Category Archives: Baseball

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.

All Blogs, Baseball, Shoulder

Tommy Kahnle’s Bicep/Shoulder Tendonitis

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Tommy Kahnle—one of the New York Yankees’ most reliable relief pitchers last year—is going on the disabled list. His performance was poor early in the season, which he ascribed to lost velocity in his fastball. While shoulder pain was never mentioned, a recent news report describes MRI findings of “biceps and shoulder tendinitis”.

The biceps anchors in two places in the shoulder. One of the anchor tendons passes right through the joint. Changes in this part of the biceps tendon are expected with age. They accompany the expected age-related changes in the small muscles that rotate the shoulder. The tendons (parts that the muscles use to move the bones) of those small muscles are flat and thin and cover (or cuff) the head (the ball) of the shoulder joint. After age 40, we all develop rotator cuff tendinopathy. There is thinning of the tendons and defects may develop. Genetic factors likely affect how quickly this advances.

Throwing athletes get tendinopathy at a younger age and in a slightly different form. Studies of professional baseball pitchers with no symptoms often find MRI changes in the biceps and rotator cuff tendons (https://www.ncbi.nlm.nih.gov/pubmed/12975193). That makes it difficult to be sure when an MRI finding is causing symptoms and when it is just an incidental finding.

It’s not clear if the doctors treating Tommy found something more than the typical changes on MRI. And it’s not clear how they have decided that Tommy’s symptoms are likely related to the findings. Periods of rest and a routine of shoulder strengthening exercises are often tried to calm the symptoms and increase throwing effectiveness.

This article was made by Paul Bonilla and David Ring

All Blogs, Baseball, Elbow, Pitcher's Elbow

José De León’s Medial Collateral Ligament

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José De León, 25 years old, was diagnosed with a torn medial collateral ligament (MCL) in his right elbow this spring. Throwing athletes (baseball pitchers and javelin throwers) can develop a looseness in the MCL after years of repeatedly throwing as hard as possible. In baseball, a single fastball creates enough force to completely tear the MCL, but the stabilizing force of the muscles prevents this. The theory is that repeated small sprains (ligament tears) outpace the body’s healing capacity leading to thinning of the MCL. A thin MCL leads to joint looseness and a specific pattern of elbow arthritis, called valgus extension overload.

All successful throwing athletes have changes in their elbow over the years. They all develop some thinning of the MCL and some level of arthritis. So “injury” is not the correct term. On occasion, the thinned ligament has an acute complete tear, but more typically it is a gradual thinning and arthritis in the elbow make a pitcher less effective.

Strengthening of the forearm muscles that stabilize the elbow can help manage symptoms and help throwers be effective again. If there is substantial laxity, the MCL can be reconstructed by taking a tendon from another part of the body and creating a new ligament. But this means a year off from throwing and does not always get throwers back to the same performance level.

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

This article was made by Hebah Mughal and David Ring