Dr. Joseph Hecht's Archives

I'm planning on a series of articles to update our readers on some of the current concepts in pitcher related injuries and diagnoses that most fans have not heard much about.

We've all had our fill of reading about pitchers with rotator cuff and glenoid labrum tears. There are some interesting trends in sportsmedicine that have lead to changes in exercise programs throughout the majors and minors in an attempt to protect pitchers from a cascade of preventable injuries most fans don't know about.

Diagnoses such as:

•GIRD: (Glenohumeral Internal Rotation Deficit...not to be confused with the stomach malady also known as GERD which Cubs fans get from watching too many losses). Pitching (both cocking phase and deceleration phase) leading to a tight or thickened posterior shoulder capsular ligament plus a loose anterior capsule and loss of internal rotation of the shoulder. Extra external rotation of the shoulder develops at the expense of internal rotation.

•Scapular Dyskinesia: Shoulder blade weakness with altered kinematics.

•Internal Impingement: Thought to be related to posterior shoulder contracture from GIRD with subsequent instability of the shoulder as the humeral head (ball of the shoulder joint) which shifts back/posteriorly and upward/superiorly). This is a different entity from subacromial or rotator cuff impingement which is more common and typically occurs from friction outside the shoulder joint.

...and finally connecting the dots, sorting out how the the injured or weakened shoulder (scapula) leads to severe strain on the elbow and tearing of the Ulnar Collateral Ligament (aka the Tommy John injury).

My attention to this topic started last summer, when  I heard a remarkable interview on XM radio with renown Orthopedic Surgeon, Dr. Craig D. Morgan with hosts Jim Memolo and Rob Dibble. The focus of the interview was Stephen Strasburg's shoulder tightness and the subsequent ulnar collateral ligament elbow injury that lead to "Tommy John" reconstruction of that ligament last summer. Dr. Morgan said that he had predicted elbow problems in Strasburg by watching the way he held his shoulder.

More on how the arm bone is connected to the...after the jump.

With yesterday's trade for Matt Garza, the by-product that caught my eye is the fact that the Cubs seem to have cornered the recent market on Ivy Leaguers. Fernando Perez studied creative writing and received a degree in American Studies at Columbia and now joins the exclusive Cub club of four.

Perez has published in Poetry Magazine.

Perez says he turns to poetry when he's "after displacement, contrast" from the game of baseball. "The thick wilderness," he continues, "of, say, late Ashbery can wrangle with the narrowness of competition."

From his Poetry Magazine article, titled: Para Rumbiar

Like poetry, baseball is a kind of counter culture. The (optional) isolation from the outside world (which I often opt for); the idleness about which—and out of which—so many poems are written or sung: I see this state of mind as a blessing.

...and if you haven't seen the Fernando Perez You Tube video on "The Working Poor" here's the link.

"nobody talks about the Fernando Perez(s), Jason Nix(s), Emilio Bonafacio(s), all these great players, playing for the minimum, that keep these guys (the stars like ARod) afloat."

Growing more Ivy, after the break...

Thoughts and tears.

#10. Third Base-MAN. Love of Wrigley Field. Putting his favorite charity, JDRF and Juvenile Diabetes on the map to show that athletes can deal with the disease. Ron's partner, Pat Hughes (Ron's been in the booth since 1990). Brant Brown, that gut wrenching, "oh-no" overlapping Pat's "he dropped the ball".  Aw, Jeez.  Entrepreneur and Restauranteur. Ron Santo Pizza. Acapulco Taco Pie. Williams-Santo-Banks. Rebel pal Randy and the real highlight of fantasy camps. Roomie Glen Beckert. Flaming Gamer, Pat: "there's smoke billowing out of the top of his head" (audio link). The classic Jack Brickhouse call was music to my ears: "back, back, back, Hey-Hey, a homer by Santo."  Harry Caray asking Ron, "when you go to bed at night with your lovely wife do you wear your toupee?" Cub captain.  Leo Durocher. Don Young. Belly flop slides into second base. Clicking Heels. Pat Hughes broadcast introduction: "Along with nine time All-Star, five time Gold Glove winner and Cub Legend..."

Ronnie's gone. He slipped into a coma Wednesday and passed away in the early hours of the morning on Friday reportedly due to complications of bladder cancer.

Paul Sullivan has one of the earlier confirmations online but I've listened to WGN radio interviews with David Kaplan and Spike O'Dell reminiscing. Overnight host on WSCR, Les Grobstein clearly struggled with his sadness when he heard the news.

