Korean J Sports Med.  2014 Dec;32(2):112-119. 10.5763/kjsm.2014.32.2.112.

Evaluation of the Kinetic Chain in Little League Elbow

• Park KB
• Cho HL
• Hwang TH
• Lee DH

• KMID: 2288667
• DOI: http://doi.org/10.5763/kjsm.2014.32.2.112

Abstract

This study is to evaluate the abnormalities in the kinetic chain in the players with little league elbow during the medical screening of middle school baseball teams. Ninety-three players were examined with elbow ultrasonography in the field. Using kinetic chain evaluation test, 27 players sonogrphically diagnosed of little league elbow in dominant arm were compared with 25 players who were normal as control. Scapular-spine distance, horizontal flexion test, combined abduction test, and glenohumeral internal rotation deficit were used for evaluating kinetic chain in the upper extremities, while tightness of quadriceps and hamstring muscles, internal rotation of stance leg, and external rotation of stride leg were used for lower extremities. Also, the single leg stance test and finger-floor distance were used for core stability and flexibility. Twenty-five of 27 players (93%) having little league elbow showed kinetic chain abnormalities of either upper or lower extremities or trunk. This rate was significantly higher for the players having the little leaguer's elbow than control (28%) (p=0.017). Each specific tests for evaluating kinetic chain were also more prevalent in little league elbow group than control, and the abnormalities in the upper extremity were more common than those in lower extremity (p=0.026). Combined abduction test (23/27) and limitation of internal rotation of stance leg (16/27) were the most prevalent abnormalities in upper and lower extremity test, respectively. Our findings showed that there are many abnormalities in kinetic chain in players having the little league elbow and it may be associated with pathogenesis of little league elbow.

Keyword

Athletic injury; Little league elbow; Ultrasonography; Kinetic chain

MeSH Terms

Arm
Athletic Injuries
Baseball
Elbow*
Humans
Leg
Lower Extremity
Mass Screening
Muscles
Pliability
Ultrasonography
Upper Extremity

Figure

• 

  Fig. 1. Photograps of scanning technique and corresponding sonographic abnormalities. (A) Transducer is placed on medial aspect of elbow and (B) medial epicondylar apophyseal separation shows more than 1 mm gap (asterisk) between medial epicondyle and trochlea. (C) Medial epicondylar apophyseal fragmentation has bony ossicle distal to medial epicondylar apophysis (arrow). U: ulna, T: trochlea, ME: medial epicondyle.

• 

  Fig. 2. Kinetic chain abnormalities of upper extremity. (A) Scapular malposition of right shoulder ch-aracterized by depression of scapula and increased spine-scap-ular distance (arrow lines). Limited mobility of right shoulder in (B) horizontal flexion test and (C) combined abduction test and (D) glenohumeral internal rotation.

• 

  Fig. 3. Kinetic chain abnormalities of trunk and core stability. (A) Increased finger-floor distance means trunk inflexibility and core instability shows (B) increased pelvic tilting, hip adduction and knee valgus in stance leg compared with (C) stride leg in single leg stance test.

• 

  Fig. 4. Kinetic chain abnormalities of lower extremity. (A) Increased heel buttock distance indicates quadriceps tightness and (B) limited straight leg raising means tightness of hamstring muscles. Rotational hip motion test reveals decreased (C) internal rotation of stance leg and (D) external rotation of stride leg.

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