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PMID:28738083
Autor:Boesmueller S; Huf W; Rettl G; Dahm F; Meznik A; Muschitz G; Kitzinger H; Bukaty A; Fialka C; Vierhapper M
Endereço:AUVA Trauma Center Meidling, Vienna, Austria.
Título:The influence of sex and trauma impact on the rupture site of the ulnar collateral ligament of the thumb.
Fonte:PLoS One; 12(7):e0181754, 2017.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:PURPOSE AND HYPOTHESIS: Although sex- and gender-specific analyses have been gaining more attention during the last years they have rarely been performed in orthopaedic literature. The primary purpose of this study was to investigate whether for injuries of the UCL the specific location of the rupture is influenced by sex. A secondary study question addressed the sex-independent effect of trauma intensity on the rupture site of the UCL. METHODS: This study is a retrospective analysis of all patients with either a proximal or distal bony avulsion or with a mid-substance tear or ligament avulsion of the UCL treated surgically between 1992 and 2015 at two level-I trauma centres. Trauma mechanisms leading to the UCL injury were classified into the following categories: (1) blunt trauma (i.e., strains), (2) low-velocity injuries (e.g., fall from standing height, assaults), and (3) high-velocity injuries (e.g., sports injuries, motor vehicle accidents). After reviewing the surgical records, patients were divided into three groups, depending upon the ligament rupture site: (1) mid-substance tears, (2) proximal ligament or bony avulsions and (3) distal ligament or bony avulsions. Dependencies between the specific rupture site and the explanatory variables (sex, age, and trauma intensity) were evaluated using χ2 test and logistic regression analysis. RESULTS: In total, 1582 patients (1094 males, 488 females) met the inclusion criteria. Mean age was 41 years (range: 9-90 years). Taking into account the effects of sex on trauma intensity (p<0.001) and of trauma intensity on rupture site (p<0.001), mid-substance tears occurred more frequently in women, whereas men were more prone to distal ligament or bony avulsions (p<0.001). In other words, sex and rupture site correlated due to the effects of sex on trauma intensity and of trauma intensity on rupture site, but taking into account those effects there still was a significant effect of sex on rupture site. CONCLUSIONS: The results of this study demonstrate that with regression analysis both sex and trauma intensity allow to predict rupture site in UCL injuries.
Tipo de publicação: JOURNAL ARTICLE


