Tag: surgery

Hip Hip Hooray: Joint Functionality Can Be Restored After Hip Labral Tear

Do you experience deep, sharp pain in your groin? Or a feeling of “catching” or “popping” in your hip joint as you go about your daily activities? Is your range of motion you once had now severely limited? If so, you could be experiencing symptoms of a hip acetabular labrum tear, an ever-increasing problem in society that fortunately, has effective treatments.

Continue reading “Hip Hip Hooray: Joint Functionality Can Be Restored After Hip Labral Tear”

What Can Different Types of Facial Wrinkles Tell Us?

Few people enjoy having wrinkles. Some people spend a lot of time, money and efforts trying to reduce the wrinkles on their face, while others simply appreciate them as something naturally occurs with aging. Regardless, wrinkles are always associated with aging. However, if we look into what different types of wrinkles are and how they form, we will find that not all wrinkles are bad. Not all wrinkles are caused by aging, and not all wrinkles should be treated the same way. Here, we introduce different types of facial wrinkles categorized by plastic surgeon and their corresponding treatment.

A person smiling that shows some wrinkles on her face.
The wrinkles created by the motion of smiling are dynamic wrinkles. They will disappear once the smile stops. Credit: Masterfile.

In general, there are two main types of wrinkles, dynamic wrinkles and static wrinkles. Dynamic wrinkles are the type of wrinkles that only appear when you make expressions such as smiling, laughing, or frowning. These wrinkles disappear once your expressions stop. The facial muscles have enough elasticity to return to their original positions. These are temporary wrinkles that everyone may have, even little kids!

Static wrinkles, on the other hand, are wrinkles that form when your muscles cannot return to their original position due to gravity and loss of collagen and elastin. These wrinkles cannot disappear like the dynamic wrinkles. When the collagen fibers become thinner, the skin loses elasticity and gets more wrinkles, whose width and height grow with age. (Lemperle, 2001) Lemperle et al. from the University of California put these wrinkles into three categories.

Three hand-drawn figures that show textures of different wrinkles.
Figures that show the textural change of skin experiencing (a) superficial wrinkles, (b) mimetic wrinkles, (c) folds. Source: A Classification of Facial Wrinkles.

The first type is superficial wrinkles. These are the less severe wrinkles that only involve textural changes of the skin surface. These wrinkles lines are separate lines at first but will gradually group together. (Arumugam, 2015) Common causes are aging, excessive exposure to UV light, and gravity. Superficial wrinkles, according to Lemperle, can be reduced or removed by chemical peeling (applying chemical solution on the face to peel off the top layer and then grow it back), or laser resurfacing. (Lemperle, 2001)

A figure with 2 side-by-side photos that show the effect of laser resurfacing before and after the treatment. The wrinkles of the person's face reduces.
Before and after laser resurfacing. Credit: Tahoe Aesthetic Medicine.

The second type is mimetic wrinkles. These are more severe and visible dermal creasing. Major causes include aging and repeated dramatic facial expression. (Arumugam, 2015) Because the facial creasing is deeper, the reduction methods include more complicated procedures such as muscle resection (cut out a portion of muscle and inserted the shortened muscle at the same place), botulinum toxin (a neurotoxic protein), or skin filler injection. (Lemperle, 2001)

The picture shows a person's lower half of the face with dash line indicating where the nasolabial line is. A needle is pointing at the dash line mimicking the process of skin filler injection.
Skin filler injection to reduce the effects of nasolabial lines. Credit: Filling in Wrinkles Safely

The last type is folds, the part of the face where droopy skin overlaps. Folds and mimetic wrinkles usually occur together. To correct the overlapping skin, tightening procedures such as blepharoplasty (surgery that repairs droopy eyelids), face lift, or skin excision are needed. (Kligman, 1985)

Noticeably, researchers have discovered that wrinkles formation may be different by gender, race, etc. For example, women in general have finer and less apparent wrinkles than men because their skin is thinner and softer. (Wu, 1995) Asian skin connects more firmly to the tissues underneath because of its thicker dermis and higher collagen density. Therefore, the repetitive pulling of the skin surface affects wrinkles on Asians and Caucasians differently. (Ahn, 1999)

Wrinkles are nothing horrible. They are something that everyone has or will have in the future. There is nothing wrong with wanting to reduce the wrinkles on your face, either. Just remember that there are many types of wrinkles and each of them requires a bit of a different treatment. Spending some time finding the appropriate treatment will most likely save you more time, money, and effort in the future.