In one of the greatest tributes a son can give his dad, Jeff Santo's movie "This Old Cub" gave us the insight as to just what made Ron tick. Ron Santo was what loving the Cubs is all about.

Thank you to Ron. We are honored that you shared so much of yourself with us.

UPDATE: Rob's thoughts after the jump, just trying to keep all this in one place.

Synonyms for Purple:     amaranthine, amethyst,  bluish-red, burgundy, grape, heliotrope, lavender, lilac, magenta, mauve, mulberry, orchid, periwinkle, perse, plum, pomegranate, puce, reddish-blue, violaceous, violet, wine.

MAJOR NEWS UPDATE:

Lou Piniella will resign after today's game vs Atlanta. His mother's health has not improved and instead of going the medical leave of absence route again, he's handing over the managerial chores to...THE FORMER IOWA CUB MANAGER... drumroll, please...[[[Mike Quade]]]. Pfffft.

There is a segment of the news reporters who actually cover medical meetings and try their hand at using medical lingo on their readers. I found this article online (and several other sources picked it up including the LA Times) but it originates from a news feed that the American Orthopaedic Society for Sports Medicine provided after their 2010 annual meeting from Providence, RI.

This is clearly an epidemiologic study. I'm thinking medical sabermetrics is a better term.

The study was based on data from MLB's disabled list published online data from 2002-2008, so it didn't really need a doctor to do this, it probably was done by a doctor who is a baseball junkie. Hmmm.

Dr. (and Major) Matthew Posner took the raw information and tabulated the frequency and distribution of injuries by anatomic site, position, AL vs NL and time of season (before or after the All-Star break). Nicely done. Clean and simple.

"Even though baseball is a passion of many people and our national pastime, there is very little information about the epidemiology, characteristics or distribution of injuries in Major League Baseball,” said Maj., Matthew Posner, MD, orthopaedic surgeon at the William Beaumont Army Medical Center in El Paso, Texas. “This study attempts to evaluate Major League injuries over the period of six years.”

On to Dr. Posner's findings after the jump...

Manager Ryne Sandberg's Iowa Cub lineup SCORED 4 runs in 9 minutes? I LOVE THIS STAT! That translates to 26.6 runs per hour. Thankfully, they suspend games in triple-A rather than just wash them out and make it a do-over. The RPH just might go up when the game resumes in a month.

Manager Lou Piniella's Chicago Cubs GAVE UP runs at a similar velocity. After last night's 17-2 debacle vs the Rockies in an 8th inning that saw 11 consecutive hits (13 total hits but 11 hits with 2 outs) and 12 runs score...that's what I'm talking about, RUNS PER MINUTE. The only problem is that the Chicago National League franchise's role model has been Captain Peter Wrongway Peachfuzz. It was too painful for me to use a stopwatch on that fiasco. The last time the Cubs gave up 12 in one inning was Sept. 24, 1985 vs the Expos. The Expos won that game 17-15 and Expo hat wearing Andre Dawson went 4-6 with 8 rbi and 3 homers. Oddly, a pitcher named Ray Fontenot took the loss for the Cubs. At least those Cubs scored 12 runs over the last 3 innings, which is more than this inept group could claim.

Why can't the I-Cubs just play out their schedule at Wrigley and hide the lame ducks in Des Moines?

As far as the trading deadline ending later this afternoon, the Saturday morning latest says Lilly is still on the block with the Dodgers, Twins, Tigers and Yankees for some reason showing interest. "Minor sniff's" on Xavier Nada and Little Babe Ruth are out there per Ken Rosenthal. Something about interest in DBack Kelly Johnson too. If they wanted him now, it seems they missed the boat since he would have come for less when he was a free agent nobody wanted last off-season. Did Jim Hendry misread the saying as buy-high and sell-low? I hate it when we get stuff bass-ackwards.

and a bit more detail on runs-per-minute after the break...

Orioles President Andy McPhail, of the royal baseball McPhail lineage (grandpa Larry, dad Lee) had a chance to snag another ex-Cub and went another direction today by hiring non-nonsense manager, Buck Showalter.  Recent speculation by Tribster, Steve Rosenbloom, had Sandberg on Andy's speed dial but it seems it wasn't so. The O's beat writer for mlb.com said the short list was former O's catcher Rick Dempsey, former Indians manager Eric Wedge and Bobby Valentine, who has recently volunteered his services as the next Cub manager.

