Health & Wellness
Presented by Barnes Jewish Hospital & Washington University Physicians

With professional athletes as our biggest investment, it's important to have doctors and physicians we can count on. It's because of that principle that the Blues work with doctors from Washington University and Barnes Jewish Hospital. Below, you'll find video and articles from one of our team physicians about common athlete injuries, how they can be treated and how well these injuries can heal. [ TEAM PHYSICIAN INDEX ]

  Matthew Smith, MD
Assistant Professor of Orthopaedic Surgery
Washington University School of Medicine

Dr. Smith serves as a team physician for the St. Louis Blues. Dr. Smith is a Washington University orthopedic surgeon who specializes in sports medicine. He practices at Barnes-Jewish Hospital & the Washington University Outpatient Orthopedic Center in Chesterfield, Missouri.

VIDEO: Elbow Pain | Dislocated Shoulder Treatment


ULNAR COLLATERAL LIGAMENT (TOMMY JOHN) RECONSTRUCTION
The elbow is a very stable joint. The bone architecture provides 50% of the joint’s stability. The ligaments and the muscles surrounding the joint provide the rest of the joint’s stability. The main ligament stabilizer on the inside of the elbow is the ulnar collateral ligament (UCL) which is also known as the Tommy John ligament. This ligament is most commonly injured in baseball pitchers but it can occur in windmill softball pitchers, javelin throwers, gymnasts and wrestlers. This ligament stabilizes the elbow during when the arm is the late cocking and early acceleration phase of the throwing motion. Often pitchers feel a pop when they injure this ligament. However, the ligament can also gradually stretch out and cause pain with repetitive hard throwing. Pitchers with a UCL injury frequently complain of pain with throwing and loss of velocity.

Treatment usually starts with rest and physical therapy aimed at strengthening the shoulder and elbow muscles. Then, a gradual return to sport is allowed. For pitchers, a controlled throwing program allows a gradual return to hard throwing. A UCL injury does not interfere with the ability to do most athletic activities or activities of daily living; however, it can be difficult for baseball pitchers and other overhead sports participants to return to a high level of competition if the UCL does not heal. For those who have persistent pain after adequate rehabilitation and evidence of ligament injury on x-rays and MRI, surgery may be necessary to reconstruct the UCL. This is done with an incision on the inside of the elbow using a tendon from the forearm, the ankle or the knee. Patients are usually put into a splint for 7-10 days following surgery, and a supervised rehab program is started. This program includes light throwing at 4 months after surgery, and return to competition for pitchers usually takes 10-12 months.


DISTAL BICEPS REPAIR

The elbow joint is made up of the upper arm bone called the humerus and two forearm bones called the radius and the ulna. The biceps muscle has a tendon that crosses the elbow and attaches to the radius in the forearm. This tendon is called the distal biceps. The main function of the biceps muscle is to bend the elbow and to rotate the forearm so the palm of the hand can face up. This tendon is strong so it does not get injured often. When it does get injured, it usually tears off of the bone deep in the front of the elbow. It most commonly tears when trying to lift something heavy or when quickly straightening the elbow to reach for something.

Often, patients who injure their distal biceps will feel a pop in the front of their elbow and have immediate pain. Patients frequently notice that the biceps muscle looks different after the injury. This “Popeye” deformity happens because the muscle shortens when it is not attached to the bone. Sometimes there will be swelling and bruising in the front of the elbow.

Treatment for a complete rupture of the distal biceps is usually surgical repair. Without surgery, patients can have less elbow bending strength and forearm rotation strength. This can be difficult for those who do manual labor. It is helpful to fix the tendon back to bone within 2 weeks. Surgery usually takes about 1 hour. The tendon is repaired through a small incision in the front of the elbow. Sometimes, a second incision in the back of the elbow may be needed. After surgery, a splint or brace is used to protect the repair for a short time while it heals. Patients usually get full motion back in 4-6 weeks, and full recovery can occur within 6 months.