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PMID:28394713
Autor:Gutierrez NM; Granville C; Kaplan L; Baraga M; Jose J
Endereço:Department of Radiology, University of Miami Hospital, Miami, Florida, USA.
Título:Elbow MRI Findings Do Not Correlate With Future Placement on the Disabled List in Asymptomatic Professional Baseball Pitchers.
Fonte:Sports Health; 9(3):222-229, 2017 May/Jun.
ISSN:1941-0921
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Injury rates among professional baseball players may reach as high as 5.8 per 1000 encounters, with pitchers being most vulnerable on account of the excessive biomechanical load on the upper extremity during the throwing motion. Anatomically, the shoulder is the most common site of pitching-related injury, accounting for 30.7% of injuries, closely followed by the elbow at 26.3%. Characteristic valgus loading imparts a predictable constellation of stresses on the joint, including medial tension, lateral compression, and posterior medial shearing. The degenerative cohort of tissue changes that result are readily detected on magnetic resonance imaging (MRI). It is not yet known whether such findings predict future placement on the disabled list (DL) in asymptomatic Major League pitchers. HYPOTHESIS: Abnormal soft tissue and osseous changes detected on MRI of the throwing elbow in asymptomatic professional pitchers will impart an increased risk of subsequent transfer to the DL in the season after MRI. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: The study aimed to examine a potential association between the total number of innings pitched (approximate lifetime valgus load) and the typical MRI degenerative changes, hypothesizing a rejection of the null hypothesis. A total of 26 asymptomatic professional pitchers from a single Major League Baseball (MLB) organization and its various minor league affiliates underwent MRI of their dominant elbow from 2003 to 2013 as a condition of their contract signing or trade. Twenty-one of those pitchers played at the Major League level while 5 played with the team's minor league affiliates including both the AA and AAA levels. Asymptomatic was defined as no related stints on the DL due to elbow injury in the 2 seasons prior to MRI. A fellowship-trained musculoskeletal radiologist reevaluated the studies after being blinded to patient name, injury history, and baseball history. A second investigator collected demographic data; this included total career number of innings pitched and any subsequent DL reports for each subject while remaining blinded to the MRI results. RESULTS: The mean age at the time of MRI was 29.6 years (range, 19-39 years). The mean number of innings pitched was 1111.7. Of the 26 pitchers, 13 had scar remodeling of the anterior bundle of the ulnar collateral ligament (UCL). Of those, 4 had partial-thickness tears of the anterior bundle of the UCL, ranging from 10% to 90% of the total thickness. Twelve had articular cartilage loss within the posteromedial margin of the ulnohumeral joint, and 12 had posteromedial olecranon marginal osteophytes. Seven pitchers had degeneration of the common extensor tendon origin, 10 had degeneration of the flexor pronator mass, 9 had insertional triceps tendinosis, 2 had enthesopathic spurs at the sublime tubercle, 3 had osteochondral intra-articular bodies, and 2 subjects had joint effusions. In the year after MRI, 6 pitchers were placed on the DL for elbow-related injuries. There was no robust correlation between any single MRI finding and subsequent transfer to the DL, and no statistically significant correlation between number of innings pitched and MRI findings, although some trends were observed for both. CONCLUSION: MRI findings in asymptomatic MLB pitchers were not associated with placement on the DL within the subsequent year. While a trend was observed with olecranon osteophytes and subsequent DL placement ( P = 0.07), this finding did not reach statistical significance. Furthermore, there was no robust correlation between the number of innings pitched with the presence of any of the aforementioned degenerative changes on MRI. CLINICAL RELEVANCE: The characteristic structural transformation that occurs in the throwing elbow of professional pitchers is predictable and readily detectable on MRI. However, this study suggests that these changes are not predictive of near-term placement on the DL in those who are asymptomatic. Abnormal findings on MRI, even high-grade partial UCL tears, do not correlate with near-term placement on the DL, mitigating their potential negative impact on signing decisions.
Tipo de publicação: JOURNAL ARTICLE


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PMID:28325273
Autor:Erickson BJ; Chalmers PN; Bach BR; Dines JS; Verma NN; Bush-Joseph CA; Cohen SB; Romeo AA
Endereço:Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA. Electronic address: brandon.j.erickson@gmail.com.
Título:Length of time between surgery and return to sport after ulnar collateral ligament reconstruction in Major League Baseball pitchers does not predict need for revision surgery.
Fonte:J Shoulder Elbow Surg; 26(4):699-703, 2017 Apr.
ISSN:1532-6500
País de publicação:United States
Idioma:eng
Resumo:HYPOTHESIS: Pitchers who return to sport (RTS) sooner will have a higher risk of revision ulnar collateral ligament reconstruction (UCLR) than those who return later. METHODS: All professional (major and minor league) baseball pitchers who underwent UCLR between 1974 and 2016 were identified. Date of the index UCLR was recorded. The date of the first game back at any professional level after surgery and the date the pitcher returned to the same level of play (if applicable) were recorded. Length of time between these dates was compared for pitchers who required a revision UCLR and those who did not. RESULTS: Overall, 569 pitchers (average age, 24.8 ± 4.1 years) underwent UCLR and had reliable game logs after surgery. No statistically significant difference existed in the length of time to RTS at any professional level or at the same professional level between those pitchers who did not require a revision UCLR and those who did (P = .442, P = .238). Pitchers who required revision UCLR returned to any level of play almost 2 months earlier (14.7 vs. 16.5 months) and returned to the same level of play >2 months earlier (15.2 vs. 17.7 months) than matched controls who did not require revision UCLR, although this was not statistically significant (P = .179, P = .204). CONCLUSION: No statistically significant difference existed in the length of time to RTS after UCLR in professional baseball players who required a revision UCLR and those who did not.
Tipo de publicação: JOURNAL ARTICLE


