Imaging and Ultrasound-Guided Steroid Injection of Internal Oblique Muscle Strains in Baseball Pitchers

Abstract

Background Internal oblique muscle injuries are common in professional baseball pitchers and may require a prolonged convalescence of up to 10 weeks. Most strains can be diagnosed clinically, but imaging can be helpful to assess the severity of injury, which may predict recovery and return to play. Hypothesis Ultrasound-guided injection of steroid and local anesthetic into the muscle tear can speed recovery and subsequent return to play. Study Design Case series; Level of evidence, 4. Methods Three professional baseball pitchers with acute tears of the internal oblique muscle confirmed by magnetic resonance imaging underwent ultrasound-guided injection of steroid and local anesthetic. Results All 3 patients experienced significant pain relief within a few days of the injection and were able to pitch at full speed within 3 weeks of injury (mean, 21 days) and return to able status by 5 weeks (mean, 30.7 days). The 3 athletes continue to pitch in Major League Baseball 36 months, 36 months, and 14 months, respectively, after injury, and none have sustained reinjury during this time. Conclusion Therapeutic injection of steroids and anesthetic under ultrasound guidance appears to speed recovery and rehabilitation in professional baseball pitchers with acute side strains.