Microtrauma at the humeral medial epicondyle: Quantifying lacunar lesions to reconstruct activity patterns in past populations.

Liagre, Elle B K; Knüsel, Christopher J; Villotte, Sébastien

doi:10.1016/j.ijpp.2026.05.002

Article (Scientific journals)

Microtrauma at the humeral medial epicondyle: Quantifying lacunar lesions to reconstruct activity patterns in past populations.

Liagre, Elle B K; Knüsel, Christopher J; Villotte, Sébastien

2026 • In International Journal of Paleopathology, 54, p. 27 - 38

Peer Reviewed verified by ORBi

Permalink
https://hdl.handle.net/2268/349031

DOI
10.1016/j.ijpp.2026.05.002

PubMed
42284684

Files (1)Send to Details Statistics Bibliography Similar publications

Files

Full Text

2026 Liagre et al. IJPP.pdf

Author postprint (4.96 MB)

Creative Commons License - Attribution, Non-Commercial, No Derivative

Download

All documents in ORBi are protected by a user license.

Send to

RIS BibTex APA Chicago Permalink X Linkedin

Details

Keywords :

3D Surface Analysis; Activity-related skeletal change; Avulsion fracture; Entheseal change; Medial ulnar collateral ligament; Humans; France; History, Ancient; Reproducibility of Results; Female; Male; Imaging, Three-Dimensional; Humerus/pathology; Humerus/injuries; Humeral Fractures/pathology; Humeral Fractures/history; Humeral Fractures; Humerus; Pathology and Forensic Medicine; Archeology (arts and humanities)

Abstract :

[en] [en] OBJECTIVE: Lacunar lesions at the anterior medial collateral ligament (MCL) bundle attachment on the humeral medial epicondyle may represent partial avulsion fractures. This study developed and validated a quantitative approach to assess their morphology. MATERIALS: Two Neolithic samples were studied: Parisian Basin (France, N = 45) and Meuse Valley (Belgium, N = 25). METHODS: Lesions were extracted using a 3D protocol with ambient occlusion and curvature filters, then screened and analyzed using size, shape and surface metrics. Reproducibility was assessed using Lin's concordance correlation coefficient. RESULTS: The protocol was successfully validated with excellent intra-observer agreement. Lesions occurred exclusively on right humeri at the anterior MCL bundle footprint, while showing uniform shape but variable size, flattening and surface characteristics. CONCLUSIONS: The protocol provides an objective, reproducible method for lesion characterization and, when applied, revealed cortical-confined depths and surface areas smaller than the anterior MCL bundle footprint, suggesting specific fiber involvement. Right-side bias indicates a potential link with handedness, while morphological patterns align with clinical descriptions of proximal MCL partial avulsion fractures common in youth throwing athletes. SIGNIFICANCE: Findings support an activity-related etiology and demonstrate potential for reconstructing past behaviors from skeletal remains while complementing clinical studies on long-term injury outcomes. LIMITATIONS: Limitations include small sample size, reliance on absolute measurements, dependence on imaging resolution, and lack of direct clinical validation. SUGGESTIONS FOR FURTHER RESEARCH: Studies should apply this protocol to larger, diverse samples, confirm the clinical association, and adapt it to additional imaging modalities for broader archaeological and clinical applications.

Disciplines :

Archaeology

Author, co-author :

Liagre, Elle B K; PACEA UMR 5199, CNRS, Université de Bordeaux, Ministère de la Culture, Pessac 33615, France. Electronic address: elle.liagre@u-bordeaux.fr

Knüsel, Christopher J ; PACEA UMR 5199, CNRS, Université de Bordeaux, Ministère de la Culture, Pessac 33615, France

Villotte, Sébastien ; Université de Liège - ULiège > Département des sciences historiques

Language :

English

Title :

Microtrauma at the humeral medial epicondyle: Quantifying lacunar lesions to reconstruct activity patterns in past populations.

Publication date :

September 2026

Journal title :

International Journal of Paleopathology

ISSN :

1879-9817

eISSN :

1879-9825

Publisher :

Elsevier Inc.

