Sunday, May 10, 2009
According to Cub’s third baseman Aramis Ramirez, he had dived for infield balls “3,000 times like that and didn’t feel anything” but this time he landed on his shoulder and it dislocated. It had been nine years since the last time it happened and the trainers tried to put it back in place on the field but failed. Team doctors relocated the joint in the locker room.
The shoulder is the most mobile and least stable joint in the body. The ability to move in many directions makes it prone to dislocation and in younger people, sports are a common reason. Throwing or reaching for ball puts the shoulder at risk because there is little that stabilizes the shoulder joint. The glenoid fossa, the small cup that holds the humeral head in place is shallow and needs the help of the labrum or cartilage to deepen the receptacle for the humerus. The rotator cuff also helps keep the bones where they belong but when those muscles are being stretched in a throwing or reaching motion, any excess force can pop the shoulder out of joint.
For regular people who dislocated their shoulder, it usually means a trip to the emergency room to get it put back in place. The injury causes muscles to spasm relatively quickly, preventing the shoulder from easily relocating. Different techniques can been used to reduce the shoulder and depending upon the cooperation and pain tolerance of the patient, medications to provide pain control, muscle relaxation and sedation may be needed.
Elite athletes are a little different in that their injuries are often witnessed by medical personnel and the shoulder can be fixed on the field before the spasm sets in.
Once the shoulder is relocated, more work needs to be done. The potential for the dislocation to recur is relatively high and the shoulder needs to be immobilized in a sling to prevent that injury. The sling gets worn all the time, even to bed or in the shower. In the time just after the injury, a routine motion like lifting your arm to comb or wash your hair may be enough to dislocate the shoulder again. The volleyball spiking position puts the integrity of the shoulder in peril.
In younger people or those who need their arms to perform aggressive work, an operation may be needed to tighten the shoulder and prevent future injuries.
The Cub’s Ramirez will need a CT and MRI of the shoulder to assess the damage inside the joint. Most often, the labrum is injured and the joint capsule is torn. There may also be an associated rotator cuff tear. There will likely be some minor bone damage that won’t affect the joint function. In the pro athlete, the decision becomes whether an operation is needed sooner than later.
Initial treatment balances the risk of repeated dislocation with the loss of range of motion in the joint and muscle strength weakness. With physical therapy, return to play may take 6-8 weeks. But surgery is often required to return the shoulder to its pre-injury state. The question becomes, do you do the surgery now and lose the whole season or wait till the year is done and hope the shoulder survives. Either way, Cub fans will need to be patient to see their third basement on the field again.