Disc injuries are difficult to prevent, but their long-term prognosis is positive.
Everyone experiences back or neck pain at some point in their lives, and baseball players are no different. We’ve seen Justin Morneau, Chris Snyder, Tim Hudson, Jason Isringhausen, Peter Moylan, and many others suffer disc injuries in the last few years alone. We have over 120 cases of injured intervertebral discs among major leaguers in our database, a number that’s sure to grow as we add more historical cases and additional aches and pains arise. As Corey tries to ignore his own sore back, let’s take a look at intervertebral disc injuries.
The spine is made up of bones, ligaments, nerves, and intervertebral discs, but we’re going to focus on the intervertebral discs. Situated between the bones of the spine, the intervertebral discs have multiple functions. They act as shock absorbers, preventing the bones from bumping into each other, and they work with the joints of the spine to allow the spine to bend and rotate.
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Taking a look at an injury being treated in-season more often thanks to improvements in surgical techniques.
Among major-league players, treatments for torn labrums in the hip are on the rise. In our database, only eight major leaguers underwent surgery on their hips from 2002-2006. From 2007-2011, 33 players had a hip procedure performed. Improvements in surgical technique and technology have significantly shortened the rehabilitation, making surgery a viable option in the middle of the season.
While hip arthroscopy has been around for many years, it has been only relatively recently that its role in treatment for athletes with femoroacetabularimpingements and/or labral tears has significantly increased. Nevertheless, much like other conditions seen in baseball players, its frequency will continue to rise in the near future, perhaps limiting the severity of acquired osteoarthritis later in life.
Catching up with the surgeries on and recoveries of Nick Markakis, Alex Rodriguez, Ian Kinsler, Jason Castro, Al Alburquerque, and other players.
Before long, spring training will be upon us, and we’ll be able to watch live baseball games again. Rounding up the usual injury suspects has been fun, and we’ll go into detail about several other injuries before putting the series on hold. However, injury news doesn’t stop being made at the end of the World Series, and since our last injury roundup, more than a few injuries have come to light. Therefore, we interrupt our regularly scheduled program to bring you this important news.
Examining a potentially career-ending, difficult-to-diagnose injury that most commonly affects pitchers.
Thoracic Outlet Syndrome (TOS) is a fairly rare condition that afflicts the nerves and blood vessels as they travel down from the neck into the arm. For a period of time, it appeared that the Rangers and the Tigers had the market cornered for TOS cases, as Kenny Rogers, John Rheinecker, Jeremy Bonderman, Hank Blalock, and Matt Harrison all came down with TOS diagnoses. In effect, they were the lucky ones, because they were able to get accurate diagnoses, which can be difficult at times. Players with TOS can suffer through periods of pain, discomfort, or neurologic symptoms without an accurate diagnosis, and as a result, their performance suffers. Even with an accurate diagnosis, it’s not a given that they will return to pre-injury levels.
TOS was first described in the late 1800s, and variations continued to be discovered in the following decades. TOS can be broken down into three different types: arterial, venous, and neurogenic, all of which we can see examples of in baseball. Abduction, external rotation, cervical lateral flexion, and cervical rotation—which, of course, we see with every pitch—can contribute to baseball players developing subtypes of TOS.
Our series continues with a look at the serious athletic injury most likely to make you giggle.
Athletic pubalgia (more commonly called sports hernias) have been getting more attention in the last few years, but reports often mistake them for inguinal hernias or otherwise misrepresent what they are. Despite the hernia connotation, this injury does not involve any actual herniation, which is defined as the protrusion of an organ or other bodily structure through the wall that normally contains it. Therefore, “athletic pubalgia” is a more appropriate term and encompasses any number of variants, including chronic adductor strains.
Football, soccer, and ice hockey have traditionally seen the highest number of cases of athletic pubalgia, but in the last few years we have seen numerous baseball players undergo surgery, including Stephen Drew, Josh Hamilton, Hunter Pence, Nick Markakis, and Kevin Youkilis. In today’s column, we’re going to look primarily at athletic pubalgia, but we’ll also discuss how they differ from inguinal hernias.
