Long head of the biceps brachii tendon: unenhanced MRI versus direct MR arthrography.

OBJECTIVE: We sought to determine the diagnostic accuracy of unenhanced MRI and direct MR arthrography (MRA) for evaluation of the intra-articular long head of the biceps brachii tendon (LHBT) using arthroscopy as the gold standard. MATERIALS AND METHODS: A retrospective review of patients who underwent shoulder MRI (n = 132) and MRA (n = 67) within 12 months prior to arthroscopy was performed. MR images were independently reviewed by two blinded musculoskeletal radiologists. Routinely recorded arthroscopic photos/videos were reviewed by an orthopedic surgeon. The LHBT was graded as normal, tendinosis, partial thickness tear less or greater than 50%, and complete tear. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for tendinosis and tear detection were calculated. RESULTS: MRI correctly diagnosed fewer normal LHBTs compared to MRA (39-54% versus 74-84%, respectively; p < 0.005). MRI and MRA did not differ significantly in the diagnosis of tendinosis (18-36% and 15-38%, respectively; p > 0.05) and tears (75-83% and 64-73%, respectively; p > 0.05). For tendinosis, MRI versus MRA showed 18-36% and 15-38% sensitivity, 69-79% and 83-91% specificity, 22-28% and 18-50% PPV, 74-76% and 80-86% NPV, and 61-64% and 70-81% accuracy; respectively. For tears, MRI versus MRA showed 75-83% and 64-73% sensitivity, 73-75% and 82-91% specificity, 66-69% and 41-62% PPV, 82-87% and 92-94% NPV, and 74-78% and 79-88% accuracy; respectively. CONCLUSIONS: No significant difference was found between unenhanced MRI and direct MRA for the detection of tendinosis and tears of LHBTs.

Performance and Injury Characteristics of Pitchers Entering the Major League Baseball Draft After Ulnar Collateral Ligament Reconstruction.

BACKGROUND: Ulnar collateral ligament (UCL) reconstruction (UCLR) has been studied and shown to be a successful procedure for returning overhead athletes to sport. Many studies of Major League Baseball (MLB) players have shown high levels of return to play with successful statistical performance. No study has followed professional advancement of drafted pitchers who underwent UCLR as amateurs when compared with drafted pitchers who did not undergo the procedure before selection in the MLB draft. HYPOTHESIS: There would be no difference in professional advancement, statistical performance, or injury rate between the UCLR and control groups. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Thirty-eight pitchers with a UCLR as an amateur and 114 controls were identified in the MLB draft between 2006 and 2010. Highest level of professional baseball achieved was collected from all players, as well as statistical performance metrics including velocity, wins, earned run average (ERA), and walks and hits per inning pitched (WHIP). Additional data on future injuries were analyzed for days on the disabled list (DL), risk of being placed on the DL, and DL assignment for elbow injury. RESULTS: Thirteen of 38 UCLR pitchers reached the major league level (34.2%) compared with 29 of 114 (25.4%) control pitchers, which was not statically significant (P = .295). The UCLR and control groups were similar for average velocity, peak velocity, innings pitched, games, games started, innings per game, ERA, WHIP, wins, losses, saves, batters faced, and innings pitched per year, as well as hits, runs, home runs allowed, strikeouts, batters walked, and batters struck per inning. The UCLR group had a significantly increased rate of DL assignment when compared with controls (86.8% vs 64.0%; P = .008); however, days on DL (152.8 vs 135.6; P = .723) and DL assignment for elbow injury (45.5% vs 43.8%; P = .877) were similar. CONCLUSION: There was no difference in the rate of professional advancement among pitchers drafted by the MLB who had undergone UCLR as amateurs compared with controls. Both groups had similar statistical performance. Pitchers in the UCLR group had an increased risk of DL assignment but no increase in the number of days on DL or risk of DL placement for elbow injury.

Shoulder functional performance status of National Collegiate Athletic Association swimmers: baseline Kerlan-Jobe Orthopedic Clinic scores.

BACKGROUND: Shoulder trouble, described in the literature as "swimmer's shoulder," has been associated with competitive swimmers. The Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score is a validated survey used to define functional and performance measures of the upper extremity in overhead athletes. To date, no study has investigated the baseline functional scores for swimmers actively competing in the sport. PURPOSE: To establish a baseline score for National Collegiate Athletic Association (NCAA) swimmers actively competing in the sport. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: After institutional review board approval, the KJOC Shoulder and Elbow Score was administered to 5 NCAA swim teams (N = 99 participants; 46 men, 53 women). The results on 10 specific individual questions and on the total score were calculated according to the survey's original description. The mean scores were calculated for all participants. The Mann-Whitney U test was used to determine differences between sexes, years swimming, and self-reported injury status. RESULTS: The mean ± SD baseline KJOC score (out of a possible 100) for all participants was 79.0 ± 18.7; the mean score for men was 81.9 ± 15.6 and for women 76.6 ± 20.8. The score for athletes identifying themselves as injured at baseline was 53.9 ± 18.8, compared with 84.4 ± 13.6 for those not reporting as injured (P < .001). Athletes competing ≥11 years had a mean score of 72.0 ± 22.1; those competing ≤10 years scored 86.4 ± 11.4 (P = .007). CONCLUSION: Baseline scores for swimmers, which were lower than expected, were lower than baseline scores seen in studies of other overhead sports athletes. The data corroborate previous studies identifying swimmers as having a high level of shoulder trouble. Further research is indicated for improving shoulder symptoms and performance in competitive swimmers.

No correlation between stroke specialty and rate of shoulder pain in NCAA men swimmers.

PURPOSE: To established an association between shoulder pain and the stroke specialization among NCAA men swimmers. MATERIALS AND METHODS: All members of the top 25 NCAA men's swim teams were invited to complete the survey. Eleven teams with a total of 187 participants completed the study survey. The teams were mailed surveys that included multiple choice questions regarding their primary stroke and their incidence of shoulder pain. Additionally, the survey included questions about risk factors including distance trained, type of equipment, weight training, and stretching. RESULTS: The analysis showed that there was no significant difference in the rates of shoulder pain among the four strokes and individual medley specialists. The other risk factors did not show a significant correlation with shoulder pain. CONCLUSIONS: This study found no significant correlation between stroke specialty and shoulder pain in male collegiate swimmers. LEVEL OF EVIDENCE: Level 3. CLINICAL RELEVANCE: Descriptive epidemiology study.