Sources:

[1] Lemperle, Gottfried, et al. “A Classification of Facial Wrinkles.” Plastic and Reconstructive Surgery, vol. 108, no. 6, 2001, pp. 1751–1752., doi:10.1097/00006534-200111000-00050.

[2] Arumugam, P, et al. “Facial Forehead Wrinkles Detection using Colour based Skin Segmentation.” Advances in Natural and Applied Sciences, Aug. 2015, pp. 71–80., doi:10.22587/anas.

[3] Kligman, A.M., et al. “The Anatomy and Pathogenesis of Wrinkles.” British Journal of Dermatology, vol. 113, no. 1, 1985, pp. 37–42., doi:10.1111/j.1365-2133.1985.tb02042.x.

[4] Wu, Yin, et al. “A Dynamic Wrinkle Model in Facial Animation and Skin Ageing.” The Journal of Visualization and Computer Animation, vol. 6, no. 4, 1995, pp. 195–205., doi:10.1002/vis.4340060403.

[5] Ahn, Ki-Young, et al. “Botulinum Toxin A for the Treatment of Facial Hyperkinetic Wrinkle Lines in Koreans.” Plastic & Reconstructive Surgery, vol. 105, no. 2, 2000, pp. 778–784., doi:10.1097/00006534-200002000-00050.

This Toner Might Be More Expensive: 3-D Printing Artificial Organs

For most people in the United States who need an organ transplant, they will need to wait an average of three to five years on a list before they can get a lifesaving surgery. On average, 20 people die daily waiting on this list. There is a possibility of being able to bypass the wait time by manufacturing the required organs with 3D printing. This manufacturing technique was first used in the medical field for prosthetics and surgery practice models, with a goal to create fully functioning organs for those in need. Instead of using plastic or printer ink, the 3D printer uses cells to create biological constructions. 

A biological 3D printer making a small model of a human heart
Biological 3D Printing Market Update Photo

Traditional methods of artificial tissue and organ creation involve the use of stem cells, which are cells that do not have a designated purpose yet, to create a scaffold or frame for the organ. If cells for a desired organ are placed on the appropriate scaffold, they could multiply and grow into an artificial organ over time. If 3D printing is implemented using the same scaffold procedure, cells could be placed more precisely; the cell diameter can be better controlled, and the speed of the process can be controlled digitally. All of these aspects allow for better replication of the complex networks and structures found within biological tissues. A major advantage of the 3D printed organs are the customizations and variability that can be implemented with the method. Implants can be made to different sizes to suit each unique individual. If the original cells used for 3D printer material are from the intended recipient, the compatibility of the implant or artificial organ is nearly guaranteed. The risk of organ rejection is always present in the time following a transplant operation. 

A man who received 3D printed skull implants following deformation from a bicycle crash.
Xilloc Medical Before and After Photo

The 3D printing process is near perfect for certain medical uses, such as prosthetics, and dental implants, but more work needs to be done with the printing of tissues and organs. Small simple organs with thin walls can be done but printing larger organs such as hearts and kidneys requires integration of the vascular network, which cannot be done at this time. As printers become more precise and able to use a higher variety of cells, the creation of these vascular networks becomes more and more plausible. 

Scientists are currently investigating a new way to print these complex organs by combining organic material with mechanical chips. These chips are able to replicate certain biological stimuli, including fluid flow and chemical gradients, in order to achieve some degree of organ function within a much simpler biological structure. Using these chips will allow for better mass production of a variety of tissues and organs. This particular technology is being used to create tissues that will be used for testing pharmaceutical drugs. There is an opportunity for these tissues to be expanded to use in the human body, but the majority of companies using this technology are still in the startup phase. 

