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Pediatric thrower’s elbow: maturation-dependent MRI findings in symptomatic baseball players

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Abstract

Background

Elbow pain is common among youth baseball players and elbow MRI is increasingly utilized to complement the clinical assessment.

Objective

To characterize, according to skeletal maturity, findings on elbow MRI from symptomatic youth baseball players.

Materials and methods

This IRB-approved, HIPAA-compliant retrospective study included pediatric (<18 years of age) baseball players with elbow pain who underwent MRI examinations between 2010 and 2021. Two radiologists, blinded to the outcome, independently reviewed examinations to categorize skeletal maturity and to identify osseous and soft tissue findings with consensus used to resolve discrepancies. Findings were compared between skeletally immature and mature patients and logistic regression models identified predictors of surgery.

Results

This study included 130 children (115 boys, 15 girls): 85 skeletally immature and 45 mature (12.8±2.3 and 16.2±1.0 years, respectively, p<0.01). Kappa coefficient for interobserver agreement on MRI findings ranged from 0.64 to 0.96. Skeletally immature children, when compared to mature children, were more likely to have elbow effusion (27%, 23/85 vs 9%, 4/45; p=0.03), medial epicondyle marrow edema (53%, 45/85 vs 16%, 7/45; p<0.01), avulsion fracture (19%, 16/85 vs 2%, 1/45; p=0.02), and juvenile osteochondritis dissecans (OCD, 22%, 19/85 vs 7%, 3/45; p=0.04), whereas skeletally mature children were more likely to have sublime tubercle marrow edema (49%, 22/45 vs 11%, 9/85; p<0.01) and triceps tendinosis (40%, 18/45 vs 20%, 17/85; p=0.03). Intra-articular body (OR=4.2, 95% CI 1.5–47.8, p=0.02) and osteochondritis dissecans (OR=3.7, 95% CI 1.1–11.9, p=0.03) were independent predictors for surgery.

Conclusion

Differential patterns of elbow MRI findings were observed among symptomatic pediatric baseball players based on regional skeletal maturity. Intra-articular body and osteochondritis dissecans were independent predictors of surgery.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Andressa Guariento, M.D., Ph. D. for her support with the project.

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Authors and Affiliations

  1. Drexel University College of Medicine, Philadelphia, PA, USA

    Shahwar M. Tariq & Vandan Patel

  2. Section of Musculoskeletal Imaging, Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Shahwar M. Tariq, Vandan Patel, Liya Gendler & Jie C. Nguyen

  3. University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Liya Gendler, Apurva S. Shah, Theodore J. Ganley & Jie C. Nguyen

  4. Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Apurva S. Shah & Theodore J. Ganley

  5. Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Jefferson, Philadelphia, PA, USA

    Adam C. Zoga

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  1. Shahwar M. Tariq
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Correspondence to Jie C. Nguyen.

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Tariq, S.M., Patel, V., Gendler, L. et al. Pediatric thrower’s elbow: maturation-dependent MRI findings in symptomatic baseball players. Pediatr Radiol 54, 105–116 (2024). https://doi.org/10.1007/s00247-023-05817-0

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