Prevalence of osteochondritis dissecans of the capitellum in elementary school baseball players based on ultrasonographic screening: a 15-year overview in Tokushima, Japan.

Background: Although several operative procedures have evolved for capitellar osteochondritis dissecans (OCD), the best outcome is achieved by early detection and conservative treatment. The objective of this study was to clarify changes in the prevalence of capitellar OCD in young baseball players over a long-term period based on consistent criteria in Tokushima, Japan between 2006 and 2020. Methods: The number of players who underwent screening and the discovery rate of capitellar OCD during the study period were investigated. School grade and radiographic stage were also evaluated. Results: The confirmation rate was significantly higher when ultrasonographic screening was performed than when screening was based on physical findings (65.8% vs. 1.9%, P < .001). The overall incidence of OCD in elementary school players based on ultrasonographic screening was 1.4% during the 10-year study period. Twenty-one (10.8%) of the 195 players identified to have OCD had experienced lateral elbow pain. When classified radiographically, the lesion was stage I in 73.3% of cases, stage II in 24.1%, and stage III in 2.6%. No cases of OCD were diagnosed before the fourth grade. The prevalence rates increased gradually from the fourth grade to the sixth grade. Conclusion: Ultrasonographic screening could be more effective for detecting capitellar OCD than screening based on physical findings. The overall prevalence of OCD among elementary school players was 1.4% over 10 years. The prevalence rates increased gradually from the fourth grade onwards.

A modified Patte classification system for rotator cuff tendon retraction to predict reparability and tendon healing in arthroscopic rotator cuff repair.

PURPOSE: The purpose of this study was to propose a modified Patte classification system for tendon retraction, including the cut-off points for predicting reparability and rotator cuff healing after arthroscopic rotator cuff repair (ARCR) and assess its prediction accuracy and measurement reliability. METHODS: This retrospective study included 463 consecutive patients scheduled to undergo ARCR for full-thickness supraspinatus tears. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-off points for predicting reparability and tendon healing. The modified Patte classification system, in which these cut-off points were combined with the original Patte classification, classified the tendon retraction as stages I-V. The prediction accuracy of reparability and tendon healing was assessed using the area under the curve (AUC). Measurement reliability was determined using Cohen's κ statistics. RESULTS: Of the 402 included patients, 32 rotator cuff tears were irreparable and 71 of the remaining 370 were diagnosed with healing failure. ROC analysis determined the cut-off point of reparability at the medial one-fifth and that of tendon healing at the medial one-third of the humeral head. The AUC of the modified Patte classification for predicting reparability and tendon healing was 0.897 (excellent) and 0.768 (acceptable), respectively. Intra-rater reliability was almost perfect (mean κ value: 0.875), and inter-rater reliability was substantial (0.797). CONCLUSION: Diagnostic performance of the modified Patte classification system was excellent for reparability and acceptable for rotator cuff healing, with high measurement reliability. The modified Patte classification system can be easily implemented in clinical practice for planning surgical procedures and counselling patients in the day-by-day clinical work. LEVEL OF EVIDENCE: Level III.

Ultrasonographic changes in quadriceps femoris thickness in women with normal pregnancy and women on bed rest for threatened preterm labor.

This study aimed to evaluate the changes in quadriceps femoris muscle thickness during the pregnancy and postpartum periods and to elucidate the effect of bed rest for threatened preterm labor on muscle thickness. In 26 women with normal pregnancy, quadriceps femoris thickness was measured at 11-13, 26, 30, and 35 weeks' gestation, and at 3-5 days and 1 month postpartum using ultrasonography. In 15 pregnant women treated with bed rest for threatened premature labor, quadriceps femoris thickness was measured at 30 and 35 weeks' gestation and postpartum. In women with normal pregnancy, quadriceps femoris thickness increased, peaking at 35 weeks' gestation, followed by a postpartum decrease. In women on bed rest, quadriceps femoris thickness showed no significant change during the pregnancy and postpartum periods, and the muscle was significantly thinner at 35 weeks' gestation than that in women with normal pregnancy. In conclusion, a significant increase in quadriceps femoris muscle thickness during normal pregnancy was found using ultrasonography. Meanwhile, in pregnant women on bed rest treatment, the quadriceps femoris was significantly thinner in the late third trimester than that in normal pregnant women. Prolonged bed rest can affect normal changes in the quadriceps femoris muscle thickness during the pregnancy and postpartum periods.

One-year follow-up ultrasonographic study of the subchondral bone surface of the distal femoral epiphysis in children aged 9-11 years.