            While the use of 3D printing to create complex artificial organs is not completely viable today, the technology is improving rapidly. Within a few years, the waiting times and problems with organ transplants could be a thing of the past.  

Tearing and repairing the meniscus

How does someone go from being the youngest NBA MVP one year to barely making headlines the next? Ask Derrick Rose. After being named the youngest MVP in the NBA, Derrick Rose tears his ACL the next year and then tears his right meniscus twice in the span of three years. Knee injuries have not been kind to Derick Rose, but how does one tear their meniscus and how does it get repaired?

The meniscus is shown in Figure 1.

Showcases the location of the meniscus in the knee. Gives the user an image of how the meniscus works, and where it is located.
Figure 1

According to Sports Health, the meniscus is a type of cartilage that provides cushioning between the bones in the knee. The meniscus main role is to absorb shock and the impact on the leg and knee when it is in motion. It allows for stability and smooth motion between the joints.

In a game of basketball, one of the biggest sports in the United States, there is plenty of running, jumping to shoot the ball into the basket, jumping up to catch a rebound, and doing sharp cuts during the game to shake off a defender. All these movements cause high loading on the knee, and if there is an over-rotation on the knee during these movements, then it can cause a tear in the meniscus. The video below shows when Derrick Rose tore his meniscus.

In the video, it shows Derrick Rose doing a relatively easy movement, he plants his foot in order to change direction to chase after the ball. It is a non-contact movement, but due to an awkward landing on his foot, he gets injured and misses games for the rest of the season.

When the meniscus is torn, there are two options in terms of healing the tear. The options are getting the meniscus removed or getting it repaired. Both options have their own recovery time. If you get the meniscus removed, then the recovery time would be from four to six weeks. However, there are setbacks to getting the meniscus removed such as leading to early arthritis. If the meniscus is repaired, then the timetable to return to play is around six months. According to USA Today , he chose to get the meniscus repaired in order to not have future complications around his knee, which is why he had to sit out for the rest of the season. Going this route also gave Derrick Rose the chance to return to his playing form before injury. According to Stein, 96.2% of athletes that undergo meniscal repair go to pre-injury level of activity after the repair, which is good news for Derick Rose.

However, Derrick Rose tore his meniscus again the following season in 2015. He would then have surgery to remove the damaged part of the meniscus and would return in a couple of weeks. This would then be his third surgery to repair his knee, and his surgeries must have an effect on his playing performance. After these surgeries, the world waits to see if Derrick Rose can reach MVP status again during his career. It would be tragic to see that these knee injuries would ruin someone’s career.

Sources and Additional readings:

General information about the meniscus

Meniscal Injuries in the NBA

Injuries in the WNBA

What is Tommy John surgery?

Baseball card of Tommy John for the Los Angeles Dodgers
From Zellner, “A History and Overview of Tommy John Surgery,” Orthopedic & Sports Medicine Specialists

In July of 1974, Tommy John, pitcher for the Los Angeles Dodgers, felt a twinge in his throwing arm, and could no longer pitch. Dr. Frank Jobe tried a new kind of surgery on John’s elbow, and after missing only one season, Tommy John returned to the mound in 1976 and continued pitching until 1989.

How?

The surgery which bears Tommy John’s name is by now a common buzzword in the baseball community. Over 500 professional and hundreds of lower level players have received this treatment, but even the most avid fan may still be unsure what it means.

Tommy John surgery is the colloquial name for surgery on the Ulnar Collateral Ligament (UCL). This ligament is vital to the elbow, especially in the throwing motion. Injury to the UCL accrues over time; fraying and eventual tearing occurs after repeated and vigorous use. Baseball pitchers, throwing around 100 times per game and at speeds upwards of 100 mph, put themselves in danger of UCL injury.

Location of the Ulnar Collateral Ligament in the human arm, shown on a baseball pitcher.
Image from Wikimedia Commons.

