{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T23:34:58Z","timestamp":1780097698051,"version":"3.54.0"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.jp","clinicalkey.com","clinicalkey.es","arthroscopyjournal.org","clinicalkey.com.au","clinicalkey.fr","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      To use ultrasound imaging to document changes over time (i.e., preseason\n                      <jats:italic>v<\/jats:italic>\n                      postseason) in the pitching elbow of high school baseball pitchers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty\u2010two high school pitchers were prospectively followed. Pitchers were evaluated after a 2\u2010month period of relative arm rest via preseason physical exams, dynamic ultrasound imaging of their throwing elbow, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) assessment. Players were reevaluated within 1 week of their last game. Dynamic ultrasound images were then randomized, blinded to testing time point, and evaluated by 2 fellowship\u2010trained musculoskeletal radiologists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Average pitcher age was 16.9 years. Average pitches thrown was 456.5, maximum velocity 77.7 mph, games pitched 7.3, and days off between starts 6.6. From preseason to postseason, there were significant increases in ulnar collateral ligament (UCL) thickness (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .02), ulnar nerve cross\u2010sectional area (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .001), UCL substance heterogeneity (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .001), and QuickDASH scores (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .03). In addition, there was a nonsignificant increase in loaded ulnohumeral joint space (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .10). No pitchers had loose bodies on preseason exam, while 3 demonstrated loose bodies postseason. The increase in UCL thickness was significantly associated with the number of bullpen sessions per week (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .01). The increase in ulnar nerve cross\u2010sectional area was significantly associated with the number of pitches (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .04), innings pitched (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .01), and games pitched (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The stresses placed on the elbow during only one season of pitching create adaptive changes to multiple structures about the elbow including UCL heterogeneity and thickening, increased ulnohumeral joint space laxity, and enlarged ulnar nerve cross\u2010sectional area.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level II prospective observational study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2015.06.019","type":"journal-article","created":{"date-parts":[[2015,9,2]],"date-time":"2015-09-02T09:28:31Z","timestamp":1441186111000},"page":"1708-1715","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":36,"title":["Pre\u2010 and Postseason Dynamic Ultrasound Evaluation of the Pitching Elbow"],"prefix":"10.1002","volume":"31","author":[{"given":"Robert A.","family":"Keller","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Henry Ford Health System Detroit Michigan U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan E.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Henry Ford Health System Detroit Michigan U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Bey","sequence":"additional","affiliation":[{"name":"Bone and Joint Center Henry Ford Health System Detroit Michigan U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafeez","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Radiology Henry Ford Health System Detroit Michigan U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney E.","family":"Scher","sequence":"additional","affiliation":[{"name":"Department of Radiology Henry Ford Health System Detroit Michigan U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marnix","family":"van Holsbeeck","sequence":"additional","affiliation":[{"name":"Department of Radiology Henry Ford Health System Detroit Michigan 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