As an eyewitness to the Alfonso Soriano
now infamous grade II quadriceps strain, the repercussions from it have taken a life of their own. I saw that gleam in Soriano’s eyes as he rounded second base. He knew he had a 5th gear and shifted the transmission so he could motor on into third base. He never did make it to third base. Inning over, and a call in to AAMCO! Mighty Alfonso had grabbed the front of his right thigh…metaphorically, there was smoke coming out of his transmission, never a good sign. He couldn’t even walk to third base, so Met David Wright walked over and tagged him. Next, in great irony, our third base coach named Quade (in the old country, the family name was Quadracepese but they shortened it when they came to America) helps him and lends a shoulder and a leg to stand on as he leaves the field. Did I wait on the MRI with baited breath? No. I knew right then and there
it was going to be 4 or more weeks for Alfonso.
The quadriceps muscle is one of the larger muscles in the body. The “quad” as its name implies, comes from 4 muscles that combine to form the composite muscle (specifically, the Rectus Femoris and three Vastus (thigh) components, the medialis, the lateralis and a central or intermedius). Above, they attach to the top of the femur and one origin is just above the hip joint. Below, they blend to form the quadriceps tendon which has the kneecap/patella embedded in it. The quad therefore has some function around the hip, but is the main knee extension muscle (it straightens out the knee and resists or balances bending forces as well).
Here is a picture
of the quadriceps muscle anatomy.
The term “strain” refers to an injured muscle (and sprain is used for ligament injury). Conventionally, a grade I, II and III system us used to categorize severity of injury, where one is minimal injury without tear, two is stretch type tear and three is a full thickness tear. Even grade III strains are usually not repaired surgically because muscle doesn’t hold sutures well although if there was a large enough gap in the muscle belly, a repair could be considered.
The grading does help predict how long it takes to recover to a certain extent, but it varies a fair amount from patient to patient as some people do heal faster than others. The MRI looks at the anatomy and can see more detail of the injured area but since most of these injuries are treated non-surgically, it usually just confirms the clinical impression from exam. The injured muscle is tender and the area that is tender (how big the area is) or if there is a palpable gap in the muscle is the key information needed. I’ve seen some definitions that say grade II strains correlate with 10-50% of the involved muscle being injured. I don’t think that the damaged area needs to be measured very precisely, as the measurements don't affect treatment very often.
The treatment is straightforward. Rest, protection of the injured muscle, in this case with crutches until the tenderness improves and it doesn't hurt to walk. Then gradual strengthening is resumed until resumption of running can be permitted.
So with the MRI report showing a small, 1 cm defect (but not a clinically palpable one), Soriano's injury is definitely a grade II strain and people are now expecting it to be more like 4-6 weeks of recovery (opposed to the earlier reports of 2-4 weeks), but it’s still just an estimate at best. The main problem with a quadriceps strain given a rush to return is that there is a significant chance of re-injury. The season isn’t long enough at this point to even think that could happen to our $18 million dollar a season five tool leadoff hitter, billygoat curse or not.
Ah, for the good old days when “Who's in Left? Why.” made one think of Bud Abbott and Lou Costello
and not Lou Piniella’s decision regarding Soriano’s temporary replacement.