Utilization of sonography and a stress device in the assessment of partial tears of the ulnar collateral ligament in throwers

Wayne Smith, Joshua G Hackel, Henry T Goitz, J Antonio Bouffard, Andrea Mraz Nelson, Wayne Smith, Joshua G Hackel, Henry T Goitz, J Antonio Bouffard, Andrea Mraz Nelson

Abstract

The non-invasive assessment of medial elbow pain in throwers can be challenging. Valgus stress transmitted to the elbow during the late cocking and acceleration phases of the throwing motion can result in injury to the medial ligamentous structures of the elbow, bony surfaces, and common tendon of the forearm flexors. The utilization of musculoskeletal (MSK) ultrasound in combination with the Telos Stress Device (TSD) (Austin & Associates Fallston, MD) can be an alternate quick assessment when radiography is not be available.

Keywords: Musculoskeletal Ultrasound Imaging; Telos Stress device; Ulnar Collateral Ligament.

Figures

Figure 1.
Figure 1.
Terason Ultrasound Unit (Teratech Corporation, Burlington, MA).
Figure 2.
Figure 2.
The elbow is flexed to 25° and the upper arm is held in external rotation approximalely 65° of abduction. The wrist is in a supinated position.
Figure 3.
Figure 3.
A counter force is applied to the radial side of elbow by a screw-threaded device with diode digital light measuring device.
Figure 4.
Figure 4.
Telos Stress Device Procedure: 1. At 0 stress an initial sonogram is taken to provide a baseline 2. The screw shaft device applies a valgus stress. 3. Sequential sonograms are then taken 10 and 15 kilo-pascals of stress (as read on the diode digital light-measuring device).
Figure 5.
Figure 5.
Ultrasound 12 MHZ frequency transducer is placed in a longitudinal plane on the medial side of the elbow. Note that the transducer is parallel with the forearm.
Figure 6.
Figure 6.
Ultrasound image of medial elbow without imposed stress. Note the origin of the common flexor tendon (F), the epicondyle (E), the trochlea (T), and ulna (U) with the UCL identifiable between the two arrows.
Figure 7.
Figure 7.
Example of a diagnostic ultrasound image of the medial elbow at 9 mpa of force. The arrowheads demonstrate small hypoechoic areas that correlate to a tear within the anterior band of the UCL. Arrow is pointing to the anterior band of UCL. Common flexor tendon (F), medial epicondyle (me) are identified.
Figure 8.
Figure 8.
Example ultrasonographic measurement of the ulnohumeral joint to assess amount of opening within the joint under valgus loading.
Figure 9.
Figure 9.
Radiograph demonstrating Telos Stress Device placement and valgus stress being applied to the elbow.

Source: PubMed

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