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Combining Imaging Best for Elbow Pain in Baseball Players

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Combining imaging improves diagnosis of elbow pain among baseball players.

Combining ultrasound and MR arthrography to evaluate baseball players presenting with medial elbow pain provides higher accuracy in diagnosis of ulnar collateral ligament (UCL) tears over either modality alone, according to a study published in Radiology.

Researchers from Thomas Jefferson University Hospital in Philadelphia, PA, undertook a retrospective study to evaluate a combined imaging approach with both conventional and valgus ultrasonography and MR arthrography in baseball players with medial elbow pain.

A total of 144 baseball players with 191 findings of medial elbow pain participated in the study. All underwent US in addition to MR arthrography. The researchers assessed the findings with each modality alone and both combined. For the evaluation of UCL tears with stress US, the interval gapping of the medial elbow joint was measured between rest and valgus stress both at the injured and at the uninjured (contralateral) elbow.

The results showed that the combination testing provided improved diagnosis of 53 UCL tears:

 
Stress Ultrasound
MR Arthrography
US + MRA
Sensitivity
96%
81%
96%
Specificity
81%
91%
99%
Accuracy
87%
88%
98%

 

 

 

 

Thirty-one patients were diagnosed with ulnar neuritis. Dual imaging also improved diagnosis in this group:

 
MR Arthrography
US + MRA
Sensitivity
74%
90%
Specificity
92%
100%
Accuracy
88%
98%

 

 

 

 

 

The combined approach with both MR arthrography and US shows higher accuracy than each modality alone for the assessment of medial elbow pain, the researchers concluded.

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