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Tag Archives: wrist

When a 98 mph Fastball Hits The Batter And Not The Bat

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.




Shaq’s Troublesome Thumb

If you follow the NBA you already know that Shaquille O’Neill recently underwent surgery for a ligament tear in his right thumb. The injury was sustained on February 25th when Boston forward Glen Davis defended Shaq during a shot attempt. Though reports have not specified, it is likely that Shaq tore the ulnar collateral ligament (UCL) of the thumb, a common sports injury and also often a byproduct of falling on an outstretched hand.  What you may not recall is that Shaq missed 22 games after suffering a similar (but likely less severe) injury in 1995 while playing with the Magic.

Wait a minute, isn’t the UCL at the elbow?
Recent columns on this site have discussed UCL injuries to pitchers’ elbows resulting in the need for Tommy John surgery as well as the implications of ankle ligament tears. First let’s quickly review the basics to help you understand the nature of Shaq’s injury.

A ligament is the connective tissue connecting one bone to another to provide stability at a joint. Each joint has at least one ligament on each side. In the hand or elbow, the inner (medial) side, or side of the ulna bone in the forearm, is called the ulnar side and the outer (lateral) side is called the radial side because of its relationship to the radius (the outer bone in the forearm). Hence, at the base of the thumb, just as at the elbow, the ligament stabilizing the innermost part of the joint is called the ulnar collateral (UCL).

Injury to a ligament diminishes stability at the joint it protects, and may do so even on a permanent basis, so

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Shaq’s prior injury may have predisposed him to re-injury.Â

Other names for the UCL tear of the thumb
Most often called “Skiers’ Thumb” these days because of its prevalence on the slopes, this injury used to be known as “Gamekeepers Thumb” because it was commonly found amongst Scottish Gamekeepers (wildlife managers) as a result of a repetitive stress and stretch to the ligament that they suffered when doing their work.Â

How does this injury occur?
A force that pulls the thumb away from the hand places stress on the UCL at the joint where the thumb meets the palm. If the force at this joint (also called the MCP, or metacarpophalangeal joint) is traumatic and causes the joint to exceed its normal limit of movement, the UCL is sprained. And, as for any ligament, a Grade III Sprain is really a complete tear.

A skier who falls while holding the pole, or anyone who tries to break a fall by reaching out with his hand to absorb the impact may suffer a Skiers’ Thumb injury. If the thumb is bent backwards and a ligament tears, it is unlikely to be able to heal in the anatomical position because of the resultant instability of the joint. That is why Shaq is having surgery. Occasionally, just as was previously discussed with regard to ligament injuries at the inner aspect of the ankle, the UCL ligament may not tear but instead might pull off a chip of bone at its point of attachment (at the base of the thumb). This injury is

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called an avulsion fracture and it too can result in instability at the joint if not corrected surgically.

So, what did Shaq’s thumb probably feel like after the injury?
Just as after any partial or complete ligament tear, fluid builds up causing swelling. Visible discoloration is an indication that a ligament (or other vascularized structure like muscle or tendon) was torn. Naturally, pain is a factor and it will hurt to use the thumb (to grip or squeeze) or to bend it backward. Reports are that Shaq will be out for six to nine weeks to heal and rehab following today’s surgery. The Cavs or course, are hoping to have him back in the line-up to help them in the later rounds of the playoffs.