08/15/08 1:35 PM ET
Keep shoulder woes at arms length
MLB backs medical study to understand, prevent injuries
By Gary Gillis / MLB.com
"The shoulder is an interesting joint with a remarkable range of motion," said Dr. Arun Ramappa, chief of sports medicine in the Department of Orthopedic Surgery at Beth Israel Deaconess Medical Center. "But it wasn't designed to withstand the stresses of pitching. Even though Tim Wakefield doesn't put the same amount of torque on his shoulder that Jonathan Paplebon does, Wakefield has a bit more mileage on his arm and a lot of wear and tear."
The Sox have noted they are hopeful Wakefield's injury will respond to a cortisone shot, and once the inflammation is reduced and the pain subsides, he'll be back in the rotation soon.
While managing injuries has become an increasingly important part of the game, preventing injuries is a preferable strategy. Which is why Major League Baseball recently awarded Ramappa a three-year grant to investigate shoulder injuries -- specifically SLAP tears, which involve the labrum and are common among baseball players.
"The labrum is a ring of cartilage in the joint, and the biceps tendon attaches to the labrum at the top of the shoulder," explained Ramappa, adding SLAP is an acronym for Superior Labrum Anterior to Posterior. "A SLAP tear occurs because of the unnatural stresses that pitching puts on the structure of the shoulder joint. The biceps tendon pulls the labrum and a tear results. It's the kind of injury that put Curt Schilling under the knife again."
What Ramappa plans to do is conduct a biomechanical study to determine the motions and the forces it takes to create labrum tears. Needless to say, there aren't too many volunteers. Well, you've heard of the phrase "dead arm" haven't you?
"We'll be using cadaver models," Ramappa said. "We've designed and are now building a pretty complex apparatus in the Ortho Biomechanics Lab at Beth Israel Deaconess Medical Center that will allow us to study the arms in various positions and under various stresses. If we can identify the deforming forces that cause the injuries, it may inform us on how to go about preventing some of them."
Ramappa will also use the grant to investigate the best rehab protocols. That part of the study would involve surgically repaired shoulders with a living, breathing body attached.
"There's a difference of opinion out there," Ramappa said. "Some people suggest that we should allow the shoulder to rest longer so the labrum heals more completely. Others believe that you need to move the shoulder as soon as possible to avoid stiffness or a 'frozen shoulder.' We want to determine how soon you can move to avoid stiffness without risking the repair."
Considering the dollars which Major League teams invest in their pitching staffs, any money spent in an effort to prevent injury or improve rehab is money well spent. But you can't put a price on the cadaver donations that will make the study possible.
"I know the results of our study will improve our ability to treat these injuries and not just in professional athletes," Ramappa said. "I'm always grateful to those who help to advance medicine."
There was a time that I'd give almost anything to be able to pitch like a Major Leaguer. If Ramappa doesn't mind waiting, I may actually have a chance.
Gary Gillis is a contributor to MLB.com. The BID Injury Report is a regular column on redsox.com. Beth Israel Deaconess Medical Center is the official hospital of the Boston Red Sox. This story was not subject to the approval of Major League Baseball or its clubs.