Dominant Elbow Research Articles

Evidence of Subclinical Medial Collateral Ligament Injury and Posteromedial Impingement in Professional Baseball Players

Background Recognition and treatment of elbow conditions such as medial collateral ligament injury and posteromedial impingement are increasing in throwing athletes. Magnetic resonance imaging may provide pivotal information in the management of these athletes. Knowledge of the utility of magnetic resonance imaging has become widespread throughout the baseball community. However, data on the frequency and extent of asymptomatic magnetic resonance imaging findings in the elbows of this throwing population are lacking. Hypothesis Abnormalities in the throwing elbows of asymptomatic professional baseball players compared to the nonthrowing elbows are frequently seen in magnetic resonance images. Study Design Descriptive anatomical study. Methods Sixteen asymptomatic professional baseball players with no history of injury underwent bilateral elbow magnetic resonance imaging using a standardized sequencing protocol. The magnetic resonance images were reviewed, in a blinded fashion, by 2 musculoskeletal radiologists and 1 orthopaedic surgeon. Results Medial collateral ligament abnormalities (including thickening, signal heterogeneity, or discontinuity) were present in 87% of players’ dominant elbows. Findings consistent with posteromedial impingement were present in 13 of 16 subjects. There was a significant correlation between medial collateral ligament thickening and posteromedial subchondral sclerosis (P = .04). The throwing elbow was correctly identified in all 16 subjects. No significant correlation between magnetic resonance imaging findings and age could be detected. Conclusions This study demonstrates a high rate of abnormal magnetic resonance imaging findings in asymptomatic throwers’ elbows. These baseline findings must be considered when magnetic resonance imaging is being used as a factor in treatment decisions.

Isokinetic profile of elbow flexion and extension strength in elite junior tennis players.

Descriptive study. To determine whether bilateral differences exist in concentric elbow flexion and extension strength in elite junior tennis players. The repetitive nature of tennis frequently produces upper extremity overuse injuries. Prior research has identified tennis-specific strength adaptation in the dominant shoulder and distal upper extremity musculature of elite players. No previous study has addressed elbow flexion and extension strength. Thirty-eight elite junior tennis players were bilaterally tested for concentric elbow flexion and extension muscle performance on a Cybex 6000 isokinetic dynamometer at 90 degrees/s, 210 degrees/s, and 300 degrees/s. Repeated-measures ANOVAs were used to test for differences between extremities, muscle groups, and speed. Significantly greater (P<0.002) dominant-arm elbow extension peak torque values were measured at 90 degrees/s, 210 degrees/s, and 300 degrees/s for males. Significantly greater (P<0.002) dominant-arm single-repetition work values were also measured at 90 degrees/s and 210 degrees/s for males. No significant difference was measured between extremities in elbow flexion muscular performance in males and for elbow flexion or extension peak torque and single-repetition work values in females. No significant difference between extremities was measured in elbow flexion/extension strength ratios in females and significant differences between extremities in this ratio were only present at 210 degrees/s in males (P<0.002). These data indicate muscular adaptations around the dominant elbow in male elite junior tennis players but not females. These data have ramifications for clinicians rehabilitating upper extremity injuries in patients from this population.

Recovery of maximal isometric grip strength following cold immersion.

The purpose of this study was to investigate the effects of various cold immersion durations on maximal grip strength and the subsequent recovery of grip strength. Sixteen healthy men between 20 and 42 years of age participated in this study. Maximal isometric grip strength was measured before, immediately after, and 5, 10, and 15 minutes after cold immersion. Subjects submerged their dominant elbow, forearm, and hand in a cold water whirlpool at 10 degrees C for 5, 10, 15, or 20 minutes. There was a significant decrease in isometric grip strength when the forearm was immersed in 10 degrees C water for durations between 5 and 20 minutes and no recovery of this strength loss for a period of 15 minutes following removal from the cold immersion (p = 0.0001). These findings suggest that clinicians should be aware of the alterations in isometric muscle strength that result from utilizing the temperature and time frames of cold application used in this study.

Comparative analysis of low-back loading on chiropractors using various workstation table heights and performing various tasks

Background: There is epidemiologic evidence that chiropractors are a high-risk group for low-back disorders. However, to date there are no known biomechanical studies to determine whether their workstations may be a contributing factor. Objective: To investigate whether chiropractors' workstation table height or the tasks they perform make them susceptible to low-back strain. As well as investigating low-back strain, a screening was performed to determine whether chiropractors' upper extremities were at risk for undue strain as workstation table height was varied. Study Design: Experimental pilot study. Setting: A university ergonomic laboratory. Methods: An adjustable manipulation table was set at 3 different heights: 465 mm, 665 mm and 845 mm.Each of the 7 volunteer chiropractors were fitted with a triaxial electrogoniometer and were videotaped and photographed for analysis while performing spinal manipulation to the cervical, thoracic, and lumbar spine of a volunteer patient at each workstation table height. Two biomechanical models, one static and one dynamic, were used to record the dependent variables. A screening of various upper extremity variables was also performed with the static model. Results: For the subjects under study, a significant difference was found for the variables maximum sagittal flexion, disk compression force, and ligament strainas table height was varied. For the lumbar and thoracic manipulation tasks, the medium table height (655 mm) was found to create the least low-back strain. For the cervical manipulation task, the high table height (845 mm) was found to be the least straining on the low-back. The low height table (465 mm) was the most straining for all tasks. Upper extremities were not significantly affected by changes to table height. Significant differences were found for the task performed for axial rotational velocity, disk compression force, ligament strain, maximum sagittal flexion, dominant (right) elbow moment, and dominant (right) shoulder momentvariables. There was no significant interaction between table height and task performed. Conclusion: Workstation table height was found to have a significant effect on low-back load of subjects under study. The results of this study demonstrate an overall unacceptably high amount of sagittal flexion, ligament strain, and disk compression force on the chiropractor subjects in the tasks performed. (J Manipulative Physiol Ther 2003;26:25-33)