Volume :

Pages :

27 - 38

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://api.elsevier.com/content/article/PII:S1879981726000355?httpAccept=text/xml

Funders :

University of Bordeaux

Funding text :

We thank the teams who facilitated access to the collections and 3D data. At the Mus\u00E9e de l\u2019Homme (MNHN), we are grateful to scientific curator Aline Thomas and to Liliana Huet and V\u00E9ronique Laborde for their technical assistance. At the RBINS, we thank scientific curator Patrick Semal, Caroline Polet, and Eric Dewamme for their support. We also acknowledge the authors ofPoletet al.(2019), in particular Merlin Leunda-Martiarena, for generously providing their data, and the authors ofLeeet al.(2025)for kindly granting permission to reproduce their figure. We thank Sacha Kacki (UMR5199 PACEA), who commented upon an earlier version of this manuscript.

Available on ORBi :

since 22 September 2026

Statistics

Number of views

20 (0 by ULiège)

Number of downloads

13 (0 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenAlex citations

Bibliography

3D Slicer, 2024. 3D Slicer image computing platform | 3D Slicer [WWW Document]. 3D Slicer is a free, open source software for visualization, processing, segmentation, registration, and analysis of medical, biomedical, and other 3D images and meshes; and planning and navigating image-guided procedures. URL 〈https://www.slicer.org/〉 (accessed 9.16.24).
Abdelgawad, A., Naga, O., Abdou, M. (Eds.), 2021. Pediatric Orthopedics and Sports Medicine: A Handbook for Primary Care Physicians. Springer International Publishing, Cham. https://doi.org/10.1007/978-3-030-48138-4
Andelman, S., DiPrinzio, E., Hausman, M., 2018. Elbow injuries in the pediatric athlete. Ann. Joint 3, 21–21. https://doi.org/10.21037/aoj.2018.03.02
Antonacci, C.L., Alberta, F.G., 2021. Medial Epicondyle Fractures in the Skeletally Mature Athlete, in: Sports-Related Conditions of the Elbow. CRC Press, Boca Raton.
Arachchige, C.N.P.G., Prendergast, L.A., Staudte, R.G., 2022. Robust analogs to the coefficient of variation. Journal of Applied Statistics 49, 268–290. https://doi.org/10.1080/02664763.2020.1808599
Armstrong, A.D., Ferreira, L.M., Dunning, C.E., Johnson, J.A., King, G.J.W., 2004. The Medial Collateral Ligament of the Elbow is not Isometric: An in Vitro Biomechanical Study. Am J Sports Med 32, 85–90. https://doi.org/10.1177/0363546503258886
Baye, J.D., 1874. Sur les grottes de la vallée de petit-Morin (Marne). bmsap 9, 225–244. https://doi.org/10.3406/bmsap.1874.3574
Berg, E.E., DeHoll, D., 1997. Radiography of the medial elbow ligaments. Journal of Shoulder and Elbow Surgery 6, 528–533. https://doi.org/10.1016/S1058-2746(97)90085-9
Borchers, H.W., 2023. pracma: Practical Numerical Math Functions. 〈https://doi.org/10.32614/CRAN.package.pracma〉.
Buck, F.M., Zoner, C.S., Cardoso, F., Gheno, R., Nico, M.A.C., Trudell, D.J., Randall, T.D., Resnick, D., 2010. Can osseous landmarks in the distal medial humerus be used to identify the attachment sites of ligaments and tendons: paleopathologic–anatomic imaging study in cadavers. Skeletal Radiol 39, 905–913. https://doi.org/10.1007/s00256-009-0799-2
Callaway, G.H., Field, L.D., Deng, X.-H., Torzilli, P.A., Oʼbrien, S.J., Altchek, D.W., Warren, R.F., 1997. Biomechanical Evaluation of the Medial Collateral Ligament of the Elbow. The Journal of Bone & Joint Surgery 79, 1223–1231. https://doi.org/10.2106/00004623-199708000-00015
