Valgus Laxity of Elbow Joint in High School Weight Lifters: Ultrasonographic Assessment

Chang-Hyuk Choi; Se-Sik Kim; Chang-Min Park; Seung-Bum Chae; Ho-Jin Chang

doi:10.5763/kjsm.2013.31.2.85

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Choi, Kim, Park, Chae, and Chang: Valgus Laxity of Elbow Joint in High School Weight Lifters: Ultrasonographic Assessment

Clinical Article

Korean J Sports Med 2013;31(2):85-91.

Published online: 10 January 2013

DOI: https://doi.org/10.5763/kjsm.2013.31.2.85

Valgus Laxity of Elbow Joint in High School Weight Lifters: Ultrasonographic Assessment

Chang-Hyuk Choi, Se-Sik Kim, Chang-Min Park, Seung-Bum Chae, Ho-Jin Chang

Department of Orthopaedics, Catholic University of Daegu and College of Medicine, Daegu, Korea

Correspondence: Chang-Hyuk Choi Department of Orthopaedics, Catholic University of Daegu and College of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea Tel: +82-53-650-4276, Fax: +82-53-650-4270, E-mail: chchoi@cu.ac.kr

Received 16 September 2013 Revised 26 November 2013 Accepted 26 November 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We evaluated abnormalities in medial portion of elbow in high-school weightlifter compared with the non weightlifter using a stress radiography and ultrsonography. The experimental group(G1) was 26 high school weightlifters with an average age of 17 years old (range, 16—18 years). The control group (G2) were comprised of 25 age matched general students. Both groups received physical examination, simple and valgus stress radiography and ultrasonography on both side of elbow. Physical examination showed 26.9% (14/52 elbows) tenderness and 19.2% (10/52 elbows) valgus laxity in G1, no tenderness and laxity in G2. There were no differences in medial joint gaps on simple radiography (G1, 3.3 mm, G2, 2.7 mm; p＞0.05), but the valgus stress view showed 5.6±0.8 mm medial joint gap in G1 and 3.8±0.8 mm in G2 (p＜0.001). Ultrasonography in G1, angular deformity was found in 67.3% (36/52) and G2 all in normal (p＜0.01). The horizontal distance was an average 4.9±1.23 mm for the G1 and 3.1±0.78 mm for the G2 (p＜0.001). Vertical distance of the proximal portion of the ulna was average 0.58±0.94 mm for the G1 and 1.59±0.49 mm for the G2 (p＜0.001). In G1, angular deformity of male was 50% (15/30 elbows) and female was 95% (21/22 elbows) (p＜0.001). Change of horizontal and vertical distance were larger in female (p＜0.05). In conclusion, there were increased incidence of medial elbow joint laxity in high school weightlifter, especially in female, regardless of career. Sustained valgus laxity could be prone to ulnar collateral ligament injury and should be evaluated with ultrasonography-assisted dynamic study.

Keywords: Elbow joint, High school weighlifter, Radiography, Ultrasonography

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Fig. 1.

Three types of angular changes of the medial collateral ligament. (A) Type A: normal stable elbow joint. (B) Type B: increased medial elbow laxity, as manifested by widening of the medial joint space and lateral shift of the proximal part of the ulna. (C) Type C: increased lateral shift of the proximal part of the ulna (arrow) causing impingement of the ulnar collateral ligament on the trochlea (arrowheads).

Fig. 2.

Ultrasonographic image of the elbow joint in normal and medial laxity. (A) Ultrasonography of normal elbow joint. The medial joint space is shown as a nonechoic space between the subchondral bone of the trochlea (arrowheads) and that of the coronoid process (large arrow). The ulnar collateral ligament (UCL) is identified as a band-like structure that attaches to the medial epicondyle and the tubercular portion of the coronoid process. The superficial surface of the ligament is seen outlined by a hyperechoic straight line (small arrows). (B) Ultrasonographic findings in ligament injury. The image showing type C angular changes with increased medial elbow laxity, as manifested by widening of the medial joint space (h=8.4 mm) and the lateral shift of the proximal part of the ulna (v=-1.2 mm). UCL tear is shown as a nonechoic gap between torn margin of the ligament (between × and +). h=horizontal distance of the medial joint space (with the assumption that the outline of the ulnar collateral ligament is a horizontal line), and v=vertical distance of the medial joint space.

Table 1.

Valgus laxity on stress radiograph and angular deformity between weightlifter and control group

Group	No. of elbow	Valgus stress view (mm)	Angular deformity
Group	No. of elbow	Valgus stress view (mm)	A	B	C
G1^*	52	5.60±0.80^‡	16^§	33	3
Dominant	26	5.54±0.66	5	20	1
Non	26	5.67±0.92	11	13	2
dominant
G2^†	50	3.81±0.74^‡	38^§	0	0

^* High school weightlifter;

^† High school general students;

^‡ Independent t test, p=0.000;

^§ Dependent t test, p=0.000.

Table 2.

Horizontal and vertical distances of medial elbow joint on ultrasonographic image between weightlifter and control group

Group	No. of elbow	Horizontal distance (mm)	Vertical distance (mm)
G1^*	52	4.92±1.23^‡	0.58±0.94^§
Dominant	26	5.06±1.12	0.48±0.86
Non	26	4.75±1.28	0.67±1.01
dominant
G2^†	50	3.11±0.78^‡	1.59±0.49^§

^* High school weightlifter;

^† High school general students;

^‡ Independent t test, p=0.000;

^§ Dependent t test, p=0.000.

Table 3.

Valgus laxity on stress radiograph and angular deformity between male and female in weightlifter group

Gender N	No. of elbow	Angular deformity
Gender N	No. of elbow	A^*	B^†	C
Male	30	15	15	0
Female	22	1	18	3

^* Independent t test p=0.000;

^† p=0.782.

Table 4.

Horizontal and vertical distances of medial elbow joint on ultrasonographic image between male and female in weightlifter group

Gender	No. of elbow	Horizontal distance (mm)^*	Vertical distance (mm)^†
Male	30	4.47±1.13	0.85±1.06
Female	22	5.40±1.22	0.41±0.82

^* Independent t test, p=0.04;

^† p=0.042.

Table 5.

Horizontal and vertical distances of medial elbow joint on ultrasonographic image according to career

Career	No. of elbow	Horizontal distance (mm)^*	Vertical distance (mm)^†
Total	52	4.92±1.23	0.58±0.94
1−2 y	14	5.14	0.61
3−4 y	20	4.72	0.49
＞5 y	18	5.0	0.61

^* Independent t test, p=0.747;

^† p=0.865.

Table 6.

Correlation between angular deformity and ultrasonographic findings (horizontal and vertical distance)

Angular deformity No. of elbow	Horizontal distance (mm)	Vertical distance (mm)
Normal 16 (type A)	2.02±2.21^*	5.09±0.83^†
Abnormal 36 (type B, C)	5.34±1.01^‡	0.17±0.79^§

^* Mann-Whitney U test, p=0.000;

^§ p=0.006.

^† p=0.000;

^‡ p=0.000;

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