The aim of this study was to investigate the subchondral bone surface of the distal femoral epiphysis and monitor the morphologic changes on ultrasonography (US) in growing children. A total of 160 football players aged 9-11 years underwent ultrasonographic examination of both knees. The regularity of the subchondral bone surface of the femoral condyles was classified as grade 0 (smooth), 1 (focal semilunar depression or indentation) or 2 (broad irregularity). The relationship between age and frequency of irregularity was analyzed. Children with a grade 2 were referred for radiography and MRI to check for osteochondritis dissecans (OCD). All players underwent repeat examination 1 year later. On initial examination, 82/320 knees (25.6%) were categorized as grade 0, 237/320 (74.1%) as grade 1 and 1 (0.3%) as grade 2. Logistic regression analysis revealed a significant association of increasing age with decreased irregularity of subchondral bone in the lateral and medial condyles (P = 0.019 and P < 0.001 for trend, respectively). One year later, logistic regression analysis showed that increasing age was significantly associated with decreased appearance of subchondral bone irregularity in the medial condyle (P = 0.005 for trend) and a greater likelihood of disappearance of irregularity in both condyles (P < 0.001 for trend). Of five knees classified as grade 2, four had evidence of OCD on radiography and MRI. Subchondral bone surface irregularity of the distal femoral epiphysis was more common on US in growing children aged 9-11 years, and transition from an irregular to a smooth outline accelerated after age 10 years. US is a reliable method for assessing the morphology of the distal femoral epiphysis and could be a useful screening tool for detecting OCD.

Repair Tension During Arthroscopic Rotator Cuff Repair is Correlated With Preoperative Tendon Retraction and Postoperative Rotator Cuff Integrity.

PURPOSE: This study aimed to examine the correlation of repair tension during arthroscopic rotator cuff repair (ARCR) with preoperative factors and to evaluate whether measuring tension during ARCR is effective for predicting rotator cuff integrity after ARCR. METHODS: Patients who underwent ARCR from May 2014 to June 2017 were enrolled in this study. Inclusion criteria were patients with medium or larger-sized tears and with a minimum of 6 months' follow-up. Patients with a partial repair were excluded. Intraoperative repair tension was measured according to Davidson's method. Correlation of repair tension with preoperative factors was evaluated with Pearson and Spearman correlation coefficient tests. Logistic regression analysis was performed on intraoperative factors, including repair tension, to identify independent predictors of retear after ARCR. Receiver operating characteristic (ROC) curve was used to determine the cutoff value of repair tension for retear. RESULTS: One-hundred twenty patients met the inclusion criteria. Mean repair tension was 26.6 ± 12.6 N, and retear was found in 29 shoulders (24.2%). Among the preoperative factors, tear size in the mediolateral (P < .001) and anteroposterior (P < .001) directions, DeOrio and Cofield's classification (P <0.001), geometric classification (P <.001), and fatty infiltration of supraspinatus (P = .006) and infraspinatus (P = .003) were significantly correlated with repair tension. However, multivariable logistic regression analysis identified only tear size in the mediolateral direction as an independent predictor of repair tension (P = .036). Logistic regression analysis showed that repair tension (P = .02) and geometric classification (P < .001) are significant factors affecting rotator cuff integrity after ARCR. ROC curve analysis showed the cutoff value of repair tension of large to massive tears for retear to be 35.6 N. CONCLUSION: This study demonstrated that intraoperative repair tension is strongly correlated with tear size in the mediolateral direction based on preoperative magnetic resonance imaging and that measuring tension during ARCR is effective for predicting rotator cuff integrity after ARCR. LEVEL OF EVIDENCE: Level IV, prognostic study.

Long-Term Outcomes of Arthroscopic Debridement With or Without Drilling for Osteochondritis Dissecans of the Capitellum in Adolescent Baseball Players: A ≥10-Year Follow-Up Study.

