All posts by David Ring

All Blogs, Basketball, Knee

Lonzo Ball’s Meniscal Tear

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Los Angeles Lakers point guard Lonzo Ball, was diagnosed with left knee meniscus at the end of the 2017- 2018 season.

The knee meniscus is a piece of cartilage that acts as a “shock absorber” between the thigh bone and shinbone. They are strong enough to help cushion the joint and keep it stable. The cushion is sometimes torn by an awkward and forceful twist of the knee. It’s important to distinguish traumatic injury of the meniscus from the types of changes and fraying that occur with normal aging (part of arthritis). Both types of problems are described as “tears” so it can be confusing.

A torn meniscus might be felt as a sudden pop or just a sore knee after playing. Although x-rays do not show meniscus tears, they can rule out other knee problems that cause similar symptoms. Magnetic resonance imaging (MRI)–a way to image the non-bone structures in the joint is used to diagnose this injury.

Treatment for a traumatic meniscus tear in a young adult athlete depends on the size and location of the tear. It’s possible to treat this injury non-surgically with stretches and pain relievers. Many feel better with time and non-specific supportive measures (e.g. ibuprofen).  Exercises help keep the knee flexible and the muscles conditioned. Surgery is considered when there is a large loose fragment of meniscus that is getting stuck between the bones of the knee joint.  The knee may get stuck or pop with movement–sometimes referred to as “mechanical symptoms.” Surgery usually just removes these fragments. Once in a while, a very large tear of the meniscus as it’s the thickest part near the edge of the knee joint is repaired and protected so that it might heal.

With or without surgery to resect a fragment, players usually feel well enough to return to play after about 4 to 6 weeks. If the meniscus is repaired it needs to be protected for 6 to 12 months. Lonzo Ball chose to have an injection of platelet-rich plasma. This is an experimental treatment based on the rationale that this type of plasma is loaded with growth factors that aid recovery. There is no evidence that this actually occurs. There is much more marketing than evidence behind these types of shots. If you have a problem with your meniscus, you should be cautious about having this type of shot or any other type of experimental treatment. It’s not clear that they are better than your body’s natural healing. There is definitely risk, discomfort, cost, and inconvenience. Lonzo Ball is expected to play when season starts.

This blog was written by Ramla Kiyar and David Ring.

 

All Blogs, Baseball, Other

Kevin Pillar’s Sternoclavicular Joint Sprain

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On July 14th, 2018, the Toronto Blue Jays’ center fielder Kevin Pillar was injured diving to catch a pop up in the third inning against the Red Sox. Pillar went down hard on his right elbow. He returned to the dugout holding his neck. He did not return to the game and was taken to the hospital.

X-Rays and CT scans were obtained at Beth Israel Deaconess Medical Center in Boston. According to Blue Jays’ head physical trainer Nikki Huffman, “there are a bunch of ligaments in the joint capsule there, and he stretched through it.” The diagnosis is a grade 1-2 Sternoclavicular SC joint sprain, meaning partial tearing of the ligaments.

The sternum (breastbone) connects to the clavicle (collarbone) where the upper chest meets the neck. A forceful impact, usually during a fall, can dislocate this joint. There is some danger if the clavicle dislocates posteriorly towards blood vessels and the trachea (windpipe).

Recommended treatment was immobilization of the arm in a sling. He is expected to be out 4-6 weeks.

This blog was written by Katharine Clement and David Ring.

Baseball, Other

Deven Marrero Strained Oblique

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Arizona Diamondbacks infielder Deven Marrero was placed on the 10 day disabled list on June 30th with what was described as a strained left oblique. The injury occurred during batting practice.

The oblique muscles attach to the rib cage and help rotate the trunk of the body.  A strain—partial tearing—of the oblique muscle can occur during a forceful twisting of the body during a swing.  This type of injury also occurs in cricket players and javelin throwers.

People with an oblique strain have pain in the side with rotation of the trunk. Muscle strains heal with time. It is important to keep active and flexible.  It’s difficult to swing and throw effectively during the initial week or two when the strain is most painful. Baseball players typically return between 1 and 3 weeks of an oblique strain.

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Other athlete media coverage of oblique strains:

  • Michael Wacha had an oblique strain on June 22nd, 2018.  It was reported that he had an MRI to confirm the severity of the strain, but there is no established value to this step.  It seems like athletes get an MRI for just about everything and most are unnecessary. Wacha is hopeful that his absence will be measured in weeks, not months, but such injuries have been known to linger. No information on treatment.
  • Arizona Diamondbacks shortstop Robbie Ray left the game on April 29th, 2018 with a strained right oblique. Ray’s MRI revealed a grade 2 strain, meaning more than a slight tear in the muscle, but not a complete detachment. Ray returned to play after 5 weeks. The use of MRI for an oblique strain is puzzling. We know from the mechanism, the location of pain reported and tenderness identified that there is an oblique strain. Surgery is never considered for this type of injury. When a player is comfortable enough to play effectively, the player returns to play. MRI does not aid diagnosis, treatment, or prognosis.

This blog was written by Paul Bonilla and David Ring.