Published online before print February 28, 2003, 10.1148/radiol.2271020288
Dynamic US of the Anterior Band of the Ulnar Collateral Ligament of the Elbow in Asymptomatic Major League Baseball Pitchers1
Levon N. Nazarian, MD,
John M. McShane, MD,
Michael G. Ciccotti, MD,
Patrick L. O’Kane, MD and
Marc I. Harwood, MD
1 From the Department of Radiology, Division of Ultrasound (L.N.N., P.L.O.), the Department of Family Medicine, Division of Sports Medicine (J.M.M., M.I.H.), and the Department of Orthopedic Surgery (M.G.C.), Thomas Jefferson University Hospital, 132 S 10th St, 7th Fl Main Bldg, Philadelphia, PA 19107-5244. From the 2001 RSNA scientific assembly. Received March 22, 2002; revision requested April 25; revision received June 8; accepted August 8. Address correspondence to L.N.N. (e-mail: levon.nazarian@mail.tju.edu).
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Figure 1. US scan of the long axis of the anterior band of the UCL (arrows) in a male cadaveric elbow. Bone acoustic landmarks include the medial epicondyle of the humerus (E), the trochlea of the humerus (T), and the coronoid process of the ulna (C). The common flexor tendon (F) is superficial to the anterior band of the UCL and can be seen inserting onto the medial epicondyle. The ulnohumeral joint is indicated by cursors.
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Figure 2a. Longitudinal US scans of the anterior band of the UCL in an asymptomatic 21-year-old pitcher. Images of the pitching elbow (a) at rest and (b) with stress show a thickened anterior band (arrowheads) that is 8.9 mm and that contains a large hypoechoic area (H). Although the ulnohumeral joint is not well depicted on these static images, it measured 2.9 mm at rest and 7.5 mm with stress at real-time imaging. (c, d) Corresponding views of the nonpitching arm. The anterior band of this ligament (arrowheads) is only 4.4 mm thick and has a normal echotexture. The ulnohumeral joint (arrows) did not widen appreciably with stress.
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Figure 2b. Longitudinal US scans of the anterior band of the UCL in an asymptomatic 21-year-old pitcher. Images of the pitching elbow (a) at rest and (b) with stress show a thickened anterior band (arrowheads) that is 8.9 mm and that contains a large hypoechoic area (H). Although the ulnohumeral joint is not well depicted on these static images, it measured 2.9 mm at rest and 7.5 mm with stress at real-time imaging. (c, d) Corresponding views of the nonpitching arm. The anterior band of this ligament (arrowheads) is only 4.4 mm thick and has a normal echotexture. The ulnohumeral joint (arrows) did not widen appreciably with stress.
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Figure 2c. Longitudinal US scans of the anterior band of the UCL in an asymptomatic 21-year-old pitcher. Images of the pitching elbow (a) at rest and (b) with stress show a thickened anterior band (arrowheads) that is 8.9 mm and that contains a large hypoechoic area (H). Although the ulnohumeral joint is not well depicted on these static images, it measured 2.9 mm at rest and 7.5 mm with stress at real-time imaging. (c, d) Corresponding views of the nonpitching arm. The anterior band of this ligament (arrowheads) is only 4.4 mm thick and has a normal echotexture. The ulnohumeral joint (arrows) did not widen appreciably with stress.
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Figure 2d. Longitudinal US scans of the anterior band of the UCL in an asymptomatic 21-year-old pitcher. Images of the pitching elbow (a) at rest and (b) with stress show a thickened anterior band (arrowheads) that is 8.9 mm and that contains a large hypoechoic area (H). Although the ulnohumeral joint is not well depicted on these static images, it measured 2.9 mm at rest and 7.5 mm with stress at real-time imaging. (c, d) Corresponding views of the nonpitching arm. The anterior band of this ligament (arrowheads) is only 4.4 mm thick and has a normal echotexture. The ulnohumeral joint (arrows) did not widen appreciably with stress.
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Figure 3a. Longitudinal US scans of the anterior band of the UCL (arrowheads) obtained (a) at rest and (b) with valgus stress in the pitching elbow of an asymptomatic 31-year-old pitcher. The anterior band is mildly heterogeneous in its gray-scale appearance. The width of the ulnohumeral joint (arrows) was 3.3 mm at rest and 5.6 mm with stress. In the nonpitching elbow (not shown), the corresponding measurements at rest and stress were 2.6 and 2.7 mm, respectively.
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Figure 3b. Longitudinal US scans of the anterior band of the UCL (arrowheads) obtained (a) at rest and (b) with valgus stress in the pitching elbow of an asymptomatic 31-year-old pitcher. The anterior band is mildly heterogeneous in its gray-scale appearance. The width of the ulnohumeral joint (arrows) was 3.3 mm at rest and 5.6 mm with stress. In the nonpitching elbow (not shown), the corresponding measurements at rest and stress were 2.6 and 2.7 mm, respectively.
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Figure 4a. Longitudinal US scans of the anterior band of the UCL obtained (a) at rest and (b) with valgus stress in the pitching elbow of an asymptomatic 26-year-old pitcher. The anterior band is hypoechoic (*), particularly near its humeral insertion. The ulnohumeral joint (arrows) was 2.8 mm at rest and 3.9 mm with stress.
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Figure 4b. Longitudinal US scans of the anterior band of the UCL obtained (a) at rest and (b) with valgus stress in the pitching elbow of an asymptomatic 26-year-old pitcher. The anterior band is hypoechoic (*), particularly near its humeral insertion. The ulnohumeral joint (arrows) was 2.8 mm at rest and 3.9 mm with stress.
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Figure 5. Longitudinal US scan of the anterior band of the UCL in an asymptomatic 30-year-old pitcher. Shadowing calcification (arrow) is seen within the substance of the anterior band (arrowheads).
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Copyright © 2003 by the Radiological Society of North America.