PURPOSE: To evaluate the long-term clinical outcomes of arthroscopic debridement for capitellar osteochondritis dissecans (OCD) in adolescent baseball players. METHODS: This retrospective study evaluated clinical outcomes of arthroscopic debridement for capitellar OCD in adolescent baseball players seen between 2003 and 2006. Inclusion criteria were at least 10 years of follow-up after surgery. Exclusion criteria were previous elbow surgery and age <12 years or >19 years. Patients were examined for presence of pain, inflammation (effusion), and range of motion. Outcome measures were determined using Timmerman/Andrews scores. Defect severity on preoperative radiographs was classified into 3 grades: small, moderate, and large. Return to baseball, pre- and postoperative range of motion and Timmerman/Andrews elbow score were evaluated according to defect severity. RESULTS: Twenty-three elbows of 23 baseball players (mean age, 14.7 [range, 13-17] years) underwent arthroscopic debridement for capitellar OCD. Mean follow-up duration was 11.5 (range, 10-13) years. Twenty patients (87%) returned to competitive baseball at their preoperative level; of these, 15 were non-pitchers and returned to the same position but only 1 of 5 pitchers returned to playing pitcher. One patient with a large defect and drilling underwent reoperation 11 years after the initial operation. Mean change in extension was 4.3° and that in flexion was 3.7°. Timmerman/Andrews score improved significantly from 160 (95% confidence interval 146.7-173.3) to 195 (95% confidence interval 185.2-204.8) at the most recent follow-up (P ˂ .0001). Osteochondral defects detected on preoperative radiographs were small in 10 patients, moderate in 7, and large in 6. There was no significant between-group difference in extension, flexion, or Timmerman/Andrews score preoperatively or at the most recent follow-up. CONCLUSIONS: Arthroscopic debridement with or without drilling allowed return to play in adolescent baseball players for positions other than pitchers. Long-term outcomes are likely durable regardless of lesion size. LEVEL OF EVIDENCE: Level IV, Case series.

Factors Associated With Knee Pain and Heel Pain in Youth Soccer Players Aged 8 to 12 Years.

BACKGROUND: Soccer is played by many children younger than 12 years. Despite its health benefits, soccer has also been linked to a high number of sport-related injuries. PURPOSE: To investigate the relationship between clinical factors and knee or heel pain in youth soccer players. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Study participants included 602 soccer players aged 8 to 12 years who were asked whether they had experienced episodes of knee or heel pain. Data were collected on age, body mass index, years of playing soccer, playing position, and training hours per week. Associations of clinical factors with the prevalence of knee or heel pain were examined by univariate and multivariate logistic regression analyses. RESULTS: Episodes of knee and heel pain were reported by 29.4% and 31.1% of players, respectively. Multivariate analyses revealed that older age and more years of playing soccer were significantly and positively associated with the prevalence of knee pain (P = .037 and P = .015 for trend, respectively) but did not identify any significant associations for heel pain. CONCLUSION: In this study of youth soccer players, knee pain was associated with older age and more years of play, but heel pain was not significantly associated with any factor.

Cumulative Incidence of Osteochondritis Dissecans of the Capitellum in Preadolescent Baseball Players.

PURPOSE: To quantify the 1-year cumulative incidence of capitellar osteochondritis dissecans (OCD) in preadolescent baseball players and identify the risk factors associated with this condition. METHODS: In total, 1,275 school-aged baseball players (aged 6-11 years) without an established diagnosis of capitellar OCD were enrolled in this longitudinal, observational study. One year later, all players underwent ultrasonographic examination of the throwing elbow on the playing field. Elbows with abnormal ultrasonographic findings at this time then underwent radiographic examination. Data for the groups with and without capitellar OCD were analyzed using multivariate logistic regression models. RESULTS: The 1-year cumulative incidence of capitellar OCD was 1.8% (95% confidence interval, 1.1%-2.7%). On multivariate analysis, players aged 10 to 11 years were 3.96 times more likely to have capitellar OCD (95% confidence interval, 1.10-18.97) than those aged 6 to 9 years; however, starting baseball at an earlier age, number of years played, training hours per week, player position, and history of elbow pain were not significantly associated with capitellar OCD. Only 34.8% of players with capitellar OCD reported elbow pain. CONCLUSIONS: The risk of OCD of the capitellum developing within a 1-year period in preadolescent baseball players was 1.8%. Players aged 10 to 11 years had a significantly greater risk of capitellar OCD development than those aged 6 to 9 years. LEVEL OF EVIDENCE: Level III, local nonrandom sample cohort.

Comparable clinical and structural outcomes after arthroscopic rotator cuff repair in diabetic and non-diabetic patients.