Camp, C.L., Jahandar, H., Sinatro, A.M., Imhauser, C.W., Altchek, D.W., Dines, J.S., 2018. Quantitative Anatomic Analysis of the Medial Ulnar Collateral Ligament Complex of the Elbow. Orthopaedic Journal of Sports Medicine 6, 2325967118762751. https://doi.org/10.1177/2325967118762751
Capasso, L., Kennedy, K.A.R., Wilczak, C.A., 1998. Atlas of Occupational Markers on Human Remains, Journal of Paleopathology Monographic Publication. Edigrafital SpA, Teramo, Italy.
Capasso, L., Pierfelice, L., Michetti, E., Fabrizio, A.D., D’Anastasio, R., 2004. Lesions linked to athletic activities in the Ancient Roman population from Herculaneum (Italy, first century AD). Anthropologie 42, 181–187.
Diederichs, G., Issever, A.-S., Greiner, S., Linke, B., Korner, J., 2009. Three-dimensional distribution of trabecular bone density and cortical thickness in the distal humerus. Journal of Shoulder and Elbow Surgery 18, 399–407. https://doi.org/10.1016/j.jse.2008.11.001
Dittmar, J.M., Mitchell, P.D., Cessford, C., Inskip, S.A., Robb, J.E., 2021. Medieval injuries: Skeletal trauma as an indicator of past living conditions and hazard risk in Cambridge, England. Am J Phys Anthropol 175, 626–645. https://doi.org/10.1002/ajpa.24225
Dominguez-Ballesteros, E., Arrizabalaga, A., 2015. Laterality in the first Neolithic and Chalcolithic farming communities in northern Iberia. Laterality: Asymmetries of Body, Brain and Cognition 20, 371–387. https://doi.org/10.1080/1357650X.2014.982130
Ducher, A., Foti, B., Verna, E., 2023. Conformational variations of the medial epicondyle of the humerus: A case study of fusion anomaly on dry bones. Morphologie S1286011523000048. https://doi.org/10.1016/j.morpho.2023.01.004
Dugas, J.R., Ostrander, R.V., Cain, E.L., Kingsley, D., Andrews, J.R., 2007. Anatomy of the anterior bundle of the ulnar collateral ligament. Journal of Shoulder and Elbow Surgery 16, 657–660. https://doi.org/10.1016/j.jse.2006.11.009
Dumbruch, I., 2007. Le Site de l’Abri-sous-Roche du “Bois-Madame” à Arbre (Province de Namur, Belgique). Archaeologia Mosellana 7, 609–612.
Dutour, O., 2000. Chasse et activités physiques dans la Préhistoire: les marqueurs osseux d’activités chez l’homme fossile. Anthropologie et Préhistoire 111, 156–165.
Dutour, O., 1986. Enthesopathies (lesions of muscular insertions) as indicators of the activities of Neolithic Saharan populations. Am. J. Phys. Anthropol. 71, 221–224. https://doi.org/10.1002/ajpa.1330710209
Dwek, J.R., 2016. A Structural and Mechanism-Based Perspective Toward Understanding Pediatric and Adult Sports Injuries. American Journal of Roentgenology 206, 980–986. https://doi.org/10.2214/AJR.15.15937
Farsetti, P., Potenza, V., Caterini, R., Ippolito, E., 2001. Long-Term Results of Treatment of Fractures of the Medial Humeral Epicondyle in Children: The Journal of Bone and Joint Surgery-American Volume 83, 1299–1305. https://doi.org/10.2106/00004623-200109000-00001
Fedorov, A., Beichel, R., Kalpathy-Cramer, J., Finet, J., Fillion-Robin, J.-C., Pujol, S., Bauer, C., Jennings, D., Fennessy, F., Sonka, M., Buatti, J., Aylward, S., Miller, J.V., Pieper, S., Kikinis, R., 2012. 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magnetic Resonance Imaging 30, 1323–1341. https://doi.org/10.1016/j.mri.2012.05.001
Fitch, W.T., Braccini, S.N., 2013. Primate laterality and the biology and evolution of human handedness: a review and synthesis. Annals of the New York Academy of Sciences 1288, 70–85. https://doi.org/10.1111/nyas.12071
Floris, S., Olsen, B.S., Dalstra, M., Søjbjerg, J.O., Sneppen, O., 1998. The medial collateral ligament of the elbow joint: Anatomy and kinematics. Journal of Shoulder and Elbow Surgery 7, 345–351. https://doi.org/10.1016/S1058-2746(98)90021-0