Distal Biceps Tendon Ruptures

The purpose of the current study was to determine the incidence of distal biceps tendon ruptures within a defined population, to describe the demographics of affected individuals, and to identify potential risk factors. The healthcare system in this study provides care to a known number of members in an area defined by zip codes and proximity to the medical center. Medical records for all members who presented with injuries about the elbow during a 5-year period were reviewed. Thirteen men and one woman with an average age of 47 years comprised the study population. The dominant extremity was involved in 86% of patients. All patients described a mechanism involving excessive eccentric tension as the arm was forced from a flexed position. The incidence of injury in the membership population averaged 1.2 ruptures per 100,000 patients per year. Forty-three percent reported regular tobacco use, whereas only 9% of all members were smokers. A Poisson regression analysis revealed a 7.5 times greater risk of distal biceps tendon rupture in patients who smoke. The incidence of distal biceps tendon ruptures is 1.2 per 100,000 patients, with the majority in the dominant elbow of men who smoke and who are in their fourth decade of life.

The effect of simulated elbow arthrodesis on the ability to perform activities of daily living.

The dominant elbow joint of 24 healthy volunteers was immobilized with a functional brace in increments of 20 degrees (6 positions ranging from 30 degrees to 130 degrees ). Average scores were obtained for personal care hygiene tasks (PCH), activity of daily living (ADL), and total functional scores (PCH + ADL) for each elbow flexion position. Functional scores increased with increasing elbow flexion, peaking at 110 degrees and then tapering down. Repeated-measures analysis of variance showed statistical significance, with functional scores improving with increasing elbow flexion for PCH, ADL, and PCH + ADL scores. Further pairwise comparisons for elbow position between 90 degrees and 110 degrees flexion groups demonstrated significant higher mean functional scores for ADL and combined PCH + ADL for the 110 degrees group. The results of this study support a clear advantage in subjects' upper-extremity functional abilities with the elbow immobilized at 110 degrees of flexion when dealing with normal upper-extremity joints. This angle of flexion should be considered in patients undergoing trial immobilization before an elbow arthrodesis.

Long term changes of the throwing arm of former elite javelin throwers.

The aim of this study was to determine long term changes in shoulder and elbow joints of former elite javelin throwers. Twenty-one elite javelin throwers were examined at an average of 19 years after the end of their high performance phase. Mean age at examination was 50 years. Functional assessment of both shoulders was determined by the Constant-score. The shoulder of the throwing arm was examined by magnetic resonance imaging. Both elbow joints were examined clinically and radiographically. Five athletes complained about transient shoulder pain in their throwing arm affecting activities of daily living, fourteen athletes had a deficit of internal rotation of at least ten degrees. Constant-scores of throwing arms were six points lower than those of non-throwing arms (P < 0.05). Complete ruptures and partial tears of the rotator cuff were frequent. Three athletes complained about transient elbow pain in their throwing arm affecting activities of daily living; ten athletes had a deficit of extension of more than five degrees. All dominant elbows had advanced arthrotic alterations (osteophytes, sclerosis) compared to the non-dominant side. Athletes who trained with weights of more than 3 kg had a significantly higher risk of degenerative changes than athletes who did not (P < 0.01). We therefore recommend to avoid throwing training with weights of more than 3 kg.

Sport injuries of the elbow.

Athletic injuries of the elbow are common especially in throwing sports such as baseball and tennis. An early diagnosis, early initiation of treatment, and appropriate referrals for surgical management enable...

Total elbow arthroplasty for flail and unstable elbows

u nsta e or al e bl fl .I lb ows significantly reduce upper extremity and hand function.20 These elbow abnormalities may occur in a number of circumstances but most frequently follow ununited elbow fractures,‘9, 22 traumatically deficient elbow joints, and severe destructive rheumatoid disease.4, 21 In elbow instability the patient is unable to position or posture the hand for normal function. Independent function of the contralateral hand is also affected, because it is frequently required to support the forearm and hand of the involved extremity. It is particularly troublesome when the dominant elbow is affected. This study reports on our experience with total elbow arthroplasty in patients with unstable or flail elbow joints caused by ununited fractures, traumatically deficient elbow articulations, and severe joint destruction in rheumatoid arthritis.

Correctable elbow lesions in professional baseball players: a review of 25 cases

In a retrospective study, 20 of 25 professional baseball pitchers (mean age, 24 years; range, 19 to 28 years) who had had a reconstructive surgical procedure on the dominant elbow had satisfactory results (able to return to competitive throwing for one full season or more after surgery). Gentle motion wasinitiated 1 week after the operation on each patient. Exercises for mobilization and muscle strengthening of grip, arm, and shoulder were increased until throwing was initiated 10 to 12 weeks postoperatively. Throwing was gradually increased over several weeks from 30 feet at no more than half speed for 15 min to 60 feet at three-quarter speed. Pitchers were instructed to warm up before throwing and warm down and to continue this practice after they began competitive throwing. The longest period of follow-up had been 4 years (mean, 2.8 years). Four of the 25 pitchers had unsatisfactory results (released from their team in less than one full season because of ineffective pitching and were not picked up by another team). The cause of the release of the other patient-player is controversial. This 25-patient group is too small and the follow-up period is too short for definite conclusions. Our evidence does suggest that surgical procedures directed at medial soft tissue and posterior intra-articular changes carry better prognosis for competitive throwers than other procedures. The radiohumeral articular condition should be evaluated at surgery.