title: Long-term stress distribution patterns across the elbow joint in baseball players assessed by computed tomography osteoabsorptiometry.
abstract: BACKGROUND
  The distribution pattern of subchondral bone density is considered to highly reflect the stress distribution across a joint under long-term physiologic loading conditions. Therefore, the biomechanical characteristics over the elbow joint surface under long-term loading conditions of baseball pitching can be determined by a measurement of the distribution pattern.
  
  
  OBJECTIVE
  Stress distribution over the elbow joint surface alters with long-term pitching activities.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  Computed tomography (CT) imaging data from the dominant elbow of 10 nonthrowing athletes, 10 college baseball fielders, and 10 college baseball pitchers were collected for the current analysis. The distribution of subchondral bone density through the distal articular surface of the humerus was measured using a CT osteoabsorptiometry method. The quantitative analysis of the obtained data focused on location and size of the maximum density area at the articular surface.
  
  
  RESULTS
  The maximum density area of subchondral bone across the articular surface of the distal humerus was located in the posterior part of the trochlea in all subjects. This maximum density area was significantly increased in the pitcher group, compared with that in other groups. Additionally, the pitcher group demonstrated a significant distribution of the maximum density area in the anterior part of the capitellum.
  
  
  CONCLUSIONS
  The results indicate that actual stress across the elbow is concentrated in the posterior part of the trochlea in humans. Baseball pitching may produce excessive or repetitive stress against not only this part, but also the anterior part of the capitellum. The majority of osteochondritis dissecans lesions affecting the elbow are found in the anterior part of the capitellum in throwing athletes. The results may support an important role of mechanical conditions in the cause of elbow osteochondritis dissecans.
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Momma
authors.forename: Daisuke
authors.initials: D
authors.lastname: Mommma
authors.forename: Norimasa
authors.initials: N
authors.lastname: Iwasaki
authors.forename: Naomi
authors.initials: N
authors.lastname: Oizumi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Nakatsuchi
authors.forename: Tadanao
authors.initials: T
authors.lastname: Funakoshi
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kamishima
authors.forename: Shigeru
authors.initials: S
authors.lastname: Tadano
authors.forename: Akio
authors.initials: A
authors.lastname: Minami
mesh_terms: D000293:Adolescent; D056352:Athletes; D001484:Baseball; D003430:Cross-Sectional Studies; D004551:Elbow Joint / Q000000981:diagnostic imaging* / Q000502:physiology*; D006801:Humans; D008297:Male; D013314:Stress, Mechanical; D014057:Tomography, X-Ray Computed; D055815:Young Adult