PURPOSE: To compare clinical outcome and rotator cuff integrity after arthroscopic rotator cuff repair (ARCR) in patients with and without diabetes mellitus. METHODS: This retrospective study involved 264 consecutive patients who underwent ARCR from 2012 to 2015. Inclusion criteria were a medium or large-sized tear and a minimum of 1-year follow-up. Clinical outcome measures included range of motion (ROM) and the Japanese Orthopaedic Association (JOA) and University of California, Los Angeles (UCLA) scores preoperatively and at final follow-up. Rotator cuff retear was evaluated with magnetic resonance imaging at 3 months post-surgery and final follow-up. Diabetic patients with poor control were pre-operatively hospitalized for intensive diabetic control. RESULTS: Our inclusion criteria were met by 30 diabetic patients and 126 non-diabetic patients. Demographic data were not significantly different between the groups, except body mass index (p = 0.021). Preoperative JOA and UCLA scores of the diabetic patients were significantly lower than those of the non-diabetic patients (p < 0.001, and p = 0.006, respectively); however, the scores at final follow-up were not different. ROM was significantly restricted in the diabetic patients before surgery (forward flexion, abduction, internal rotation: p < 0.001, external rotation: p = 0.035), but at the final follow-up, there was no significant difference except for internal rotation (p = 0.005). The retear rate in diabetic patients (23.3%) was not significantly different from that in non-diabetic patients (15.1%). CONCLUSIONS: Diabetic patients who had good perioperative glycemic control showed clinical and structural outcomes comparable to non-diabetic patients after ARCR. Intensive perioperative glycemic control and patient education are recommended for preoperative uncontrolled diabetic patients. LEVEL OF EVIDENCE: III.

Clinical Outcome of Arthroscopic Treatment for Posteromedial Elbow Impingement in Adolescent Baseball Players.

PURPOSE: To evaluate the clinical outcomes of arthroscopic treatment in adolescent baseball players with posteromedial elbow impingement. METHODS: This retrospective study evaluated the clinical outcome of arthroscopic treatment for posteromedial elbow impingement in adolescent baseball players. Patients were eligible for participation if they had undergone surgery at least 2 years earlier and excluded if they had arthritis, loose bodies, osteochondritis dissecans, ulnar collateral ligament tear, flexor/pronator injuries or medial epicondylitis, or nerve problems. Patients were also excluded if they had undergone prior elbow surgery, were younger than 13 years, or were older than 19 years. Arthroscopic treatment included debridement of posteromedial synovitis, fragment removal, and olecranon spur excision. At a mean follow-up of 26.7 (range 24-42) months, patients were evaluated based on a questionnaire, examination, and the previously reported elbow outcome score. RESULTS: This retrospective study involved 15 male patients, comprising 6 pitchers, 3 catchers, and 6 fielders, of mean age 15.7 (range 14-17) years. Mean time from onset of symptoms to surgery was 4.9 (range 3-18) months. Intraoperative findings included posteromedial synovitis and olecranon spurs in all patients and fragments in 10. The elbow outcome score was considered excellent in 11 patients and good in 2, with a mean score of 92 points (maximum 100 points). The mean postoperative range of motion at the elbow was 5° to 139.7° of flexion. All patients were able to return to their previous level of play after an average of 3.4 (range 2.5-4.5) months. No patient developed medial instability that later required reconstructive surgery. CONCLUSIONS: Arthroscopic debridement, excision of the olecranon spur, and removal of fragments yield reliable subjective and objective results and allow a return to baseball in adolescent patients. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Bilateral Osteochondritis Dissecans of the Capitellum in Fraternal Twins: A Case Report.

CASE: We report the cases of 15-year-old male fraternal twins with bilateral osteochondritis dissecans (OCD) of the capitellum in the absence of syndromic features. At the time of presentation, they had been actively engaged in competitive rhythmic gymnastics for 3 years. Both patients had chronic symptoms in the right elbow, and both underwent arthroscopic evaluation and management. CONCLUSION: The cases of these 2 patients provide evidence to support the theory that the etiology of OCD may have a genetic background.

Two-year follow-up study of subchondral surface irregularities of the capitellum on ultrasonography in baseball players under the age of 10 years.

OBJECTIVE: To determine whether subchondral surface irregularities of the capitellum on ultrasonography in baseball players under the age of 10 years are indicative of early osteochondritis dissecans (OCD) of the capitellum. MATERIALS AND METHODS: A total of 321 players aged 6-9 years underwent ultrasonographic examination, and the findings for the subchondral bone of the capitellum on the throwing side were graded as 0, 1a, 1b, 2, or 3. Subjects classified as grade 1a or 1b showed irregularities of the subchondral bone surface and were investigated radiographically for OCD. All players continued to throw and were re-examined by ultrasonography after 1 and 2 years. RESULTS: At the first examination, 11/321 (3.4%) had irregularities at the subchondral surface of the capitellum [grade 1a in 7/321 (2.2%); grade 1b in 4/321 (1.2%)]. The seven players with grade 1a showed no evidence of OCD or Panner's disease on radiography and were reclassified as grade 0 at the 2-year follow-up. All four players with grade 1b were reclassified as grade 0 at follow-up 1 and 2 years later. CONCLUSION: Subchondral bone surface irregularities of the capitellum on ultrasonography in children under the age of 10 years may not be indicative of disease, but rather represent variation of ossification during normal development.

