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Articles Tagged Arthroscopic Surgery 

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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, Daisuke Matsuzaka, 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.

Anatomy
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.


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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.

Anatomy
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 glenoid fossa. 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.
 



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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.


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September 6, 2011 5:00 am

Collateral Damage: The Season-Ending Injury Edition

1

Corey Dawkins and Ben Lindbergh

Hanley Ramirez moves closer to surgery, Brennan Boesch won't be around for October, Franklin Gutierrez's lost season gets worse, Mike Stanton strains a hamstring, and Conor Jackson kicks off his Boston career by running into a wall.

Hanley Ramirez, FLO (Left shoulder surgery—instability) [AGL: 94, ATD: +.065] (Explanation)
As the situation with Ramirez's shoulder progresses, we're finding out more about his options. In light of the mechanism of injury, we know the shoulder is unstable in at least the anterior direction. As with any injury, there is the option of not doing anything and continuing to rehabilitate the shoulder in the hope that it gets strong enough. Ramirez has already pursued that option, and the shoulder continued to be unstable, even on practice swings. That leaves us two surgical options that Ramirez is also considering: arthroscopic and open.

Arthroscopic procedures are minimally invasive and generally have a shorter recovery time. Small incisions are made in the shoulder to allow the instruments to be passed into the shoulder. Before addressing any repair of the capsule itself, the surgeon will take a look at the labrum, rotator cuff, and articular cartilage on the end of the humerus. If any of these is injured, repair of that structure will ensue.


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June 28, 2008 12:00 am

Player Profile: Mike Gonzalez

0

Marc Normandin, Will Carroll and Eric Seidman

Can he give the Braves what they need as the main man in their bullpen?

With the Atlanta Braves fighting for a playoff spot in the crowded National League East, any assistance they can get without having to trade away talent is a plus towards achieving that goal. They added just that kind of help back to their roster this month when Mike Gonzalez, who missed almost all of the 2007 season due to Tommy John surgery, made his season debut on June 18. Between the ongoing issues with keeping Rafael Soriano in action, the loss of Peter Moylan for the year, and the bouncing around where John Smoltz moved from the rotation to closing and finally to the Disabled List for the remainder of the season, having a pitcher of Gonzalez' ability fall in your lap should be considered a gift. Of course, this assumes that Gonzalez is capable of being the dominating force he was before his injury trouble. Today, we'll take a look and see if that's the case today.

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May 3, 2007 12:00 am

Future Shock: Unpaid Hazards

0

Kevin Goldstein

Pitching in college may not make for 'safe' picks in the amateur draft.

In Sunday's draft notebook, I characterized Missouri State southpaw Ross Detwiler as a "safe and solid pick." For saying so, I got taken to task by a reader, who asked just how safe any pitcher can really be. The answer in the end is, not very safe at all. Right now, it's almost certain that a college pitcher, Vanderbilt's David Price, will be selected by the Devil Rays with the first overall pick in June. In addition, the first ten picks in the draft could feature as many as four college pitchers, with anywhere from six to eight more being selected in the 20 picks that comprise the rest of the first round. Taking a look at the first five college arms selected in each draft of the new millennium, one finds some disturbing patterns.

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October 27, 2003 12:00 am

Under The Knife: All Kinds of Time

0

Will Carroll

From the NY Post : "An MRI revealed an inflamed tendon in Jason Giambi's left knee as well as patellar tendinitis. The condition is chronic and he will have to undergo diagnostic arthroscopic surgery after the World Series." Sometimes, it's good to know where my work hasn't made it. You, of course, realize that an inflamed tendon is the very definition of tendinitis. Giambi will have surgery, but the recent pain that kept him out of the World Series could indicate more damage than expected. This will surely bear close watch. The Yankees will also be watching as Derek Jeter undergoes his expected off-season shoulder surgery. As we saw with Phil Nevin, the time period from surgery to game-ready is reduced from previous expectations due to new technologies and techniques. Jeter should return in plenty of time for Spring Training, assuming he maintains the new timeline we've seen established in the past year. There should be no ill effects and in fact, Jeter should be expected to improve slightly, on a pure health basis.

  • From the NY Post : "An MRI revealed an inflamed tendon in Jason Giambi's left knee as well as patellar tendinitis. The condition is chronic and he will have to undergo diagnostic arthroscopic surgery after the World Series." Sometimes, it's good to know where my work hasn't made it. You, of course, realize that an inflamed tendon is the very definition of tendinitis. Giambi will have surgery, but the recent pain that kept him out of the World Series could indicate more damage than expected. This will surely bear close watch.
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    Getting accurate injury information is about as easy as getting good seafood in Indianapolis, so adding in language barriers, time zone calculations, and trying to figure out the vagaries of international calling on my cell phone makes things especially challenging. So went the quest to find out the status of Mariners reliever Kazuhiro Sasaki.

    Getting accurate injury information is about as easy as getting good seafood in Indianapolis, so adding in language barriers, time zone calculations, and trying to figure out the vagaries of international calling on my cell phone makes things especially challenging. So went the quest to find out the status of Mariners reliever Kazuhiro Sasaki.

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