It's official. I've double-dared (if I were Ryan Theriot, it would be a single dare) the Baseball Gods to invoke their wrath. All I can hope for is that they won't think about reversing reverse psychology.

My spouse loves to travel. I love baseball season. This has lead to 30 years of negotiating the avoidance of travel during just a few parts of the year. Early April and September-October.

I'm serious losing this battle. Last year we took a 3 week trip to China, breaking my string of being at Wrigley Field for opening day, a streak of over 30 years (I've been back in Chicago since college days).

The one absolute taboo was that we wouldn't take a major trip in September or October because that was the wrapup of the baseball season and playoffs. Her argument was September/October is the best weather for travel to many of her favorite places. For years, she checks in every so often asking that if the Cubs were out of contention, could we take a trip in September or October.

After taking this seasons beatings and holding out hope as long as I could, I've given in. The plane tickets are booked to southern France and I'm daring the Baseball Gods to beat me up, invoking the 1935 Cubs as my lesson on what I'm about to miss...

Little Jack Horner

Sat in the corner, eating a Christmas pie;
He put in his thumb, and pulled out a plum...

Just to take our minds off the train wreck that the 2010 season has become, I'm going to tangent into just what made Aramis Ramirez so miserable this year. His left thumb injury (diagnosed as a deep bone bruise) may or not have been related to his season long slump or it just may have prevented him from coming out of it as the weather warmed up. He's been 'missing', even when present for most of 2010 which is somewhat different than his absence last season, starting on May 9th, 2009 from what happened at a similar point in the season, when he dislocated his left shoulder diving for a ball on May 8th in Milwaukee.

From a Gordon Wittenmeyer, Sun-Times article:

Ramirez, mired in a two-month slump, first hurt the hand on a swing-and-miss May 9 in Cincinnati. When it got worse two weeks later, the Cubs considered putting him on the DL, ''but I didn't want to do it because I thought I was good enough to play,'' said Ramirez, who got a cortisone shot instead. Manipulating his bat handle to take pressure off the top of the left hand also didn't work because it was uncomfortable, he said.

''This is the right time to do it. This is the right thing to do,'' he said.

He'll be eligible to return June 23 in Seattle, but a return then is anything but certain considering the down time that'll require before he is even allowed to resume normal baseball activities.

Supposedly, his injury was a deep bone bruise. I have not read any reports about an injured ligament. He has tried to play through the soreness but his thumb kept getting re-traumatized from his attempts at hitting. He didn't want to go on the DL until it was clear he couldn't shake the injury.

A collective cheer can be heard in that state of mind known as Wrigleyville...

UPDATE: (tweet from Gordon Wittenmeyer) Grabow to DL, Cashner called up.

I wrote this piece before the update. Sometimes things just make sense.

Randy Wells, aka Buzz Lightyear "To Infinity and Beyond" (5 runs and no outs is an ERA of ∞) gets a DO-OVER. After Randy Wells failed on just about all of the 16 pitches (and 5 runs) he threw in the first inning 'bullpen' tryout on friday vs the Cardinals. He gets to show management that he actually can once again go deep into a game with a quick return to the first inning on the holiday-day game against the Pirates. His competition for that bullpen spot, Tom Gorzellany won the battle to the bullpen. Gorz matched Wells with five quick runs vs the Dodgers on Wednesday's game which was so disappointing that Com-Ed pulled the plug on the Wrigley light grid.

Wells also is returning to the scene of the crime from May 6th, his other ugly outing. As we recall, he also gave up 5 first inning runs in the first on two walks, two singles and two doubles. Lou didn't have quite the quick hook that day as Wells stayed in to give up two more runs in the 2nd inning in what was to be an 11-1 blowout to the Buccos.

Oh, oh Domino. Tom Gorzellany will be in the pen, ready to pitch mop up in the first few innings if history should repeat itself. Gorz, the newest long reliever supplants big Z in the bullpen. Zambrano is supposed to start Wednesday in Pittsburgh, although Z never did get stretched out in a game even as the opportunity presented itself in Wells "oopsie" friday.

With all the roster shuffling soon to occur, the questions are who goes away when Andrew Cashner arrives this week and why isn't Cashner coming today? Is it management indecision or can't they get the radiologist who read John Grabow's MRI  to review it again to see that there IS something wrong, very wrong.

From today's Sun-Times:

Grabow already has undergone an MRI on his left knee after experiencing discomfort, but no injury was found.

Shoe? He don't need no stinkin' shoe

more after the break...

