Jose Reyes, New York Mets’ infielder, left Sunday’s game against the Mariners in the fifth inning after being hit on the left forearm by a 98 mph fastball. X-rays were reportedly negative. Though Reyes noted by end game that he was able to move his fingers, something he wasn’t able to do in the immediate aftermath of the injury, the area remained very sore. Amazingly, reports noted that – due to the absence of fracture – Reyes hopes to return to the lineup as early as Tuesday. That seems unlikely.
The area of the impact to Reyes’ forearm was near the wrist, a region with little soft tissue to soften the blow. Since the injury was to his left and he throws right-handed, it is hitting that will clearly pose the greatest problem. Despite being a switch-hitter, everything from cocking the wrists at the early phase of hitting, to rotating the forearms (the upper pronates, while the lower supinates during the swing) could cause pain. Even simply having to absorb the impact of the ball on the bat – will stress the affected area. Whether he bats righty or lefty, demands will be placed on the extensor and supinator muscles that comprise the extensor (dorsal) surface of Reyes’ left forearm.
Though MRI findings were not reported, a bone contusion (in addition to more superficial bruising) is Reyes likely diagnosis. A bone contusion is a traumatic injury that is caused by forceful impact,
It entails disruption to the bone marrow that rests below the joint cartilage. Microfractures, hemorrhages and edema to the inner layers of the bone (known as cancellous bone) are the result. Since the outer, or cortical layers of bone and the cartilage that surfaces the bone (articular cartilage) are not affected, contusions are not referred to as fractures. MRI assists with diagnosis, as these injuries are not visible on x-ray. Interestingly however, even when initial x-rays are negative, fracture may not be definitively ruled out.
When nerves are involved, a contusion can result in tingling, numbness or burning sensations in the area of impact as well as distal to it (further away from the center of the body).
Time to healing varies and depends on the severity of the injury, the presence of other injuries and the demands placed on healing areas. Mild injury may heal sufficiently within three weeks, and almost half of sufferers have been found by some studies to exhibit no evidence of injury six weeks after insult. Other studies report up to six months to full healing after contusions. One in particular on the scaphoid (a bone at the wrist) demonstrated good outcomes for all patients studied, though eight of 41 subjects remained symptomatic at three months, four of whom continued to exhibit some degree of pathology. These also went on to complete recovery.
Returning to play too soon is likely to prolong recovery and may even result in concomitant pathologies. In the case of muscle contusions these can include excessive scar tissue formation and myositis ossificans. It isn’t worth it.
The news out of the Washington Nationals’ Strasburg watch is that he won’t miss a start in spite of the slight stiffness and soreness reported in his throwing forearm after Tuesday’s game, in which he threw 93 pitches. Though by all accounts Strasburg’s elbow and arm are structurally sound, even Scott Boras, Strasburg’s agent had acknowledged the symptoms, which Manager Davey Johnson said might be due to a nerve irritation from the electrical stimulation used pre-game. Though I’ve no first hand knowledge of the situation, I highly doubt the treatment was the cause. Johnson also reported that Strasburg has not had any trouble with
his pitching mechanics.
Strasburg, a prodigy who is apparently a perfectionist and wants no coddling, famously underwent Tommy John surgery in September of 2010 and was benched against his wishes before the playoffs in 2012 to safeguard his arm.
Though the 24-year-old phenom has already learned he is not indestructible, I hope Strasburg’s youth and desire won’t stand in the way of his listening to his body if symptoms persist or worsen.
You may recall that Tommy John surgery repairs a tear in the ulnar collateral ligament (UCL), which is the primary stabilizer of the elbow. However, the undue stresses pitchers place on the medial (inner) elbow, and the excessive loading of this region can impact not only the UCL, but can also create inflammatory conditions in all of the structures in the area. These include the wrist flexor muscles (which are in the forearm but attach at the inner elbow), the forearm pronators (which turn the palm downward), the elbow joint capsule, and the ulnar nerve. The repetitive demands of pitching and the nature of the motion itself – particularly the acceleration phase – are the primary culprits. If not heeded, persistent pain, which is a reflection of an issue, leads to weakness, breakdown and altered mechanics.
Even mild forearm soreness and stiffness may be significant for a pitcher. Hopefully Strasburg’s is as mild as he claims and will be as transient as he anticipates.
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