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PMID:28314694
Autor:Kim NR; Moon SG; Park JY; Choi JW; Oh KS
Endereço:Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
Título:Stress ultrasound in baseball players with ulnar collateral ligament injuries: additional value for predicting rehabilitation outcome.
Fonte:J Shoulder Elbow Surg; 26(5):815-823, 2017 May.
ISSN:1532-6500
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: The purpose of this study was to evaluate the additional value of stress ultrasound (US) for predicting rehabilitation outcome in baseball players with ulnar collateral ligament (UCL) injury. METHODS: Stress US and magnetic resonance imaging (MRI) in 41 baseball players with UCL injury who received rehabilitation treatment for more than 6 weeks were retrospectively compared between the rehabilitation group (n = 23) and surgery group (n = 18). The MRI grade of UCL injury was assessed as intact continuity, low-grade partial tear, high-grade partial tear, and complete tear. To estimate sonographic joint laxity, we assessed 3 sonographic criteria as present or absent: ligamentous waviness, joint gapping, and intra-articular ring-down artifact. In addition, the presence of concomitant tenderness was checked during stress US. The diagnostic validity of MRI with and without stress US was analyzed as a predictor for the rehabilitation outcome. RESULTS: The MRI grade was higher in the surgery group than in the rehabilitation group (P < .001). Sonographic joint laxity showing the ring-down artifact and concomitant tenderness with stress were significantly more frequent in the surgery group (P = .024 and P = .006, respectively). Sensitivity, specificity, and accuracy were 61.1%, 86.9%, and 75.6%, respectively, for MRI alone and 83.3%, 56.5%, and 68.2%, respectively, for the combination of MRI with joint laxity showing the ring-down artifact. For MRI in combination with joint laxity and concomitant tenderness, these values were 72.2%, 82.6%, and 78.0%, respectively. CONCLUSION: The addition of stress US showing the ring-down artifact and concomitant tenderness was helpful for predicting the rehabilitation outcome of UCL injuries.
Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE


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PMID:28160922
Autor:Keller RA; Mehran N; Khalil LS; Ahmad CS; ElAttrache N
Endereço:Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA, USA. Electronic address: robkeller23@gmail.com.
Título:Relative individual workload changes may be a risk factor for rerupture of ulnar collateral ligament reconstruction.
Fonte:J Shoulder Elbow Surg; 26(3):369-375, 2017 Mar.
ISSN:1532-6500
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: With an increasing number of Major League Baseball (MLB) players undergoing ulnar collateral ligament (UCL) reconstruction, there remains limited literature on appropriate post-reconstruction workload management to limit the risk of reinjury. METHODS: A total of 28 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction were identified and compared with 137 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared 3 years before and after primary reconstruction. Results were then compared between groups. RESULTS: Pitchers who later required revision increased their games pitched by 14.1% after reconstruction whereas the no-revision group pitched 13.6% fewer games than before reconstruction (P < .01). Inning workload was reduced by 9.8% after surgery (89.8 innings after vs 99.6 innings before) for the revision group compared with the no-revision group, which threw 26% fewer innings after surgery (86.3 innings after vs 116.7 innings before) (P = .05). In addition, the revision group pitched 6.6% more pitches after reconstruction, 1138.9 pitches, compared with before reconstruction, 1068.6 pitches. Pitchers who did not require revision, in contrast, pitched 19.6% fewer pitches after reconstruction than before reconstruction (P = .08). CONCLUSIONS: This study's findings suggest that MLB pitchers who require revision UCL reconstruction after returning to play following primary UCL reconstruction pitch at or above their pre-primary UCL reconstruction workload whereas control pitchers who do not require revision pitch significantly less, below their pre-primary UCL reconstruction workload.
Tipo de publicação: JOURNAL ARTICLE