The Ricketts Family owns the Cubs. That sentence has a certain lasting ring to it. We've all followed the travails of how the Cubs ownership has transitioned from the now bankrupt Tribune company and was midwived through the gnarly fingers of real estate magnate Sam Zell, finally getting delivered into our proud new Papa's (Tom Ricketts) loving grasp. To celebrate this rite of passage, I decided to learn more about the events that took place over 90 years ago when the last dynastic family came into control of our Chicago National League franchise.

Sherman, set the Wayback Machine to 1916.

I'll leave it up to the media to tell us what's going on with Angel Guzman's shoulder problems.

On second thought, I'd better not.

Once again the media doesn't get it. From Howard Schlossberg's piece in the Daily Herald:

While surgery is a possibility, the Cubs are aware that most major rotator-cuff surgeries, while successful in and of themselves, don't always enable the player to make a comeback.

Thank God it wasn't Bruce Miles writing this (I love Miles work). It does show, once again, a lack of understanding regarding what gets reported.

To quote Dan Aykroyd, "Just the facts, ma'am":

1. The Cubs.com article reports, Angel Guzman's MRI showed a "significant tear in a ligament in his right shoulder" which medically speaking translates into a torn inferior glenohumeral ligament (see diagram, item C). If the glenoid or socket's labrum is also torn, this means the entire front of his shoulder is very loose and may be detached. This is an injury that leads to instability, as in shoulder dislocations or subluxations (partial dislocations). This is what Aramis Ramirez had last season in his glove side shoulder (not his throwing shoulder).

Will Carroll, BP's staff writer focusing on team health had this very interesting recent quote, from his "Cubs Team Health Report":

Age is a poor predictor of injuries. Younger players get hurt more, but they heal more quickly. Older players get hurt less, a variant of the survivor effect, but heal more slowly.

The media that follows baseball does it's best to understand and decipher sports injuries. It's a tough job for them and much gets lost in translation of medical terminology. Injured athletes often don't understand what they are being told about an injury or they are just afraid to fess up that their ache might be a significant problem until it goes on for weeks or longer. Trainers and medical staff are often reluctant to discuss information on the grounds of patient-physician confidentiality and some teams are just less open to giving what information they have to the media. The information is important to us fans, since key players dealing with even minor injuries and not performing to their best ability can drastically affect how a team plays. In 2009, Alphonso Soriano apparently had a knee injury that he tried to work through until it was so obvious that he couldn't run, leading to his arthroscopic knee surgery in September. An injury that flies under the radar screen of the medical staff, as in Soriano's case was costly and not in a way you can put the usual "days lost" analysis to.

"Andre Dawson, the Hawk...no player in baseball history worked harder, suffered more or did it better than Andre Dawson. He's the best I've ever seen. The Hawk, I watched him win an MVP for a last place team in 1987. It was the most unbelievable thing I've ever seen in baseball. He did it the right way, the natural way and he did it in the field and on the bases and in every way. I hope he will stand up here one day."

                          --Ryne Sandberg, in his Hall of Fame Induction Speech

No matter what hat his hall of fame plaque has, Andre Dawson will represent the Cubs honorably into Baseball's Shrine. This is a man who overcame his own obstacles, or more specifically his own knees. We all know that Dawson came to the Cubs in 1987 to flee the hard artificial turf of Montreal Olympic Stadium which was playing havoc with his knees.

Dawson might have never made it to Chicago, where he said he rejuvenated his career, were it not for the encouragement of his wife, Vanessa. Dawson was in so much pain in his fourth big league season because of a “fractured knee” that he told her he didn’t know if he could play any longer. Pain medication was barely getting him through games.

“The third (Darvocet) took the pain away but it came back at night. That’s why I didn’t want to do it anymore,” Dawson said. “And she looked at me and said, `You know you’re hurting now, but just see what the problem is because a year, two years from now you are going to regret walking away.”’

The last 10 years of his career (including 6 with the Cubs) were based in home parks where right field had mother natures own soft grass turf. This prolonged his career well beyond what most of his early teammates could have projected.

In 1985, then-Expos teammate Tim Wallach said of Dawson's perpetual struggles with his knees, "It hurts me as much as it hurts him. Sometimes I wish I could give him my knees. He never moans. He never complains. He has no excuses. Everyone here respects him."

Most watched in awe at the agony he put up with but few knew why Dawson had to methodically prepare for games and baseball seasons. He made it onto the field for 2627 games over 21 seasons.