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PURPOSE OF REVIEW: To summarize the current anatomy, biomechanics, presentation, treatment, and outcomes of injuries to the biceps and superior labral complex in overhead athletes. RECENT FINDINGS: The biceps and superior labral complex is composed of anatomically distinct zones. The inability to accurately diagnose biceps lesions contributes to continued morbidity especially as arthroscopy and advanced imaging fail to fully evaluate the entire course of the biceps tendon. Superior labrum anterior and posterior (SLAP) repair, long head of biceps tenodesis, and tenotomy are the most common operative techniques for surgical treatment of biceps-labral complex (BLC) pathology. Labral repair in overhead athletes has resulted in mixed outcomes for athletes and is best indicated for patients under age 40 years old. SUMMARY: Injuries to the BLC are potentially challenging injuries to diagnose and treat, particularly in the overhead athlete. SLAP repair remains the treatment of choice for high-level overhead athletes and patients younger than 40 years of age, while biceps tenodesis and tenotomy are preferred for older patients.

Elbow ulnar collateral ligament injury : , Elbow ulnar collateral ligament injury : , کتابخانه دیجیتال جندی شاپور اهواز

Prior to Jobe’s description of a reconstruction technique for ulnar collateral ligament (UCL) insufficiency, the injury was career ending. Despite successful results in about 70 % of cases, concerns with elevation of the flexor-pronator mass, ulnar nerve complications and relatively large bone tunnels in the medial epicondyle of the humerus led to modifications to Jobe’s technique. One of the most novel modifications was the “docking technique.” Differences included: (1) arthroscopic evaluation and management, when indicated, of concomitant intra-articular pathology, (2) maintenance of the ulnar nerve in situ unless symptoms specifically indicate transposition, (3) use of a muscle splitting approach through the flexor mass, and (4) “docking” of the graft into a humeral socket. Ulnar preparation remained the same as originally described Jobe. These modifications facilitated improved graft tensioning while minimizing the number of large tunnels drilled in the relatively small medial epicondyle. Intraoperative morbidity was minimized by the muscle-splitting approach and the reservation of ulnar nerve transposition only when indicated based on preoperative exam. Clinical results have been excellent using this technique, and it is our preferred technique for UCL reconstruction.

Ulnar nerve injuries are not uncommon among throwing athletes. The anatomy of the ulnar nerve and the course in which it travels through the upper extremity make it susceptible to injury, especially when the elbow is loaded in the extremes that come with throwing sports such as baseball pitching. In addition to occurring in isolation, ulnar nerve symptoms may present in patients with ulnar collateral ligament (UCL) insufficiency. Postoperative ulnar nerve dysfunction is the most commonly cited complication after reconstructive surgery. This can be attributed to the fact that the ulnar nerve is in close proximity to the native ulnar collateral ligament and is at risk for injury during surgery. To identify and protect the nerve, Jobe in his original description of the procedure, dissected out the nerve from the cubital tunnel and then transposed the nerve anteriorly in a submuscular fashion after the reconstruction was performed. However, the dissection and transposition itself may also present a risk for postoperative ulnar neuropathy. In light of this, Jobe’s original surgical technique which has undergone several modifications in the surgical approach to the UCL and handling of the ulnar nerve, which has improved the postsurgical complication rate.

In the overhead athlete, medial ulnar collateral ligament (MUCL) insufficiency can develop from the repetitive valgus loads across the elbow during the throwing motion. This injury can be potentially career ending for the athlete. Treatment options include conservative care or potential surgical intervention with ligament reconstruction. Given the prolonged recovery period after surgical intervention, other avenues for successful treatment of MUCL insufficiency have been explored including potential injections into the ligament including platelet-rich plasma (PRP). Recently, PRP has drawn interest as a tool for biologic augmentation of tendon and ligamentous healing as it is an autologous concentration of platelets and growth factors including vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF-1), fibroblast growth factor-2 (FGF-2), platelet-derived growth factor (PDGF), and transforming growth factor-s (TGF-s). Recent clinical work has shown that PRP injections into the MUCL may play a role in the management for the young overhead athlete that has acute damage to an isolated part of the ligament, and in those athletes that are unwilling or unable to undergo the extended rehabilitation required after surgical reconstruction of the ligament.