The ulnar collateral ligament response to valgus stress, repetitive pitching, and elbow muscle contraction in asymptomatic baseball pitchers

Background: In baseball, repetitive pitching leads to medial elbow injuries, particularly to the ulnar collateral ligament (UCL). To prevent pitchers from UCL injuries, it is important to quantify the response to elbow stress. Repetitive elbow external valgus torque and muscular fatigue induced by repetitive pitching could affect markers of the response, that is, humeroulnar joint gap and UCL morphology. The aims of the study were three-folded: to investigate the effect of (1) exerted handgrip force on the humeroulnar joint gap, (2) repetitive pitching on the humeroulnar joint gap and the UCL morphology, and (3) exerted handgrip force on the humeroulnar joint gap for different levels of elbow valgus stress is different after compared to before repetitive pitching in asymptomatic baseball pitchers. Methods: Medial elbow ultrasound images were collected in 15 asymptomatic male baseball pitchers. Three levels of static elbow valgus stress (0N, 50N, 100N) were applied with a TELOS device before and after repetitive pitching and with or without handgrip force. These images were used to assess the humeroulnar joint gap size and UCL length and thickness. After 110 fastball pitches or when 80% self-perceived fatigue on a VAS scale was reached, participants were instructed to stop throwing. Repeated measures ANOVAs were used to statistically test significant differences. Results: Handgrip force did not significantly affect the humeroulnar joint gap. The UCL thickness and length and the humeroulnar joint gap were also not different after compared to before repetitive pitching. While higher levels of applied valgus stress significantly increased the humeroulnar joint gap (P < .001), this effect was not significantly different in the interaction with handgrip force and repetitive pitching. Conclusion: The humeroulnar joint gap changes for different levels of elbow valgus stress. However, adult baseball pitchers did not respond to elbow stress after a single pitching session with or without submaximal handgrip force in the humeroulnar joint gap and UCL morphology.