Tendons in the elbow joint, with the Ulnar Collateral Ligament marked
Image from Wikimedia Commons

What can be done when a player injures his or her UCL?

Prior to 1974, not much. Ice and rest, the most common suggestions, would do little to improve serious UCL damage. A “dead arm” spelled the end of a player’s career. Dr. Jobe would change that. 

Jobe removed part of a tendon from Tommy John’s non-pitching forearm and grafted it into place in the elbow. John’s recovery required daily physical therapy before slowly starting to throw again.

Since Jobe’s pioneer surgery on Tommy John, most patients undergo a similar kind of reconstruction procedure. A tendon from either the forearm (palmaris longus) or the hamstring (gracilis), is looped through holes drilled in the humerus and ulna, the bones of the upper arm and inner side of the forearm. In some modern cases, the hope is to repair the UCL with a brace that lets it heal itself rather than total replacement. This allows for faster recovery time because the new blood vessels that have to form in traditional ligament replacement are unnecessary. In either case, athletes recovering from UCL surgery, a procedure which itself takes less than two hours, typically require at least a year to restore elbow stability, function, and strength.

Some misconceptions about Tommy John surgery exist. One 2015 study found that nearly 20% of those surveyed believe the surgery increases pitch speed. However, increase in pitch speed may be affected more by the extensive rehabilitation process rather than the new tendon itself.

The study also found that more than a third of coaches and more than a quarter of high school and collegiate athletes believe the surgery to be valuable for a player without an injured elbow. This perception of Tommy John surgery makes it seem like a superhuman kind of enhancement, as if out of The Rookie of the Year, or worse, it becomes like a performance enhancing drug. In reality, a replacement UCL at best replicates normal elbow behavior. A procedure capable of creating a superhero might be attractive, but for now, Tommy John surgery just helps players get back in the game.

 

For further information:

 

How Many MLB Players Have Had Tommy John Surgery?

What Makes Someone More Likely to Tear Their UCL?

It takes a lot to make a professional athlete collapse to the ground during a game. After throwing a pitch on September 14, 2019, Toronto Blue Jays pitcher Tim Mayza knelt on the side of the mound while clutching his arm, expecting the worst. The next day, MRI revealed that what he had feared: Mayza had torn his Ulnar Collateral Ligament (UCL).

player following through after throwing baseball
Photo by Keith Johnston on Unsplash

Because of UCL reconstruction, or Tommy John, surgery, this injury is no longer the career death-sentence that it once was, but there is still a long road ahead for Mayza. He probably will not pitch in a game again until 2021. Sadly, this injury is only becoming more and more common among MLB pitchers. In the 1990s, there were 33 reported cases of UCL tears by MLB pitchers. In the 2000s, this number more than tripled to 101. From 2010 to the beginning of the 2015 MLB season, 113 UCL reconstruction surgeries had already been conducted. It has become so common that surgeons have called it an epidemic, and researchers in the US and abroad are attempting to find a way to combat this increase.

Digital image of elbow joint, with a small, red tear in the UCL
Orthopaedic and Neurosurgery Specialists, 2019

The UCL connects the ulna and humerus at the elbow joint, and its purpose is to stabilize the arm. During the overhead pitching motion, the body rotates in order to accelerate the arm and ball quickly, putting a large amount of stress on the UCL. In fact, according to a study by the American Sports Medicine Institute, the torque, or twisting force, experienced by the UCL during pitching is very close to the maximum load that the UCL can sustain.

Recently, many studies have investigated factors that could make pitchers more susceptible to UCL injuries, with a hope of identifying ways to prevent them. One of the biggest findings has been the correlation between UCL tears and pitch velocity. According to a study from the Rush University Medical Center, there is a steady increase in the frequency of UCL tears as max velocity increases. This makes intuitive sense, as more torque would be required to accelerate a baseball to the higher velocities. While this finding does have a very strong correlation, it does not help the players avoid injuries. Pitchers are unlikely reduce their velocity because it would also decrease their effectiveness, so another answer must be found.

