All posts by Javier Granados

All Blogs, strain

Giancarlo Stanton Bicep Strain

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On Sunday, March 31st, Yankees’ outfielder/designated hitter Giancarlo Stanton felt immediate discomfort in his left arm after a swing. Initially thought to be a cramp, Stanton finished the game. But on Monday, April 1st, Stanton was put on the Injured List diagnosed with a grade 1 left biceps strain. There is no date set for his return. Manager Aaron Boone expects Stanton to miss at least a month.

People often refer to the muscle on the front of the arm–the muscle that bends the elbow–as the biceps. But the major elbow flexor and the majority of the bulk on the anterior arm is the brachialis muscle. The biceps is a smaller, narrow muscle on top of the brachialis that is mainly used for forceful supination (rotating the forearm to a palm up position).

A strain is a partial or complete tear of the muscle fibers. Strains are due to a sudden, typically eccentric (lengthening a contracting muscle) force. The amount of muscle tearing determines the grade of the strain. Grade 1 strain indicates a tear of relatively few muscle fibers. Diagnosis is based on interview and examination.

Muscle strains heal over time. Ice and heat can be used to improve comfort. Athletes can return when they are comfortable enough to be effective.

All Blogs, Baseball, Wrist/Hand

Kyle Seager Thumb Injury

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On Friday, March 8th, Seattle Mariners third baseman Kyle Seager injured his left hand when attempting to dive and catch a ball. Initial X-rays showed no fracture or dislocation. On March 12th, Seager underwent surgery to repair a ligament in his left thumb. Seager’s injury likely occurred when the thumb was forcefully radially deviated.

 

This is likely an injury to the ulnar collateral ligament of the joint between the metacarpal and the proximal phalanx of the thumb (MCP joint). The second joint of the thumb.  The UCL is the structure that stabilizes the MCP joint on the side of the thumb that faces the rest of the hand. When it ruptures this ligament pulls off the phalanx. The part of the ligament towards the tip of the thumb comes off the bone. If that end of the ligament flips over the top of another structure in the area (the adductor aponeurosis), it won’t heal back and the thumb will be loose with pinch.  It can be difficult to tell by examination (or even MRI) if the ligament is in this non-healing position. People often consider surgery when there is substantial laxity and the possibility of not healing is higher.

 

Timetable to return is described as 10-12 weeks. That means that he might plan to return when the ligament is about 80% strength, which is reasonable.

 

All Blogs, Baseball, strain

Todd Frazier Oblique Strain

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After a few weeks into Spring Training, Mets’ third baseman Todd Frazier felt increasing discomfort on the left side of his chest and abdomen while swinging. After an MRI on February 25th, team personnel diagnosed an oblique muscle strain. There is currently no timetable for his return. He was treated with a cortisone shot and he will stop swinging to rest the muscle.

The oblique is a large abdominal muscle extending from the lower rib to the pelvis, the large bone that supports your hip. This muscle plays an important role in twisting motions of the trunk. The oblique can be strained (pulled), meaning partially torn with a hard swing of the baseball bat. Muscle strains usually occur with eccentric contractions, meaning that the muscle is forcibly lengthened when it is trying to contract and shorten (do it’s job). Muscle strains heal themselves. The pain from a strain can make an athlete less effective a their sport.

It’s not typical to have an MRI to diagnose this problem. It’s usually obvious in context (symptoms) and on examination (signs). It’s also not typical to have a steroid injection. Steroids decrease inflammation. Inflammation is an important part of the healing process. Inflammation also causes pain. Steroid injections are usually used to relieve pain in the hopes of returning to play sooner.