7/17/24: Dr. Nick Early From OrthoCincy, On Four Reds Injuries, And Nick Hagglund

Dr. Nick Early from OrthoCincy joined us to discuss injuries to four different Reds - Carson Spiers, Graham Ashcraft, Nick Martini, and Luke Maile - as well as Nick Hagglund's recent surgery.

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Episode Transcript

(00:00):
On Wednesdays we talk injuries with oneof the experts from Ortho Sinsey. The
great thing about Orthosincy is they havespecialists and locations throughout the tri State.
They offer walk in orthopedic urgent careweekdays nine to nine and Saturday's nine eight
to one p Learn more at orthosincdot com. That's orthos ci n Cy

(00:22):
dot com. Doctor Nick Early fromOrthos Sincy is with us. There's a
lot to talk about. Let's beginwith Carson Spiers pitch last Friday night through
really well struck out. The firstsix guys had nine punchouts, and then
less than twenty four hours later he'son the injured list with a right shoulder
impingement. Let's begin with that.What is an impingement? So you can

(00:47):
think about this like almost a pinchingin his shoulder. So the way your
shoulder is built is that you haveyour shoulder blade kind of comes up on
top of your shoulder, and youhave your big bustle, your delta one
in the outside of your arm thereand underneath that there's almost there's a space
and then deep in your shoulder surroundingkind of the ball, part of the
ball and socket. They're you haverota aarcuff tenons and oftentimes you see this

(01:10):
and people who are very active withany kind of overhead stuff, especially throwers,
you can get impingement where basically youget pinching of those rotator cuff tendons
and the tissue that's kind of deepin the shoulder and these stuff that's kind
of surrounding it. And so it'skind of a way of you know,
phrasing an injury or a problem suchthat there's not a lot of structural damage,
but there's just kind of an irritationand you know, it can cause

(01:34):
you know, some difficulty with withthrowing or other you know, strength activities
that would require kind of stabilization ofthe shoulder as you're going through the motion.
So he pitched in the game onFriday despite feeling some discomfort. Could
that have made this worse? Yeah, and definitely if he was already having
some symptoms, you know, whenhe pushed through and obviously, like I

(01:55):
said, he was very effective withthrowing hard and everything. Afterward, he
probably you know, just had anincrease in his symptoms. That was just
noticing, Okay, something doesn't feelright, but it was you know,
not that necessarily something was really significantlydamaged as much as there's probably some inflammation
and you know, and things arejust kind of more out of control from

(02:15):
what was already going on rather thansomething new being dangered. So let's talk
about the timeline here. The redsare expressing optimism that this is the sort
of thing that paired with the AllStar break is going to mean that he
doesn't have to miss a lot oftime. Does that feel realistic to you?
Yeah, yeah, hopefully, likeI said, given that he had
a clean MRI, you know,with this type of thing, a little

(02:36):
bit of rest, you know,some manti inflammatories and doing physical therapy exercises
to kind of get the shoulder movingand also kind of stimulate those muscles to
just kind of help stabilize thing.You know. A lot of times you
can turn the round pretty quickly.Now that's said, there's also the other
side of the coin, which issometimes this can be an ongoing thing where
you're kind of dealing with it offand on. So but hopefully it was

(02:57):
good timing for him having a fewdays off there. This news came on
the heels of finding out that GrahamAshcraft has had to go on the injured
list. He is dealing with anelbow strain and this this has played out
in sort of a weird way.So he pitched against the Yankees back on
July the second, felt something stillpitched, they went to send him to
Louisville, and then they rescinded thatbecause actually, well he's got an elbow

(03:23):
strain, and so they've put himon the injured list. The initial plan
is to give him a PRP injection. They've determined he's going to be out
until September. I think a lotof people look at this and feel like
maybe they're just delaying the inevitable andhe's ultimately going to have Tommy John surgery.
Is that maybe a rush to judgmentthat's unfair, you know, and

(03:43):
it's hard to say. I wouldtell you that that would definitely be a
concern, you know, with thatwhen you're talking about a strain or you're
starting to see, you know,reasons why you might do a PRP injection,
you are a little bit more concernedabout like structural issues. Now,
it must not be to the tothe point where it's concerning that it's like,
Okay, he definitely needs it.Oftentimes you will try some conservative stuff

(04:05):
with rehab and medical treatment, suchas an injection first, and the reason
being is because if you go theroute of okay, we're gonna do you
know Tommy John surgery that he's basicallyyou know, at all next season,
you know, for the most part, or at least at a good portion
of it potentially, And so youknow, if you look at that,
if you can resolve this and avoidthat, that's definitely you know, preferable.

