Seattle Mariners outfielder Ichiro Suzuki looks right at the camera during an at-bat against the Texas Rangers on April 12, 2012 at Rangers Ballpark in Arlington, Texas. Ichiro, who got his 3,000th major league hit on Aug. 7, 2016, with the Miami Marlins in a game against the Colorado Rockies in Denver, became the 30th player to join the 3,000-hit club. (Darren Carroll)
GALLERY: SI’s Best Photos of Ichiro Suzuki
One of the most interesting injuries in the 2014 NFL season was Carson Palmer’s axillary nerve contusion. Touted as a sneaky sleeper in a high powered, vertical, Bruce Arians offense, Palmer, coming off an ACL injury, unfortunately was bitten by the injury bug again in the first game of the season (yes, he was on my team). The brachial plexus is a network of nerves that runs from the spine at the back of your neck/shoulder area and branches off into many different paths. The axillary nerve comes from the posterior cord of the brachial plexus and highways a series of sensory fibers to an oval shaped area over the lateral shoulder, innervating the deltoid and teres minor muscles. These muscles play a role in shoulder abduction (lifting shoulder away from the body) and rotating the arm in a throwing motion.
An axillary nerve contusion is quite a rare football injury that is most often seen in car accidents [contusion is a fancy name for a bruise]. Direct trauma associated with shoulder dislocation or humeral fractures (Goslin & Krivickas, 1999) or sleeping in a position with the arms raised above your head could cause its surrounding muscles of the quardrilateral space to pinch on the nerve (Brown et al., 2015; Hoskins et al., 2005). This construct of muscles are formed by the teres minor muscle superiorly, humerus laterally, long head of the triceps medially, and the teres major muscle inferiorly. Patients will report a sharply-defined region of sensory loss over the lateral shoulder, weakness, and numbness (Goslin & Krivickas, 1999). This dulling sensation isn’t more intense because the shoulder and arm can recruit other muscles to perform its tasks.
The timetable for recovery is usually set at 3-4 months. However, nerve injuries are a finicky ordeal and its comfort level may vary day-by-day. Conservative treatments such as physical therapy and exercise to maintain range of motion are the first course of action, but more invasive, surgical procedures are available. Nerve grafting is usually deemed as a last resort for severe lesions and for those who don’t improve in the first few months of conservative measures and recurrent shoulder dislocations (Steinmann & Moran, 2001; Perlmutter, 1999).
Relevant Players:
On Deck: Todd Gurley’s ACL
In the Hole: Julius Randle’s broken leg
The 2014-2015 fantasy footballseason was not my year. It was a year where Adrian Peterson, my #1 overallpick, lost for the year due to child abuse charges. It was a year where I bounced back, wheeled and dealed to get LeSean McCoy AND Eddie Lacy BUT STILL missed the playoffs. It was a year where Jay Cutler threw 18 interceptions and lost the confidence of his head coach despite having two #1 WRs in Brandon Marshall and Alshon Jeffrey. It was a year where the tone was set when I saw my Victor Cruz carted off the field, bawling because he will no longer be able to salsa for the rest of the season.
Before the Cruz injury, I was holding on to the thread of hope of scoring a garbage time TD during the 27-0, Philadelphia Eagles pounding of the New York Giants. While running a route to the back corner of the end zone, my hopes were dashed as Victor Cruz jumped awkwardly and clutched his knee in pain throughout his flight. A torn ACL was the first thing that jumped into mind when I saw the year ending prognosis. However, the salsa dancer was diagnosed with a torn patellar tendon, a much less common injury for those under 40 years old but usually occurring during an explosive movement (Saragaglia et al., 2013).
The patellar tendon connects the quadriceps muscle to the shinbone or tibia. It may be confused as a ligament, connective tissue that links bone to bone, because it helps in keeping the patella (kneecap) attached to the tibia. However, it is most commonly called a tendon, connective tissue that connects muscle to bone, because it is part of the quadriceps tendon that stretches from the quad muscle to the tibia, which helps extend the leg. The patellar tendon originates at the inferior end, distal to the patella and inserts at the tibia turbecle. In contrast, the quadriceps tendon lies proximal to the patella (Hak et al., 2010).Complete tendon tears usually occur 2 cm distal to the patellar tendon insertion or 2 cm proximal to the quadriceps tendon insertion. Many patellar tendon tears are often associated with patellar avulsion fractures, which is when a fragment of bone is separated from the main mass of bone as a result of trauma. ACL tears and other injuries may also be associated.