Flynn, J.M., Skaggs, D.L., Waters, P.M., Rockwood, C.A., Wilkins, K.E. (Eds.), 2015. Rockwood & Wilkins’ Fractures in Children, Eighth edition. ed. Lippincott Williams & Wilkins, Philadelphia.
Frangiamore, S.J., Moatshe, G., Kruckeberg, B.M., Civitarese, D.M., Muckenhirn, K.J., Chahla, J., Brady, A.W., Cinque, M.E., Oleson, M.L., Provencher, M.T., Hackett, T.R., LaPrade, R.F., 2018. Qualitative and Quantitative Analyses of the Dynamic and Static Stabilizers of the Medial Elbow: An Anatomic Study. Am J Sports Med 46, 687–694. https://doi.org/10.1177/0363546517743749
Furushima, K., Itoh, Y., Mitsui, Y., Kusano, H., 2016. Risk of Fragments in Ulnar Collateral Ligament Injuries Of Baseball Players. Orthopaedic Journal of Sports Medicine 4, 2325967116S00100. https://doi.org/10.1177/2325967116S00100
Fuss, F.K., 1991. The ulnar collateral ligament of the human elbow joint. Anatomy, function and biomechanics. J Anat 175, 203–212.
Glencross, B., Stuart-Macadam, P., 2001. Radiographic clues to fractures of distal humerus in archaeological remains. Int. J. Osteoarchaeol. 11, 298–310. https://doi.org/10.1002/oa.565
Glencross, B., Stuart-Macadam, P., 2000. Childhood Trauma in the Archaeological Record. International Journal of Osteoarchaeology 10, 198–209.
Gottschalk, H.P., Eisner, E., Hosalkar, H.S., 2012. Medial Epicondyle Fractures in the Pediatric Population: Journal of the American Academy of Orthopaedic Surgeons 20, 223–232. https://doi.org/10.5435/JAAOS-20-04-223
Grahn, P., Hämäläinen, T., Nietosvaara, Y., Ahonen, M., 2021. Comparison of outcome between nonoperative and operative treatment of medial epicondyle fractures. Acta Orthopaedica 92, 114–119. https://doi.org/10.1080/17453674.2020.1832312
Green, N.E., 2020. Green’s skeletal trauma in children, 6th edition. ed. Elsevier/Saunders, Philadelphia, PA.
Gugenheim, J.J., Stanley, R.F., Woods, G.W., Tullos, H.S., 1976. Little League survey: the Houston study. Am J Sports Med 4, 189–200. https://doi.org/10.1177/036354657600400501
Habel, K., Grasman, R., Gramacy, R.B., Mozharovskyi, P., Sterratt, D.C., 2025. geometry: Mesh Generation and Surface Tessellation. 〈https://doi.org/10.32614/CRAN.package.geometry〉.
Hang, D.W., Chao, C.M., Hang, Y.-S., 2004. A Clinical and Roentgenographic Study of Little League Elbow. The American Journal of Sports Medicine 32, 79–84.
Harrell Jr, F.E., 2025. Hmisc: Harrell Miscellaneous. 〈https://doi.org/10.32614/CRAN.package.Hmisc〉.
Hotchkiss, R.N., Weiland, A.J., 1987. Valgus stability of the elbow. Journal Orthopaedic Research 5, 372–377. https://doi.org/10.1002/jor.1100050309
Ikezu, M., Edama, M., Matsuzawa, K., Kaneko, F., Shimizu, S., Hirabayashi, R., Kageyama, I., 2020. Morphological Features of the Ulnar Collateral Ligament of the Elbow and Common Tendon of Flexor-Pronator Muscles. Orthopaedic Journal of Sports Medicine 8, 232596712095241. https://doi.org/10.1177/2325967120952415
Jackson, T.J., Jarrell, S.E., Adamson, G.J., Chung, K.C., Lee, T.Q., 2016. Biomechanical differences of the anterior and posterior bands of the ulnar collateral ligament of the elbow. Knee surg. sports traumatol. arthrosc. 24, 2319–2323. https://doi.org/10.1007/s00167-014-3482-7
Kholinne, E., Zulkarnain, R.F., Lee, H.-J., Adikrishna, A., Jeon, I.-H., 2018. Functional Classification of the Medial Ulnar Collateral Ligament: An In Vivo Kinematic Study With Computer-Aided Design. Orthopaedic Journal of Sports Medicine 6, 2325967118762750. https://doi.org/10.1177/2325967118762750
