitative and quantitative radiographic landmarks for the attachments of the main posterolateral knee structures are reproducible among observers of various experience levels and allow for improved intraoperative and postoperative identification of these attachment sites. STUDY DESIGN Descriptive laboratory study. METHODS Dissections were performed on 11 cadaveric knee specimens. The attachments and locations of the investigated structures were labeled with radiopaque markers. The positions of the attachments relative to other attachment sites, labeled bony landmarks, and superimposed reference lines were quantified on anteroposterior and lateral radiographs. Measurements were performed by 3 independent examiners. Intraobserver and interobserver reliability was determined using intraclass correlation coefficients. RESULTS Overall intraclass correlation coefficients for intraobserver reproducibility and interobserver reliability were calculated to be 0.981 and 0.983, respectively. On the anteroposterior view, the perpendicular distances from a line intersecting the femoral condyles to the popliteus tendon, proximal fibular collateral ligament, and lateral gastrocnemius tendon were 14.5, 27.1, and 34.5 mm, respectively. On the lateral view, the femoral attachments of the fibular collateral ligament, popliteus tendon, and lateral gastrocnemius tendon were 4.3, 12.2, and 13.1 mm, respectively, from the lateral epicondyle. In addition, the fibular collateral ligament and popliteus tendon were located within 1 mm of a reference line projected along the posterior femoral cortex distally, and also were located within the posteroinferior quadrant bound by the posterior femoral cortex extension reference line and another reference line perpendicular to it at the posterior margin of Blumensaat's line. CONCLUSION Comprehensive qualitative and quantitative guidelines for assessing posterolateral knee structures on both anteroposterior and lateral knee radiographs were described. CLINICAL SIGNIFICANCE This radiographic information regarding the attachment sites of posterolateral structures can serve as a valuable reference for preoperative, intraoperative, and postoperative assessments of surgical reconstructions.
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Affiliation(s)
- Sean D Pietrini
- Division of Sports Medicine and the Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota 55454, USA
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Abstract
Coronoid fractures of the ulna are relatively uncommon, yet critical injuries to recognize. They often occur in association with elbow dislocations and play an important role in elbow instability. Historic recommendations are to fix all large coronoid fracture fragments, as well as small fracture fragments associated with instability. There is little data regarding management of small coronoid fracture fragments. The coronoid process acts as a bony buttress to prevent posterior dislocation and has three soft tissue insertions which lend stability as well: the anterior joint capsule of the elbow, the brachialis muscle and the medial ulnar collateral ligament. Injured patients often present with swelling, tenderness and limited range of motion. After obtaining a detailed history and performing a careful physical examination, plain radiographs should be obtained. If present, dislocations are reduced and post-reduction stability is assessed. If the elbow is unstable, management usually consists of a combination of bony and soft-tissue repairs often including coronoid process repair. Loss of motion is the most common complication of these injuries. The current recommendation is to repair virtually all coronoid fractures associated with instability.
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Affiliation(s)
- Jason Wells
- University of Wisconsin School of Medicine and Public Health, Department of Orthopedics and Rehabilitation, K4/7 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-7375, USA
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Rubin LE, Miki RA, Taksali S, Bernstein RA. Metacarpophalangeal collateral ligament reconstruction after band saw amputation: case report with review of MCP anatomy and injury. Iowa Orthop J 2008; 28:53-57. [PMID: 19223949 PMCID: PMC2603350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Reconstruction of the radial border of the index metacarpophalangeal (MCP) joint after band saw amputation is described. The entire radial MCP collateral ligament unit was cleanly retained within the amputated segment, still attached to wafers of corticocancellous bone from the radial aspect of the metacarpal head and base of the proximal phalanx. Acute bone to bone osteosynthesis of the amputated segment led to successful osseous integration of both bone fragments and restoration of stability of the joint. Surgical repair of the radial collateral ligament of the index MCP joint is crucial in achieving an optimal outcome after such an injury.
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Affiliation(s)
- Lee Eric Rubin
- Yale University, Department of Orthopaedics and Rehabilitation, Yale New-Haven Hospital, New Haven, CT 06520-8071, USA.
