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Using Sonography for the Early Detection of Elbow Injuries Among Young Baseball Players

Mikio Harada1, Masatoshi Takahara1, Junya Sasaki1, Nariyuki Mura1, Tomokazu Ito2 and Toshihiko Ogino1

1 Department of Orthopaedic Surgery, Yamagata University School of Medicine, Iida Nishi 2-2-2, Yamagata 990-9585, Japan.
2 Department of Orthopaedic Surgery, Saiseikai Yamagata Hospital, Yamagata, Japan.


Figure 1
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  		Fig. 1 —Photograph depicts technique for scanning medial aspect of elbow.

 

Figure 2
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  		Fig. 2A —Sonography and radiography of medial aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Imaging technique: transducer is placed on medial aspect of elbow in 90° of flexion.

 

Figure 3
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  		Fig. 2B —Sonography and radiography of medial aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Diagram shows imaging plane of medial aspect of elbow. Asterisk indicates medial epicondyle.

 

Figure 4
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  		Fig. 2C —Sonography and radiography of medial aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Sonogram (C) and corresponding diagram (D) show medial aspect of elbow on nonthrowing side. Asterisk indicates medial epicondyle; large arrow, growth plate between humeral medial epicondyle and trochlea; small arrows, humeral trochlea; and arrowheads, ulnar collateral ligament.

 

Figure 5
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  		Fig. 2D —Sonography and radiography of medial aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Sonogram (C) and corresponding diagram (D) show medial aspect of elbow on nonthrowing side. Asterisk indicates medial epicondyle; large arrow, growth plate between humeral medial epicondyle and trochlea; small arrows, humeral trochlea; and arrowheads, ulnar collateral ligament.

 

Figure 6
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  		Fig. 2E —Sonography and radiography of medial aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Sonogram (E) and corresponding diagram (F) show medial aspect of elbow on throwing side. Medial epicondylar fragmentation (arrow) is evident as discontinuity of medial epicondyle (asterisk).

 

Figure 7
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  		Fig. 2F —Sonography and radiography of medial aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Sonogram (E) and corresponding diagram (F) show medial aspect of elbow on throwing side. Medial epicondylar fragmentation (arrow) is evident as discontinuity of medial epicondyle (asterisk).

 

Figure 8
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  		Fig. 2G —Sonography and radiography of medial aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Anteroposterior radiograph of elbow on throwing side flexed at 45°. Asterisk indicates medial epicondyle.

 

Figure 9
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  		Fig. 2H —Sonography and radiography of medial aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Magnification of radiograph shows medial aspect of elbow on throwing side. Asterisk indicates medial epicondyle. Extent of medial epicondylar fragmentation (arrows) shown on radiography appears smaller than that shown on sonography.

 

Figure 10
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  		Fig. 3A —Sonography and radiography of lateral aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Imaging technique: Transducer is placed on lateral aspect of elbow in 0° of extension.

 

Figure 11
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  		Fig. 3B —Sonography and radiography of lateral aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Diagram shows imaging plane of lateral aspect of elbow.

 

Figure 12
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  		Fig. 3C —Sonography and radiography of lateral aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Sonogram (C) and corresponding diagram (D) of lateral aspect of elbow on nonthrowing side show humeral capitellum (C) and radial head (R) from sagittal view. Subchondral bone of capitellum is identified as hyperechoic area (arrows), whereas its articular cartilage is identified as hypo-echoic area (arrowheads).

 

Figure 13
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  		Fig. 3D —Sonography and radiography of lateral aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Sonogram (C) and corresponding diagram (D) of lateral aspect of elbow on nonthrowing side show humeral capitellum (C) and radial head (R) from sagittal view. Subchondral bone of capitellum is identified as hyperechoic area (arrows), whereas its articular cartilage is identified as hypo-echoic area (arrowheads).

 

Figure 14
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  		Fig. 3E —Sonography and radiography of lateral aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Sonogram (E) and corresponding diagram (F) of lateral aspect of elbow on throwing side. Gap between fragment (asterisk) and its base (arrows) in capitellum indicates osteochondritis dissecans. R = radial head, C = capitellum.

 

Figure 15
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  		Fig. 3F —Sonography and radiography of lateral aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Sonogram (E) and corresponding diagram (F) of lateral aspect of elbow on throwing side. Gap between fragment (asterisk) and its base (arrows) in capitellum indicates osteochondritis dissecans. R = radial head, C = capitellum.

 

Figure 16
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  		Fig. 3G —Sonography and radiography of lateral aspect of elbow in 12-year-old male baseball player. No player was symptomatic at time of sonographic examination. Anteroposterior radiograph of elbow on throwing side flexed at 45°. Early stage of osteochondritis dissecans of humeral capitellum is shown as radiolucent region (arrows).

 

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