Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Reviews in Musculoskeletal Medicine
Published in: Current Reviews in Musculoskeletal Medicine 3/2021

Open Access 01-06-2021 | Magnetic Resonance Imaging | Injuries in Overhead Athletes (J Dines and C Camp, Section Editors)

Radiographic and MRI Assessment of the Thrower’s Elbow

Authors: G. M. Powell, N. S. Murthy, A. C. Johnson

Published in: Current Reviews in Musculoskeletal Medicine | Issue 3/2021

Login to get access

Abstract

Purpose of Review

Throwing athletes are vulnerable to elbow injuries, especially in the medial elbow, related to high stress and valgus load in both acute and chronic settings as a result of this complex biomechanical action. This current review details the relevant anatomy and imaging features of common elbow pathology identified with radiographs and MRI in throwing athletes.

Recent Findings

Although elbow pathology in throwing athletes is well documented, advances in imaging technology and technique, particularly with MRI, have allowed for more detailed and accurate imaging description and diagnosis.

Summary

Pathology of thrower’s elbow occurs in predictable patterns and can be reliably identified radiologically. Clinical history and physical examination should guide radiologic evaluation initially with radiographs and followed by an MRI optimized to the clinical question. Constellation of clinical, physical, and radiologic assessments should be used to guide management.
Literature
1.
2.
Meister K. Injuries to the shoulder in the throwing athlete. Part one: biomechanics/pathophysiology/classification of injury. Am J Sports Med. 2000;28(2):265–75.PubMedCrossRef
3.
Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part II: abnormalities of the ligaments, tendons, and nerves. Skelet Radiol. 2004;34(1):1–18.CrossRef
4.
Richard MJ. Traumatic valgus instability of the elbow: pathoanatomy and results of direct repair. J Bone Joint Surg Am. 2008;90(11):2416–22.PubMedCrossRef
5.
Potter HG, Ho ST, Altchek DW. Magnetic resonance imaging of the elbow. Semin Musculoskelet Radiol. 2004;8(1):5–16 (Copyright© 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA).PubMedCrossRef
6.
Kaplan LJ, Potter HG. MR imaging of ligament injuries to the elbow. Radiol Clin N Am. 2006;44(4):583–94.PubMedCrossRef
7.
Johnson D, Stevens KJ, Riley G, Shapiro L, Yoshioka H, Gold GE. Approach to MR imaging of the elbow and wrist: technical aspects and innovation. Magn Reson Imaging Clin N Am. 2015;23(3):355–66.PubMedPubMedCentralCrossRef
8.
Timmerman LAL, Schwartz MLM, Andrews JRJ. Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. Evaluation in 25 baseball players with surgical confirmation. Am J Sports Med. 1994;22(1):26–32.PubMedCrossRef
9.
Magee T. Accuracy of 3-T MR arthrography versus conventional 3-T MRI of elbow tendons and ligaments compared with surgery. AJR Am J Roentgenol. 2015;204(1):W70–5.PubMedCrossRef
10.
LiMarzi GM, O’Dell MC, Scherer K, Pettis C, Wasyliw CW, Bancroft LW. Magnetic resonance arthrography of the wrist and elbow. Magn Reson Imaging Clin N Am. 2015;23(3):441–55.PubMedCrossRef
11.
Munshi M, Pretterklieber ML, Chung CB, Haghighi P, Cho JH, Trudell DJ, et al. Anterior bundle of ulnar collateral ligament: evaluation of anatomic relationships by using mr imaging, mr arthrography, and gross anatomic and histologic analysis. Radiology. 2004;231(3):797–803.PubMedCrossRef
12.
Sugimoto H, Ohsawa T. Ulnar collateral ligament in the growing elbow: MR imaging of normal development and throwing injuries. Radiology. 1994;192(2):417–22.PubMedCrossRef
