Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, California, USA.
Department of Orthopedic Surgery, University of California, San Diego, San Diego, California, USA.
Am J Sports Med. 2020 Feb;48(2):466-472. doi: 10.1177/0363546519888647. Epub 2019 Dec 4.
Prior studies have revealed magnetic resonance imaging (MRI) evidence of elbow pathology in single-season evaluation of competitive youth baseball players. The natural history of these findings and risk factors for progression have not been reported.
To characterize the natural history of bilateral elbow MRI findings in a 3-year longitudinal study and to correlate abnormalities with prior MRI findings, throwing history, playing status, and physical examination.
Cohort study; Level of evidence, 2.
A prospective study of Little League players aged 12 to 15 years was performed. All players had preseason and postseason bilateral elbow MRI performed 3 years before this study. Players underwent repeat bilateral elbow MRI, physical examination, and detailed assessment of throwing history, playing status, and arm pain. Imaging was read by a blinded musculoskeletal radiologist and compared with prior MR images to assess for progression or resolution of previously identified pathology.
All 26 players who participated in the previous single-season study returned for a 3-year assessment. At the completion of the study, 15 players (58%) had dominant arm MRI pathology. Eighty percent (12/15 players) of MRI findings were new or progressive lesions. Players with postseason MRI pathology at the beginning of the study were more likely to have MRI pathology at the 3-year follow-up than players with previously normal postseason MRI ( < .05), although 6 of the 14 players (43%) with previously normal MRI developed new pathology. Year-round play was a significant predictor of tenderness to elbow palpation ( = .027) and positive MRI findings at 3 years ( = .047). At the 3-year follow-up, 7 players (27%) reported having throwing elbow pain and 3 had required casting. Additionally, differences were noted in the dominant arm's internal and external rotation in those that continued to play baseball ( < .05).
Dominant elbow MRI abnormalities are common in competitive Little League Baseball players. Year-round play imparts significant risk for progression of MRI pathology and physical examination abnormalities.
先前的研究已经揭示了磁共振成像（MRI）在对单赛季青少年棒球运动员进行评估时发现肘部病变的证据。这些发现的自然病史以及进展的危险因素尚未报道。
在一项为期 3 年的纵向研究中描述双侧肘部 MRI 发现的自然病史，并将异常与先前的 MRI 发现、投掷史、比赛状态和体格检查相关联。
队列研究；证据水平，2 级。
对 12 至 15 岁的小联盟球员进行了一项前瞻性研究。所有球员在本研究前 3 年都接受了双侧肘部 MRI 术前和术后检查。球员们接受了双侧肘部 MRI 重复检查、体格检查，并详细评估了投掷史、比赛状态和手臂疼痛。由一位经过盲法肌肉骨骼放射科医生进行影像学检查，并与先前的 MRI 图像进行比较，以评估先前确定的病理学是进展还是消退。
所有参加之前单赛季研究的 26 名球员都返回进行了 3 年评估。在研究结束时，15 名球员（58%）的优势手臂 MRI 有病理学改变。80%（15 名球员中的 12 名）的 MRI 发现是新的或进展性病变。在研究开始时患有术后 MRI 病理学的球员比那些术前 MRI 正常的球员更有可能在 3 年随访时出现 MRI 病理学改变（<.05），尽管 14 名术前 MRI 正常的球员中有 6 名（43%）出现了新的病理学改变。全年打球是肘部触诊压痛（=.027）和 3 年时阳性 MRI 发现（=.047）的显著预测因素。在 3 年随访时，7 名球员（27%）报告有投掷肘疼痛，3 名球员需要打石膏。此外，在继续打棒球的球员中，还注意到了优势手臂的内外旋差异（<.05）。
在有竞争力的小联盟棒球运动员中，优势肘部 MRI 异常很常见。全年打球会显著增加 MRI 病理学和体格检查异常进展的风险。