A patellar tendon rupture usually occurs during an acute, explosive event where a sudden, strong contraction of the quad muscles occurs (jumping or changing direction) or when the knee is flexed, fixed to the ground while the upper trunk is driven backwards (Brooks, 2009). Another instance is when the knee is already flexed at least 60 degrees and an external force causes the knee to increase its degree of flexion. For example, a volley ball player that lands on someone’s foot so that their already flexed knee suddenly has to flex even more while absorbing the force of the landing. A pop, followed by swelling, sharp knee pain and difficulty to bear weight ensues. Chronically, patients may suffer from patellar tendinopathy which is prevalent in 50% of jumping sport athletes (Lian et al., 2005; Peers & Lysens, 2005). Glucocorticoid injections also may pose a higher risk for such injuries to occur (Chen et al., 2008). Patients suffering from a torn patellar tendon will have limited knee extension, can’t maintain a straight leg, or raise the leg against gravity while laying down (supine).
Non-surgical and surgical options can be effective but the time of diagnosis is one of the biggest influences on its recovery. Early diagnosis, within one week of injury, and prompt surgical intervention for repair vastly improves outcomes (Ilan et al., 2003). Conservative approaches include RICE (rest, ice, compress, elevate), stretching to improve range of motion, and isometric strengthening to restore the extensor mechanism muscles. However, for more serious ruptures, surgical procedures are required to manually tie the torn ends of the tendon together and apply the proper tension. In serious cases, the surgeon may need to reattach the tendons to the bone itself. The trickiest part of the procedure is in determining the proper amount of tension that needs to be applied on the tendon. Too lose, and the knee cap will be unstable, but too tight, and range of motion will be compromised. The normal timetable for recovery is 3 months until normal daily activity and 4-6 months until sport can be resumed. However, long term weakness may be experienced and Victor Cruz may not be the same receiver who reeled off more than 2,000 yards and 19 TDs in two seasons before the injury.
Relevant Players:
On Deck: Carson Palmer’s Nerve
In the Hole: Todd Gurley’s ACL
References
UPDATE: Sherman will opt for conservative measures and rehab, for now, instead of surgery per SB Nation.
Last week, I raved about the exciting 2015 NFC Championship game finish between the Seattle Seahawks and Green Bay Packers. But, your 2014-2015 NFL experience would not be complete if you missed the Super Bowl last Sunday. After a ridiculously miraculous Jermaine Kearse catch, the Seahawks looked like they were destined for back-to-back championships. However, unheralded Patriots safety, Malcolm Butler, had other plans and picked off Russell Wilson’s pass at the 45th second mark in their own one-yard line to bring Super Bowl XLIX to an abrupt end. The 28-24 Patriots victory was chock-full of storylines: Pete Carroll’s decision to pass on the two-yard line instead of handing the ball off to BeastMode; Bill Belichick’s choice to withhold a timeout and let the clock tick below the minute mark with the Seahawks inches away from taking the lead; Chris Matthews’ heroic 109 yards, 1 TD performance only months after jumping out of his Foot Locker day job; “Deflate Gate”; Tom Brady’s 4th Super Bowl win.
Buried under the pile of headlines was the injury status of the Seattle Seahawks’ Legion of Boom. Even more criminal is the absence of debate of who was the best cornerback in the NFL between Richard Sherman and Darrelle Revis. The injury that Sherman sustained in the NFC Championship game may have averted such comparisons for another time. As James Starks raced down the right sideline, Sherman and “Bam Bam” Kam Chancellor converged to maul Starks out of bounds. It seemed like a routine tackle, but Sherman was visibly in pain as he picked himself up, favoring his left elbow. Instead of calling it a night, Sherman stayed in the game and kept his elbow in a bent position as if it was in an invisible sling. After the inspiring performance, an MRI indicated a sprained elbow, which Sherman played through again after two weeks of rest. Once the confetti has settled, Coach Pete Carroll told the media that Sherman may have suffered ulnar nerve damage and may need Tommy John surgery to repair the ulnar collateral ligaments (UCL).