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Kofler J, Kneissl S, Malleczek D. MRI and CT diagnosis of acute desmopathy of the lateral collateral sesmoidean (navicular) ligament and long-term outcome in a horse. Vet J 2007; 174:410-3. [PMID: 17049889 DOI: 10.1016/j.tvjl.2006.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2006] [Revised: 08/08/2006] [Accepted: 08/09/2006] [Indexed: 11/29/2022]
Abstract
Clinical, magnetic resonance imaging (MRI) and computed tomography (CT) findings of acute desmopathy of the lateral collateral sesmoidean (navicular) ligament (CSL) in a 13-year-old Hanoverian mare are presented. On admission to the clinic the horse showed a grade 5/6 left front-limb lameness at the walk, pain on coffin joint manipulation, and coffin joint effusion. Despite a positive palmar digital nerve block, radiographs and ultrasonography did not indicate reasons for the severe clinical signs. However, MRI revealed damage to the CSL and bone marrow oedema of the navicular bone (NB), whereas a focal bone defect of the NB at the CSL insertion zone was demonstrated best by CT. The horse was managed with complete box rest and a fibreglass cast for four weeks followed by a controlled exercise program. Follow-up examination revealed no lameness at the trot three months later and the patient had fully recovered within six months.
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Affiliation(s)
- J Kofler
- Clinical Department of Horses and Small Animals, Clinic for Orthopaedics in Large Animals, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria.
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Rochet S, Gallinet D, Garbuio P, Tropet Y, Obert L. Entorse grave du pouce: opérer selon la position des sésamoïdes lors des clichés en stress. ACTA ACUST UNITED AC 2007; 26:200-5. [PMID: 17897862 DOI: 10.1016/j.main.2007.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 08/17/2007] [Indexed: 11/18/2022]
Abstract
AIM Acute complete ruptures of the ulnar collateral ligament should be treated with surgical repair of the ligament. But diagnosis using ultrasound, dynamic X ray and magnetic resonance imaging are unable to diagnose surely the complete rupture. According to Rotella and Urpi if the radiograph shows no parallelism between the sesamoid bones and the metacarpal head, the injury of ulnar collateral ligament is total and complete and requires surgical reparation. The aim of this work was to verify the finding of Rotella and Urpi and the relationship between the lost of parallelism and the Stener lesion (interposition of adductor aponeurosis between the ruptured ulnar collateral ligament and its site of insertion on the base of the proximal phalanx). MATERIAL AND METHODS Embalmed anatomical specimens were used to systematically investigate and document the role played in joint stability by each of the anatomical elements. Each ligament was sectioned and instability documented. A retrospective radiological study was performed on 93 patients who had an history of injured ulnar collateral ligament of the thumb. RESULTS The anatomical study confirmed the result of Rotella and Urpi in showing that the loss of parallelism between the sesamoid bones and the metacarpal head was associated with complete rupture of ulbnar collateral ligement The clinical study showed that the lost of parallelism was associated with a Stener lesion (N=23). CONCLUSION The association between the lost of parallelism of sesamoid bones and Stener lesion confirm that the rupture of all elements of the ulnar collateral ligament. This anatomical and clinical findings have to be confirmed by a prospective clinical study.
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Affiliation(s)
- S Rochet
- Service de traumatologie, d'orthopédie, de chirurgie plastique et reconstructrice, hôpital Jean-Minjoz, CHU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
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Pike J, Goetz T. Traumatic transposition of the ulnar nerve in a patient with posteromedial varus rotatory instability of the elbow: a case report. J Shoulder Elbow Surg 2007; 17:e5-8. [PMID: 17644007 DOI: 10.1016/j.jse.2007.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2006] [Revised: 11/29/2006] [Accepted: 01/13/2007] [Indexed: 02/01/2023]
Affiliation(s)
- Jeffrey Pike
- Department of Orthopaedics, University of British Columbia, Vancouver General Hospital, Canada
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Saliou G, Kocheida M, Vernois J, Bonnaire B, Lehmann P, Vanden Abeel B, Boulu G, Le Blanche AF, Vallée JN. [Ankle and foot sprains: conventional radiography aspects]. ACTA ACUST UNITED AC 2007; 88:541-7. [PMID: 17464252 DOI: 10.1016/s0221-0363(07)89853-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Emergency departments frequently encounter pathology resulting from injury to the foot and ankle, with approximately 6000 case per day in France. In an ankle sprain, 85% of the lesions involve the lateral collateral ligament. Many other, much rarer, types of lesion with different therapeutic consequences can present, however. Interpretation of the initial conventional radiographs is vital to establishing the type lesion and to proposing adapted and rapid treatment. The objective of this article is to review the various osteoarticular and ligament injuries encountered in the foot and the ankle.
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Affiliation(s)
- G Saliou
- Service de radiologie A, CHU Nord, place Victor Pauchet, 80054 Amiens cedex 1, France.