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PMID:28104091
Autor:Keller RA; Mehran N; Marshall NE; Okoroha KR; Khalil L; Tibone JE; Moutzouros V
Endereço:Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI, USA. Electronic address: robkeller23@gmail.com.
Título:Major League pitching workload after primary ulnar collateral ligament reconstruction and risk for revision surgery.
Fonte:J Shoulder Elbow Surg; 26(2):288-294, 2017 Feb.
ISSN:1532-6500
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Literature has attempted to correlate pitching workload with risk of ulnar collateral ligament (UCL) injury; however, limited data are available in evaluating workload and its relationship with the need for revision reconstruction in Major League Baseball (MLB) pitchers. METHODS: We identified 29 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction and compared them with 121 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared for the seasons after returning from primary reconstruction and for the last season pitched before undergoing revision surgery. RESULTS: The difference in workload between pitchers who did and did not require revision reconstruction was not statistically significant in games pitched, innings pitched, and MLB-only pitch counts. The one significant difference in workload was in total pitch counts (combined MLB and minor league), with the pitchers who required revision surgery pitching less than those who did not (primary: 1413.6 pitches vs. revision: 959.0 pitches, P = .04). In addition, pitchers who required revision surgery underwent primary reconstruction at an early age (22.9 years vs. 27.3 years, P < .001) and had less MLB experience (1.5 years vs. 5.0 years, P < .001). CONCLUSIONS: There is no specific number of pitches, innings, or games that place a pitcher at an increase risk for injury after primary UCL reconstruction. However, correlations of risk may be younger age and less MLB experience at the time of the primary reconstruction.
Tipo de publicação: JOURNAL ARTICLE


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PMID:28095019
Autor:Wong TT; Lin DJ; Ayyala RS; Kazam JK
Endereço:1 Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032.
Título:Elbow Injuries in Adult Overhead Athletes.
Fonte:AJR Am J Roentgenol; 208(3):W110-W120, 2017 Mar.
ISSN:1546-3141
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVE: The purpose of this article is to review common elbow injuries found in overhead athletes with focus on mechanism, clinical features, imaging appearance, and treatment options. CONCLUSION: The overhead throwing motion subjects the elbow to a variety of complex forces, which places both osseous and soft-tissue structures at high risk for injury.
Tipo de publicação: JOURNAL ARTICLE; REVIEW


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PMID:28060236
Autor:Erickson BJ; Romeo AA
Endereço:1Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois.
Título:The Ulnar Collateral Ligament Injury: Evaluation and Treatment.
Fonte:J Bone Joint Surg Am; 99(1):76-86, 2017 Jan 04.
ISSN:1535-1386
País de publicação:United States
Idioma:eng
Tipo de publicação: JOURNAL ARTICLE; REVIEW


