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Ultrasonography has high positive predictive value for medial epicondyle lesions among adolescent baseball players

Knee Surgery, Sports Traumatology, Arthroscopy volume 27, pages 3261–3268 (2019)Cite this article

Abstract

Purpose

Only few studies have investigated medial epicondyle (MEC) lesions, particularly in the 12–18 age group. To the best of our knowledge, no study has compared ultrasonography (US), radiography and magnetic resonance imaging (MRI) in detecting MEC lesions. The aims of this study were to examine the value of US for detecting MEC lesions and to investigate correlations among diagnostic tools.

Methods

A prospective, comparative study was performed. Young baseball players from southern Taiwan were recruited, and basic characteristics, as well as passive range of motion (pROM) of the upper extremities, were recorded. Screening US was performed to identify MEC lesions, and players with MEC lesions received follow-up plain radiography and MRI.

Results

A total of 299 young baseball players were screened using US, and 28 of 299 players with possible MEC lesions were identified with a positive predictive value (PPV) of 88% according to MRI findings. The MEC lesions were primarily comprised of unfused ossicles and bony fragmentation. Other diagnoses, including UCL strain and medial epicondylitis, were also found by MRI in players with abnormal US screening results. The pROM of shoulder external rotation (ER) of the throwing hand was significantly reduced in players with MEC lesions (p = 0.006).

Conclusions

Bony cortical discontinuity or fragmentation over the MEC warrants further research, and US provides good PPV for types of MEC lesions. Decreased shoulder ER may relate to MEC lesions and should be taken into consideration. The use of US may facilitate early detection and intervention.

Level of evidence

IV, Cross-sectional study.

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Abbreviations

MEC:

Medial epicondyle

UCL:

Ulnar collateral ligament

LLE:

Little league elbow

US:

Ultrasonography

MRI:

Magnetic resonance imaging

pROM:

Passive range of motion

ER:

External rotation

IR:

Internal rotation

BMI:

Body mass index

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Acknowledgements

The authors thank the players, coaches, members of baseball associations, and the staff for their assistance. The authors also express gratitude to their families for providing moral support and warm encouragement.

Funding

This work was supported by a grant from Chang Gung Memorial Hospital in Taiwan, ROC (Grant no. CMRPG8E0901).

Author information

Affiliations

  1. Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China

    Yan-Yuh Lee, Tsung-Hsun Yang, Yu-Chi Huang, Po-Cheng Chen, Chia-Hao Hsu & Lin-Yi Wang

  2. Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China

    Chung-Cheng Huang

  3. Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan, Republic of China

    Wen-Yi Chou

  4. Medical Mechatronic Engineering Program, Cheng Shiu University, Kaohsiung, Taiwan, Republic of China

    Wen-Yi Chou

Authors
  1. Yan-Yuh Lee
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  2. Tsung-Hsun Yang
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  3. Chung-Cheng Huang
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  4. Yu-Chi Huang
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  5. Po-Cheng Chen
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  6. Chia-Hao Hsu
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  7. Lin-Yi Wang
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Contributions

LYW and WYC have made substantial contributions to the conception, design and acquisition of data and have been involved in revising it critically for important intellectual content. YYL and THY have made substantial contributions to acquisition of data, statistical analysis and interpretation of data and have been involved in drafting the manuscript. PCC and CHH have made substantial contributions to acquisition of data and have been involved in drafting the manuscript. CCH and YCH participated in the creation of figures and tables. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Lin-Yi Wang or Wen-Yi Chou.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Lee, YY., Yang, TH., Huang, CC. et al. Ultrasonography has high positive predictive value for medial epicondyle lesions among adolescent baseball players. Knee Surg Sports Traumatol Arthrosc 27, 3261–3268 (2019). https://doi.org/10.1007/s00167-018-5178-x

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  • DOI: https://doi.org/10.1007/s00167-018-5178-x

Keywords

  • Baseball
  • Medial epicondyle
  • Little league elbow
  • Ultrasonography
  • Adolescent
  • Ulnar collateral ligament
  • Apophysitis