The Socket Joint: Analysis of the Torn Rotator Cuff, as Well As Hurley's Torn Laburm

Rotator Cuff Repair

In order to repair a torn rotator cuff, the surgeon reattaches the damaged tendon (or tendons) to the upper arm (humerus). (Some rotator cuff injuries involve more than one torn tendon.)

The following is a detailed analysis of the injury, and techniques used to fix a torn rotator cuff, as well as information on Eric Hurleys "frayed" labrum.

More following the jump.

This surgery involves several key steps:

In order to gain access to the injured rotator cuff, the surgeon makes a two- to three-inch incision in the shoulder, then cuts through the deltoid muscle.

The surgeon removes any scar tissue that has built up on the tendon.

The surgeon carves a small trough at the top of the upper arm, then drills small holes through the bone.

via www.eorthopod.com

Finally, the surgeon sews the tendon to the bone, with the sutures going through the tiny holes in the upper arm. (Sometimes a surgeon will use permanent anchors to attach the tendon to bone.)

via www.emedx.com

During this operation, the surgeon also removes bone spurs and releases any ligaments that are pressing on the tendon. If a bursa is inflamed, the surgeon excises or removes it. The surgeon also may remove a small portion of the acromion to make sure the repaired rotator cuff has enough room to move.

Afterwards, the patient’s arm is placed in a sling. With time, healing occurs, as scar tissue connects the tendon to bone. Because tendons receive such poor blood supply, this is a slow process.

via static.flickr.com

Physical Therapy

Physical therapy exercises should be performed at least three and preferably five times every day. Each exercise should be repeated 10 to 15 times, with the number of repetitions gradually being increased. Positions should be held for a three to five seconds.

via www.yourpalchrismal.com

The initial goal of physical therapy is to restore the full range of motion to the surgically repaired shoulder. Within one to three weeks after surgery, it should be possible to move the arm as much as the uninjured shoulder.

Beginning Exercises

Forward elevation of the arm. This exercise is performed while lying on the back. It’s designed to move the surgically repaired arm through its full range of motion.
Begin with the injured arm laying at your side and your elbow straight.

via www.apta.org

The physical therapist slowly lifts the injured arm, moving it through a 180-degree arc, until it is alongside your head. You should use your uninjured arm to lift the arm on which you had surgery. In this way you can perform your exercises without the need for assistance.

Don’t use the muscles of the surgically repaired arm to perform this exercise. Also, don’t arch your back. Keep the elbow straight.

Sports that place a great deal of strain on the shoulder, such as tennis, baseball, softball, and racquetball, require at least a six-month recovery period.

SO, as I said before. This should be the guys timetable.

May: Light throwing, lifting, running, movement exercises. The arm should have full range of motion.

At this point, one or both will probably have a scoping procedure to remove scar tissue and clean the area, which will have a two to three week rest period.

Late June: At this point, both will start throwing extensively. I detailed in my earlier post what I thought about the chances of both pitching this year.

Benoit: Will pitch this year, most likely in late August/September, ESPECIALLY if the Rangers are in contention.

Hurley: Will probably return to Arizona, work there with the team through July, then go to the bullpen in Frisco for August. After that season is over, he will probably shut it down for a month, UNLESS the Rangers are in contention and need an arm and he is doing well, but I doubt the Rangers push it. Then, he does the Fall league, Winter league, and is ready to go in Spring Training.

Wish me luck, Behavioral Research in Psychology exam, 3 hours and counting.

IN ADDITION!  SLAP TEAR FOR ERIC HURLEY!

I didnt realize that Eric Hurley had also had a torn laburm, which could be the reasoning behind his supposed non-expectant return.  A SLAP tear is an injury to a part of the shoulder joint called the labrum. The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within.

A specific type of labral tear is called a SLAP tear; this stands for Superior Labrum from Anterior to Posterior. The SLAP tear occurs at the point where the tendon of the biceps muscle inserts on the labrum.

How does a SLAP tear occur?
Common reasons for a SLAP tear include:

•  
  • Fall onto an outstretched hand
  • Repetitive overhead actions (throwing)
  • Lifting a heavy object

The area of the labrum where the SLAP tear occurs is susceptible to injury because it is an area of relatively poor vascularity. Other parts of the labrum often heal more easily because the blood supply delivers a healing capacity to the area of the tear. In the area of SLAP tears this is not the case, and chronic shoulder pain can result.

via www.tennent.net

A SLAP repair is performed arthroscopically using sutures to reattach the torn labrum back to the bone. The steps of a SLAP repair are:

1. The SLAP tear is identified and excess tissue is removed.

2. A small hole is drilled into the bone where the labrum has torn off (the SLAP tear).

3. An anchor is placed into this hole; attached to the anchor is a strong suture.

4. The suture is used to tie the torn labrum snuggly against the bone.

Once healed, the SLAP repair allows normal function of the previously damaged labrum and biceps attachment.

Disclaimer! : I do not know for sure if Eric Hurley had what is reffered to as a "slap tear", however, this injury is the common one when reffering to laburm tears in baseball players, so it is fairly safe to assume so.