Kim, T.-K., Park, J.-T., Cho, H.-L., Jin, H.-K., 2013. Intra-Apophyseal Avulsion Fracture of Medial Epicondyle in a Adolescent Baseball Player. Korean J Sports Med 31, 115. https://doi.org/10.5763/kjsm.2013.31.2.115
Knüsel, C., 2000. Activity-related skeletal change, in: Fiorato, V., Boylston, A., Knüsel, C. (Eds.), Blood Red Roses: The Archaeology of a Mass Grave from the Battle of Towton AD 1461. Oxbow Books, Oxford, pp. 103–118..
Knüsel, C.J., 2011. Men Take Up Arms for War. Sex and Status Distinctions of Humeral Medial Epicondylar Avulsion Fractures in the Archaeological Record, in: Breathing New Life into the Evidence of Death: Contemporary Approaches to Bioarchaeology, School for Advanced Research Advanced Seminar Series. School for Advanced Research Press, Santa Fe, NM, pp. 221–250.
Knüsel, C.J., Robb, J., 2016. Funerary taphonomy: An overview of goals and methods. Journal of Archaeological Science: Reports 10, 655–673. https://doi.org/10.1016/j.jasrep.2016.05.031
Larsen, N., Moisan, A., Witte, D., Ellzey, A., Sawyer, J.R., Warner, W.C., Beaty, J.H., Kelly, D.M., 2013. Medial Ulnar Collateral Ligament Origin in Children and Adolescents: An MRI Anatomic Study. Journal of Pediatric Orthopaedics 33, 664–666. https://doi.org/10.1097/BPO.0b013e3182a008d2
Lee, R.C., Syed, A.N., Bowen, M.A., Lawrence, J.T.R., 2025. Partial Avulsion Patterns in the Pediatric Humeral Medial Epicondyle. Am J Sports Med 53, 537–542. https://doi.org/10.1177/03635465241310407
Liagre, E.B.K., Remy, F., Villotte, S., Knüsel, C.J., 2025. A Standardized, Three-Dimensional Cropping Protocol for Analyzing the Medial Epicondyle of the Humerus. American Journal of Biological Anthropology 187, e70100. https://doi.org/10.1002/ajpa.70100
Liang, D., Onodera, T., Hamasaki, M., Hishimura, R., Homan, K., Xu, L., Tian, Y., Kanai, S., Iwasaki, N., 2021. Quantification of Cartilage Surface Degeneration by Curvature Analysis Using 3D Scanning in a Rabbit Model. CARTILAGE 13, 1734S-1741S. https://doi.org/10.1177/19476035211059597
Lin, L.I.-K., 1989. A Concordance Correlation Coefficient to Evaluate Reproducibility. Biometrics 45, 255. https://doi.org/10.2307/2532051
Loffing, F., Sölter, F., Hagemann, N., 2014. Left Preference for Sport Tasks Does Not Necessarily Indicate Left-Handedness: Sport-Specific Lateral Preferences, Relationship with Handedness and Implications for Laterality Research in Behavioural Sciences. PLoS ONE 9, e105800. https://doi.org/10.1371/journal.pone.0105800
Martin, R.B., Burr, D.B., Sharkey, N.A., Fyhrie, D.P., 2015. Skeletal Tissue Mechanics. Springer New York, New York, NY. https://doi.org/10.1007/978-1-4939-3002-9
McBride, G.B., 2005. A proposal for strength-of-agreement criteria for Lin’s concordance correlation coefficient. NIWA client report: HAM2005-062 45, 307–310.
Milz, S., Tisher, T., Buettner, A., Schieker, M., Maier, M., Redman, S., Emery, P., McGonagle, D., Benjamin, M., 2004. Molecular composition and pathology of entheses on the medial and lateral epicondyles of the humerus: a structural basis for epicondylitis. Annals of the Rheumatic Diseases 63, 1015–1021. https://doi.org/10.1136/ard.2003.016378
Miyazaki, C.S., Maranho, D.A., Agnollitto, P.M., Nogueira-Barbosa, M.H., 2017. Study of Secondary Ossification Centers of the Elbow in the Brazilian Population. Acta ortop. bras. 25, 279–282. https://doi.org/10.1590/1413-785220172506170954
Morrey, B.F., An, K.-N., 1983. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med 11, 315–319. https://doi.org/10.1177/036354658301100506
