Optimal Elbow Angle for Sonographic Visualization of the Ulnar Collateral Ligament

Daniel R. Lueders; Adam M. Pourcho; Jacob L. Sellon; Diane L. Dahm; Jay Smith

doi:10.1016/j.pmrj.2015.03.015

Optimal Elbow Angle for Sonographic Visualization of the Ulnar Collateral Ligament

Daniel R. Lueders, Adam M. Pourcho, Jacob L. Sellon, Diane L. Dahm, Jay Smith

Physical Medicine and Rehabilitation

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Objective: To formally examine the sonographic appearance of the elbow ulnar collateral ligament (UCL) at 30° versus 70° of elbow flexion in asymptomatic baseball pitchers. Design: A prospective, cross-sectional design. Setting: Sports medicine clinic in a tertiary academic medical center. Participants: Thirty asymptomatic adolescent baseball pitchers 13-18 years of age (mean 15.8 years), with at least 3 years of continuous pitching experience and no significant history of elbow pain or injury. Methods: Static sonographic images of the bilateral UCLs were obtained at 30° and 70° of elbow flexion by a single experienced examiner. Images were anonymized and randomized into a slide set. Three clinicians with different levels of ultrasound experience reviewed the static 30° and 70° images for each elbow and chose their preferred image based on UCL conspicuity. The clinicians reviewed a re-randomized slide set 1 week later. A different study co-investigator measured UCL cross-sectional area (CSA) on all images using ultrasound machine electronic calipers. Main Outcome Measures: Preference for the sonographic conspicuity of the UCL at 30° versus 70° of elbow flexion, and UCL CSA at 30° versus 70° of flexion. Results: Each clinician demonstrated a significant preference for UCL images obtained at 70° of flexion when compared to those obtained at 30° (80.3% overall preference for 70°, P < .001). There was no statistically significant effect of clinician experience or arm dominance on image preference. The sonographically determined CSA of the UCLs were on average 1.4 mm² greater at 70° than at 30° of flexion (P < .001) when combining dominant and nondominant arms. Conclusions: Static sonographic evaluation of the UCL at 70° of elbow flexion should be integrated into UCL imaging protocols. Furthermore, when performing sonographically guided procedures targeting the UCL, clinicians should consider positioning the elbow at >30° of flexion to optimize UCL conspicuity and CSA.

Original language	English (US)
Pages (from-to)	970-977
Number of pages	8
Journal	PM and R
Volume	7
Issue number	9
DOIs	https://doi.org/10.1016/j.pmrj.2015.03.015
State	Published - 2015

ASJC Scopus subject areas

Physical Therapy, Sports Therapy and Rehabilitation
Rehabilitation
Neurology
Clinical Neurology

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10.1016/j.pmrj.2015.03.015

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title = "Optimal Elbow Angle for Sonographic Visualization of the Ulnar Collateral Ligament",

abstract = "Objective: To formally examine the sonographic appearance of the elbow ulnar collateral ligament (UCL) at 30° versus 70° of elbow flexion in asymptomatic baseball pitchers. Design: A prospective, cross-sectional design. Setting: Sports medicine clinic in a tertiary academic medical center. Participants: Thirty asymptomatic adolescent baseball pitchers 13-18 years of age (mean 15.8 years), with at least 3 years of continuous pitching experience and no significant history of elbow pain or injury. Methods: Static sonographic images of the bilateral UCLs were obtained at 30° and 70° of elbow flexion by a single experienced examiner. Images were anonymized and randomized into a slide set. Three clinicians with different levels of ultrasound experience reviewed the static 30° and 70° images for each elbow and chose their preferred image based on UCL conspicuity. The clinicians reviewed a re-randomized slide set 1 week later. A different study co-investigator measured UCL cross-sectional area (CSA) on all images using ultrasound machine electronic calipers. Main Outcome Measures: Preference for the sonographic conspicuity of the UCL at 30° versus 70° of elbow flexion, and UCL CSA at 30° versus 70° of flexion. Results: Each clinician demonstrated a significant preference for UCL images obtained at 70° of flexion when compared to those obtained at 30° (80.3% overall preference for 70°, P < .001). There was no statistically significant effect of clinician experience or arm dominance on image preference. The sonographically determined CSA of the UCLs were on average 1.4 mm2 greater at 70° than at 30° of flexion (P < .001) when combining dominant and nondominant arms. Conclusions: Static sonographic evaluation of the UCL at 70° of elbow flexion should be integrated into UCL imaging protocols. Furthermore, when performing sonographically guided procedures targeting the UCL, clinicians should consider positioning the elbow at >30° of flexion to optimize UCL conspicuity and CSA.",

author = "Lueders, {Daniel R.} and Pourcho, {Adam M.} and Sellon, {Jacob L.} and Dahm, {Diane L.} and Jay Smith",

note = "Publisher Copyright: {\textcopyright} 2015 American Academy of Physical Medicine and Rehabilitation.",

year = "2015",

doi = "10.1016/j.pmrj.2015.03.015",

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AU - Sellon, Jacob L.

