Ankle Sprains, Lost in Translation
Per Carrie Muskat:
He limped off the field, and tried to convince manager Rick Renteria to let him keep playing. Instead, Castro had an MRI and X-rays, which showed no fracture or ligament damage.
Something is getting lost in the translation from what the Cubs doctors told the baseball staff. Although I don't have a direct quote from the Cubs medical staff, what gets lost in translation is simple to repair.
An ankle sprain is ligament damage. That's what ankle sprains are. Starlin Castro has a grade 2 high ankle sprain. I'll translate that in what follows.
Presenting the TCR, "ABC's" to ankle sprains, after the jump...
Here is a link to the image describing all the lateral ankle ligaments. Here is another excellent tutorial to the ankle anatomy and terminology (about 6 minutes). It includes key terms such as the ankle mortise and the difference between ligaments and tendons and all the ankle ligament anatomy.
First, all ligament injuries (even outside the ankle) are graded 1-3. This is true for all joints including the shoulder (AC joint) and the knee (ACL, MCL, etc).
Type 1 is a sprain/ligament injury where the fibers of the ligament are injured but not stretched. Type 2 sprains are when the collagen fibers of the ligament are injured and stretched but not completely torn apart. Regarding the ankle, these rarely need surgery and heal with conservative measures such as bracing and therapy but take a bit longer to resolve, usually 4-8 weeks. Finally, type 3 sprains represent a complete disruption or tear of the ligament. Jed Hoyer, when reporting to the media on Castro's ankle injury said that there was "no torn ligaments" (implying it wasn't a grade 3 injury). The media then reported no ligament injury. Voilà, Lost in Translation.
What Starlin Castro has, isn't the most common or typical ankle sprain. Watching the video of his slide at home plate, his spike got caught under him and forced the ankle downward. Most common lateral ankle sprains roll the hindfoot under the ankle. A high ankle sprain involves ligaments that connect the fibula (lateral malleolus or outside ankle bone) to the tibia (larger ankle bone). The ligaments are significant and are both in front of (anterior tibiofibular ligament) and behind (posterior tibiofibular ligament) both bones. There is a membrane (interosseous membrane) that also connects the two bones and runs the entire length of the leg. High ankle sprains can take a bit longer to recover compared to lateral sprains, in the range of 6-12 weeks and that will depend on the grade of injury. Castro's was described as grade 2. Grade 3 sprains are more significant as ligaments are completely disrupted and if the space between fibula and tibia is widened, could require surgery to tighten the ligaments as they heal.
Conventional, roll your ankle, lateral sprains involve the ligaments from the distal fibula on the outside of the ankle (again, lateral malleolus or lateral ankle bone and distal means lower on the fibula) to the hindfoot bones: the calcaneus/heel bone and the talus, which is the bone that makes up the bottom of the ankle joint. The most commonly injured of these is the anterior talofibular ligament. The calcaneofibular and posterior talofibular ligaments are often injured in more severe lateral sprains. Most non-athletes get non-surgical treatment even in grade 3 sprains but there are situations where recurrent sprains occur because the ligaments healed with significant laxity. In this situation, there are many operative procedures designed to tighten up the ligament complex. The most popular of these procedures currently is named the Brostrom procedure. I'll keep the videos schematic but there are live videos of the procedure available for those who are interested.
The medial (inside) ankle ligament is called the deltoid. It can also be sprained and similar options for treatment are available. This ligament is more oftened injured in conjunction with a fibular fracture. If it is a grade 3 ligament injury, the ankle joint (mortise, hinge) is widened and is treated by surgically fixing the fibular fracture. Sometimes, if the ligament gets trapped in the joint, it can block the ability to restore the joint space to normal. In this situation, opening and repairing that ligament will restore the ankle mortise. Once the widening of the ankle joint alignment is restored, the deltoid ligament will heal at an appropriate length. The above described ankle ligaments are all extra-articular, meaning outside the joint. There is excellent blood supply to let these ankle ligaments heal in comparison to the knee's anterior cruciate ligament (ACL) which runs inside the knee (intra-articular) and when torn (grade 3) will not heal with normal function because it crosses the joint through joint fluid where the blood supply to the ligament is limited.
Arizona Phil 2 hours 51 min ago (view)
The Cubs have purchased the contract of 25-year old 6'5 260 RHP Adam Heidenfelder from Gary (American Association) and he has been assigned to the ACL Cubs.
Hagsag 12 hours 59 min ago (view)
Does anyone know what type of injury Amaya has?
Hagsag 13 hours 2 min ago (view)
I can not believe what a good 3b he has been playing.
Wrigley Rat 18 hours 53 min ago (view)
Robert Stock was claimed off waivers by the Mets.
crunch 20 hours 53 min ago (view)
HR in the 8th. dope.
crunch 23 hours 3 min ago (view)
he's back out in the field in the top 3rd...must be okay, but he sure doesn't look confidently healthy. *shrug* off-day tomorrow...
crunch 23 hours 13 min ago (view)
p.wisdom seems to have injured his right leg/knee swinging a bat...
crunch 23 hours 35 min ago (view)
“It did not feel good to take Javy out of the game,” Ross said. “I never feel comfortable doing that at all. That's a pit in my stomach and it was in my stomach the entire game.”
“I blame it on myself. I lost the count of the outs,” Báez said. “We talked about it. We're on the same page. I'll be there tomorrow to help the team.”
First.Pitch.120 1 day 1 hour ago (view)
The thing that gets me is that she cheated with the guy providing religous-based pre-marital counseling. Hmmm... this guy is abusing his (quasi-)professional couseling position to pursue an intimate relationship; forgot the parts of the Bible about lying, cheating, & doing dirty by the 2016 WS MVP; and clearly has very conflicted feelings on the marriage construct... yep, I'm blowing up multiple people's lives to ride-or-die with THAT guy.
Hagsag 1 day 1 hour ago (view)
I am with my hero Zo.
crunch 1 day 3 hours ago (view)
whole zobrist thing got fleshed out (no pun) in public now...
Arizona Phil 1 day 9 hours ago (view)
The Cubs have signed C Harrison Wenson (ex-LAA) to a minor league contract and he has been assigned to Hi-A South Bend. Wenson spent five seasons in the Angels organization, and he got an NRI to MLB Spring Training as an extra catcher with the Halos this past spring.
crunch 1 day 22 hours ago (view)
69 (nice) pitches...goes 4.2ip and leaves with a man on 1st
4.2ip 3h 1bb 5k, 3r/er (2hr)
alzolay continues to have the HR screw him over. 12 given up in 62.1ip
crunch 1 day 22 hours ago (view)
d.ross pulls baez for alcantara for what was either a mental mistake forgetting the outs or totally not hustling by baez in the bottom 4th running the bases.
cubs are down by 1.
hell of manager power play. hope this plays out well...expect it will.
crunch 1 day 23 hours ago (view)
nico expected back in early july...duffy had a "setback" and is in limbo...bote has started baseball activities, but nowhere near a return time.
crunch 1 day 23 hours ago (view)
haha. ump checked alzolay's hat and glove between innings and declared it all clear.
stuff so nasty they wanna make sure you're not on that "sticky fingers" bandwagon.