The University of Michigan conducted another study, and found that, in addition to velocity, the number of rest days between appearances decreased by just under a full day for pitchers who later needed Tommy John surgery. While this does not seem like a large number, starting pitchers typically only receive 4 days of rest between starts, so the extra .8 days is equivalent to a 20% increase in rest time.

Because of these findings, the MLB has increased the max roster size from 25 to 26 for the 2020 season, with the hope that teams will use the extra player to reduce the frequency that each pitcher is used. In addition, pitch counts in Little League Baseball have had a positive effect on youth injuries. This can be explored further here. This discovery has already made a tangible impact on Major League Baseball, and hopefully more findings will reduce the rate of UCL tears in the future.

Brace yourself… You might need surgery

A surgery? For my PCL? Could be more likely than you think.

Usually hiding behind it’s annoying and commonly ruptured brother the ACL, the PCL (posterior cruciate ligament) is a durable ligament that usually doesn’t cause problems for athletes… until it does.

Because of the strong nature of the ligament, injuries that tear the PCL are usually sudden and traumatic. Think car accidents, falling hard on a bent knee… you get the picture. When enough force is applied to the top of the tibia, the tibia can be pushed backwards, past the threshold of the PCL. Even though the PCL does its best to hold your femur and tibia together in the right spot, it just doesn’t hold up to the brute force of a dashboard. These injuries can usually be diagnosed by the presence of a “sag.” When your doctor holds your bent knee up, it looks like your shin bone is sagging underneath your knee. This is your torn PCL crying for aid.

A photo showing the location of the PCL and ACL inside of the right knee. The ACL crosses from left to right over the PCL. Both are attached at the top to the femur and at the bottom to the tibia.

When it comes to fixing these injuries, the nonsurgical approach has typically been recommended for low-grade tears that don’t totally rip the PCL apart. These braces are attached to the leg right above the knee, and are supposed to hold the bottom part of your leg under the knee in place. This prevents from your knee from going too far forwards and backwards, and allows scar tissue to build up over your PCL. While your body tries to heal itself with scar tissue, you will work with a physical therapist to build up your quad strength and restore your range of motion. Over 80% of athletes are able to return to play after bracing their knees.

A PCL brace is shown in place on a knee. There are two stabilizing straps above the knee, and two below the knee. They are connected by a metal frame that meets at a hinge joint over the side of the knee.

However, surgery, which was once only reserved for extreme PCL tears, is now seen as a viable, cost-efficient option for even low-grade tears. PCL surgery is intended to restore normal knee biomechanics and stability to about 90% of their post-injury strength. Sometimes, a part of the Achilles tendon is used to create a graft, or a “new” PCL. This is called an allograft, and results in safer and shorter surgeries (8). Within a month, the athlete can walk and bear their own weight. After six months, athletes are able to return to sports.

In theory, surgery sounds like the most “permanently good” option there is for fixing your PCL. However, no scientific studies have yet been done that can accurately compare the return-to-play rates, or even the relative healing of people in braces versus people who immediately got surgery. When people don’t comply with their treatment plans (aka, take off their braces early, skip physical therapy after surgery, etc.) the data for comparisons between bracing and getting surgery aren’t clear. While your PCL may be out of commission, so is the jury on this one. At the end of the day, the best treatment method for you is dependent on the mechanism of injury, severity of your injury, and whether you plan on listening to your doctor or not!

For more info on PCLs:

Posterior Cruciate Ligament Injury

Management of PCL tears

ACL Reconstruction: Which Option Is Best For You?

200,000 ACL injuries occur each year, and ACL reconstruction is the 6th most performed surgery in the United States, so to come back bigger, faster, and stronger, the right recovery path is critical.

The anterior cruciate ligament (ACL) is a critical part of the knee joint that connects the femur (‘thighbone’) to the tibia (‘shinbone’). Its main functions are to support the knee joint during side-to-side motion, such as cutting, shuffling, or pivoting, and to prevent the tibia from moving too far forward relative to the femur. When an ACL ruptures, it is very common to reconstruct it to bring someone back to performance level.