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Shinohara T, Horii E, Majima M, Nakao E, Suzuki M, Nakamura R, Hirata H. Sonographic diagnosis of acute injuries of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Clin Ultrasound 2007; 35:73-7. [PMID: 17195989 DOI: 10.1002/jcu.20289] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE To evaluate the significance of the ultrasonographic appearance of the aponeurosis for deciding the best treatment for ulnar collateral ligament (UCL) injuries of the thumb metacarpophalangeal joint. METHODS Fourteen patients (11 men, 3 women; mean age, 41 years; range, 15-66 years) who had an acute UCL tear were included. All patients were examined by ultrasonography (US) with a 7.5-MHz transducer and subsequently underwent surgery. The ultrasonographic findings were compared to the intraoperative findings. RESULTS UCL injuries were classified into two types by US according to the appearance of aponeurosis and its spatial relationship with the UCL: the intra-aponeurosis type (5 patients) and the extra-aponeurosis type (9 patients). In the 5 patients with intra-aponeurosis, ultrasonographic findings were well consistent with intraoperative findings. In contrast, extra-aponeurosis cases contained two different pathologies: of the 9 patients, 7 had so-called 'Stener lesions', one showed folding of a ruptured capsule, and one showed a ruptured aponeurosis. CONCLUSIONS Because US is highly reliable in differentiating intra-aponeurosis from extra-aponeurosis types of injuries, the aponeurosis is a more reliable reference than Stener lesion for treatment decision by US.
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Affiliation(s)
- Takaaki Shinohara
- Department of Hand Surgery, Nagoya University School of Medicine, Nagoya 466-8550, Japan
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Peterson JJ, Bancroft LW, Kransdorf MJ, Berquist TH, Magee TH, Murray PM. Evaluation of Collateral Ligament Injuries of the Metacarpophalangeal Joints with Magnetic Resonance Imaging and Magnetic Resonance Arthrography. Curr Probl Diagn Radiol 2007; 36:11-20. [PMID: 17198888 DOI: 10.1067/j.cpradiol.2006.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Injuries of the collateral ligaments of the metacarpophalangeal (MCP) joints of the hand require accurate diagnosis and prompt treatment to prevent loss of function. The most common and well-known collateral ligament injury is injury to the ulnar collateral ligament of the first MCP joint of the hand, often referred to as a gamekeeper injury. Although less common, injuries involving the collateral ligaments of the second through fifth digits and the radial collateral ligament of the first digit also occur. The diagnosis of collateral ligament injury is often made clinically, however, magnetic resonance imaging and magnetic resonance arthrography of the MCP joints can be very useful in the evaluation of severity of the injury. This provides important information for the hand surgeon and aids in treatment planning. Imaging of the collateral ligaments requires small fields of view and several technical considerations can provide improved image quality. These factors will be discussed and illustrated in this article.
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49
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Jacquet S, Coudry V, Denoix JM. Severe tear of the collateral sesamoidean ligament in a horse. Vet Rec 2006; 159:818-20. [PMID: 17158715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- S Jacquet
- CIRALE-ENVA, UMR-INRA 957, RN 175 Goustranville, 14430 Dozulé, France
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Ebrahim FS, De Maeseneer M, Jager T, Marcelis S, Jamadar DA, Jacobson JA. US Diagnosis of UCL Tears of the Thumb and Stener Lesions: Technique, Pattern-based Approach, and Differential Diagnosis. Radiographics 2006; 26:1007-20. [PMID: 16844929 DOI: 10.1148/rg.264055117] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The thumb is a central component supporting the intricate movements of the hand. Patients with acute thumb pain, particularly after trauma, require prompt evaluation of structural integrity, thus avoiding long-term morbidity such as instability, chronic pain, and osteoarthritis. Injury to the ulnar collateral ligament (UCL) of the thumb requires imaging for diagnosis of surgically important entities such as the Stener lesion. Historically, routine radiography including stress views does not allow such diagnosis and is potentially detrimental to patient care. Both magnetic resonance imaging and ultrasonography (US) are currently used for direct evaluation of the UCL of the thumb and are safe and accurate. US is more dynamic and less time-consuming and may be easier to perform. Furthermore, other disorders such as tenosynovitis, tendon tears, and articular pathologic conditions can involve the thumb and thenar region and may also be diagnosed with US. In this context, US is an underused tool because it is potentially an adjunct to the clinical examination in the appropriate setting. A sound knowledge of the regional anatomy and basic training in the principles of US should equip the imager with the skills necessary to evaluate the UCL of the thumb and its surrounding structures.
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Affiliation(s)
- Farhad S Ebrahim
- Department of Radiology, University of Michigan Health System, Taubman/B-1/Room 132, Box 0302, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0302, USA.
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