All posts by David Ring

All Blogs, Basketball, Wrist/Hand

Lebron James Right Hand Bone Contusion

Leave a comment

Following Game 4 of the NBA Finals, LeBron James revealed he had suffered what was described as “a deep bone contusion” on his right hand right after Game 1 when he punched a black board in the locker room.

Punching usually injures the metacarpal bone of the small finger. The head (end) of the metacarpal forms your knuckle when you make a fist.

An MRI was done, which suggests that radiographs were normal. Two MRIs were done with the explanation that the contusion was only visible when some of the swelling went down. Swelling should not affect diagnosis of fracture on an MRI so it is unclear why two exams were ordered.  For most people a normal radiograph would be sufficient. One non-concerning MRI would be more than enough. A contusion that is difficult to see on MRI is quite minor. A bone contusion means that the bone is injured, but remains structurally sound.

The body heals a bone bruise without immobilization or projection.  It’s better to keep the hand moving to limit stiffness and swelling.

Bone bruises are painful. The bone may be a little weaker due to microscopic damage, but only for a month or two. It’s safe to play.

This blog was written by Paul Bonilla and David Ring.

ACL Injuries, All Blogs, Knee

Manuel Lanzini’s ACL Tear

Leave a comment

Manuel Lanzini from Argentina’s national team tore his anterior cruciate ligament (ACL) during practice on June 8, 2018.

The ACL runs through the center of the knee joint. It stabilizes the knee when a player plants the foot and turns.  That maneuver is often referred to “pivoting.” One forceful pivot can tear the ligament.  This is one of the few ligaments in the body that don’t heal when they rupture.

There is often a pop that is heard or felt.  The knee usually fills with blood and the effusion can be detected on examination.  Specific examination techniques can look for the greater laxity that tends to occur after ACL rupture.  Because pain and guarding may mask that exam, and an x-ray only shows fractures, an MRI is typically used to confirm ACL tear. The MRI might also show injury to other ligament, the meniscus, or bone.  That information would mostly affect prognosis.

ACL tears are nearly always complete.  The body cannot heal an ACL tear.  The first step is to regain motion in the knee.  That usually takes a few weeks of stretching.  People with ACL tears are offered surgery to reconstruct the ACL with a tendon or ligament taken from another part of the body or from a tissue bank is offered.  High-level athletes in sports with a lot of pivoting usually choose surgery if they want to their sport. People that do very little pivoting or who are willing to limit those activities often choose to leave the ACL unrepaired.

Lanzini will have surgery to reconstruct the ACL.  Return to play takes about a year, because the graft needs to be solidly healed and the muscles strong in order to limit the risk of reinjuring.

This blog was written by Paul Bonilla and David Ring.

All Blogs, Basketball, Knee

Andre Iguodala’s Left Knee Contusion

Leave a comment

On May 20, 2018 during Game 3 of the NBA Western Conference Finals, Andre Iguodala was hit on the outside of his left knee. He left the game shortly thereafter. The injury was diagnosed as a contusion (a bruise).

Direct injury to the skin, muscle, and bone can cause uncomfortable tissue damage, bleeding, and swelling that makes it difficult to move and jump. But structurally, things are fine.

A bruise is easy to diagnose on examination. A fracture is unlikely in people that are able to walk. It seems like every athlete gets an MRI for every injury, but that is unusual and difficult to justify, at least in everyday practice.

The body heals bruises over time. Treatments such as ice or pain relievers are for comfort only. Media reports often talk about athletes getting “treatment” which sounds mysterious and magical. This creates a misconception. There is no known way to speed the body’s healing process. In fact, some doctors suggest that athletes avoid anti-inflammatory medications because inflammation is an important part of the healing process that should not be slowed or interfered with.

It is safe to play with a contusion.

This blog was created by Paul Bonilla and David Ring.