Separation anxiety

Friday, October 5, 2007

Another opinion is always a good idea except when too many cooks spoil the broth. In medicine, second opinions are routine, whether they come by formal consultation with another doc, or by curbside discussion. It comes as no surprise, then, that Alex Smith’s MRI made its way from San Francisco to Dr. James Andrews in Birmingham to be reviewed. Xrays don’t happen often on film anymore, but instead are bytes of data that can be emailed anywhere the internet reaches. In fact, radiologists living in Australia and Europe read x-rays done in the middle of the night in the US and using the same time zone differences, American radiologists return the favor.

The question about Alex Smith’s virtual consultation was to answer whether the 49er quarterback needed an operation to fix his shoulder separation. This is a reasonable question for an elite athlete needing an arm to throw, but for the rest of the world a separated shoulder is an inconvenience that tends to get better with a little time and therapy.

The shoulder is made up of three bones, the humeral head, or ball at the top of the arm and the two bones that form the socket: the collarbone and the acromion, a piece of bone that is part of the shoulder blade and projects forward. There is a joint where the acromion and collarbone come together. When force is apply directly to the lateral or outside part of the shoulder, the ligaments that hold this joint intact tear and the end of the collarbone springs up, making it tough to throw a ball. The separation of the Acromion and the collarbone (Clavicle) and is also called an AC joint. This mechanism of injury can be imagined when a defensive lineman tackles the quarterback and drives him into the ground right onto the point of the shoulder.

The degree of shoulder separation depends on how much displacement occurs. A first degree sprain occurs if the collarbone still aligns with the acromion, a second degree if it springs up a little and third degree if it springs up a lot. In the real world, the treatment is the same regardless of the degree of injury. The question for the elite athlete is whether other underlying structures are damaged and whether those structures will be impinged on scarred when healing occurs, limiting future shoulder range of motion.

The major long term complication of this injury is inability to toss a spiral 50 yards or throw a major league curve ball. While most of us know that we could have played pro if only we had a chance, these limitations make little difference in our life. For Alex Smith, getting the treatment right makes a big difference to him, to the 49er fan nation and to fantasy football fans everywhere.

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