13.
14.
Callaway GH, Field LD, Deng XH, Torzilli PA, O’Brien SJ, Altchek DW, et al. Biomechanical evaluation of the medial collateral ligament of the elbow. J Bone Joint Surg Am. 1997;79(8):1223–31.PubMedCrossRef
15.
Morrey BF, An K. Functional anatomy of the ligaments of the elbow. Clin Orthop Relat Res. 1985;201:84–90.CrossRef
16.
Bryce CDC, Armstrong ADA. Anatomy and biomechanics of the elbow. Orthop Clin North Am. 2008;39(2):141–54.PubMedCrossRef
17.
Hauptfleisch J, English C, Murphy D. Elbow magnetic resonance imaging: imaging anatomy and evaluation. Top Magn Reson Imaging. 2015;24(2):93–107.PubMedCrossRef
18.
Husarik DB, Saupe N, Pfirrmann CWA, Jost B, Hodler J, Zanetti M. Ligaments and plicae of the elbow: normal mr imaging variability in 60 asymptomatic subjects. Radiology. 2010;257(1):185–94.PubMedCrossRef
19.
Gaary EA, Potter HG, Altchek DW. Medial elbow pain in the throwing athlete: MR imaging evaluation. AJR Am J Roentgenol. 1997;168(3):795–800 (PubMed—NCBI).PubMedCrossRef
20.
Cinque ME, Schickendantz M, Frangiamore S. Review of anatomy of the medial ulnar collateral ligament complex of the elbow. Curr Rev Musculoskelet Med. 2020;13:96–102.PubMedPubMedCentralCrossRef
21.
Ouellette H, Kassarjian A, Tretreault P, Palmer W. Imaging of the overhead throwing athlete. Semin Musculoskelet Radiol. 2005;9(4):316–33.PubMedCrossRef
22.
McCarty LP 3rd. Approach to medial elbow pain in the throwing athlete. Curr Rev Musculoskelet Med. 2019;12(1):30–40.CrossRef
23.
Bucknor MD, Stevens KJ, Steinbach LS. Elbow imaging in sport: sports imaging series. Radiology. 2016;279(1):12–28.PubMedCrossRef
24.•
Wong TT, Lin DJ, Ayyala RS, Kazam JK. Elbow injuries in adult overhead athletes. AJR Am J Roentgenol. 2017;208(3):W110–20 This article does good job detailing the MRI appearance and underlying biomechanical explanation of the findings related to posteromedial impingement.
25.
Wo S, Mulcahy H, Richardson ML, Chew FS, Gee A, Hsu J, et al. Pathologies of the shoulder and elbow affecting the overhead throwing athlete. Skelet Radiol. 2017;46(7):873–88.CrossRef
26.
Lurie B, Fritz J, Potter H. MR imaging in patients with ulnar collateral ligament injury. In: Dines J, Altchek D, editors. Elbow ulnar collateral ligament injury. Boston: Springer; 2015.
27.
Salvo JP, Rizio L, Zvijac JE, Uribe JW, Hechtman KS. Avulsion fracture of the ulnar sublime tubercle in overhead throwing athletes. Am J Sports Med. 2002;30(3):426–31.PubMedCrossRef
28.
Ramkumar PN, Frangiamore SJ, Navarro SM, Lynch TS, Forney MC, Kaar SG, et al. Interobserver and intraobserver reliability of an MRI-based classification system for injuries to the ulnar collateral ligament. Am J Sports Med. 2018;46(11):2755–60.PubMedCrossRef
29.
Ramkumar PN, Haeberle HS, Navarro SM, Frangiamore SJ, Farrow LD, Schickendantz MS. Prognostic utility of an magnetic resonance imaging-based classification for operative versus nonoperative management of ulnar collateral ligament tears: one-year follow-up. J Shoulder Elb Surg. 2019;28(6):1159–65.CrossRef
30.
Hurd WJ, Eby S, Kaufman KR, Murthy NS. Magnetic resonance imaging of the throwing elbow in the uninjured, high school-aged baseball pitcher. Am J Sports Med. 2011;39(4):722–8.PubMedPubMedCentralCrossRef
31.
Potter HG. Imaging of posttraumatic and soft tissue dysfunction of the elbow. Clin Orthop Relat Res. 2000;2000(370):9–18.CrossRef
32.
Mirowitz SAS, London SLS. Ulnar collateral ligament injury in baseball pitchers: MR imaging evaluation. Radiology. 1992;185(2):573–6.PubMedCrossRef
33.