The skinny on an elusive injury that increasingly plagues pitchers.
Superior Labrum Anterior to Posterior (SLAP) tears are an increasingly common injury in baseball players. Much more common in throwing athletes than non-throwers, SLAP lesions have gained a lot more attention as baseball pitchers have been studied in greater detail.
Anatomy As we described in a previous article, the shoulder is made up of three bones but many different soft tissues. The clavicle, scapula, and humerus serve as attachment sites for the various muscles, ligaments, tendons, and nerves in order for proper function to occur. In the case of SLAP lesions, we are most interested in the labrum and the tendon of the long head of the biceps.
UCL injuries are less disastrous than they used to be but remain an injury to be reckoned with.
Tommy John surgery: three words that no player wants to hear. It doesn’t matter that technology, surgical techniques, and rehabilitation methods have significantly improved since the first surgery in 1974. All the injured player knows is that he’s going to be down for a while and that he’s not guaranteed to return to his pre-injury performance level. In 2011, several key players went down with Tommy John surgery (TJS), including Adam Wainwright, John Lackey, DaisukeMatsuzaka, Joba Chamberlain, Jorge De La Rosa, Brett Anderson, and Jenrry Mejia, and we also saw the return of Stephen Strasburg after TJS in 2010. We’ve touched on the surgical procedure before, but for our first installment of Collateral Damage in 2012, let’s review the ins and outs of Tommy John Surgery.
Unlike many of the other injuries we’ve discussed, the anatomy of TJS is fairly straightforward. The UCL arises off the medial epicondyle of the humerus and involves three major components. The anterior oblique bundle is a little over three-quarters of an inch in length and despite its small size is the main stabilizer between 20 and 120 degrees of flexion, making it the most stressed part during pitching. When the elbow is fully extended, the UCL, bony articulations, and other soft tissues like the capsule split the stress fairly evenly—roughly one-third for each.
Ankle sprains can heal fairly quickly, but when surgery is required, the injured player's season is at stake.
The ankle is among the most commonly injured body part across all sports. Thousands of people sprain their ankles every day during relatively routine activities. In baseball, ankle sprains don’t usually end up requiring an extended stay on the disabled list, but when they do, they’re gruesome to watch. In 2011 alone, severe ankle injuries took out Stephen Drew and Buster Posey, but they don’t have to be that severe in order to affect performance. Velocity and control can be affected in pitchers, while bat speed and control can be affected in hitters. With that in mind, let’s examine the different types of ankle sprains.
What we consider the ankle joint is actually two different joints called the subtalar joint and the talocrural joint, which are composed of the tibia, fibula, talus, and calcaneus. For our purposes, the subtalar joint is the interaction between the talus and the calcaneus, while the talocrural joint is made up of the tibia, fibula, and talus. Together, these three bones of the talocrural joint are also called the mortise. The talocrural joint allows dorsiflexion and plantarflexion, while the subtalar joint allows for inversion, eversion, pronation, and supination.
Thumb injuries can be just as unfortunate for baseball players as they are for hitchhikers, Roger Ebert, and the Fonz.
Some would argue that the thumb’s primary purpose is to be raised in the manner of Arthur “Fonzie”Fonzarelli from Happy Days, but we are most concerned with its role in gripping and grabbing objects in baseball. In order for that to happen, the thumb has to be working right. You can’t play baseball at a high level with your thumb sticking up in the air like the Fonz, or if you just hit it with a hammer. One of the most common injuries to the thumb involves the ulnar collateral ligament of the metacarpophalangeal joint. In today’s installment, we are going to look at a few specific injuries to the UCL of the thumb, namely Gamekeeper’s thumb and Stener lesions.
