A New Look At Ulnar Collateral Ligament "Tommy John" Elbow Injuries

My partner at Washington University Matthew Smith MD an elbow ligament and throwing injury expert and Spencer Lake PhD a Washington University Mechanical Engineer have received a grant to look at innovative ways to image the ulnar collateral ligament in the elbow utilizing polarized light. This should give us more information regarding structural properties and how better to treat these injuries. This work featured in the St. Louis Post Dispatch article from the Business Section HERE is truly exciting given the number of these injuries that are occurring in younger and younger athletes.

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

Cardinal's Rosenthal Will Undergo UCL (Tommy John) Surgery. What does That Mean?

Trevor Rosenthal by report will undergo ulnar collateral surgery. UCL reconstruction or Tommy John surgery as it is commonly called involves replacing a torn ligament on the inside of the elbow. The anterior band of the UCL is typically replaced with a graft. The graft may come from the forearm, knee or sometimes a cadaver. Fortunately, the results are frequently good and elbow procedures are more successful in returning throwers to the previous level than many shoulder procedures in pitchers. Read this American Journal of Sports Medicine STUDY of UCL reconstructions we performed at Washington University in the Sports Medicine group that showed a 92% success rate at returning patients to their previous level of throwing. Typically recovery takes 12 months to return to pitching competitively. 

Dexter Fowler Out With Plantar Fasciitis: What Is It?

Plantar fasciitis also commonly referred to as a bone spur in the foot is a painful condition involving the ligamentous attachment on the heel bone on the bottom of the foot. Usually the bone spur is a byproduct and not a cause of the pain. The tough ligamentous tissue undergoes microtears with collagen breakdown and scarring. It usually begins slowly over time and may be related to over use  The hallmark of symptoms is pain when first walking in the morning or after sitting for an extended period. It can be very difficult to cure or improve. Stretching is the mainstay of managing it and I advise patients to stretch their achilles and bottom of the foot every time before arising to walk. While it may take time this typically will help. Night splints may also help. Cortisone is rarely used and surgery is almost never indicated.

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.

Oblique Muscle Strains

Once again this season baseball players have been affected by oblique muscle strains. Most recently it impacted the St. Louis Cardinals when their All Star infielder Matt Carpenter sustained the injury missing a month of games including the All Star Game. Why are these such significant injuries for some sports and playing positions while you never hear about them in other sports?

The oblique muscles reside on both sides of the abdomen and chest running from the pelvis to the chest and ribs in the front and chest and spine in the back. There are 2 muscle groups on each side--- the internal and external obliques. Rather than running straight vertically or horizontally they run “obliquely” across the body and thus their name is derived.

These muscles are critical for rotational activities and that is why they are more impactful for certain sports. While challenging for any athlete an oblique muscle strain is the worst for those athletes that repetitively rotate. Thus baseball pitchers and hitters are highly affected. Hockey players are also bothered by it while shooting especially during slap shots.

We have had several with the St. Louis Blues over the years that resulted in several man games lost. It much less frequently affects sports that are more linear such as track, swimming, football or basketball. It is an infrequent injury even for quarterbacks and I can’t remember a significant oblique injury with loss of time for any of the Rams quarterbacks.

Treatment is similar to other muscle strains and involves conservative management with ice, NSAIDs and rehabilitation including stretching and strengthening. Nothing seems to shorten

the recovery which for baseball position players is typically a month. If anything more than a minor strain for a pitcher it can cost 6-8 weeks. Cortisone injections can be utilized, but still time is the best ally and cortisone is relatively a quick fix. These muscle strains typically are diffuse over a relatively large area and thus difficult to pinpoint for an injection. Likewise there is no scientific evidence that platelet rich plasma (PRP) or stem cell injections will speed recovery. That is why these are difficult injuries for the athletes and the fans that follow them. It is hard to be patient.