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Bum (with a Bad) Shoulder

I try not to burden my friends, so I’ve only hinted at it a couple of times in this space, but yours truly has been playing hurt since mid-June. In a horseplay-related swimming pool accident — exactly the kind your mother warned you about — I injured my right shoulder. Hanging out at my pal Nick’s parents’ place in Northampton, MA, I agreed, in my infinite wisdom, to some competitive tomfoolery which involved me diving onto a flotation mat. Genius. My hands instinctively went out to cushion my landing, but my right hand slipped and slid sideways across the mat, pinning my elbow in the vicinity of my sternum and sending a sickening jolt of pain through my shoulder.

The short version is that I tore my labrum, and after three months of physical therapy that haven’t solved the problem, I’m slated to undergo arthroscopic surgery on Wednesday, November 19 to repair the damage. I’ve spent the last two weeks shuttling back and forth between doctors and labs, getting all of my ducks in a row in preparation for this. I’ve been stuck with needles so many times feel like a human pincushion, but I guess that’s good practice for what will happen next week.

The labrum is a ring of fibrous cartilege that surrounds the end of the scapula (the shoulder blade) and holds the head of the humerus (the upper arm bone) as a ball-and-socket joint. My magnetic resonance scans (MRI), which weren’t done until about a month after the injury, showed that I sustained a common type of tear called a SLAP tear. In addition to being something I’m tempted to do to myself every time I explain my injury, SLAP stands for Superior Labral Anterior Posterior. Basically, the lining of my shoulder joint was torn front to back.

Following the diagnosis by my orthopedic surgeon, I went through three months of physical therapy, which did help some in alleviating the impingement syndrome from which I suffered. But even now, my shoulder is still unstable, I’ve been unable to return to anything approaching my normal regimen of lifting weights, and many of my daily activities, such as opening windows and doors or holding onto a railing on the subway, cause me pain. I wake up several times each night to reposition my arm. I haven’t thrown a baseball since a couple of hours after sustaining the injury, which I attempted for diagnostic purposes, finding that even flipping the ball twenty feet was a chore. Basically, my shoulder’s felt as though it had the wind knocked out of it, and though I can’t point to a single specific area that’s sore, getting through a day pain-free is like trying to cover for an unfilled cavity — sooner or later I do something to remind myself just how much I hurt.

My doctors and every other reliable source of information I’ve consulted have been pretty unanimous that at this stage the shoulder isn’t going to get any better by itself, and that the surgery, which is 85-95% successful, is about as minimal as it gets. Basically, I’ll be put out via general anesthesia and given a nerve block via a shot to my neck (mmmmm). Three incisions about a centimeter in diameter will be made in my shoulder, one in the back and two in the front. Using an arthroscope, a narrow fiber optic instrument with a camera, they’ll peek into the joint through the incisions. They’ll check my rotator cuff, which by most indications is probably normal, and reattach my labrum to the scapula via suture anchors. This kind of surgery is an outpatient procedure, so I’ll be going home the same day, and after a few days of convalescing, I should be able to work the following week.

It’s the rehab which is a bitch. To give my shoulder time to heal, I can’t do much of anything for the first four weeks beyond the simple things — feeding myself, typing, and some light range-of-motion stuff. So long, ski season. After that I’m looking at about 4.5 to 6 months before I can resume full activity, including breaking out my mitt to toss the ol’ horsehide around. That feels like an eternity right now, but it’s a better outlook than chronic pain and a throwing motion my girlfriend wouldn’t sign for (she can zing it).

