Alex Reyes Underwent Latissimus Repair: What Does That Mean?

Cardinal pitcher Alex Reyes underwent latissimus dorsi repair after recently injuring it. Tony Romeo a Philadelphia surgeon performed the repair. The latissimus muscle originates on the ribs and thoracic spine and inserts on the humerus (arm bone) near the shoulder joint. It is responsible for the following actions: extension, adduction, horizontal abduction, flexion froman extended position and internalrotation of the shoulder joint. Given the time to heal and then the lengthy time to return to throwing this will be a season ending injury for him. Read a description of the technique HERE

Frozen Shoulder Treatment

Frozen shoulder or Adhesive Capsulitis is a condition seen in middle aged men and women predominantly. It is more common in diabetics. A trivial shoulder injury can initialize the process which is fibrosis and scar formation in the shoulder making it is stiffer and stiffer. The natural history is increasing stiffness for 1-2 years followed by a natural return to normal range of motion that may take another year. Obviously, patients do not want to wait this long.  The past several years I have been using a cortisone injection into the joint which seems to stop the process and reversed the stiffness when done in conjunction with physical therapy.  Since adopting this approach I have not had to operate on someone with frozen shoulder for several years.  A recent study in the American Journal of Sports Medicine highlighted a randomized trial that corroborated my impression. You can find details  HERE

Pitch Counts for Young Pitchers

There continues to be an epidemic of shoulder and elbow injuries from little leaguers through the professionals. Tommy John surgery rates are climbing the fastest in high school pitchers. The problem is present in the pros who are always in search of increased velocity. Read a sad opinion piece HERE.

Pitch counts have been set up for Little League and can be found HERE. It can be hard to keep the exact numbers memorized. In general a pitcher should be limited to 5 pitches per year of age per outing and 10 pitches per year of age per week with plenty of rest between starts. As Jimmy Andrews frequently says -- no breaking balls before they start shaving-- can be helpful in helping limit young arm injuries. Make sure your child's coach is aware of the rules and enforces them to help us prevent injuries or loss of time from the game.

Shoulder Separations

It is football season with hockey not too far behind so we are beginning to see shoulder separation injuries showing up at the Washington University Orthopedic Injury Clinic. Patients always are confused as is the media on the difference between a shoulder separation and a shoulder dislocation. A Shoulder Disloction and its Treatment as previously reviewed on this blog refers to the humeral head (ball) sliding off the glenoid (socket). This frequently needs to be put back in place and frequently requires surgery to prevent future episodes.

A shoulder separation on the other hand is typically treated conservatively and rarely requires surgical reconstruction except in severe circumstances such as the injury Sam Bradford sustained while playing for Oklahoma. The injuries most commonly occur in contact sports but are also frequently seen in cycling injuries when riders fly over the handle bars and land on their shoulder. It is typically a blow to the point of the shoulder that drives the shoulder blade down and stretches or tears the ligaments that connect the collar bone (clavicle). These ligaments are called the coracoclavicular

ligaments and are 2 tough bands running from the collar bone to the coracoid -- a bony prominence projecting from the scapula. It also occurs frequently in hockey when players are checked into the boards or fall and hit the ice. Typically it causes local pain in the shoulder area with limited range of motion and weakness. Initially it is treated with a sling ice. A plain x-ray showing the depressed shoulder blade and ruling out a fracture is all that is necessary. An MRI is not required.

Physical Therapy is begun soon after the injury with a focus on motion and strength. Once the pai n is tolerable and full motion and strength is regained the athlete can return to sports with no long term sequelae except some prominence of the clavicle in that area.

 There are 6 grades of injury with most falling into Grades 1,2 and 3. Grades 1 and 2 are always treated conservativeley. Grade 3 with worse ligament damage and more deformity is still usually handled without surgery. Occasionally throwers or other overhead repetitive workers require repair/reconstruction of the ligaments. Fortunately, despite several injuries of the Type 3 severity with the St. Louis Blues we have never had to perform a surgical reconstruction. Grade 1 injuries typically require 1-2 weeks for recovery, Grade 2 2-4 weeks of recovery and Grade 3 treated without surgery are 6 week injuries.

Pectoralis Muscle Injuries

It is the start of football training camps across the country and already there have been reports of pectoralis muscle injuries leading to lost time and frequently surgery. Manny Lawson the Buffalo Bills outside linebacker expects to miss time with a partial tear. The Bengals' first round draft pick William Jackson III a cornerback will have surgery shortly for a complete tear as did Desmond Bryant a defensive lineman for the Browns. Previously, we discussed rotator cuff injuries, but this represents a different type of shoulder muscle injury.

The pectoral musccle is in the front of the chest and is active in use of the arm extended away from the body or in pushing objects away from the chest. It has 4 parts with the major portion attaching to the humerus (arm bone) as a thick tendon.

Many are muscle strains that represent a partial tear of the muscle much like a hamstring strain. These do not require surgery and will recover with ice and rest followed by physical therapy including stretching and strengthening. A complete pectoral tear involves the tendon pulling off the bone. This typically requires reattachment to the bone to restore function in healthy active individuals.

Frequently the injuries occur while weight lifting especially bench press. Also specific football acts that increase the risk is using the arms in extended fashion away from the body as offensive lineman do frequently.

Diagnosis is made by a loss of contour of the chest in the front, pain, weakness and significant bruising. An MRI can help determine the severity of a partial tear, but may not be necessary for a complete tear diagnosis.

Commonly this is a 3-6 month recovery for most athletes with 6 weeks of minimal activity followed by 6 weeks of intensive rehabilitation. At this point more functional rehabilitation and training can occur, but it is difficult to return to true sports before 4-6 months. Thus, it is frequently a season ending injury especially for offensive linemen.