AU - Dahm, Diane L.

AU - Smith, Jay

PY - 2015

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N2 - Objective: To formally examine the sonographic appearance of the elbow ulnar collateral ligament (UCL) at 30° versus 70° of elbow flexion in asymptomatic baseball pitchers. Design: A prospective, cross-sectional design. Setting: Sports medicine clinic in a tertiary academic medical center. Participants: Thirty asymptomatic adolescent baseball pitchers 13-18 years of age (mean 15.8 years), with at least 3 years of continuous pitching experience and no significant history of elbow pain or injury. Methods: Static sonographic images of the bilateral UCLs were obtained at 30° and 70° of elbow flexion by a single experienced examiner. Images were anonymized and randomized into a slide set. Three clinicians with different levels of ultrasound experience reviewed the static 30° and 70° images for each elbow and chose their preferred image based on UCL conspicuity. The clinicians reviewed a re-randomized slide set 1 week later. A different study co-investigator measured UCL cross-sectional area (CSA) on all images using ultrasound machine electronic calipers. Main Outcome Measures: Preference for the sonographic conspicuity of the UCL at 30° versus 70° of elbow flexion, and UCL CSA at 30° versus 70° of flexion. Results: Each clinician demonstrated a significant preference for UCL images obtained at 70° of flexion when compared to those obtained at 30° (80.3% overall preference for 70°, P < .001). There was no statistically significant effect of clinician experience or arm dominance on image preference. The sonographically determined CSA of the UCLs were on average 1.4 mm2 greater at 70° than at 30° of flexion (P < .001) when combining dominant and nondominant arms. Conclusions: Static sonographic evaluation of the UCL at 70° of elbow flexion should be integrated into UCL imaging protocols. Furthermore, when performing sonographically guided procedures targeting the UCL, clinicians should consider positioning the elbow at >30° of flexion to optimize UCL conspicuity and CSA.

AB - Objective: To formally examine the sonographic appearance of the elbow ulnar collateral ligament (UCL) at 30° versus 70° of elbow flexion in asymptomatic baseball pitchers. Design: A prospective, cross-sectional design. Setting: Sports medicine clinic in a tertiary academic medical center. Participants: Thirty asymptomatic adolescent baseball pitchers 13-18 years of age (mean 15.8 years), with at least 3 years of continuous pitching experience and no significant history of elbow pain or injury. Methods: Static sonographic images of the bilateral UCLs were obtained at 30° and 70° of elbow flexion by a single experienced examiner. Images were anonymized and randomized into a slide set. Three clinicians with different levels of ultrasound experience reviewed the static 30° and 70° images for each elbow and chose their preferred image based on UCL conspicuity. The clinicians reviewed a re-randomized slide set 1 week later. A different study co-investigator measured UCL cross-sectional area (CSA) on all images using ultrasound machine electronic calipers. Main Outcome Measures: Preference for the sonographic conspicuity of the UCL at 30° versus 70° of elbow flexion, and UCL CSA at 30° versus 70° of flexion. Results: Each clinician demonstrated a significant preference for UCL images obtained at 70° of flexion when compared to those obtained at 30° (80.3% overall preference for 70°, P < .001). There was no statistically significant effect of clinician experience or arm dominance on image preference. The sonographically determined CSA of the UCLs were on average 1.4 mm2 greater at 70° than at 30° of flexion (P < .001) when combining dominant and nondominant arms. Conclusions: Static sonographic evaluation of the UCL at 70° of elbow flexion should be integrated into UCL imaging protocols. Furthermore, when performing sonographically guided procedures targeting the UCL, clinicians should consider positioning the elbow at >30° of flexion to optimize UCL conspicuity and CSA.

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Optimal Elbow Angle for Sonographic Visualization of the Ulnar Collateral Ligament

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