(04:30):
And so you'll know in a ina relatively short amount of time over
of course of you know, weeksto months with the conservative treatment, if
you can, if you're looking likeyou're gonna get some improvement, and if
not, you know, you mayhave lost some time there towards the inevitable
uh surgery. But you know,if you if you go that route,
you're definitely missing a significant amount oftime. Can can you walk through exactly

(04:51):
what the p RP injection does?Yeah? So PRP stands for platelet rich
plasmas. Basically, what you dois you you take some blood from the
patient. You actually then spin itin this large machine that kind of separates
the components of the blood and inyour blood. You have part of the
blood's called plasma and part of theplasma that has platelets in it. The

(05:12):
platelets are you know, part ofthe blood that kind of produce a lot
of growth actors. They do afew things are involved with clotting, but
they produce a lot of growth factorsthat can actually aid in healing. And
so, yeah, out of thatvolume of blood, you actually then inject
a small volume of the plasma theplatelets in it, into an area where
there's damage. And we do thisfor a lot of different things, and
this can actually induce healing and reallyhelp, you know, with with some

(05:34):
of these types of conditions. Allright, we have another thread to talk
about. Nick Martini recently had thumbsurgery. They're holding out hope that he
can maybe still play at some pointin late September. Based on what we
know about the strain, it's theucl of the thumb. Does it seem
realistic that he could actually come backand help this team this year? Yeah,

(05:57):
potentially, It kind of depends exactlyon the degree of injury. A
lot of times, you know,you will need some time for healing after
a surgery like that. For themost part, you know, it's just
a matter of like kind of lettingthings kind of scar down and heal after
the surgery, and then the rehabis not you know, too crazy.
You can get your motion back prettyquickly, and it's more about kind of

(06:19):
supporting it. So if he healsup well, you know, potentially towards
the end of the season, itstill might be difficult, just because he'll
need at least a period of timethere for healing afterward before he could you
know, grip a battle hard ordo anything like that. Like there's going
to be some some period of timewe have to avoid stress on it.
But once that period of time isover, then you kind of start ramping

(06:41):
things up and hopefully, you know, get him back, but you know,
the timing of that will be somewhatin question. You watch it off
baseball, you see a lot ofguys, maybe Elie de la Cruz most
notably. I actually see a lotof kids rocking this, and I think
they do it for cosmetic reasons morethan anything else. But they they where
when they get on base what lookslike oven mit, and that's kind of
what it's called the protective oven mitthat's become so popular. Would you recommend

(07:05):
that if you're a base runner,you put that on to avoid something like
this. Yeah, you know,honestly, I think in today's you know
game, where as many headfirst slides, as you're seeing everything, there's no
harm in doing it. Like yousaid, it looks cool too, So
there's that. But but yeah,I mean, I don't see a downside,
you know, really, I don'tthink it would it would be a

(07:27):
problem. And yeah, these littleinjuries that happen to the hands and stuff,
it's just it's a shame when ithappens, because you got it's a
freak thing. And if you couldavoid that, then hey, yeah,
put it on. Uh. DoctorNick Early from Orthosinsia is with us one
more red Luke Maley is dealing witha herniated disc. They are also holding
out hope that he'll be able tocome back sooner rather than later. Let's
start with the injury. What isa herniated disc? So you have these

(07:51):
discs in between the bones in yourspine. Okay, they're called invertuble discs,
and they're kind of squishy at theside. Is a more firm part
of the inside a little bit squishier. And what can happen is that you
can get like a little herniation orlike a little weakness in the outside parks
is a little bit more firm andthe squishy inside part can kind of push

(08:11):
out, and we call that aherniation, and it can push on nerves
that can push on on things thatcan kind of cause pain. It's actually
very common for people to have herniateddiscs. Sometimes they're very symptomatic, can
cause a lot of pain and pushon a nerve, and that makes somebody
really miserable, and sometimes it's nottoo bad. As we age, our
discs become less healthy. So ifyou were to look at like an X

(08:35):
ray of an eighty year old person'sspine, it would look very different than
a sixteen year old spine in termsof their disk spaces and just the way
things look. So naturally, you'llget some damage to those discs over time,
but you can actually have kind ofa traumatic herniation too, where let's
say it's a person with a young, healthy spine and they twist or do
something a bad way that kind ofpushes out some of that disk material and

(08:58):
they can push on the nerve andpotential problem. So he got an injection
that was the original of the initialtreatment is is that going to be sufficient?
Do we feel like it's realistic toexpect that Looke comes back sometime soon?
Yeah, you know, kind ofgoing back to some of the other
stuff. The first thing you dofor hernia disk is is conservat treatments.
You're looking at like medications, physicaltherapy stuff, and then oftentimes an injection.

