Dynamic US of the Anterior Band of the Ulnar Collateral Ligament of the Elbow in Asymptomatic Major League Baseball Pitchers

PURPOSE: To determine whether dynamic ultrasonography (US) can reveal abnormalities of the anterior band of the ulnar collateral ligament (UCL) of the elbow in asymptomatic major league professional baseball players.

MATERIALS AND METHODS: US was performed in 26 asymptomatic major league professional baseball pitchers before spring training. Images were obtained in both pitching and nonpitching arms with a multifrequency 13-MHz linear-array transducer. The thickness of the anterior band of the UCL and the width of the joint it spans (the ulnohumeral joint) were measured with the elbow at 30° of flexion, both at rest and with valgus stress. The thickness of the anterior band of the UCL and the width of the joint space were compared for pitching and nonpitching arms by using the Student t test. The prevalence of hypoechoic areas and calcifications within the anterior band of the UCL in pitching and nonpitching arms was compared by using the McNemar test. The average time of the US examinations was recorded.

RESULTS: At rest, the mean thickness (± 1 SD) of the anterior band of the UCL was 6.3 mm ± 1.1 in pitching arms and 5.3 mm ± 1.0 in nonpitching arms. This difference was statistically significant (P < .01). With stress, the anterior band thickness was 6.3 mm ± 1.4 in the pitching arms and 4.8 mm ± 0.9 in the nonpitching arms (P < .001). The joint space width at rest was 2.8 mm ± 1.0 in the pitching arms and 2.5 mm ± 0.7 in the nonpitching arms (not statistically significant). When stress was applied, however, the joint space width was significantly greater in the pitching arms than in the nonpitching arms (4.2 mm ± 1.5 vs 3 mm ± 1.0, respectively; P < .01). Hypoechoic foci within the anterior band of the UCL were seen in 18 of 26 (69%) pitching arms and three of 26 (12%) nonpitching arms (P < .001). Calcifications were detected in nine of 26 (35%) pitching arms but in none of the nonpitching arms (P < .001). The average time for bilateral US was 10.4 minutes.

CONCLUSION: Dynamic US provides a rapid means for evaluating the anterior band of the UCL in professional baseball pitchers. In pitching arms, this band is thicker, is more likely to have hypoechoic foci and/or calcifications, and demonstrates more laxity with valgus stress.

