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A COMPARISON OF ULNAR COLLATERAL LIGAMENT STRESS PROTOCOLS FOR ULTRASOUND IMAGING IN COLLEGE BASEBALL PLAYERS

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Date Issued:
2019-06-18
Summary:
Introduction: Musculoskeletal ultrasound imaging (UI) is an increasingly popular and reliable tool in addition to physical examination for assessment of anatomical structures and injuries. Ulnar collateral ligament (UCL) injuries in baseball players are becoming more frequent and account for a large portion of missed playing time. Studies have suggested that the ligamentous laxity of the UCL can be a predictor for future injury. There has been an effort to develop a standardized test for ligamentous laxity of the UCL using UI. Purpose: The purpose of this study was to assess the effect of gravity and manually applied valgus forces on humeroulnar joint gapping (HJG) compared to rest in the throwing arm of NCAA Division I collegiate baseball players using UI. Methods: This was a non-experimental quantitative repeated measures study. Ten NCAA Division I collegiate baseball players (mean age 20.3 ± 1.3 SD yrs) with no history of UCL injury participated. Images were obtained with a Phillips Lumify L12-4 ultrasound unit under three different conditions of valgus force. For measurement one, the subjects throwing shoulder was fully supported with the subject positioned supine with the throwing shoulder at 90 degrees of abduction, 45 degrees of external rotation, and 30 degrees of elbow flexion. For measurement two the subject’s forearm was unsupported with gravity applying a valgus force. For measurement three one clinician applied a 3 kg valgus stress using a handheld dynamometer (Hoggan Scientific MicroFET 2 hand held dynamometer) 20 cm distal to the medial epicondyle while also stabilizing the humerus. Post collection measurements were performed using a DICOM reader (MicroDicom DICOM viewer). The humeroulnar joint width measurements were taken from the distal edge of the trochlea and the proximal edge of the ulna in millimeters (mm). A Shapiro-Wilk test of normality was performed to determine whether the data followed a normal distribution. Due to the non-normal distribution of data, a Friedman Test was performed to assess whether a statically significant difference in HJG existed between the three groups. After a statistically significant difference between the three groups was found, three separate Wilcoxon Signed-Rank Tests were performed to assess for difference between pairs of groups. Results: There was a statistically significant increase in humeroulnar joint space with a gravity applied valgus force compared to rest (Z = -2.807, p < .005). There was also a statistically significant increase in humeroulnar joint space with a manually applied valgus force compared to gravity applied valgus force (Z = -2.805, p < .005). Finally, there was a statistically significant increase in humeroulnar joint space with a manually applied valgus force compared to rest (Z = -2.81 p < .005). Conclusion: A gravity induced valgus force can cause a statistically significant increase in HJG compared to rest, however further joint space opening was found when adding external valgus force. Further research is needed to investigate if the amount of HJG achieved through gravity is sufficient to identify ligamentous laxity.
Title: A COMPARISON OF ULNAR COLLATERAL LIGAMENT STRESS PROTOCOLS FOR ULTRASOUND IMAGING IN COLLEGE BASEBALL PLAYERS.
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Name(s): Caton, Sutter, Author
Marieb College of Health & Human Services, Degree granting institution
Type of Resource: text
Genre: Research Project
Issuance: single unit
Date Issued: 2019-06-18
Extent: 23 pgs.
Language(s): English
Summary: Introduction: Musculoskeletal ultrasound imaging (UI) is an increasingly popular and reliable tool in addition to physical examination for assessment of anatomical structures and injuries. Ulnar collateral ligament (UCL) injuries in baseball players are becoming more frequent and account for a large portion of missed playing time. Studies have suggested that the ligamentous laxity of the UCL can be a predictor for future injury. There has been an effort to develop a standardized test for ligamentous laxity of the UCL using UI. Purpose: The purpose of this study was to assess the effect of gravity and manually applied valgus forces on humeroulnar joint gapping (HJG) compared to rest in the throwing arm of NCAA Division I collegiate baseball players using UI. Methods: This was a non-experimental quantitative repeated measures study. Ten NCAA Division I collegiate baseball players (mean age 20.3 ± 1.3 SD yrs) with no history of UCL injury participated. Images were obtained with a Phillips Lumify L12-4 ultrasound unit under three different conditions of valgus force. For measurement one, the subjects throwing shoulder was fully supported with the subject positioned supine with the throwing shoulder at 90 degrees of abduction, 45 degrees of external rotation, and 30 degrees of elbow flexion. For measurement two the subject’s forearm was unsupported with gravity applying a valgus force. For measurement three one clinician applied a 3 kg valgus stress using a handheld dynamometer (Hoggan Scientific MicroFET 2 hand held dynamometer) 20 cm distal to the medial epicondyle while also stabilizing the humerus. Post collection measurements were performed using a DICOM reader (MicroDicom DICOM viewer). The humeroulnar joint width measurements were taken from the distal edge of the trochlea and the proximal edge of the ulna in millimeters (mm). A Shapiro-Wilk test of normality was performed to determine whether the data followed a normal distribution. Due to the non-normal distribution of data, a Friedman Test was performed to assess whether a statically significant difference in HJG existed between the three groups. After a statistically significant difference between the three groups was found, three separate Wilcoxon Signed-Rank Tests were performed to assess for difference between pairs of groups. Results: There was a statistically significant increase in humeroulnar joint space with a gravity applied valgus force compared to rest (Z = -2.807, p < .005). There was also a statistically significant increase in humeroulnar joint space with a manually applied valgus force compared to gravity applied valgus force (Z = -2.805, p < .005). Finally, there was a statistically significant increase in humeroulnar joint space with a manually applied valgus force compared to rest (Z = -2.81 p < .005). Conclusion: A gravity induced valgus force can cause a statistically significant increase in HJG compared to rest, however further joint space opening was found when adding external valgus force. Further research is needed to investigate if the amount of HJG achieved through gravity is sufficient to identify ligamentous laxity.
Identifier: fgcu_ETD_0311 (IID)
Degree Awarded: Doctorate in Physical Therapy
Department: Rehabilitation Sciences
Committee Chair: Arie J. van Duijn, EdD, PT, OCS
Committee Member(s): Rob Sillevis, PT, DPT, Ph.D., OCS, FAAOMPT, MTC; Jacqueline van Duijn, PT, DPT, OCS
Subject(s): Physical therapy
Persistent Link to This Record: http://purl.flvc.org/fgcu/fd/fgcu_ETD_0311
Use and Reproduction: Creator(s) holds copyright.
Use and Reproduction: http://rightsstatements.org/vocab/InC/1.0/
Host Institution: FGCU