Risk factors for shoulder and elbow pain in youth baseball players.

OBJECTIVES: This study sought to quantify the 1-year cumulative incidence of shoulder and elbow pain among youth baseball players and identify risk factors associated with the occurrence of shoulder and elbow pain. METHODS: In total, 900 youth baseball players (aged 7-11 years) were enrolled in a 1-year prospective follow-up study. One year later, the players were asked whether they had experienced episodes of shoulder or elbow pain and the following risk factors for such pain were investigated: age, position, length of baseball experience, training hours per week, and history of shoulder or elbow pain. Data for the groups with and without shoulder or elbow pain were analyzed using multivariate logistic regression models. RESULTS: Episodes of shoulder pain were reported by 18.3% of players and episodes of elbow pain were reported by 35.2% of players. Multivariate analysis showed that shoulder pain was associated with pitcher position, catcher position, longer training hours per week, and history of shoulder and elbow pain, and that elbow pain was associated with age, pitcher position, catcher position, longer training hours per week, and history of elbow pain. Length of baseball experience was not associated with shoulder or elbow pain. CONCLUSION: History of elbow pain, pitcher position, catcher position, and longer training hours per week were associated with both types of pain. History of shoulder pain was associated with shoulder pain but not elbow pain. Age was associated with elbow pain but not shoulder pain.

Pediatric isthmic spondylolisthesis showing radiologic evidence of slippage after physis injury.

The pathogenesis of slippage in pediatric spondylolisthesis is still unclear, although epiphyseal injury may account for many cases based on preclinical studies. However, no reports have described a pediatric case of isthmic spondylolisthesis showing radiologic evidence of epiphyseal injury. We report such evidence in a 13-year-old boy with low-back pain. Radiography revealed rounding of the S1 surface, a fracture line below the S1 endplate surface, and a bone marrow lesion in addition to slippage. Slippage and the rounding deformity were partially reversed (from 20 to 14% and from 42 to 27%, respectively) with conservative treatment and natural bone remodeling.

Outcome of an elbow check-up system for child and adolescent baseball players.

PURPOSE: Our aim was to examine the outcome of an elbow check-up system for youth baseball players. In particular, we investigated the nature of elbow injuries in youth baseball players with elbow pain and ultrasonographic findings of the capitellum. MATERIALS AND METHODS: A total of 1605 players participating in the regional summer championship in July 2013 underwent a questionnaire survey, physical examination, ultrasound imaging, and radiographic examination. RESULTS: A total of 499 (31.1%) players reported episodes of elbow pain, of whom 320 (64.1%) had abnormal findings on physical examination, and 115 (35.9%) agreed to undergo radiography. Among them, 98 (85.2%) exhibited radiographic abnormalities. On the initial ultrasonography screening, 60 (3.7%) players had an abnormal finding and 55 (91.7%) agreed to undergo radiography. Among them, 26 (47.3%) were found to have osteochondritis dissecans (OCD) of the capitellum on radiographs. CONCLUSIONS: About 30% of youth baseball players had episodes of elbow pain, and 64.1% of players with elbow pain had abnormal findings on physical examination. Furthermore, 85.2% of subjects who underwent radiographic examination exhibited radiographic abnormalities. About 4% of young baseball players had an abnormal finding on initial ultrasonography screening, and nearly 50% of them had OCD of the capitellum on radiographs. J. Med. Invest. 63: 171-174, August, 2016.

Efficacy of Achilles Suture Bridge Technique for Insertional Achilles Tendinosis in an Obese and Athletic Patient.

