Download PDF
Semin Musculoskelet Radiol 2010; 14(4): 412-418
DOI: 10.1055/s-0030-1263256
© Thieme Medical Publishers

Throwing Elbow in Adults

Hugue A. Ouellette1 , William Palmer1 , Martin Torriani1 , Miriam A. Bredella1
  • 1Massachusetts General Hospital, Boston, Massachusetts
Further Information

Publication History

Publication Date:
08 September 2010 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Biomechanics are central in understanding the pathophysiology and magnetic resonance (MR) imaging of overhead throwing athlete injuries. Repetitive excessive valgus forces at the elbow result in characteristic injuries due to medial joint distraction, lateral joint compression, and rotatory forces at the olecranon. MR imaging is useful for assessment of the throwing elbow in adults.

KEYWORDS

Elbow MRI - throwing injuries - ulnar collateral ligament

REFERENCES

  • 1 Miller C D, Savoie III F H. Valgus extension injuries of the elbow in the throwing athlete.  J Am Acad Orthop Surg. 1994;  2(5) 261-269
    PubMedGoogle Scholar
  • 2 Schwartz M L, al-Zahrani S, Morwessel R M, Andrews J R. Ulnar collateral ligament injury in the throwing athlete: evaluation with saline-enhanced MR arthrography.  Radiology. 1995;  197(1) 297-299
    CrossrefPubMedGoogle Scholar
  • 3 Andrews J R. Bony injuries about the elbow in the throwing athlete.  Instr Course Lect. 1985;  34 323-331
    PubMedGoogle Scholar
  • 4 Safran M R, Baillargeon D. Soft-tissue stabilizers of the elbow.  J Shoulder Elbow Surg. 2005;  14(1, Suppl S) 179S-185S
    CrossrefPubMedGoogle Scholar
  • 5 Morrey B F, An K N. Stability of the elbow: osseous constraints.  J Shoulder Elbow Surg. 2005;  14(1, Suppl S) 174S-178S
    Google Scholar
  • 6 Fleisig G S, Barrentine S W, Escamilla R F, Andrews J R. Biomechanics of overhand throwing with implications for injuries.  Sports Med. 1996;  21(6) 421-437
    CrossrefPubMedGoogle Scholar
  • 7 Cain Jr E L, Dugas J R, Wolf R S, Andrews J R. Elbow injuries in throwing athletes: a current concepts review.  Am J Sports Med. 2003;  31(4) 621-635
    PubMedGoogle Scholar
  • 8 Wilson F D, Andrews J R, Blackburn T A, McCluskey G. Valgus extension overload in the pitching elbow.  Am J Sports Med. 1983;  11(2) 83-88
    CrossrefPubMedGoogle Scholar
  • 9 Hotchkiss R N, Weiland A J. Valgus stability of the elbow.  J Orthop Res. 1987;  5(3) 372-377
    CrossrefPubMedGoogle Scholar
  • 10 Morrey B F, Tanaka S, An K N. Valgus stability of the elbow. A definition of primary and secondary constraints.  Clin Orthop Relat Res. 1991;  (265) 187-195
    PubMedGoogle Scholar
  • 11 Regan W D, Korinek S L, Morrey B F, An K N. Biomechanical study of ligaments around the elbow joint.  Clin Orthop Relat Res. 1991;  (271) 170-179
    PubMedGoogle Scholar
  • 12 Munshi M, Pretterklieber M L, Chung C B et al.. Anterior bundle of ulnar collateral ligament: evaluation of anatomic relationships by using MR imaging, MR arthrography, and gross anatomic and histologic analysis.  Radiology. 2004;  231(3) 797-803
    CrossrefPubMedGoogle Scholar
  • 13 Glajchen N, Schwartz M L, Andrews J R, Gladstone J. Avulsion fracture of the sublime tubercle of the ulna: a newly recognized injury in the throwing athlete.  AJR Am J Roentgenol. 1998;  170(3) 627-628
    PubMedGoogle Scholar
  • 14 Han K J, Kim Y K, Lim S K, Park J Y, Oh K S. The effect of physical characteristics and field position on the shoulder and elbow injuries of 490 baseball players: confirmation of diagnosis by magnetic resonance imaging.  Clin J Sport Med. 2009;  19(4) 271-276
    CrossrefPubMedGoogle Scholar
  • 15 Lynch J R, Waitayawinyu T, Hanel D P, Trumble T E. Medial collateral ligament injury in the overhand-throwing athlete.  J Hand Surg [Am]. 2008;  33(3) 430-437
    PubMedGoogle Scholar
  • 16 Field L D, Callaway G H, O'Brien S J, Altchek D W. Arthroscopic assessment of the medial collateral ligament complex of the elbow.  Am J Sports Med. 1995;  23(4) 396-400
    CrossrefPubMedGoogle Scholar
  • 17 Mulligan S A, Schwartz M L, Broussard M F, Andrews J R. Heterotopic calcification and tears of the ulnar collateral ligament: radiographic and MR imaging findings.  AJR Am J Roentgenol. 2000;  175(4) 1099-1102
    PubMedGoogle Scholar
  • 18 Rijke A M, Goitz H T, McCue F C, Andrews J R, Berr S S. Stress radiography of the medial elbow ligaments.  Radiology. 1994;  191(1) 213-216
