Factors Related to Increased Ulnar Collateral Ligament Thickness on Stress Sonography of the Elbow in Asymptomatic Youth and Adolescent Baseball Pitchers

Alfred Atanda, Lauren W. Averill, Maegen Wallace, Tim A. Niiler, Levon N. Nazarian, Michael G. Ciccotti

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


Background: Stress ultrasound (SUS) of the elbow has demonstrated changes in the anterior band of the ulnar collateral ligament (UCL) in professional and high school-aged pitchers. However, there have been no large reports correlating pitching history data with SUS changes in youth and adolescent baseball pitchers. Hypothesis: Changes of the UCL on SUS will correlate with pitching volume in youth and adolescent baseball pitchers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: SUS of the elbow was performed in both elbows of 102 youth and adolescent baseball pitchers. UCL thickness and the width of the ulnohumeral joint, at rest and with 150 N of valgus stress, were measured using a standardized, instrumented device. Demographic data, arm measurements, and a pitching history questionnaire were recorded as well. The pitchers were separated into 2 groups based on age: group 1 (12-14 years) and group 2 (15-18 years). SUS findings of the dominant elbows were compared between the 2 groups. Correlation analysis and linear regression were used to identify relationships between SUS findings and pitching history data. Results: In all pitchers, the mean UCL thickness was 4.40 mm in the dominant elbow and 4.11 mm in the nondominant elbow (P =.03). There was no significant difference between elbows in any joint space characteristics. A comparison of group 1 versus group 2 demonstrated significant differences in UCL thickness (4.13 vs 4.96 mm; P <.001), resting joint space width (6.56 vs 4.04 mm; P <.001), and stressed joint space width (7.68 vs 4.07 mm; P <.001). There was no difference in the change in joint space width between the 2 groups (1.11 vs 0.76 mm; P =.05). The UCL was significantly thicker in pitchers who threw more than 67 pitches per appearance (4.69 vs 4.14 mm), who pitched more than 5 innings per appearance (4.76 vs 4.11 mm), and who had more than 5.5 years of pitching experience (4.71 vs 4.07 mm; P <.001). Linear regression demonstrated that age, weight, and pitches per appearance (R 2 = 0.114, 0.370, and 0.326, respectively) significantly correlated with UCL thickness. Conclusion: These findings suggest that UCL thickness increases as pitchers get older and heavier and as they increase their pitch volumes.

Original languageEnglish (US)
Pages (from-to)3179-3187
Number of pages9
JournalAmerican Journal of Sports Medicine
Issue number12
StatePublished - Dec 1 2016
Externally publishedYes


  • baseball
  • stress ultrasound
  • ulnar collateral ligament
  • youth pitchers

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Orthopedics and Sports Medicine


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