© RSNA, 2003


  • 1 Jobe FW, Nuber G. Throwing injuries of the elbow. Clin Sports Med 1986; 5:621-636. Crossref, MedlineGoogle Scholar
  • 2 Rettig AC. Elbow, forearm, and wrist injuries in the athlete. Sports Med 1998; 25:115-130. Crossref, MedlineGoogle Scholar
  • 3 Pappas AM, Zawacki RM, Sullivan TJ. Biomechanics of baseball pitching: a preliminary report. Am J Sports Med 1985; 13:216-222. Crossref, MedlineGoogle Scholar
  • 4 Hyman J, Breazeale NM, Altchek DW. Valgus instability of the elbow in athletes. Clin Sports Med 2001; 20:25-45. Crossref, MedlineGoogle Scholar
  • 5 Chen FS, Rokito AS, Jobe FW. Medial elbow problems in the overhead-throwing athlete. J Am Acad Orthop Surg 2001; 9:99-113. Crossref, MedlineGoogle Scholar
  • 6 Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med 1983; 11:315-319. Crossref, MedlineGoogle Scholar
  • 7 Schwab GH, Bennett JB, Woods GW, Tullos HS. Biomechanics of elbow instability: the role of the medial collateral ligament. Clin Orthop 1980; 146:42-52. MedlineGoogle Scholar
  • 8 Fu SF. The ulnar collateral ligament of the human elbow joint: anatomy, function, and biomechanics. J Anat 1991; 175:203-212. MedlineGoogle Scholar
  • 9 Morrey BF, An KN. Functional anatomy of the ligaments of the elbow. Clin Orthop 1985; 201:84-90. MedlineGoogle Scholar
  • 10 Schwartz ML, Al-Zahrani S, Morwessel RM, Andrews JR. Ulnar collateral ligament injury in the throwing athlete: evaluation with saline-enhanced MR arthrography. Radiology 1995; 197:297-299. LinkGoogle Scholar
  • 11 Timmerman LA, Schwartz ML, Andrews JR. 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; 22:26-32. Crossref, MedlineGoogle Scholar
  • 12 Fritz RC, Steinbach LS, Tirman PFJ, Martinez S. MR imaging of the elbow: an update. Radiol Clin North Am 1997; 35:117-144. Crossref, MedlineGoogle Scholar
  • 13 Cotten A, Jacobson J, Brossmann J, et al. Collateral ligaments of the elbow: conventional MR imaging and MR arthrography with coronal oblique plane and elbow flexion. Radiology 1997; 204:806-812. LinkGoogle Scholar
  • 14 Popovic N, Ferrara MA, Daenen B, Georis P, Lemaire R. Imaging overuse injury of the elbow in professional team handball players: a bilateral comparison using plain films, stress radiography, ultrasound and magnetic resonance imaging. Int J Sports Med 2001; 22:60-67. Crossref, MedlineGoogle Scholar
  • 15 Ferrara MA, Marcelis S, Popovic N, Dondelinger RF. Modifications of the elbow induced by the practice of handball on radiography, US, and MRI. JBR-BTR 1999; 82:222-227. MedlineGoogle Scholar
  • 16 Timmerman LA, Andrews JR. Histology and arthroscopic anatomy of the ulnar collateral ligament of the elbow. Am J Sports Med 1994; 22:667-673. Crossref, MedlineGoogle Scholar
  • 17 Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes: treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am 1992; 74:67-83. Crossref, MedlineGoogle Scholar
  • 18 Kuroda S, Sakamaki K. Ulnar collateral ligament tears of the elbow joint. Clin Orthop 1984; 208:266-271. Google Scholar
  • 19 Lesin BE, Balfour GW. Acute rupture of the medial collateral ligament of the elbow requiring reconstruction. J Bone Joint Surg Am 1986; 68:1278-1280. Crossref, MedlineGoogle Scholar
  • 20 Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am 1986; 68:1158-1163. Crossref, MedlineGoogle Scholar
  • 21 Indelicato PA, Jobe FW, Kerlan RK, et al. Correctable elbow lesions in professional baseball players: a review of 25 cases. Am J Sports Med 1979; 7:72-75. Crossref, MedlineGoogle Scholar
  • 22 King JW, Brelsford HJ, Tullos HS. Analysis of the pitching arm of the professional baseball pitcher. Clin Orthop 1969; 67:116-123. MedlineGoogle Scholar
  • 23 Mulligan SA, Schwartz ML, Broussard MF, Andrews JR. Heterotopic calcification and tears of the ulnar collateral ligament: radiographic and MR imaging findings. AJR Am J Roentgenol 2000; 175:1099-1102. Crossref, MedlineGoogle Scholar
  • 24 Ellenbecker TS, Mattalino AJ, Elam EA, Caplinger RA. Medial elbow joint laxity in professional baseball pitchers: a bilateral comparison using stress radiography. Am J Sports Med 1998; 26:420-427. Crossref, MedlineGoogle Scholar
  • 25 Sasaki J, Takahara M, Ogino T, et al. Ultrasonographic assessment of the ulnar collateral ligament and medial elbow laxity in college baseball players. J Bone Joint Surg Am 2002; 84:525-531. Crossref, MedlineGoogle Scholar
  • 26 Rijke AM, Goitz HT, McCue FC, Andrews JR, Berr SS. Stress radiography of the medial elbow ligaments. Radiology 1994; 191:213-216. LinkGoogle Scholar

Article History

Published in print: Apr 2003