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PMID:27745810
Autor:Kim HM; Andrews CR; Roush EP; Pace GI; Lewis GS
Endereço:Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, Hershey, PA, USA. Electronic address: hkim2@hmc.psu.edu.
Título:Effect of ulnar tunnel location on elbow stability in double-strand lateral collateral ligament reconstruction.
Fonte:J Shoulder Elbow Surg; 26(3):409-415, 2017 Mar.
ISSN:1532-6500
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Double-strand lateral ulnar collateral ligament (LUCL) reconstruction is an effective treatment for posterolateral rotatory instability (PLRI) of the elbow, but anatomic landmarks for ulnar tunnel placement are often difficult to identify intraoperatively, which potentially can result in a nonanatomic LUCL reconstruction. This study investigated the effect of ulnar tunnel location on joint stability in double-strand LUCL reconstruction. METHODS: PLRI was artificially created in 7 cadaveric elbows, and double-strand LUCL reconstruction was performed. Five different ulnar tunnels were made along the length of the ulna. In each specimen, each possible pair of 2 tunnels (10 total) were used for graft passage. Varus and posterolateral joint gapping was measured after joint loading using a 3-dimensional digitizer system and X-ray image intensifier. RESULTS: No significant gapping was observed at the posterolateral ulnohumeral joint regardless of the location of the ulnar tunnels (P > .05). In contrast, the lateral radiocapitellar joint showed statistically significant varus gapping when both ulnar tunnels were placed proximal to the radial head-neck junction (P < .05). DISCUSSION: This findings of study suggest that the location of the ulnar tunnels may not be as critical as that of the humeral tunnel during double-strand LUCL reconstruction and that posterolateral rotatory elbow stability can be achieved reasonably well as long as at least 1 of the 2 ulnar tunnels is located at or distal to the radial head-neck junction level.
Tipo de publicação: JOURNAL ARTICLE


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PMID:27590172
Autor:Meyer CJ; Garrison JC; Conway JE
Endereço:Texas A&M University, College Station, Texas, USA.
Título:Baseball Players With an Ulnar Collateral Ligament Tear Display Increased Nondominant Arm Humeral Torsion Compared With Healthy Baseball Players.
Fonte:Am J Sports Med; 45(1):144-149, 2017 Jan.
ISSN:1552-3365
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Previous work has suggested that an increase in the amount of developmentally acquired, dominant arm humeral retrotorsion (D HRT) in the thrower's shoulder may be a potentially protective mechanism. Although the relationship between HRT and shoulder injuries has been reported, the relationship between HRT and ulnar collateral ligament (UCL) tears in baseball players is not known. PURPOSE: To determine whether D HRT and nondominant arm HRT (ND HRT) measurements in baseball players with a UCL tear differ statistically from a matched healthy cohort. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: D HRT and ND HRT were measured in 112 male competitive high school and collegiate baseball players seen over an 18-month period from 2013 to 2015. A total of 56 participants with a clinical and magnetic resonance imaging-confirmed diagnosis of a throwing-arm UCL tear (UCLInj group) were compared with 56 healthy baseball players with no history of an elbow injury who were matched for age, experience, and position (NUCLInj group). The mean ages in the UCLInj and NUCLInj groups were 17.9 ± 2.2 and 17.6 ± 2.8 years, respectively. Using a previously validated ultrasound method, D HRT and ND HRT were measured in the supine position, and the HRT side-to-side difference (D HRT - ND HRT) was calculated. A 1-way multivariate analysis of variance was used to determine the mean statistical differences between groups ( P < .05). RESULTS: Baseball players with a UCL tear displayed significantly more humeral torsion (ie, less retrotorsion) in their nondominant arm compared with healthy baseball players (UCLInj = 33.27° ± 10.27°, NUCLInj = 27.82° ± 10.88°; P = .007). Baseball players with a UCL tear did not display any differences in D HRT compared with healthy baseball players (UCLInj = 18.67° ± 9.41°, NUCLInj = 17.09° ± 9.92°; P = .391). Significant side-to-side differences in HRT existed between groups (UCLInj = -14.60° ± 6.72°, NUCLInj = -10.72° ± 6.88°; P = .003). CONCLUSION: There was a significant increase in mean nondominant arm humeral torsion (ie, less retrotorsion) in the UCL tear group, but there was no significant difference in the mean D HRT between the injured and uninjured groups. A greater HRT side-to-side difference was displayed in the UCL tear group. The extent to which a thrower has developmentally acquired both D HRT and ND HRT may affect elbow UCL tear risk. Furthermore, it is possible that the extent of genetically predisposed ND HRT may influence the throwing-related increase in D HRT.
Tipo de publicação: JOURNAL ARTICLE



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