Dodson CC, Thomas A, Dines JS, Nho SJ, Williams RJ, Altchek DW. Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes. Am J Sports Med. 2006;34(12):1926–32.PubMedCrossRef
34.
Glousman R, Barron J, Jobe FW, Perry J, Pink M. An electromyographic analysis of the elbow in normal and injured pitchers with medial collateral ligament insufficiency. Am J Sports Med. 1992;20:311–7.PubMedCrossRef
35.
Potter HGH, Hannafin JAJ, Morwessel RMR, DiCarlo EFE, O’Brien SJS, Altchek DWD. Lateral epicondylitis: correlation of MR imaging, surgical, and histopathologic findings. Radiology. 1995;196(1):43–6.PubMedCrossRef
36.
Gabel GT, Morrey BF. Operative treatment of medial epicondylitis: influence of concomitant ulnar neuropathy at the elbow. J Bone Joint Surg Am. 1995;77(7):1065–9.PubMedCrossRef
37.
Hash T, Bogner E. Nerve entrapment and compression syndromes of the elbow. Semin Musculoskelet Radiol. 2010;14(4):438–48.PubMedCrossRef
38.••
Logli AL, Bernard CD, O’Driscoll SW, et al. Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm. Curr Rev Musculoskelet Med. 2019;12(1):1–12 An excellent review and discussion of the clinically important imaging findings of OCD lesions including their importance in directing treatment and predicting outcomes.
39.
Collins MS, Tiegs-Heiden CA. Osteochondral lesions of the lateral trochlear ridge: a rare, subtle but important finding on advanced imaging in patients with elbow pain. Skelet Radiol. 2020;49(4):593–9.CrossRef
40.
Patel NB, Thomas S, Lazarus ML. Throwing injuries of the upper extremity. Radiol Clin N Am. 2013;51(2):257–77.PubMedCrossRef
41.
Sofka CM, Potter HG. Imaging of elbow injuries in the child and adult athlete. Radiol Clin N Am. 2002;40(2):251–65.PubMedCrossRef
42.
Satake H, Takahara M, Harada M, Maruyama M. Preoperative imaging criteria for unstable osteochondritis dissecans of the capitellum. Clin Orthop Relat Res. 2013;471(4):1137–43.PubMedCrossRef
43.
Itsubo T, Murakami N, Uemura K, Nakamura K, Hayashi M, Uchiyama S, et al. Magnetic resonance imaging staging to evaluate the stability of capitellar osteochondritis dissecans lesions. Am J Sports Med. 2009;37(2):298–304.
44.
Kohyama S, Ogawa T, Mamizuka N, Hara Y, Yamazaki M. A magnetic resonance imaging-based staging system for osteochondritis dissecans of the elbow: a validation study against the International Cartilage Repair Society Classification. Orthop J Sports Med. 2018;6(9):2325967118794620.PubMedPubMedCentralCrossRef
45.
Metadata
Title
Radiographic and MRI Assessment of the Thrower’s Elbow
Authors
G. M. Powell
N. S. Murthy
A. C. Johnson
Publication date
01-06-2021
Publisher
Springer US
Published in
Current Reviews in Musculoskeletal Medicine / Issue 3/2021
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-021-09702-x

Other articles of this Issue 3/2021

Current Reviews in Musculoskeletal Medicine 3/2021 Go to the issue

Non-Operative Management of Anterior Knee Pain (M Fredericson and T Besier, Section Editors)

Narrative Review — Knee Pain in the Pediatric Athlete

Injuries in Overhead Athletes (J Dines and C Camp, Section Editors)

The Science and Biomechanics of Long-Toss

Hot Topics

Megaprosthesis Versus Allograft Prosthesis Composite for the Management of Massive Skeletal Defects: A Meta-Analysis of Comparative Studies

Hot Topics

Scapulothoracic Dyskinesis: A Concept Review

Non-Operative Management of Anterior Knee Pain (M Fredericson and T Besier, Section Editors)

Narrative: Review of Anterior Knee Pain Differential Diagnosis (Other than Patellofemoral Pain)

Compressive Neuropathies in the Upper Extremity (E Shin, Section Editor)

Radial Tunnel Syndrome