Elbow pain may be caused by damage to the joint or it surrounding structures. The elbow joint most resembles the hinge model, which consists of the humerus (bone of upper arm), ulna (larger bone of lower arm), and radius (smaller bone of lower arm). Surrounding structures of the joint include:
Sherman’s sprained elbow is the result of a ligament strain that is seen most often in throwing athletes. The UCL is part of the network of ligaments that support the elbow. Tears in the UCL may occur when there is an acute, traumatic injury to the elbow resulting from a fall on an outstretched arm or a twist on a planted hand. Research on throwers with ruptured UCLs found that 50% had a single catastrophic event while the other half had symptoms before the event itself (Jobe et al., 1986). The cumulative effect of repetitive throwing may chip away at the ligament because the force generated during the cocking and acceleration phases of throwing causes valgus stress on the elbow (Behr & Altchek, 1997). When the arm is fully extended, valgus stability is divided equally among the medial collateral ligament, anterior capsule, and bony articulation. When the elbow is flexed 90 degrees, the anterior capsule’s load is taken up by the medial collateral ligament, which contributes about 55% of the stabilizing contribution to valgus stress. Meanwhile, varus stress is resisted by the anterior capsule (32%), joint articulation (55%) and radial collateral ligament (14%) (Morrey & An, 1983). These studies elucidate that the UCL is under the most stress and subject to injury during the throwing motion.
Tommy John Surgery is the premiere surgical operation for UCL damage. Previously known as ulnar collateral ligament reconstruction surgery, the procedure involves replacing the damaged UCL with a tendon from elsewhere in the body. Donor tendons are usually spliced from the palmaris tendon in the forearm of the same or opposite elbow, patellar tendon from below the knee, or a cadaver (donor). Dr. Frank Jobe, orthopedic surgeon and Los Angeles Dodgers team physician in 1968-2008, performed the first UCL reconstruction surgery procedure and coined the term after the patient of his first case. Tommy John, pitcher for the Dodgers, missed the entire 1975 season rehabbing his arm after going under the knife in 1974. Before the surgery, he had won 124 games. After 1975, Tommy John won 164 games and pitched until he was 46 years old. Dr. Jobe’s Tommy John surgery resurrected Tommy John’s career that included an NL Comeback Player of the Year in 1976 and 2nd place finish in the Cy Young voting of 1997. At the time of Tommy John’s operation, Jobe put his chances at 1 in 100. Today, 83% of throwing athletes who have the procedure will return to previous or high levels of competition in less than 1 year (Cain et al., 2010).
Relevant Players:
Richard Sherman, CB, Seattle Seahawks: When asked about Sherman’s recovery timetable, Pete Carroll joked, “I really don’t think so [it will take a long time], as long as Sherm doesn’t want to become a late-inning reliever.” Organized team activities (OTAs) generally start around June, which will give Sherman a good 6 months to have the surgery and recover. Like Carroll said, the Seahawks are lucky this isn’t Russell Wilson we’re talking about because Sherman’s positional demands don’t require him to make throws downfield. All-Pro defensive end, DeMarcus Ware, had a similar elbow surgery in February 2014 and was able to recover in time for the season. There won’t be any question that Sherman can return with full force, in time for the upcoming season and thrusting himself back in the discussion of who is the best cornerback in the game. The only question that still lingers is if there would have been a different Super Bowl XLIX outcome had the heart (and the mouth) of the Legion of Boom been healthy.
On Deck: Victor Cruz’s PCL
In the Hole: Carson Palmer’s Nerve
References:
WHAT. A. GAME. Last year’s NFC Championship game had set the bar high on the thriller scale and this year’s game did not disappoint. Up until the last 3 minutes of the game, the Seattle Seahawks were still down 19-7 against the Green BayPacker. Russell Wilson had already thrown, a personal worst, four interceptions and the 12th man were starting file towards the aisles. But with Richard Sherman playing through an elbow injury and Marshawn Lynch who refused to be denied, an inspired Seahawks team scored a touchdown to make it 19-14 at the 2:09 mark. An onside kick recovery, another Marshawn Lynch touchdown, and a2-point conversion later put the Seahawks up by 3; 19-22. Mason Crosby drilled a 48-yard field goal as time expired to push the game to overtime but the Seahawks, riding on a wave of momentum, threw a 35-yard touchdown bomb against a Packer defense that was expecting a run. Game Over. Seahawks are Super Bowl bound. The end to the top 5 games I have ever seen in my 23 years of life.
The biggest headline before the momentous game was zeroed in on Aaron Rodgers’ “severely”strained calf and partial tear as reported by ESPN’s Chris Morenson. There aremany overlapping muscles and tendons that make up the anatomy of the calf, butwe will focus our attention to two of it’s main muscles: the gastrocnemius and soleus (Bianchi & Martinoli 2007; Dixon, 2009). Both muscles are attached to the Achilles tendon, a tendon that stretches all the way down and attaches to the calcaneus (the heel bone), and play a role in ankle plantar flexion (pointing the foot away from the body). A calf strain involves a tear to either of the two calf muscles and occurs at the muscular tendinous junction where the muscles meet the Achilles tendon. About 20% of patients report prodromal symptoms like soreness/tightness in their calf muscles prior to the injury (Campbell 2009).
