Relationship Between Ulnar Nerve Instability and the Degree of Ulnar Collateral Ligament Laxity in High School Baseball Pitchers

Abstract

Introduction Ulnar nerve instability (UNI) is a common cause of ulnar neuropathy. The relationship between UNI and medial elbow instability has not yet been investigated in baseball pitchers. We investigated the association between UNI and the degree of ulnar collateral ligamentous laxity in high school baseball pitchers. Methods We examined 172 local high school baseball pitchers. A clinical examination assessed pitchers' physical condition during the winter off-season from 2021 to 2023. Ultrasound examinations were conducted on the medial joint gap of both sides of the pitchers during valgus stress and non-stress conditions. The participants were divided into three groups based on the ultrasonographic findings of UNI: no instability (type N), subluxation (type S), and dislocation (type D). For the pitching side, we assessed the relationship between the type of UNI and medial elbow instability and other clinical and physical findings, including ulnar nerve symptoms, grip strength, and key pinch strength. Results The prevalence of UNI on the throwing side was 62% (subluxation, 32%; dislocation, 30%) and 60% (subluxation, 26%; dislocation, 34%) on the non-throwing side. Regarding the rates according to the three types of UNI, there was no significant difference between the pitching and non-pitching sides. There was a significant difference in the distance between the medial joint gap under stress and non-stress conditions, with 0.59 mm on the throwing side and 0.36 mm on the non-throwing side; however, no significant difference was found in the degree of ulnar collateral ligamentous laxity when comparing each type of UNI on the throwing side. Conclusion In this study of 172 high school baseball pitchers, UNI occurred on the throwing side in 62% of subjects (32% subluxation, 30% dislocation) and on the non-throwing side in 60% of subjects (26% subluxation, 34% dislocation). There was no significant difference in the rates of the three types of UNI between the pitching and non-pitching sides. Additionally, there was no association between UNI type and the presence or absence of ulnar nerve symptoms. The medial joint gap distance under both stress and non-stress conditions was significantly larger on the throwing side compared to the non-throwing side. However, no significant association was found between the different types of UNI and the degree of ulnar collateral ligamentous laxity on the throwing side in this population.

Keywords: baseball pitcher; elbow; instability; ulnar collateral ligament; ulnar nerve; ultrasonography.