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Mark Melancon’s Pronator Syndrome

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The San Francisco Giants right hand pitcher Mark Melancon has stated he is day-to-day and will undergo surgery for pronator syndrome if his symptoms persist or at the end of the season.

What is pronator syndrome?
Pronator syndrome is a diagnosis that some doctors believe exists and others do not. The syndrome is troublesome forearm pain that is fairly diffuse and activity-related. Numbness is not one of the symptoms. The proposed pathophysiology is a compressive neuropathy in the front of the elbow or in the upper part of the forearm.

How do you diagnose pronator syndrome?
One of the sources of debate is that pronator syndrome cannot be confirmed by an objective test such as electrodiagnostic testing. The examination is normal except for imprecise and subjective things like tenderness and slight weakness resisting substantial force. Press reports indicate that Mark Melancon’s diagnosis of pronator syndrome was suggested by MRI findings, but there is no evidence that MRI can accurately and reliably diagnose pronator syndrome.

Why do some doctors use the diagnosis of pronator syndrome and others do not?
Non-specific, activity-related forearm pain is very common. For surgeons that believe in pronator syndrome, the “proof” is that patients feel better and thank them after surgery. However, people can be very resilient after surgery; even pretend or sham surgery. People can feel better and do more not because the surgery addressed an important problem, but because it gave them confidence and energy that allowed them to adapt. In research, we call this the placebo effect.

How could we determine if pronator syndrome is a useful diagnosis?
They only way to know if pronator syndrome is a useful diagnosis would be to compare real surgery and sham surgery and make sure the patient and evaluators had no way of knowing which one they got. Until we have a few such studies, people that have surgery for pronator syndrome are putting faith in what may be a social construction (a diagnosis that exists only because we behave as if it exists) and exposing themselves to the potential harm of surgery unnecessarily.

https://sites.utexas.edu/sports-blog/pitchers-elbow/ ‎

References: Rodner, C.M., B.A. Tinsley, and M.P. O’Malley, Pronator syndrome and anterior interosseous nerve syndrome. J Am Acad Orthop Surg, 2013. 21(5): p. 268-75.

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Is Opioid Misuse a Problem Among Professional Athletes?

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The United States is currently in the midst of a crisis of opioid misuse and overdose deaths. Former NFL players are increasingly open about their troubles with prescription opioids. Under pressure to perform in spite of injury and pain, doctors and athletes sometimes used anesthetics and pain relievers to allow professional athletes to play more comfortably. When opioids are used in this way, athletes are at risk for future opioid misuse.

What is the role of opioids in pain relief?
Patients in other countries (and many if not most patients in the United States) experience adequate pain relief using few opioids. Nociception is the physiology of actual or potential tissue damage. Pain is the unpleasant thoughts, emotions and behaviors that can accompany nociception. The intensity of pain for a given nociception is largely related to stress, distress and less effective coping strategies. Greater pain and more prolonged opioid use is associated with psychosocial factors. The best pain reliever is peace of mind and opioids should be used in the smallest doses for the shortest time possible.

Are opioid medications dangerous?
The last three decades’ experience with increasing opioid use reaffirms how addictive and dangerous they are. Surgeons in the United States tend to give more pills than people use. That can lead to using the pills for fun rather than for pain relief, which leads to problems. Unused pills can be diverted to friends and family or sold and misused.

Tiger Woods’ recent DUI is a good example of how dangerous these medications can be. Opioid medications when taken can lead to mental impairment and are dangerous when operating a motor vehicle. They are addictive and can slow and even stop your breathing, which can kill you.

All Blogs, Golf, Other

Is Tiger Woods’ Back Problem an ‘Injury’?

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Injury is “hurt, damage or loss,” Tiger Woods did not break or dislocate the bones in his back. Changes in the discs and bones are expected with age. Variations in the spine are age-related. Nonspecific back pain is extremely common and associated with structural problems.

Does golf (or any activity) create changes in the spine?
The best evidence suggests that changes are related to genes and aging and are not clearly related to activity.

Is back surgery necessary?
Back surgery is rarely necessary. People choose surgery to try to feel better. But only if it fits their values and preferences.

Does back surgery help people?
Back surgery is unpredictable. Repeated back surgery has a poor track record.

There are lots of older golfers still on tour. How do they do it?
It may be partly the luck of the draw in getting genes for a body that stays healthy longer. But evidence suggests that adaptation and resiliency may be just as important. Healthy exercise and eating, and attention to healthy thoughts and emotions can go a long way.