The gastrocnemius is the biggest of the two calf muscles, attaches above the knee joint, and lies at the middle of the junction between the muscle and tendon. It contains both slow and fast twitch muscle fibers, thus accounting for most of the power generated by the calf during plyometric exercises such as sprinting or jumping. Most injuries occur at the musculoskeletal junction of the gastrocnemius or the aponeurosis between the medial head of the gastrocnemius and soleus muscles (Delgado et al., 2002). This injury is most commonly known as “Tennis Leg” because of it’s high occurance in tennis players.
Complementarily, the smaller soleus muscle originates below the knee joint and lies underneath the gastrocnemius. Composed of mostly slow twitch muscle fibers, the soleus maintains the strength and endurance for repeated plantar flexion during activity. Soleus strains can develop when the ankle is passively dorsiflexed while the knee is flexed like during a landing when running up hill (Campbell 2009). Strains of this nature usually develop chronically, stemming from overuse.
As with any strain, each are graded based on level of severity:
Relevant Players
On Deck: Richard Sherman’s elbow
In the Hole: Victor Cruz’s PCL
References
Before the world knew Ray Rice for his domestic violence case in 2014, I knew him as an unforgivable, fantasy football bust in 2013. After being selected in most leagues as a top 5 draft pick for the last 3 seasons, Rice only totaled 660 rushing yds, 4 TDs, 321 receiving yds, 0 reception TDs in 15 games. These numbers were nearly half of his production in previous seasons. In addition, Pro Football Focus ranked Rice dead last among RBs in yards per carry with 3.1, also a career low. “The injury I had this year wasn’t something that you just bounce back from and say, ‘Oh you know I had a hip’. It was definitely very hard to play through week in and week out. So when I look at things like that – statistics – I don’t worry,” Rice explained to the Baltimore Sun in February. But you know what, Mr. Rice? We fantasy owners do have to worry; statistics are the crutch of our success. As a listener described during Matthew Berry’s Fantasy Focus Football podcast, “Ray Rice looks like a fat kid running in a snow suit.”
This article would make more sense if it were written before Week 16, when a questionable Quintorris Lopez “Julio” Jones and the Falcons wait to punch their ticket into the playoffs against the New Orleans Saints. Yes, the Falcons had a legitimate shot at the playoffs despite having only six wins. And yes, Julio Jones’ real name is Quintorris. Sorry for the extremely late post, but I guess laziness happens during the holidays.
Anyways, the hip joint’s ball-and-socket model is similar to that of a shoulder joint. The ball (femoral head) and socket (acetabulum) allows for a wide range of motion for your legs to drive your body in every which direction. The acetabular labrum is a cartilaginous ring that surrounds the socket and increases the surface area of contact with the femoral head to deepen the socket. This cartilage prevents dislocation (subluxation), distributes pressure, absorbs the shock, and lubricates the joint. When all of these intricate parts work together, the hip joint can bear up to eight times its body weight during a simple jog (Anderson et al., 2001).
From my research, I’m having a tough time sifting through the differences of groin and hip injuries. Because both the groin and the hip play complementary roles, I can see why both body parts are often lumped together in medical diagnoses. In fact, it is suggested that hip stiffness can later develop into chronic groin injury (Verrall et al., 2007). In most conversations, hip injuries usually refer to some type of trauma to the hip bone, while groin injuries are involve injury to the hip flexor muscles. I realize now that last weeks article on the groin could very well be this week’s hip article (in fact, it may be more of a case of iliopsas tendinopathy). The secretive nature of NFL coaches also does not help our investigation so instead, let’s delve deeper into hip labral tears.
There are three main ways in which a labral tear can occur:
There are two types of labral tears:
Nonsteroidal anti-inflammitary drugs (NSAIDs) and rest are often the primary treatment plan. There are surgical options but usually require a longer healing time. For severe Type 1 labral tears, absorbable sutures are used to anchor split ends onto the pelvis. Type 2 tears require the torn labral tissue to be debrided, the removal of unhealthy tissue to promote healing. A majority of hip injuries, not just labral tears, have a return of play of two weeks. However, intra-articular injuries, injuries situated within the hipbone, demand longer healing times. Labral tears are a part of the “sports hip triad”, a common source of injury for athletes, which also includes adductor and rectus strains (Feeley et al., 2008).
Relevant Players:
On Deck: Aaron Rodger’s calf
In the Hole: Richard Sherman’s elbow
References:
mlb