Changes in medial elbow elasticity and joint space gapping during maximal gripping: reliability and validity in evaluation of the medial elbow joint using ultrasound elastography

Hiroshi Hattori; Kiyokazu Akasaka; Takahiro Otsudo; Toby Hall; Katsuya Amemiya; Yoshihisa Mori; Katsunobu Sakaguchi; Yomei Tachibana

doi:10.1016/j.jse.2019.11.005

Changes in medial elbow elasticity and joint space gapping during maximal gripping: reliability and validity in evaluation of the medial elbow joint using ultrasound elastography

J Shoulder Elbow Surg. 2020 Jun;29(6):e245-e251. doi: 10.1016/j.jse.2019.11.005. Epub 2020 Feb 12.

Authors

Hiroshi Hattori¹, Kiyokazu Akasaka², Takahiro Otsudo³, Toby Hall⁴, Katsuya Amemiya⁵, Yoshihisa Mori⁶, Katsunobu Sakaguchi⁷, Yomei Tachibana⁷

Affiliations

¹ Department of Physical Therapy, Saitama Medical University Graduate School of Medicine, Saitama, Japan; Department of Rehabilitation, Kawagoe Clinic, Saitama Medical University, Saitama, Japan.
² Department of Physical Therapy, Saitama Medical University Graduate School of Medicine, Saitama, Japan; School of Physical Therapy, Saitama Medical University, Saitama, Japan. Electronic address: akasaka-smc@umin.ac.jp.
³ Department of Physical Therapy, Saitama Medical University Graduate School of Medicine, Saitama, Japan; School of Physical Therapy, Saitama Medical University, Saitama, Japan.
⁴ School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.
⁵ Department of Rehabilitation, Kawagoe Clinic, Saitama Medical University, Saitama, Japan.
⁶ Department of Rehabilitation, TUMS Urayasu Hospital, Chiba, Japan.
⁷ Division of Sports Medicine and Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan.

PMID: 32061511
DOI: 10.1016/j.jse.2019.11.005

Abstract

Background: Medial elbow injuries are common in baseball pitchers. This study investigated the reliability of medial elbow elastography measurement and the characteristics of the medial elbow stabilizers.

Methods: Medial elbow joint space gapping and the strain ratios of the ulnar collateral ligament (UCL) and the forearm flexor-pronator muscle (FPM) were measured at rest and during gripping in 29 healthy college students. The intraclass correlation coefficients of elastography were calculated. The data were compared between tissues and between rest and gripping.

Results: The intraclass correlation coefficients (ICC_1,3) of the elastography measurements were 0.91 and 0.83 for the UCL and 0.80 and 0.85 for the FPM for each examiner. Medial elbow joint space gapping during gripping (3.1 ± 0.6 mm) was significantly less than that at rest (3.8 ± 0.8 mm, P < .001). The strain ratios for both the UCL and FPM during gripping were significantly greater than those at rest (17.64 ± 10.97 during gripping vs. 3.94 ± 1.92 at rest for UCL, P < .001; 1.72 ± 0.99 during gripping vs. 0.35 ± 1.92 at rest for FPM, P < .001). The strain ratio for the UCL was significantly greater than that for the FPM both at rest (P < .001) and during gripping (P < .001).

Conclusions: Elastography measurements of the UCL and FPM have almost perfect reliability. Gripping reduces medial elbow joint space gapping compared with rest. For both tissues, gripping reduces their elasticity compared with rest. The elasticity of the UCL is less than that of the FPM both at rest and during gripping.

Keywords: Elbow; baseball; elastography; forearm flexor-pronator muscle; injury prevention; ulnar collateral ligament; ultrasound.

MeSH terms

Collateral Ligament, Ulnar / diagnostic imaging*
Collateral Ligament, Ulnar / physiology
Elasticity / physiology*
Elasticity Imaging Techniques*
Elbow Joint / diagnostic imaging*
Elbow Joint / physiology
Forearm
Hand Strength / physiology*
Humans
Male
Muscle, Skeletal / diagnostic imaging*
Muscle, Skeletal / physiology
Reproducibility of Results
Young Adult