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Background: Radiographic and physical examination findings of ulnar nerve instability have been recognized in overhead throwing athletes, despite the fact that some of these abnormalities may be asymptomatic and represent adaptive changes. While recommendations for screening and early detection have been made that can adversely impact an athletes' career, the presence of bilateral ulnar nerve subluxation and its relationship with medial elbow symptoms has not been characterized in professional overhead throwing athletes., Purpose: To characterize the prevalence of bilateral ulnar nerve subluxation among professional baseball pitchers., Methods: A cross-sectional observational analysis was conducted utilizing standardized ultrasonographic examinations of bilateral elbows in 91 consecutive professional baseball pitchers (median age, 22 years; range, 17-30 years). The relationship between ulnar nerve subluxation and ulnar nerve signs, symptoms, and provocative physical examination maneuvers was also investigated., Results: The prevalence of bilateral ulnar nerve subluxation was 26.4% (95% CI, 17.7%-36.7%; 24 of the 91 athletes). Thirty-five athletes (38.5%; 95% CI, 28.4%-49.2%) had subluxation in at least 1 elbow. No athletes with subluxation had positive ulnar nerve signs, symptoms, or provocative tests., Conclusion: Ulnar nerve subluxation is common among professional pitchers, and is more often than not bilateral. In this population of athletes, ulnar nerve subluxation does not appear to be associated with pathological findings., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: The ABR has recently changed the format of the board examination, in which the oral examination was replaced by a computer based multiple-choice test. The purpose of this study was to determine resident's perceptions of a new conference resembling the new ABR format., Methods: Residents were requested to review a series of didactic pediatric imaging presentations prior to attending case conference. During conference, unknown cases reflecting the subject matter from the didactic presentations were presented along with multiple-choice questions. We then surveyed resident perspectives after each case conference., Results: Between 14 and 18 residents were surveyed at the end of each subspecialty case review presentation. About 94% of resident respondents felt that the independent didactic study followed by an interactive case review session would better prepare them for the ABR certification exams, compared to didactic lectures alone. Furthermore, 95% of the respondents indicated that they preferred the independent didactic review followed by interactive case review versus didactic lecture alone. Most the respondents (85%) felt that combining independent didactic review with interactive unknown case sessions made the material more interesting and provided greater understanding of the material. There was no statistically significant difference in the distribution of answers across the subspecialty sessions (p > .05)., Conclusion: Radiology residents favorably reviewed the combination of independent review of didactic material prior to interactive case review. Material presented in this fashion is felt to be more interesting and is thought to result in enhanced understanding of pediatric radiology material., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Hypothesis and Background: Baseball players commonly present with decreases in internal rotation (IR) and concurrent increases in external rotation (ER) motion. Several glenohumeral (GH) adaptations have been theorized to cause these changes in motion, including humeral retroversion (HR) and posterior capsule thickness (PCT). However, limited data exist examining the inter-relationship between HR and PCT. Therefore, the purpose of this study was to measure HR, GH IR and ER rotation, and PCT., Materials and Methods: HR and PCT were measured with an ultrasound system (Sonosite Titan; Sonosite, Bothell, WA, USA), and GH IR and ER were measured with a digital inclinometer., Results: The dominant arm had significantly more HR (15.6°, P = .0001) than the nondominant arm. Pearson correlation coefficients showed a significant negative relationship between HR and GH IR (-0.472, P = .001) and a significant positive relationship between HR and GH ER (0.295, P = .042). A significant positive correlation was also found between HR and PCT (0.427, P = .003)., Discussion: This was the first study to identify a relationship between HR and PCT in addition to GH IR and ER. The identification of these multiple correlations appears to suggest that the loss of IR caused by HR may be placing additional stress on the posterior capsule during the deceleration phase of the throw, thereby causing a fibroblastic healing response., Conclusions: HR has previously been identified as a positive adaptation because of the increase in ER without anterior capsule attenuation. However, this study suggests that HR may be contributing to the negative adaptation of PCT., (Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

Hypothesis: We hypothesized that posterior capsule thickness (PCT) would be greater on the dominant arm compared to the non-dominant arm. We also hypothesized that PCT would negatively correlate with glenohumeral internal rotation and scapular upward rotation. In addition, PCT would positively correlate with glenohumeral external rotation. However, currently PCT has not been measured nor have correlations been identified to exist with glenohumeral and scapular motion. Therefore, the purpose of the study was to determine if the posterior capsule was hypertrophied on the dominant arm and to identify if relationships exist with glenohumeral internal rotation (IR), external rotation (ER), and scapular upward rotation (SUR)., Materials and Methods: PCT was measured using a 10-MHz transducer. Glenohumeral IR and ER was measured supine using a digital inclinometer. SUR was measure at 0°, 60°, 90°, and 120° of glenohumeral abduction using a modified digital inclinometer., Results: PCT was greater on the dominant compared with the nondominant arm (P = .001). A negative correlation was found between PCT and IR (-0.498, P = .0001). A positive correlation was found between PCT and ER (0.450, P = .002) and between PCT and SUR at 60°, 90°, and 120° of glenohumeral abduction (0.388, P = .006; 0.327, P = .023; 0.304, P = .036, respectively)., Discussion: This in vivo study demonstrated a hypertrophied posterior capsule and its association with GIRD, ER, and SUR. These observations suggest that PCT does occur on the throwing arm of baseball players and is linked with glenohumeral and scapular alterations., Conclusions: This methodology could be used as a noninvasive screening evaluation for overhead athletes to identify those who may be at risk for shoulder injuries due to excessive capsular thickening., (Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)