Location of the ACL inside the knee joint with other labeled bones and ligaments with another diagram showing a ruptured ACL.
Image from Wikimedia Commons “Anterior Cruciate Ligament”

The basis of ACL reconstruction is using living tissue, also known as grafts, to replace, and function as a substitute, for the torn ACL. There are four types of ACL reconstruction surgeries that use different types of grafts. Those four types of surgeries are classified as autograft reconstruction, allograft reconstruction, xenograft reconstruction, and synthetic reconstruction. Autograft surgeries require one’s own grafts to repair the ACL, allografts require a cadaver’s grafts to repair the ACL, xenografts require an animal’s grafts, and synthetics require manufactured materials. Additional articles on xenograft reconstruction and synthetic reconstruction can be accessed here and here.

Each surgery requires the removal of the damaged ACL, and then the incorporation of a new substitute by tunneling the newly selected graft through the femur and tibia. Within the autograft group, the two popular grafts for reconstruction are patellar tendon and hamstring tendon, with quadricep tendon being another, less popular, choice. The patellar tendon surgery takes the middle third of the patellar tendon, a tendon that connects the kneecap to the tibia, and makes sure to include the bony ends.

The hamstring tendon surgery takes two small slivers of each of the two hamstring tendons, connecting the hamstring muscle to the tibia, coils them up, and then finally bundling them to increase strength.

A knee joint with bones, ligaments, and tendons labeled.
Image from Wikipedia “Knee Joint”

For the allograft surgeries, a surgeon may select an Achilles, patellar, hamstring, or quadricep tendon from the donor.

It is very important to choose the right surgery. While the determination of which surgery and technique to perform falls heavily on the surgeon’s and patient’s preference, there are advantages and disadvantages of each technique which tend to persuade the choice of surgery. The main concepts surrounding the decision of which surgery to perform are the activeness of the patient, muscle strength, and previous knee injuries. Depending on the job, sport, or activity of the patient and the desired return time, one technique may be a better fit.

For a patient participating in low demand activities, allograft surgery may be the best fit due to less post-surgery pain and quicker surgery time, however it is very expensive and offers less tensile strength compared to autografts. As for autograft surgeries, patellar tendon reconstruction allows faster recovery time due to the bone-to-bone bonding and offers a strong substitute for a torn ACL, however future knee pain is very common. Hamstring tendon reconstruction requires more recovery time; however, the post-surgery pain is significantly less than the patellar tendon reconstruction and the tensile strength of the hamstring tendon is the strongest possible substitute.

Additional reading and comparisons between the popular autografts and allograft techniques can be accessed here and here.

The Spinal Fusion that Reignited a Legendary Career

Can you imagine being the best player in the world at a certain sport and one day, aggravating an injury that not only put your athletic career in doubt, but also did not allow you to do normal daily activities? This is the challenge that faced Tiger Woods.

Tiger Woods is one of the greatest golfers to ever play the sport but has been plagued with back issues over the past few years that have prevented him from winning and also playing in golf tournaments. A golf swing applies a significant amount torque to one’s back. Repeating this motion as many times as Tiger has, through practice and tournaments since he began his career, caused him to have chronic back issues that had to be dealt with. In order to deal with these back issues, he had three back surgeries over the course of three years. After these, he was still unable to not only golf but also do daily activities without pain such as get out of bed, or play ball with his kids. Tiger was at a crossroads, and decided to get a spinal fusion surgery.

An image of the spine with the three regions labeled: cervical (upper region), thoracic (middle region), lumbar (lower region)
Taken from Wikimedia Commons

The spine has three regions: cervical, thoracic and lumbar. The cervical region is in the upper spine near the neck, the thoracic region is in the middle of the spine and the lumbar region is in the lower back. The lumbar region takes the majority of force in a golf swing and is where Tiger had his fusion done. In the spine, discs are in between each vertebra. The disc acts as a shock absorber and allows for slight mobility of the spine. Tiger had a severely narrowed disc in between two of his vertebrae in the lumbar region due to the previous three back surgeries he had. In order to be pain free, that disc had to be removed. This brought about the discussion of him receiving spinal fusion surgery.

