Atanda Alfred, Averill Lauren W, Wallace Maegen, Niiler Tim A, Nazarian Levon N, Ciccotti Michael G
Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
Department of Radiology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
Am J Sports Med. 2016 Dec;44(12):3179-3187. doi: 10.1177/0363546516661010. Epub 2016 Sep 1.
Stress ultrasound (SUS) of the elbow has demonstrated changes in the anterior band of the ulnar collateral ligament (UCL) in professional and high school-aged pitchers. However, there have been no large reports correlating pitching history data with SUS changes in youth and adolescent baseball pitchers.
Changes of the UCL on SUS will correlate with pitching volume in youth and adolescent baseball pitchers.
Cross-sectional study; Level of evidence, 3.
SUS of the elbow was performed in both elbows of 102 youth and adolescent baseball pitchers. UCL thickness and the width of the ulnohumeral joint, at rest and with 150 N of valgus stress, were measured using a standardized, instrumented device. Demographic data, arm measurements, and a pitching history questionnaire were recorded as well. The pitchers were separated into 2 groups based on age: group 1 (12-14 years) and group 2 (15-18 years). SUS findings of the dominant elbows were compared between the 2 groups. Correlation analysis and linear regression were used to identify relationships between SUS findings and pitching history data.
In all pitchers, the mean UCL thickness was 4.40 mm in the dominant elbow and 4.11 mm in the nondominant elbow (P =.03). There was no significant difference between elbows in any joint space characteristics. A comparison of group 1 versus group 2 demonstrated significant differences in UCL thickness (4.13 vs 4.96 mm; P < .001), resting joint space width (6.56 vs 4.04 mm; P < .001), and stressed joint space width (7.68 vs 4.07 mm; P < .001). There was no difference in the change in joint space width between the 2 groups (1.11 vs 0.76 mm; P = .05). The UCL was significantly thicker in pitchers who threw more than 67 pitches per appearance (4.69 vs 4.14 mm), who pitched more than 5 innings per appearance (4.76 vs 4.11 mm), and who had more than 5.5 years of pitching experience (4.71 vs 4.07 mm; P < .001). Linear regression demonstrated that age, weight, and pitches per appearance (R = 0.114, 0.370, and 0.326, respectively) significantly correlated with UCL thickness.
These findings suggest that UCL thickness increases as pitchers get older and heavier and as they increase their pitch volumes.
肘部应力超声（SUS）已显示职业和高中年龄的投手尺侧副韧带（UCL）前束有变化。然而，尚未有大量报告将青少年棒球投手的投球历史数据与SUS变化相关联。
青少年棒球投手SUS上UCL的变化将与投球量相关。
横断面研究；证据等级，3级。
对102名青少年棒球投手的双侧肘部进行SUS检查。使用标准化的仪器设备测量肘部在休息时以及施加150 N外翻应力时UCL的厚度和尺肱关节的宽度。还记录了人口统计学数据、手臂测量数据和投球历史问卷。投手根据年龄分为两组：第1组（12 - 14岁）和第2组（15 - 18岁）。比较两组优势肘部的SUS检查结果。采用相关分析和线性回归来确定SUS检查结果与投球历史数据之间的关系。
在所有投手中，优势肘部UCL的平均厚度为4.40 mm，非优势肘部为4.11 mm（P = 0.03）。在任何关节间隙特征方面，双侧肘部之间均无显著差异。第1组与第2组的比较显示，UCL厚度（4.13对4.96 mm；P < 0.001）、休息时关节间隙宽度（6.56对4.04 mm；P < 0.001）和施加应力时关节间隙宽度（7.68对4.07 mm；P < 0.001）存在显著差异。两组之间关节间隙宽度的变化无差异（1.11对0.76 mm；P = 0.05）。每次出场投球超过67次的投手（4.69对4.14 mm）、每次出场投球超过5局的投手（4.76对4.11 mm）以及投球经验超过5.5年的投手（4.71对4.07 mm；P < 0.001）的UCL明显更厚。线性回归表明，年龄、体重和每次出场投球数（分别为R = 0.114、0.370和0.326）与UCL厚度显著相关。
这些发现表明，随着投手年龄增长、体重增加以及投球量增加，UCL厚度会增加。
