In recent years, there has been a documented increase in the number of professional baseball players on the disabled list and the total number of days on the disabled list. Pitchers account for the largest number of disabled list reports. To examine the relationship between magnetic resonance imaging (MRI) findings in asymptomatic professional pitchers and subsequent time on the disabled list (DL). Cohort study (Prognosis); Level of evidence, 2. A total of 21 asymptomatic professional pitchers from a single Major League Baseball (MLB) organization underwent preseason MRIs of their dominant shoulder from 2001 to 2010. Asymptomatic was defined as no related DL stays in the 2 seasons before the MRI. These studies were reevaluated by a fellowship-trained musculoskeletal radiologist who was blinded to patient name, injury history, and baseball history. A second investigator who was blinded to the MRI results collected demographic data, total career number of innings pitched, and any subsequent DL reports for each subject. The mean age at the time of MRI was 29.04 years (range, 20-39 years). Eleven of 21 pitchers had a rotator cuff tear (RCT): 9 had an articular surface tear (AST), and 2 had a full-thickness rotator cuff tear (FTT). Ten had superior labral anterior posterior (SLAP) tears, and 13 had either anterior or posterior labral tears. There was a statistically significant relationship between the number of innings pitched and presence of an RCT (AST + FTT). The mean number of career innings pitched by those with an RCT was 1014 compared with a mean of 729 innings pitched in pitchers without an RCT (P < .01). In addition, the number of career innings pitched was moderately correlated with presence of RCT (r = 0.46) and presence of superior and anterior/posterior labral tears (r = 0.43). There were no statistically significant findings between any single preseason MRI finding and subsequent time on the DL. The MRI findings in asymptomatic MLB pitchers do not appear to be related to near future placement on the DL. However, there was a significant difference in numbers of innings pitched between pitchers who had an RCT and those who did not and a moderate correlation between innings pitched and the presence of RCT as well as the presence of labral lesions. This finding supports the notion that RCT and labral injury in pitchers may result from repetitive overhead motion with subsequent strain on the rotator cuff tendons and glenoid labrum. Asymptomatic shoulder lesions in professional baseball pitchers appear to be more frequent than previously thought.

Few patients require angiography and therapeutic embolization for bleeding pelvic fractures, but they are risk for significant morbidity and mortality. In hemodynamically unstable trauma patients with pelvic fractures, the decision to proceed to the operating room (OR) to address intraabdominal bleeding, or angiography to address pelvic bleeding (ANGIO), is rarely straightforward. This study tested the hypothesis that outcomes are similar regardless if the sequence was OR-ANGIO or ANGIO-OR. All pelvic fractures between 1999 and 2011 were retrospectively reviewed and stratified by initial management with ANGIO or OR. Of 2,922 patients with pelvic fractures, only 183 (6%) required angiography for suspected bleeding. For OR-ANGIO (n = 49) versus ANGIO (n = 134), injury severity score was similar (40 ± 15 vs. 35 ± 16), but systolic blood pressure (97 ± 28 vs. 108 ± 32 mmHg, p = 0.038) and base excess were both lower (−9 ± 5 vs. −5 ± 5 mEq/L, p < 0.001). During initial resuscitation and in the first 24 hours, crystalloid, blood product usage and total fluid requirements were all increased 50% to 100% (all p < 0.001). Despite these differences, lengths of stay (32 ± 32 vs. 26 ± 28 days) and mortality (33% vs. 31%) were similar. The same trends in fluid requirements remained in the subset of patients with unstable pelvic fractures, with an increased mortality (67% vs. 20%, p = 0.011) in those requiring ANGIO-OR versus OR-ANGIO. These data support current management algorithms. In hemodynamically unstable trauma patients with pelvic fractures, those who proceeded immediately to the OR to address intraabdominal bleeding tended to be sicker but had outcomes that were the same or better compared with those who received angiography to address pelvic bleeding. III, retrospective review.

Ultrasound technology continues to improve with better image resolution and availability. Its use in evaluating peripheral nerve lesions is increasing. The current review focuses on the utility of ultrasound in traumatic injuries. In this report, the authors present 4 illustrative cases in which high-resolution ultrasound dramatically enhanced the anatomical understanding and surgical planning of traumatic peripheral nerve lesions. Cases include a lacerating injury of the sciatic nerve at the popliteal fossa, a femoral nerve injury from a pseudoaneurysm, an ulnar nerve neuroma after attempted repair with a conduit, and, finally, a spinal accessory nerve injury after biopsy of a supraclavicular fossa lesion. Preoperative ultrasound images and intraoperative pictures are presented with a focus on how ultrasound aided with surgical decision making. These cases are set into context with a review of the literature on peripheral nerve ultrasound and a comparison between ultrasound and MRI modalities.