Morrey, B.F., Tanaka, S., An, K.-N., 1991. Valgus Stability of the Elbow: A Definition of Primary and Secondary Constraints. Clinical Orthopaedics and Related Research 265, 187.
Muntoni, A., Cignoni, P., 2025. PyMeshLab v2023.12.post3. 〈https://doi.org/10.5281/zenodo.14974687〉.
Nguyen, J.C., Caine, D., 2024. The Immature Pediatric Appendicular Skeleton. Semin Musculoskelet Radiol 28, 361–374. https://doi.org/10.1055/s-0044-1786151
Ochi, N., Ogura, T., Hashizume, H., Shigeyama, Y., Senda, M., Inoue, H., 1999. Anatomic relation between the medial collateral ligament of the elbow and the humero-ulnar joint axis. Journal of Shoulder and Elbow Surgery 8, 6–10. https://doi.org/10.1016/S1058-2746(99)90046-0
Ogawa, K., Yoshida, A., Matsumura, N., Inokuchi, W., 2022. Fracture-Separation of the Medial Humeral Epicondyle Caused by Arm Wrestling: A Systematic Review. Orthopaedic Journal of Sports Medicine 10, 23259671221087606. https://doi.org/10.1177/23259671221087606
Omoumi, P., Gondim Teixeira, P.A., Ward, S.R., Trudell, D., Resnick, D., 2021. Practical ultrasonographic technique to precisely identify and differentiate tendons and ligaments of the elbow at the level of the humeral epicondyles: anatomical study. Skeletal Radiol 50, 1369–1377. https://doi.org/10.1007/s00256-020-03693-5
Paepe, M.D., Polet, C., 2007. «Numerous and tall»: a revision of the Late Neolithic human remains found in a collective burial site at Sclaigneaux (Prov. Namur), Belgium. Notae Praehistoricae 27, 163–168.
Pampush, J.D., Winchester, J.M., Morse, P.E., Vining, A.Q., Boyer, D.M., Kay, R.F., 2016. Introducing molaR: a New R Package for Quantitative Topographic Analysis of Teeth (and Other Topographic Surfaces). J Mammal Evol 23, 397–412. https://doi.org/10.1007/s10914-016-9326-0
Papadatou-Pastou, M., Ntolka, E., Schmitz, J., Martin, M., Munafò, M.R., Ocklenburg, S., Paracchini, S., 2020. Human handedness: A meta-analysis. Psychological Bulletin 146, 481–524. https://doi.org/10.1037/bul0000229
Pariat, J.-G., Boursier, F., 2022. Faut-il encore travailler sur des collections anciennes ? L’exemple de l’allée sépulcrale de Mériel « 159, Grande Rue » (Val-d’Oise). Revue archéologique d’Île-de-France 127.
Patel, B., Reed, M., Patel, S., 2009. Gender-specific pattern differences of the ossification centers in the pediatric elbow. Pediatr Radiol 39, 226–231. https://doi.org/10.1007/s00247-008-1078-4
Patton, N.R., Lohse, K.A., Godsey, S.E., Crosby, B.T., Seyfried, M.S., 2018. Predicting soil thickness on soil mantled hillslopes. Nat Commun 9, 3329. https://doi.org/10.1038/s41467-018-05743-y
Polet, C., Martiarena, M.L., Villotte, S., Vercauteren, M., 2019. Throwing Activities Among Neolithic Populations from the Meuse River Basin (Belgium, 4500–2500 BC) with a Focus on Adolescents. Childhood in the Past 12, 81–95. https://doi.org/10.1080/17585716.2019.1638555
Posit team, 2024. RStudio: Integrated Development Environment for R.
R Core Team, 2023. _R: A language and environment for statistical computing_.
Regan, W.D., Korinek, S.L., Morrey, B.F., An, K.-N., 1991. Biomechanical Study of Ligaments Around the Elbow Joint. Clin Orthop Relat Res 271, 170–179.
Resnick, D., Jacobson, J.A., Chung, C.B., Kransdorf, M.J., Pathria, M.N., 2024. Resnick’s bone and joint imaging, Fourth edition. ed. Elsevier, Philadelphia.
Resnick, D., Niwayama, G., 1983. Entheses and enthesopathy. Anatomical, pathological, and radiological correlation. Radiology 146, 1–9. https://doi.org/10.1148/radiology.146.1.6849029