(09:20):
That injection is usually a steroid injectionaround the area of the disc,
and you're kind of around the areawhere the nerves are trying to decrease the
swelling and the area of the diskand the nerve trying to decrease the symptoms
that somebody's experiencing. The position thathe plays make him more susceptible to dealing
with this again potentially, you know, just all the you know, squatting

(09:45):
and standing up and everything like that. But like I said, you know,
honestly, this can happen, youknow, to people in everyday you
know, occupations and everything as well. But you know, I don't specifically
known anything. I would say,like you know, catch he would be
more likely to have it, butyou know, their body get beat up,
so they wouldn't surprise me. Ifthere's some reason why that would would

(10:05):
have contributed, no question one more. It's an FC Cincinnati favorite, Nick
Haglin had ankle ligament damage and sohad ankle ligament reconstructive surgery. That's very
that's very very verbose. I guessthat sounds complex what's involved. So,
yeah, it is a complex issue, and depending on what's going on.

(10:28):
You know, oftentimes what this isfrom is from recurrent sprains, like multiple
injuries to the ankle where you havedamage to the ligaments and they kind of
heal, they either don't heal wellor they heal kind of stretched out,
and so that there's this kind ofchronic instability of the ankle. And somebody
will experience, you know, kindof recurrent sprains pain, they'll have popping

(10:48):
in their act, We'll have allsorts of different symptoms. I get swelling,
and it's just a it's a problem. So once it comes to surgery,
you're looking at either repairing some ofthose ligaments by tiding him up and
also often not sometimes augmenting those eitherwith some kind of surgical device which can
help with that, or potentially evenusing like cadaver tendon to reconstruct some the

(11:11):
ligaments. And there's different techniques forthat and it can be pretty complicated,
but most of the time, actuallypeople do fairly well. Haglan is thirty
one years old. I know hewants to resume his career next season twenty
twenty five. Do we feel likethat's a realistic possibility or could this be
the sort of thing that threatens atleast the beginning of next year. You

(11:37):
know, I would say it kindof depends on how his rehab goes.
There's a hope that, you know, he would be able to make it
back. I would say, youknow, the older you get, the
harder it is to redound from thesetypes of things. You know. With
that said, you know, lookingat his ankle health overall, like if
this is one of the things wherehe doesn't have a lot of other stuff

(11:58):
going on, I mean, there'snot a lot of damage to cartilage,
is not getting any r price inthe ankle or anything like that. You
know, if you if you lookat the you know, how people tend
to do after these reconstructive, youknow, ligament surgeries in general, they
do fairly well. Now getting backto an occupation like being a professional soccer
player, though it is a completelydifferent, you know, level of know
how you're going to do so.It's always difficult to get back after something

(12:22):
like that to your pre injury levelof performance, especially at you know,
as you continue to age. ButI think it's realistic to hope at least
to say, Okay, there's achance here that he can get back and
perform well and be able to geton the field and do what he needs
to do. We've been doing thesesegments for a couple of years now.
I think we've set the record withfive injuries. Awesome. As always,

(12:43):
I appreciate the time man, thanksso much, of course, Yeah,
thanks a lot. There you go, Doctor Nick Early from Ortho Sinsey.
We say this all the time.The great thing about the people that Ortho
Sinsey is specialists and locations across theTri State. This includes walk in.
Walk in means you do not needan appointment. Walk in orthopedic urgent care
weekdays nine a to nine p.Saturday's nine a to one p in both

(13:07):
Edgewood and Anderson. It's easier andit's definitely cheaper than going to an er
whenever you have an urgent orthopedic injury. And remember when my daughter broke her
foot, what we did went toorthosincy, you do the same orthosincy dot
com. That's ortho c I nc y dot com.