Nicholas Mark Gutierrez MD, Presenter: Nothing to Disclose

Jean Jose MS, DO, Abstract Co-Author: Nothing to Disclose

Michael Baraga, Abstract Co-Author: Nothing to Disclose

Bryson Lesniak MD, Abstract Co-Author: Nothing to Disclose

Kevin O'Donnell MD, Abstract Co-Author: Nothing to Disclose

James Banks MD, Abstract Co-Author: Nothing to Disclose

Lee Kaplan MD, Abstract Co-Author: Nothing to Disclose

To analyze the relationship between the total innings pitched and MRI findings of the elbow in asymptomatic and symptomatic professional pitchers, and to identify whether any asymptomatic MRI findings predicted a subsequent throwing related elbow injury that required a stay on the disabled list.

Between 2001 to 2010, 25 asymptomatic Major League Baseball pitchers underwent MRI of their pitching arm at the time of a contract signing or a trade. Thirteen additional MRIs were performed on players as a result of new onset elbow symptoms during the course of the season. 2 MR arthrograms and 38 MRIs without intra-articular contrast were performed with a closed 1.5-T magnet at 1 of 4 different centers. The images were reviewed by a musculoskeletal radiologist who was blinded to the original MRI interpretations, the subjects’ injury status, and innings pitched. The total innings that the player pitched prior to the MRI was recorded in addition to elbow injuries requiring a stay on the disabled list following the MRI. Statistical analysis was performed to examine association between total career innings pitched and the presence of a particular MRI finding as well as between MRI findings and a subsequent disabled list stay.

When grouped as a whole and analyzed for MRI findings in relation to innings pitched several trends were observed that reached statistical significance. There was a greater number of innings pitched in players with degenerative findings of the UCL, cartilage lesions, olecranon osteophytes, flexor pronator mass tendinosis, and increased signal in the extensor wad.

The major league baseball pitcher’s elbow is subject to repetitive valgus torque over the course of their career, leading to adaptive and degenerative changes with the medial elbow and intra-articular structures. Though detected on MRI, these findings do not necessarily correlate with elbow pain or dysfunction. Analysis of a small but significant number of asymptomatic pitchers, who later sustained elbow injuries requiring a stay on the disabled list, revealed that all had degeneration of the UCL with olecranon osteophytes, and most had flexor pronator mass tendinosis.

Degenerative findings along the medial elbow are commonly observed on MRI in professional pitchers. However, these findings are often clinically insignificant and do not correlate with time on the disabled list.

Gutierrez, N, Jose, J, Baraga, M, Lesniak, B, O'Donnell, K, Banks, J, Kaplan, L, Correlation of Elbow MRI findings with Innings Pitched in Symptomatic and Asymptomatic Major League Baseball Pitchers.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005793.html