Resnick, D., Shaul, S.R., Robins, J.M., 1975. Diffuse Idiopathic Skeletal Hyperostosis (DISH): Forestier’s Disease with Extraspinal Manifestations. Radiology 115, 513–524. https://doi.org/10.1148/15.3.513
Rhodes, J.A., 2004. Humeral torsion and activity-related change in the human upper limb and pectoral girdle. A biomechanical investigation and social implications. (Ph.D. thesis). University of Bradford, Bradford.
Rogers, J., Shepstone, L., Dieppe, P., 1997. Bone formers: osteophyte and enthesophyte formation are positively associated. Annals of the Rheumatic Diseases 56, 85–90. https://doi.org/10.1136/ard.56.2.85
Rothman, K.J., Greenland, S., Lash, T.L., 2008. Modern epidemiology. Wolters Kluwer Health/Lippincott Williams & Wilkins Philadelphia.
Safran, M.R., Baillargeon, D., 2005. Soft-tissue stabilizers of the elbow. Journal of Shoulder and Elbow Surgery 14, S179–S185. https://doi.org/10.1016/j.jse.2004.09.032
Schaefer, M., Scheuer, L., Black, S.M., 2009. Juvenile osteology: a laboratory and field manual. Elsevier/Academic Press, Amsterdam; Burlington, MA.
Scharoun, S.M., Bryden, P.J., 2014. Hand preference, performance abilities, and hand selection in children. Front. Psychol. 5. https://doi.org/10.3389/fpsyg.2014.00082
Schlager, S., 2017. Chapter 9 - Morpho and Rvcg – Shape Analysis in R: R-Packages for Geometric Morphometrics, Shape Analysis and Surface Manipulations, in: Zheng, G., Li, S., Székely, G. (Eds.), Statistical Shape and Deformation Analysis. Academic Press, pp. 217–256. https://doi.org/10.1016/B978-0-12-810493-4.00011-0
Schlager, S., Francois, G., Schaefer, T., Wang, Z., 2025. Rvcg: Manipulations of Triangular Meshes Based on the “VCGLIB” API. 〈https://doi.org/10.32614/CRAN.package.Rvcg〉.
Schober, P., Boer, C., Schwarte, L.A., 2018. Correlation Coefficients: Appropriate Use and Interpretation. Anesthesia & Analgesia 126, 1763–1768. https://doi.org/10.1213/ANE.0000000000002864
Schwab, G.H., Bennett, J.B., Woods, G.W., Tullos, H.S., 1980. Biomechanics of Elbow Instability: The Role of the Medial Collateral Ligament. Clinical Orthopaedics and Related Research 146, 45–52. https://doi.org/10.1097/00003086-198001000-00007
Shaibani, A., Workman, R., Rothschild, B.M., 1993. The significance of enthesopathy as a skeletal phenomenon. Clinical and Experimental Rheumatology 11, 399–403.
Signorell, A., 2024. DescTools: Tools for Descriptive Statistics. 〈https://doi.org/10.32614/CRAN.package.DescTools〉.
Sinha, R., Wyatt, C.W., Althoff, C., Jones, J.C., Johnson, B., Ellis, H.B., Wilson, P.L., 2024. Avulsion and Soft Tissue Injuries of the Ulnar Collateral Ligament in Children and Adolescents. Am J Sports Med 52, 2101–2109. https://doi.org/10.1177/03635465241252156
Sládek, V., Berner, M., Holt, B., Niskanen, M., Ruff, C.B., 2018. Past Human Manipulative Behavior in the European Holocene as Assessed Through Upper Limb Asymmetry, in: Ruff, C.B. (Ed.), Skeletal Variation and Adaptation in Europeans. Wiley, pp. 163–208. https://doi.org/10.1002/9781118628430.ch7
Sugimoto, H., Ohsawa, T., 1994. Ulnar collateral ligament in the growing elbow: MR imaging of normal development and throwing injuries. Radiology 192, 417–422. https://doi.org/10.1148/radiology.192.2.8029407
Syed, A., Lee, R.C., Bowen, M.A., Yellin, J.L., Lawrence, J.T., 2025a. Paper 38: Proximal Bony UCL Avulsion Fractures of the Pediatric Medial Epicondyle: Radiographic Union Rate and Early Clinical Outcomes. Orthopaedic Journal of Sports Medicine 13, 2325967125S00095. https://doi.org/10.1177/2325967125S00095