    PubMedGoogle Scholar
  • 19 Timmerman L A, Schwartz M L, Andrews J R. Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. Evaluation in 25 baseball players with surgical confirmation.  Am J Sports Med. 1994;  22(1) 26-31, discussion 32
    CrossrefPubMedGoogle Scholar
  • 20 Kaplan L J, Potter H G. MR imaging of ligament injuries to the elbow.  Magn Reson Imaging Clin N Am. 2004;  12(2) 221-232, v–vi
    CrossrefPubMedGoogle Scholar
  • 21 Hill Jr N B, Bucchieri J S, Shon F, Miller T T, Rosenwasser M P. Magnetic resonance imaging of injury to the medial collateral ligament of the elbow: a cadaver model.  J Shoulder Elbow Surg. 2000;  9(5) 418-422
    CrossrefPubMedGoogle Scholar
  • 22 Nakanishi K, Masatomi T, Ochi T et al.. MR arthrography of elbow: evaluation of the ulnar collateral ligament of elbow.  Skeletal Radiol. 1996;  25(7) 629-634
    CrossrefPubMedGoogle Scholar
  • 23 Cohen M S, Bruno R J. The collateral ligaments of the elbow: anatomy and clinical correlation.  Clin Orthop Relat Res. 2001;  (383) 123-130
    PubMedGoogle Scholar
  • 24 Chung C B, Kim H J. Sports injuries of the elbow.  Magn Reson Imaging Clin N Am. 2003;  11(2) 239-253
    CrossrefPubMedGoogle Scholar
  • 25 Richard M J, Aldridge III J M, Wiesler E R, Ruch D S. Traumatic valgus instability of the elbow: pathoanatomy and results of direct repair. Surgical technique.  J Bone Joint Surg Am. 2009;  91(Suppl 2) 191-199
    CrossrefPubMedGoogle Scholar
  • 26 Schwartz M L, Thornton D D, Larrison M C et al.. Avulsion of the medial epicondyle after ulnar collateral ligament reconstruction: imaging of a rare throwing injury.  AJR Am J Roentgenol. 2008;  190(3) 595-598
    CrossrefPubMedGoogle Scholar
  • 27 Bordalo-Rodrigues M, Rosenberg Z S. MR imaging of entrapment neuropathies at the elbow.  Magn Reson Imaging Clin N Am. 2004;  12(2) 247-263, vi
    CrossrefPubMedGoogle Scholar
  • 28 Conway J E, Jobe F W, Glousman R E, Pink M. Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament.  J Bone Joint Surg Am. 1992;  74(1) 67-83
    PubMedGoogle Scholar
  • 29 Gabel G T, Morrey B F. Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow.  J Bone Joint Surg Am. 1995;  77(7) 1065-1069
    PubMedGoogle Scholar
  • 30 Cummins C A, Schneider D S. Peripheral nerve injuries in baseball players.  Phys Med Rehabil Clin N Am. 2009;  20(1) 175-193, x
    PubMedGoogle Scholar
  • 31 Britz G W, Haynor D R, Kuntz C et al.. Ulnar nerve entrapment at the elbow: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings.  Neurosurgery. 1996;  38(3) 458-465; discussion 465
    CrossrefPubMedGoogle Scholar
  • 32 Dellon A L. Techniques for successful management of ulnar nerve entrapment at the elbow.  Neurosurg Clin N Am. 1991;  2(1) 57-73
    PubMedGoogle Scholar
  • 33 Chung C B, Chew F S, Steinbach L. MR imaging of tendon abnormalities of the elbow.  Magn Reson Imaging Clin N Am. 2004;  12(2) 233-245, vi
    CrossrefPubMedGoogle Scholar
  • 34 Baumgard S H, Schwartz D R. Percutaneous release of the epicondylar muscles for humeral epicondylitis.  Am J Sports Med. 1982;  10(4) 233-236
    CrossrefPubMedGoogle Scholar
  • 35 Peiss J, Adam G, Casser R, Urhahn R, Günther R W. Gadopentetate-dimeglumine-enhanced MR imaging of osteonecrosis and osteochondritis dissecans of the elbow: initial experience.  Skeletal Radiol. 1995;  24(1) 17-20
    CrossrefPubMedGoogle Scholar
  • 36 Mesgarzadeh M, Sapega A A, Bonakdarpour A et al.. Osteochondritis dissecans: analysis of mechanical stability with radiography, scintigraphy, and MR imaging.  Radiology. 1987;  165(3) 775-780
    PubMedGoogle Scholar
  • 37 Kijowski R, De Smet A A. MRI findings of osteochondritis dissecans of the capitellum with surgical correlation.  AJR Am J Roentgenol. 2005;  185(6) 1453-1459
    CrossrefPubMedGoogle Scholar
  • 38 O'Driscoll S W, Bell D F, Morrey B F. Posterolateral rotatory instability of the elbow.  J Bone Joint Surg Am. 1991;  73(3) 440-446
    PubMedGoogle Scholar
  • 39 Nestor B J, O'Driscoll S W, Morrey B F. Ligamentous reconstruction for posterolateral rotatory instability of the elbow.  J Bone Joint Surg Am. 1992;  74(8) 1235-1241
    Google Scholar

Hugue A OuelletteM.D. 

Massachusetts General Hospital, Yawkey 6

55 Fruit St., Boston, MA 02114

Email: haouellette@partners.org

      >