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Research Papers

Evaluating Changes in Shear Modulus of Elbow Ulnar Collateral Ligament in Overhead Throwing Athletes Over the Course of a Competitive Season

[+] Author and Article Information
Seyedali Sadeghi

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

Che-Yu Lin

Department of Biomedical Engineering,
University of Michigan,
Ann Arbor, MI 48109
e-mail: d97543011@ntu.edu.tw

Dov A. Bader

Department of Orthopaedics and Rehabilitation,
Penn State College of Medicine,
University Park, PA 16802
e-mail: dbader@pennstatehealth.psu.edu

Daniel H. Cortes

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

1Corresponding author.

Manuscript received July 25, 2018; final manuscript received September 11, 2018; published online October 1, 2018. Assoc. Editor: Azra Alizad.

ASME J of Medical Diagnostics 1(4), 041008 (Oct 01, 2018) (6 pages) Paper No: JESMDT-18-1033; doi: 10.1115/1.4041503 History: Received July 25, 2018; Revised September 11, 2018

The anterior band of the ulnar collateral ligament (UCL) is commonly subjected to repetitive stress in overhead-throwing athletes, causing high subfailure strain and change in mechanical properties of the ligament. Understanding the change in UCL mechanical properties after repetitive loading can help to evaluate the health status of UCL. The objective of this study was to evaluate changes in UCL shear modulus in overhead-throwing, Division I college-level athletes over the course of a competitive season using ultrasound shear wave elastography (SWE). The proposed protocol quantified changes in shear modulus of UCL in 17 baseball players at preseason and season-end time points as well as in five football quarterbacks at preseason, midseason, and season-end time points. The highest shear modulus values were obtained in the nondominant arm at preseason time points in both groups of athletes. The average UCL shear modulus at the season-end decreased by 39.35% and 37.96% compared to the preseason values in dominant and nondominant arms, respectively. This study shows that SWE could quantify changes in the shear modulus of the UCL after repetitive loading, suggesting that it could be a useful clinical tool for evaluating the risk of UCL injury. Further research on injured overhead-throwing athletes is warranted.

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Figures

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Fig. 1

The experimental setup for elastography of the UCL. Participant is lying supine with the elbow at 30 deg of flexion, and the shoulder at 30 deg of abduction and 90 deg of external rotation during measurement.

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Fig. 2

Ultrasound B-mode image of the UCL including the medical epicondyle (M), trochlea of the humerus (T), coronoid process of the ulna (C), and superficial part of the UCL

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Fig. 3

Elastography measurement of the UCL

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Fig. 4

Shear modulus of UCL (average, standard deviation) in 17 baseball players (six position players and eleven pitchers combined) at preseason and season-end time points. The black dots represent the shear modulus of individual participants.

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Fig. 5

Shear modulus of UCL (average, standard deviation) in 11 baseball pitchers at preseason and season-end time points. The black dots represent the shear modulus of individual participants.

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Fig. 6

Shear modulus of UCL (average, standard deviation) in six baseball position players at preseason and season-end time points. The black dots represent the shear modulus of individual participants.

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Fig. 7

Bland–Altman plot of differences in shear modulus at preseason and season-end time points in the dominant arm. The solid line represents the mean of shear modulus difference of ratings. The dashed lines define the limits of agreement (mean of the differences ±1.96 SD).

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Fig. 8

Bland–Altman plot of differences in shear modulus at preseason and season-end time points in the nondominant arm. The solid line represents the mean of shear modulus difference of ratings. The dashed lines define the limits of agreement (mean of the differences ±1.96 SD).

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Fig. 9

Shear modulus of UCL (average, standard deviation) in five football quarterbacks at preseason, midseason and season-end time points

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