Syed, A., Lee, R.C., Yellin, J.L., Shah, A.S., Lawrence, J.T., 2025b. Poster 48: Fracture Patterns in Pediatric Humeral Medial Epicondyle: An MRI-Based Investigation. Orthopaedic Journal of Sports Medicine 13, 2325967125S00159. https://doi.org/10.1177/2325967125S00159
Tariq, S.M., Patel, V., Gendler, L., Shah, A.S., Ganley, T.J., Zoga, A.C., Nguyen, J.C., 2023. Pediatric thrower’s elbow: maturation-dependent MRI findings in symptomatic baseball players. Pediatr Radiol 54, 105–116. https://doi.org/10.1007/s00247-023-05817-0
Thiery, G., Guy, F., Lazzari, V., 2023. doolkit: Exploration of Dental Surface Topography (Version 1.42.2). 〈https://doi.org/10.32614/CRAN.package.doolkit〉.
Uomini, N.T., Ruck, L., 2018. Manual laterality and cognition through evolution: An archeological perspective, in: Progress in Brain Research. Elsevier, pp. 295–323. https://doi.org/10.1016/bs.pbr.2018.06.015
Vanderveken, S., 1997. Les ossements humains néolithiques de Maurenne et Hastière (Province de Namur). Notae Praehistoricae 17, 177–184.
Varalli, A., Villotte, S., Dori, I., Sparacello, V.S., 2020. New Insights into Activity-Related Functional Bone Adaptations and Alterations in Neolithic Liguria (Northwestern Italy). BMSAP 32, 34–58. https://doi.org/10.3166/bmsap-2020-0072
Verlinden, P., Lewis, M.E., 2015. Childhood trauma: Methods for the identification of physeal fractures in nonadult skeletal remains. American J Phys Anthropol 157, 411–420. https://doi.org/10.1002/ajpa.22732
Villotte, S., 2009. Enthésopathies et activités des hommes préhistoriques: recherche méthodologique et application aux fossiles européens du paléolithique supérieur et du mésolithique, BAR International Series. BAR Publishing. https://doi.org/10.30861/9781407305264
Villotte, S., Churchill, S.E., Dutour, O.J., Henry-Gambier, D., 2010. Subsistence activities and the sexual division of labor in the European Upper Paleolithic and Mesolithic: Evidence from upper limb enthesopathies. JHE 59, 35–43. https://doi.org/10.1016/j.jhevol.2010.02.001
Villotte, S., Santos, F., 2023. The effect of age on entheseal changes: A study of modifications at appendicular attachment sites in a large sample of identified human skeletons. Intl J of Osteoarchaeology oa.3197. https://doi.org/10.1002/oa.3197
Wadell, H., 1935. Volume, Shape, and Roundness of Quartz Particles. The Journal of Geology 43, 250–280. https://doi.org/10.1086/624298
Woods, G.W., Tullos, H.S., 1977. Elbow instability and medial epicondyle fractures. The American Journal of Sports Medicine 5, 23–30.
Yoshizawa, T., Okamoto, Y., Tanaka, K., Makihara, T., Tonoe, T., Minami, M., Yamazaki, M., 2018. Normal imaging laterality on magnetic resonance imaging of the medial epicondyle of the elbow on the dominant side of adolescent male baseball players. Skeletal Radiol 47, 1237–1244. https://doi.org/10.1007/s00256-018-2921-9
Zell, M., Dwek, J.R., Edmonds, E.W., 2013. Origin of the medial ulnar collateral ligament on the pediatric elbow. Journal of Children’s Orthopaedics 7, 323–328. https://doi.org/10.1007/s11832-013-0518-3
Zellner, B., May, M.M., 2013. Elbow injuries in the young athlete—an orthopedic perspective. Pediatr Radiol 43, 129–134. https://doi.org/10.1007/s00247-012-2593-x
Zheng, E.T., Bae, D.S., Yen, Y.-M., Vuillermin, C.B., Miller, P.E., Heyworth, B.E., 2025. Medial Epicondylar Apophyseal Avulsion Fractures in Youth Throwers: A Severe Variant of Little League Elbow. Orthopaedic Journal of Sports Medicine 13, 23259671251365974. https://doi.org/10.1177/23259671251365974
Zwanenburg, A., Leger, S., Vallières, M., Löck, S., 2016. Image biomarker standardisation initiative - feature definitions. 〈https://doi.org/10.48550/arXiv.1612.07003〉.