All posts by Shashwat Tripathi

All Blogs, Pitcher's Elbow

Adam Wainwright Elbow Inflammation

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St. Louis Cardinals pitcher Adam Wainwright went on the disabled list on May 16, 2018 with what was described as “elbow inflammation”. Elbow pain is very common among baseball pitchers. The repeated throwing a baseball creates expected changes to the elbow (see the thrower’s elbow).
It was reported on May 16 that “the initial MRI gave inconclusive results so a second MRI test will be issued”. This is misleading because all professional pitchers have changes on MRI. It is difficult to determine when a finding is new or when a finding merits treatment.
Wainwright will be placed on a 60 day disabled list while he rests his elbow and likely works on forearm muscle strengthening exercises and possibly throwing mechanics-exercises that can help people continue throwing effectively as their elbow wears out. There is still no timetable on Wainwright’s return.

This article was created by Paul Bonilla and David Ring.

All Blogs, Ankle/Foot

Brandon Graham Ankle Surgery

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Philadelphia Eagles Defensive end Brandon Graham had a high ankle sprain Christmas night in a game against the Oakland Raiders. A high ankle sprain is a tearing of some of the fibers between the two lower leg bones below the knee (the tibia and the fibula). A regular ankle sprain is a tearing of some of the ligaments between the leg bones and the foot bones. Brandon returned for the post-season games and helped the Eagles win the Super Bowl.
He had surgery on May 1 due to “slow healing” and hopes to be back in training camp on July 1st. Since ligaments and bones don’t typically heal in two months, this may be a procedure that uses heavy suture between the two bones (the tibia and the fibula) to reinforce the ligaments and help bear the load. The idea is that will make it more comfortable to get back to high-level sports sooner. Surgery hurts, there are risks, and subjective factors such as confidence and vulnerability are also important. This type of surgery should be considered experimental. We need more data to be sure this type of surgery has a good balance of risks and benefits. Data comparing surgery to simulated surgery would be necessary to control for the powerful forces of adaptation and resilience. Professional athletes seem on occasion to opt for different treatments than most of us, perhaps due to the pressure of returning to play again as soon as possible.

This article was created by Alexa Ryder and David Ring.

All Blogs, Wrist/Hand

David Price Carpal Tunnel Syndrome

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David Price, pitcher for the Red Sox, had not been as effective as usual early this year. He is reportedly experiencing numbness in this throwing hand and is being evaluated for carpal tunnel syndrome. David Price was out from May 3rd until May 12 when he started, threw effectively and won in Toronto.
Current best evidence suggests that some of us are born with narrower wrist (carpal) tunnels where the tendons and nerves pass into the hand. This tunnel is like the ring on a fishing rod—holding the tendons and nerves in place. If you are born with a narrower tunnel, eventually you may start to have problems with the nerve that passes through the tunnel. The role of activity in causing or worsening carpal tunnel syndrome is highly debatable (Lozano-Calderón, S., Anthony, S., & Ring, D.).
Media reports have emphasized David’s love of video gaming and suggested that it might be contributing to the carpal tunnel syndrome. Although he rightly questions this association as not based on scientific evidence, he will be giving up his favorite game for the time being in order to limit this distraction.
Carpal tunnel is a result of compression on the median nerve as it passes into the hand. This nerve runs along the palm side of your hand—referred to as the carpal tunnel. This nerve allows for feeling in the thumb, pointer finger, and parts of the ring finger. When compressed, this affects the ability to feel causing numbness. Swelling of the wrist causes this compression leading to numbness, tingling, and weakness. Pain may occur with extreme pressure.
Price hopes to avoid surgery and is opting for an “acupuncture-like procedure”. This is outside of best scientific evidence. Splints that keep the wrist from bending can limit night-time numbness (the classic symptom of carpal tunnel syndrome). There are no other proved palliative (symptom relieving) treatments. The only treatment that can prevent progression of the disease (carpal tunnel syndrome can cause permanent nerve damage) is surgery to release the transverse carpal ligament.

This Article was made by Alexa Ryder and Dr. David Ring.
Citations:
Lozano-Calderón, S., Anthony, S., & Ring, D. (2008). The Quality and Strength of Evidence for Etiology: Example of Carpal Tunnel Syndrome. The Journal of Hand Surgery, 33(4), 525-538. doi:10.1016/j.jhsa.2008.01.004