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Research Papers

Ultrasound Shear Wave Elastography of the Elbow Ulnar Collateral Ligament: Reliability Test and a Preliminary Case Study in a Baseball Pitcher

[+] Author and Article Information
Che-Yu Lin

Department of Mechanical and
Nuclear Engineering,
College of Engineering,
The Pennsylvania State University,
State College, PA 16802
e-mail: d97543011@ntu.edu.tw

Seyedali Sadeghi

Department of Mechanical and
Nuclear Engineering,
College of Engineering,
The Pennsylvania State University,
State College, PA 16802
e-mail: sus653@psu.edu

Dov A. Bader

Department of Orthopaedics & Rehabilitation,
The Pennsylvania State University,
State College, PA 16802
e-mail: dbader@pennstatehealth.psu.edu

Daniel H. Cortes

Department of Mechanical and
Nuclear Engineering,
Department of Biomedical Engineering,
College of Engineering,
The Pennsylvania State University,
State College, PA 16802
e-mail: dhc13@psu.edu

1Corresponding author.

Manuscript received August 4, 2017; final manuscript received October 18, 2017; published online November 14, 2017. Editor: Ahmed Al-Jumaily.

ASME J of Medical Diagnostics 1(1), 011004 (Nov 14, 2017) (5 pages) Paper No: JESMDT-17-2023; doi: 10.1115/1.4038259 History: Received August 04, 2017; Revised October 18, 2017

Overhead throwing athletes are at high risk of the elbow ulnar collateral ligament (UCL) injury, and there is a need for clinical tools to objectively diagnose severity of injury and monitor recovery. Mechanical properties of ligaments can potentially be used as biomarkers of UCL health. The objectives of this study are to evaluate the reliability of shear wave ultrasound elastography (SWE) for quantifying UCL shear modulus in 16 healthy nonthrowing individuals and use this technique to evaluate the difference in UCL shear modulus between the injured and uninjured elbows in a baseball pitcher with UCL tear. In the reliability test, the UCL shear modulus of both elbows of each participant was evaluated by SWE for five trials. The same procedures were repeated on two different days. The intra-day and day-to-day reliabilities were determined by the five measurements on the first day and two averages on the two days, respectively. In the case study, each elbow of the baseball pitcher with UCL tear was tested for five trials, and the average was calculated. The intra-day (intraclass correlation coefficient (ICC) = 0.715, Cronbach's alpha = 0.926) and day-to-day (ICC = 0.948, Cronbach's alpha = 0.955) reliabilities were found to be good. There was no difference between both sides. In the case study, the UCL shear modulus of the injured elbow (186.45 kPa) was much lower than that of the uninjured elbow (879.59 kPa). This study shows that SWE could be a reliable tool for quantifying the mechanical properties and health status of the UCL.

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Figures

Grahic Jump Location
Fig. 1

The participant laying supine on the examination tablewith the elbow at 30 deg of flexion, and the shoulder at 30 deg of abduction and 90 deg of external rotation during measurement

Grahic Jump Location
Fig. 2

Shear wave elastography evaluation of the UCL. An acceptable B-mode image for evaluating the UCL includes the medical epicondyle (M) and trochlea of the humerus (T), coronoid process of the ulna (C), common flexor tendon (CFT) and superficial part of the UCL. The two-dimensional shear modulus map corresponding to the rectangular FOV shows the shear modulus levels of the tissues represented by colors ranging from red (stiff) to blue (soft). The band-like shear modulus distribution of the UCL could be observed in the central horizontal region of the image. The high shear modulus distributions observed in the upper and lower left regions of the FOV correspond to the common flexor tendon and the periosteum of the trochlea of the humerus, respectively.

Grahic Jump Location
Fig. 3

The shear modulus of the UCL was determined by selecting a region of interest (the solid-line region) by manually tracing the contour of the superficial part of the UCL in the corresponding B-mode image using a custom-designed matlab program. The UCL shear modulus was defined as the median shear modulus in that region. Measurements of the UCL thickness (the length of the right dashed line) and the width of the ulnohumeral joint space (the length of the left dashed line) were illustrated.

Grahic Jump Location
Fig. 4

The scatterplot of the averages on two different days for the UCL shear modulus in 16 healthy nonthrowing participants. The dashed line indicates the 1:1 perfect agreement.

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