 

Spinal fusion surgery is a process which removes the problematic disc from the spine and inserts a bone graft in place of the disc. A plate with screws is then placed in the vertebrae above and below the bone graft. The plate helps with the healing process and over time, it will heal as one unit. The essential goal of spinal fusion surgery is to take two vertebrae in your spine and make them act as one. When these two vertebrae become one through the surgery, it eliminates motion in between them and hopefully, removes the pain as well.

This is an image of a spinal fusion surgery with screws helping to hold the vertebrae together
Image taken from Wikimedia Commons

This spinal fusion surgery was a huge success for Tiger and allowed him to keep playing golf at a high level. Through his win at the 2019 Masters tournament, it’s safe to say that he has at least a few more years of winning tournaments and playing competitive golf before calling it a career.

Additional information and sources used can be found here and here. 

 

The Shoulder: Super Joint or Super Hazard?

The shoulder joint is one of the most incredible joints in the human body.  Humans have been recorded throwing 100+ mph fastballs, pressing nearly 600lbs overhead, and performing incredible gymnastics moves. The shoulder is a ball-and-socket joint, and it is by far the most mobile joint in the human body.  But this great range of motion comes at the price of being the most unstable joint in the body.

The contact between the shoulder blade and the humerus (upper arm) is analogous to the contact between a golf ball and golf tee.  A golf ball is perched precariously on top of a tee, and can be removed from its resting place with very little force.  Thankfully, the shoulder joint is a bit more complex than a golf tee, giving it more stability.  However, it is still very weak in relation to the rest of the human body, as it is only held together by the four, small rotator cuff muscles, the glenoid labrum, the biceps tendon, and several ligaments.

graphic of a shoulder joint with muscles, tendons, and bones labelled
Image from Wikipedia

One of the most common shoulder injuries is a shoulder dislocation.   This injury occurs about 200,000 times per year.  This injury occurs most often in men in their 20s and in men and women above age 60.  The younger group sustains this injury most often from a violent incident, either from a sports injury or a motor vehicle accident.  The older age group sustains this injury mostly from non-violent injuries, such as falling.  This causes a tear in the labrum, resulting in future instability.

image showing the difference between a healthy labrum and a torn labrum
Image from Huang Orthopaedics

The labrum is a cartilaginous ridge around the joint that adds stability by creating a seal between the humerus and shoulder blade.  Returning to the golf ball analogy, the labrum is like a rubber ring around the top of the golf tee that helps keep the ball from falling off.  When this is torn, it does not often heal, as there is very little blood flow in the shoulder joint.  This tear remains and makes it more likely for future dislocations to occur.

This lack of stability can be addressed both surgically and non-surgically.  Non-surgically is generally the preferred, but less successful option.  It involves strengthening the shoulder muscles to make up for the lost stability of the labrum.  The rotator cuff muscles as well as other larger muscles are strengthened to compensate for the torn labrum.  While the muscles can help immensely with reducing instability, they cannot always entirely replace the labrum.  If this is the case, surgery can be done to re-attach the labrum and give the shoulder nearly all the stability that it had prior to the tear.

One example of someone who had this surgery and then returned to a near pre-injury level of function is Saints’ quarterback, Drew Brees. Brees suffered a torn labrum and had it repaired with twelve anchors. He then would return to the NFL and become one of the greatest quarterbacks of all time.  He was the MVP of Super Bowl XLIV and is a twelve-time Pro-Bowler.  A labral tear can be devastating, but as can be seen by Brees’ story, it can be overcome. So while the shoulder comes with its fair share of liabilities, it is still one of the most impressive joints in the body.

 

Sources and Further Reading:

The Story of Drew Brees and the ‘1 in 500 Injury’ That Couldn’t Stop His Historic Career

Mayo Clinic – Dislocated Shoulder

Huang Orthopaedics – Shoulder Dislocation and Instability

Teach Me Anatomy – The Shoulder Joint

PMC – Anterior Shoulder Dislocation