In the elbow, the capitellum and the radius touch to absorb some the pressure transmitted from the wrist. In certain sports, like baseball and gymnastics, and in professions that require heavy lifting, more pressure than normal is transmitted to the outside of the elbow. This sometimes causes injury to the bone and cartilage of the capitellum called an osteochondral defect (osteo = bone, chondral = cartilage). Occasionally, osteochondral defects arise without injury. The reasons for this are not well understood. We often see this problem on an elbow x-ray; however, an MRI is most helpful for determining what type of treatment is needed.
Treatment for an osteochondral defect depends on what the cartilage surface looks like on an MRI. If the cartilage surface is intact, an extended period of rest may allow the bone under the cartilage to heal. If the cartilage surface is broken and fragmented, surgery may be needed to clean out the pieces, especially if the pieces are causing the elbow lock up with motion. Surgery to treat this problem is usually done arthroscopically through small incisions. On occasion, if the bone is badly damaged, a piece of bone and cartilage from another part of the body may need to be transplanted into the defect. This can also be done arthroscopically but may require a bigger incision if the defect is large. Recovery after surgery depends on the surgery.


OSTEOCHONDRAL DEFECT OF THE CAPITELLUM
The elbow joint is made up of the upper arm bone called the humerus and two forearm bones called the radius and the ulna. There are two cartilage-covered parts of the end on the humerus:

1. The trochlea on the inside of the elbow
2. The capitellum on the outside of the elbow

In the elbow, the capitellum and the radius touch to absorb some of the pressure transmitted from the wrist. In certain sports, like baseball and gymnastics, and in professions that require heavy lifting, more pressure than normal is transmitted to the outside of the elbow. This sometimes causes injury to the bone and cartilage of the capitellum called an osteochondral defect (osteo = bone, chondral = cartilage). Occasionally, for reasons that are not well understood, osteochondral defects arise without injury. Patients with this problem will often have pain on the outside of the elbow that is worse with throwing or lifting heavy objects. Occasionally, patients will complain of mechanical symptoms like something catching in the elbow or that the elbow locks up on them. We can often see this problem on an elbow x-ray; however, an MRI is more helpful to see the extent of the injury and to help determine what type of treatment is needed.

Treatment for an osteochondral defect depends on what the cartilage surface looks like on MRI. If the cartilage surface is intact, an extended period of rest may allow the bone under the cartilage to heal. If the cartilage surface is broken and fragmented, surgery may be needed to clean out the pieces, especially if the pieces are causing the elbow to lock up with motion. Surgery to treat this problem is usually done arthroscopically through a couple of small incisions. On occasion, if the bone is badly damaged, a piece of bone and cartilage from another part of the body may need to be transplanted into the defect. This can also be done arthroscopically but may require a bigger incision if the defect is large. Recovery after surgery depends on what is done in surgery.


SHOULDER DISLOCATION

The shoulder is the most frequently dislocated joint in the body. The ball and “flat” socket configuration of the joint allows a large range of motion but sacrifices stability. A shoulder dislocation usually occurs from a traumatic injury that forces the ball out of its socket. On occasion, the shoulder slides back into place on its own. Most of the time the shoulder needs to be put back into place in the hospital with medication to help relax the muscles. Once the shoulder is back in place, patients are usually put into a sling for a couple of weeks to allow the shoulder to heal. Unfortunately, the torn tissue with the joint does not always heal enough to restore stability to the joint. Therefore, if someone dislocates their shoulder once, there is a good chance that it will happen again. Physical therapy aimed at strengthening the muscles that help to stabilize the joint may be all that is needed to keep the shoulder from dislocating again.

Surgical treatment of a shoulder dislocation depends on what is injured in the shoulder. X-rays and an MRI are done to look for what is injured inside the joint. Surgery to fix the shoulder can be done arthroscopically through small incisions most of the time. Surgery is aimed at repairing the small bumper of tissue, called the labrum, that tears off of the socket. On occasion, an open surgery may need to be done to repair the labrum or to fix bone fragments that have broken off the socket to improve stability. If the bone on the socket wears away from repeated shoulder dislocations, bone from another part of the body may be needed to reconstruct the socket to make the shoulder stable again.

After surgery, patients are placed in a sling to protect the shoulder for 4 weeks. Patients then begin a controlled physical therapy program and return to sports often takes 5-6 months.

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