It’s a good thing my baseball career is limited to the occasional game of catch or a rare turn in the batting cage, because a torn labrum is something no ballplayer wants to mess with. To find out why, I turned to medhead extraordinaire Will Carroll, who writes the Under the Knife column for Baseball Prospectus. Will and his father, orthopedic surgeon Dr. William Carroll, wrote a big piece on injuries, “The Medhead Manifesto,” in the Baseball Prospectus 2003 book, including half a page on SLAP lesions, which are one of the “big five” injuries that cause nearly fifty percent of all lost playing time. Here’s what the Carrolls have to say:

The SLAP Lesion (Superior Labrum Anterior Posterior) is an overuse syndrome injury commonly associated with overhead activities, such as the throwing motion in baseball. Technically, the anatomical structure that makes the SLAP lesion possible is the origin of the tendon of the long head of the biceps muscle and the way it hooks over the head of the humerus (the bone of the upper arm that makes up part of the shoulder joint). If the arm is forcibly bent inward at the shoulder as it is in the throwing motion, the humerus acts as a lever and tears the biceps tendon and the labrum. The lining of the shoulder joint from the glenoid cavity is torn in a front-to-back fashion, hence the name SLAP — the superior aspect of the labrum is torn from anterior to posterior.

Usually the signs and symptoms involve the athlete either complaining of pain or instability in the shoulder while throwing. This condition worsens when the athlete puts his arm into the “cocked position” ready to throw. Some athletes with this condition may experience pain while doing overhead weight lifting and some have reported actually hearing a clicking sound in the shoulder when attempting to throw.

Unfortunately this condition is seldom discovered until the damage to the labrum is already done. Athletic trainers and physicians utilize a clinical test called the shoulder impingement test to clinically identify this condition. The test is performed by stabilizing the rear of the athlete’s shoulder, extending his elbow and passively forward flexing the arm. If the test is positive for a SLAP lesion, the athlete will experience pain near the end of the range of motion. If this test is positive, usually an MRI will be done to confirm the diagnosis.

If the damage to the labrum is not significant, withholding the athlete from activity and prescribing anti-inflammatory medications may treat the condition. Stretching and stabilization exercises can be utilized under supervision when the pain lessens. It is extremely important that the athlete not return to sports-specific activity (such as throwing) until the pain has entirely disappeared.

If the labrum is significantly torn, the only viable treatment for someone who wants to continue to be active in the sport is a surgery in which the surgeon arthroscopically reattaches the torn labrum. After the surgery it is very important that the athlete undergoes supervised rehabilitation designed to both strengthen the shoulder muscles and gain flexibility in the joint. Unlike the generally more positive outcomes that result from Tommy John surgery, only a small percentage of players of those that suffer significant labral tears are able to successfully return to anywhere near their previous level of performance. Most often, players that are able to come back lose significant velocity, are forced to alter their mechanics, creating further injury risk, and often retear the labrum. Recent cases such as Mike Sirotka and Mariners prospect Ryan Anderson come to mind as typical.

Yeeech. That’s two players who haven’t thrown competitively since the 2000 season — not exactly good company.

Will was kind enough to grant me some time to talk further about torn labrums. Basically the injury is a more drastic one for a ballplayer than a rotator cuff tear or an ulnar collateral rupture (which requires Tommy John surgery) because it’s harder to detect and because there’s no good rehabilitation protocol. Sports medicine has made many advances in treating other injuries thanks to the advent of the MRI, but in Will’s opinion, it will probably be another 10 years before labrum rehab becomes routine in baseball. He points to Dodger rightfielder Shawn Green’s surgery as a worst-case scenario — Green’s labrum was torn too severely to repair, so the damaged cartilege was removed, and he’s got some bone-on-bone in the shoulder. Somehow, after talking about that, a best-case scenario didn’t come up, but Will did reassure me that my surgery will likely be “as minimal as it goes.”

So for once I’m sitting here thinking that I’m glad I don’t have to hit big league pitching or keep my fastball in the mid-90s to put food on the table. This isn’t going to be a joyride, but with my doctors I feel as though I’m in good hands. I’ll be up and around in a few days after surgery, probably milking the experience for another column or two here. In a few weeks I’ll be hoisting beers with Will and Alex Belth during baseball’s Winter Meetings in New Orleans. Don’t worry, I’ll be hoisting with my left hand.

• • •

Christian Ruzich is back online, and one of the things he’s done is set up a live Pitchers and Catchers countdown. At last notice, there were 95 days, 21 hours, 41 minutes and 36 seconds until the big event.

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