Anatomy The thumb, despite its appearance, is an extremely complex group of bones, tendons, and ligaments that somehow work together to allow gripping of objects and marathon gaming sessions. It is composed of five different bones (metacarpal, proximal phalanx, distal phalanx, radial metacarpophalangeal (MCP) sesamoid, and ulnar MCPsesamoid) and three main joints (carpometacarpal, MCP, and interphalangeal). The MCP and IP joints also have ligaments on the ulnar side closest to the palm (UCL) and on the radial side on the outside of the thumb (RCL).
Fractures are never fun, but more of them will be prevented on the field in coming years.
In this installment, it’s back to the basics as we look at how fractures heal. Baseball players suffer their fair share of fractures. Clavicles, fingers, toes, hands, feet, tibias, fibulas, forearm bones, wrists, and sometimes the humerus—hey, it’s not funny when it’s broken—are among those most commonly injured. They all heal through the same mechanisms, although some take longer than others.
Functions of bone/skeletal system Bone is a living tissue that has six major functions: support, movement, protection, blood cell production, storage, and endocrine regulation. We’re all familiar with the support and protection functions, and when we think about it, movement makes sense too. Unless you’re a worm, muscles need something to pull on to produce the force required for motion. Without bone marrow, blood cells would not be made. Bone cells secrete the hormone osteocalcin, which helps regulate blood sugars and fat deposits, and they also store calcium and ferritin, which are involved in calcium metabolism and iron metabolism, respectively.
A rotator cuff tears isn't a death sentence for a pitcher's career, but it's far from a positive prognosis.
Baseball pitchers and rotator cuff problems seem to go hand-in-hand despite the rotator cuff being much smaller than other muscles about the shoulder and upper back. The four small muscles that make up the rotator cuff are vital to the shoulder’s health and to a pitcher’s playing career. In fact, at one time, rotator cuff surgery was considered a career-ending sentence. That isn’t the case any longer, but it still hasn’t reached the level of relative certainty of ACL surgery or even Tommy John surgery. Without a healthy rotator cuff, a significant cascade effect culminating in shoulder instability and/or tears of the labrum is possible, if not inevitable. In today’s episode of Collateral Damage, we will be looking at the rotator cuff and ways of treating it in all of their complexity.
The rotator cuff is made up of four muscles that attach at different sites on the scapula, a.k.a. the shoulder blade. These four muscles are known as the supraspinatus, infraspinatus, teres minor, and subscapularis. The main function of the rotator cuff as a group is to ensure that the humeral head stays centralized in the glenoidfossa. This cannot be emphasized enough. Two of the muscles—infraspinatus and teres minor—assist in external rotation of the shoulder, while the subscapularis is the only rotator cuff muscle whose role is as an internal rotator. The supraspinatus also assists in abduction, especially early in the motion. Without that rotator cuff, the humeral head would slide all over the place and tear up the labrum, articular cartilage, and other tendons in the area.
We give you the lowdown on an ailment which is becoming increasingly common and the procedures that have been developed to combat it.
We’re hearing reports of microfracture surgery, arthritis, and osteochondral and articular cartilage injuries increasingly often. Given today’s emphasis on year-round training at an earlier and earlier age, cartilage injuries are going to become only more common in the future. We’ve made numerous advances in repairing cartilage injuries, but we still aren’t 100 percent there. Local cartilage defects are more of a problem than degenerative arthritis in the young, athletic population we report on here, so in this installment, we will primarily look at focal cartilage injuries and their management.
Background Anatomy Articular cartilage is the hyaline cartilage on the ends of the bones in a synovial joint, very similar to the white cartilage on the ends of chicken bones. It’s important to note that this is a different type of cartilage from that found in the labrum or meniscus. Typically we hear about cartilage injuries in the weight-bearing joints of the lower extremities, but there is articular cartilage throughout the remainder of the body. Synovial joints come in many different varieties, including ball-and-socket (hip and shoulder), hinged (elbow, knee, fingers, toes), gliding (wrist), pivot (top of neck), saddle (CMC joint of thumb), and condyloid (forearm to wrist joint). The cartilage gets the majority of its nutrition through the synovial fluid that is present inside the joints.