Here, we report the efficacy of the suture bridge technique for treating insertional Achilles tendinosis in an obese and athletic patient. A 48-year-old man presented to our department with a 6-month history of left posterior heel pain. The patient was an athlete (triathlon) and appeared obese (height: 197 cm, body weight: 120 kg, body mass index: 30.9). A diagnosis of insertional Achilles tendinosis was made. Because 6 months of conservative treatments had failed, we performed open resection of the calcaneal exostosis and Haglund's deformity along with debridement of the degenerative tissue of the tendon. Wide detachment of the insertion of the Achilles tendon was necessary, and reattachment of the tendon was performed using the Arthrex SpeedBridge(TM) system (Arthrex, Inc., Naples, FL). Six weeks postoperatively, this patient was allowed to walk with full weight bearing. Twelve weeks after surgery, this patient started jogging with neither pain nor evidence of Achilles tendon rupture. The suture bridge technique was effective for the reconstruction of the Achilles tendon in an obese and athletic patient. J. Med. Invest. 63: 310-314, August, 2016.

Optimizing baseplate position in reverse total shoulder arthroplasty in small-sized Japanese females: technical notes and literature review.

The management of cuff tear arthropathy (CTA) has always been a challenge for shoulder surgeons. Introduction of reverse total shoulder arthroplasty (RTSA) helped in providing pain relief and improved shoulder function in patients with CTA. In this study, we aimed to evaluate the short-term clinical results and some clinical details regarding the types of available prosthesis, positioning, and size of the components for RTSA in a population of short-stature female Japanese. In our seven cases, the average glenoid size was 23.9 mm in width and 34.2 mm in height. The average width was smaller than the size of all available baseplates. We implanted reverse shoulder prostheses with baseplate that measured 28 mm in diameter and two locking screws. The center of the baseplate was shifted to allow slight anterior overhang relative to the anatomical center to avoid breakage of the posterior cortex and to achieve firm fixation. One case of humeral shaft fracture occurred while inserting the humeral stem and required encircling wiring. In our experience, the short term clinical results of RTSA were excellent, but a new prosthesis that is designed to fit the short stature of Asians with smaller glenoid and humerus should be considered.

Arthroscopic excision of unstable os acromiale associated with impingement syndrome: a case report.

Os acromiale is a rare anatomical variant that is caused by failure of fusion of the acromial apophysis and is usually asymptomatic. We report a case of impingement syndrome of the left shoulder secondary to unstable os acromiale, which was initially overlooked and confirmed only during arthroscopic examination. Arthroscopic excision of the unstable fragment was successful without residual dysfunction of the deltoid muscle.

Pigmented villonodular synovitis of the knee joint in a 5-year-old girl treated with combined open and arthroscopic surgery: a case report.

Pigmented villonodular synovitis is an extremely rare disease in skeletally immature patients. Erosive destruction of the involved joint leads to early arthritis, and its high recurrence rate makes treatment challenging. Multiple surgical approaches exist, but it is unclear as to which among them achieves the lowest possible recurrence rate and morbidity. We report the case of a 5-year-old girl with left knee pain and swelling who was diagnosed with diffuse pigmented villonodular synovitis of the left knee based on MRI findings. Combined open and arthroscopic surgery was performed to completely remove the tumor. Postoperative histopathological examination confirmed the diagnosis of diffuse pigmented villonodular synovitis. The postoperative course was uneventful, with a gradual improvement in symptoms. There were no signs of recurrence on postoperative MRI performed at the 8-month follow-up, with neither knee pain nor limitation of range of motion. The favorable outcome in this case suggests that combined open and arthroscopic surgery may be an effective method for treating pigmented villonodular synovitis in skeletally immature patients.

Epidemiology of shoulder and elbow pain in youth baseball players.

OBJECTIVES: There are relatively few published epidemiological studies examining the differences in the risk of shoulder and elbow pain in young baseball players. The purpose of this study was to investigate risk factors for shoulder and elbow pain in child and adolescent baseball players. METHODS: A total of 1563 players aged 7 to 12 years participated in this investigation. Subjects were asked whether they had experienced episodes of shoulder or elbow pain. We investigated the following risk factors for shoulder and elbow pain: age, position, years of baseball experience, and training hours per week. Data from the groups with and without shoulder and elbow pain were analyzed using multivariate logistic regression models. RESULTS: Among the 1563 participants, 15.9% and 29.2% reported episodes of shoulder and elbow pain, respectively. Multivariate analysis showed that shoulder pain was associated with age 10, 11, and 12 years, and that elbow pain was associated with age 10, 11, and 12 years, playing catcher, and >2 years of baseball experience. Training hours per week were not associated with either shoulder or elbow pain. CONCLUSION: In over 1000 baseball players aged 7 to 12 years, 15.9% reported episodes of shoulder pain, while 29.2% reported elbow pain in the throwing arm. The associated risk factors were different for each type of pain. Shoulder pain was associated with increased age while elbow pain was associated with increased age, increased years of baseball experience, and playing catcher.