Garcia Grant H, Gowd Anirudh K, Cabarcas Brandon C, Liu Joseph N, Meyer John R, White Gregory M, Romeo Anthony A, Verma Nikhil N
Seattle Orthopedic Center, Seattle, Washington, USA.
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Orthop J Sports Med. 2019 Jan 29;7(1):2325967118818413. doi: 10.1177/2325967118818413. eCollection 2019 Jan.
Repetitive pitching produces significant stress on the elbow that may result in structural abnormalities discernable on magnetic resonance imaging (MRI) without causing symptoms.
To determine whether there exists an association between subclinical MRI findings in asymptomatic elbows of Major League Baseball (MLB) players and future placement on the disabled list (DL) or future operative procedure.
Cohort study; Level of evidence, 3.
MRI scans of the elbows of professional-level baseball pitchers, taken during routine presigning imaging at a single organization from 2005 to 2017, were retrospectively reviewed. Publicly available databases were queried to exclude pitchers with an injury before the earliest session of elbow MRI. Three blinded reviewers reviewed all MRI scans independently to evaluate for the presence of chondral damage to the joint, loose bodies, ulnar collateral ligament (UCL) heterogeneity or tears, flexor pronator mass defects, and signs of posteromedial (PM) impingement. Binary imaging findings were related to future placement on the DL for elbow complaints and future elbow surgery.
A total of 41 pitchers had asymptomatic MRI findings with no prior DL placement. For players who eventually went on the DL, there were a statistically greater number of players with UCL heterogeneity ( = .021), humeral-sided partial UCL tears ( = .031), and PM impingement ( = .004) on preinjury MRI compared with players who remained healthy. PM impingement was related to future elbow-related surgery ( = .003). Pitchers with UCL heterogeneity were associated with reduced career strike zone percentage, innings pitched, and fastball percentage ( < .05 for all).
UCL heterogeneity, PM impingement, and humeral-sided partial tears were correlated with future DL placement for elbow-related reasons in MLB pitchers. Asymptomatic PM impingement may be a precursor to future surgery.
重复性投球动作会给肘部带来巨大压力，这可能会在磁共振成像（MRI）上显示出结构异常，却不引发症状。
确定美国职业棒球大联盟（MLB）球员无症状肘部的亚临床MRI表现与未来进入伤病名单（DL）或未来接受手术之间是否存在关联。
队列研究；证据等级，3级。
回顾性分析2005年至2017年在单一机构进行的常规签约前成像期间，职业水平棒球投手肘部的MRI扫描结果。查询公开可用数据库，排除在最早一次肘部MRI检查前就已受伤的投手。三位盲法评审员独立审查所有MRI扫描结果，以评估关节软骨损伤、游离体、尺侧副韧带（UCL）异质性或撕裂、屈肌旋前肌肿块缺损以及后内侧（PM）撞击征的存在情况。二元成像结果与未来因肘部问题进入DL以及未来肘部手术相关。
共有41名投手有无症状的MRI表现且此前未进入过DL。与保持健康的球员相比，最终进入DL的球员在伤前MRI上出现UCL异质性（P = .021）、肱骨侧部分UCL撕裂（P = .031）和PM撞击征（P = .004）的人数在统计学上更多。PM撞击征与未来肘部相关手术有关（P = .003）。有UCL异质性的投手与职业生涯的好球区百分比、投球局数和快球百分比降低相关（所有P均< .05）。
UCL异质性、PM撞击征和肱骨侧部分撕裂与MLB投手未来因肘部相关原因进入DL有关。无症状的PM撞击征可能是未来手术的先兆。
