All Episodes

September 19, 2023 • 14 mins
Bone and Joint Takeover
Mark as Played
Transcript

Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:04):
Back on The Rob Devil's Show withBen Darnell in your Afternoon Drive, it
is our virtual Hartford Healthcare Bona JointInstitute Day and that doctor Jeff Olson joins
us now and doctor Olson, I'mseeing a lot of pitchers and some football
players. They're injuring their terrorists majors, and they're also injuring their terrorists miners,

(00:24):
which is right around the rotator cuffin the back of the shoulder.
Is there any way to stabilize thatarea. That's a good question. You
know, the terrys major is kindof one of these, you know,
muscles that's kind of inably involved withthe shoulder and originates from the scapula and
inserts on the on the upper partof the arms humorous and so it's not

(00:46):
a it's just below the rotator cuffmuscles. So when you talk about the
glenningham Ron joint, the rotator cuffmuscles are four muscles that actor primarily stabilize
the the you know, the ballin the socket. And it becomes increasingly
important as you talk about pictures,especially trying to stabilize their shoulder as they
come through their you know, theirwind up in their throwing mechanics, whereas

(01:08):
the terry's major is a muscle thatcomes off the scapula and in terms some
of the humors and help that kindof add doctor bring the arm towards the
body. So I think along thelines of you know, throwing related injuries,
a lot of this has to dowith you know, proper mechanics and

(01:29):
in a strong core, a strongtorso, and trying to help offload the
different areas of the arm and theshoulder as much as possible. You know,
these these injuries are hard to diagnose, and this is a very specific
population that you see them. Anddoctor Chris Ahmad, who's Dena Columbia,
you know, talks about these andthey're very specific injuries that the patient comes

(01:51):
in with kind of this nebulous shoulderback pain and they have uh tenderness right
at the area where that that terry'smajor you know, comes off this scapula
and the other thing that kind ofcomes along these latisimus doors. He cares,
and you know, they're frustrating injuries. They're hard to manage. They
often don't need surgery and they justneed a good period of you know,

(02:13):
recovery and rest and rehab, Sothey're not really common. You know,
I don't see them or hear aboutthem as often in football players. It's
more the throwing athletes that we tendto see them, but they're a little
bit nebulous for Candy even stick juststicking with baseball, saw did you see

(02:34):
Costas? By the way, Dibbsis going to get shut down because they
found shoulder inflammation on Nick Cossas,so they're going to put him on the
shelf for the rest of the season. Tristan, why I say, Nick,
I don't know where I got thatfrom must Grove also from the padres
he had shoulder inflammation, Like thisis a kind of thing, and especially
for baseball players, doctor, Ithink like it's an inherent thing for them,

(02:57):
and Dibbs probably knows that. You'rejust going to deal with pay Man.
Your arm is going to feel likeit's fallen off in September, even
if you play outfield. Compared toeven some pictures in Major League Baseball,
do you literally see that inflammation?Is it something that someone tells you about?
You said, diagnosis is really hard, and it always is with athletes
because they don't want to tell youanything. But how do you find shoulder

(03:21):
inflammation and know that this is goingto be a problem that we got to
stop right now, right And youknow, one of the things that you
know, reading headlines and just seeingthis, you know, these general news
and headlines, it's it's always alittle bit mysterious to me. Things they
say, is like shoulder inflammation.We know that in throwing athletes when there's

(03:42):
what they're at risk for is whatwe call post your capsuler contraction and stiffness.
And so what happens is they're soused to cocking back and extra rotation,
they get a relative loss of interrotationas the post your capsule contracts,
and a lot of it's due toan imbalance. And you see this in
young athletes who don't focus on theircore, don't focus on their trunk,
and you know, rely just ontheir arm. And and so I don't

(04:04):
when when they say, you know, shoulder inflammation, I'm still unsure about
what they're talking about. This postyour capsular contractor can lead to what we
call internal impingement. Where as theas the arm comes back in the experamentation,
you start to get a translation ofthe humor head on the glenoid because
of the asymmetry in the capsule.You know, the capsule is like a

(04:27):
thin, whispy veil like tissue that'ssupposed to be very flexible, and when
it gets inflamed, it gets verythickened and scarred, and you know,
and much like a frozen shoulder,which is all generalized capsule inflammation. This
post your capsule and these throwing athletesis primarily affected. And as as that
pathology starts to impede or impact theirthrowing motion, you start to see other

(04:48):
things along these the spectrum of internalimpingement like flap tears and what we call
posti legions are partial articular superspande istend hair. So I still don't know
what they mean when they talk aboutcapsule or you know, shoulder inflammation.
I don't know if they're talking about, Okay, does this pitching or the

(05:08):
pitcher actually have a road trick orcoupleas you know, or do they have
a slack care and you know,there's their arm just aches because they've been
throwing for you know, you know, dozens of games throughout the year.
So you know, I think thisis probably something where it's it's probably falls
somewhere along that spectrum and you know, a good much like any you know,
adolescent or athletes, they just needsome time off. They need to

(05:30):
you know, work on stretching,to push their capsule and work on you
know, just common everything down.But like you said, you know a
lot of it's just it's just thevolume of pitching and and it's pitching all
year round and they're throwing hard,and you know, this just it just
happens. And so you know,I think it's it's it's hard to imagine
a throwing athlete not having pain atsome point. Not does that necessarily mean

(05:54):
as a major structure a reason?Uh, you know, who knows,
But you know, it's it's notuncommon to see these types of things,
as you pointed out with Cossas andMusgrove talking to doctor Jeff Olson, orthopedic
surgeon, Harford Hospital, Bone andJoint Institute. He does mainly shoulders and
elbows, and so I have someelbow questions for you because Shohyotany for the

(06:15):
second time needs Tommy John surgery.But he's not the only everyday player.
Now, Doc Bryce Harper's coming backfrom Tommy John. Jason Dominguez now at
twenty needs Tommy john So besides thepitchers and the throwing motion, I threw
right hit hit left. Harper throwsright hits left. Dominguez is a switch

(06:38):
hitter, and show Hey throws righthits left. Can that constant snapping of
the bats as well as the throwingmotion could be that damaging the UCL.
And there's a whole timeline here ofbroken fingernails, fatigue, all kinds of
stuff with show Hey son, canyou kind of you know, package all

(06:59):
that stuff up together and bundle ittogether and then tell us is there any
way to stop these UCL injuries fromhappening? Because I get the question asked
a lot. I work with theyounger pitchers, and I always say,
no, you know, when whenit's your time, your your body's going
to tell you when you you've overtweakedit. Right. Yeah, that's a
good question. You know, Inever really thought about these these players being

(07:20):
you know, left handed batters andright handed throwers. It seems a little
not all that intuitive to me.You know, when we talk when we
talk about me to own a clatteror ligament injuries and these athletes, it's
you know, because there's a lotof valguus stress and torque on the elbow.
And so if you're thinking about someonewho's batting lefty, I don't know

(07:42):
that that you know, when you'rewhen when you're right, arms forward and
carrying through your swing. I don'tknow that there's a whole lot of valgus
stress on the elbow, much likethere is in a throwing motion. I
could be wrong. It's something that'sa little bit less known injury in the
hitting athlete. And I've seen acouple of papers coming out kind of describing

(08:03):
these things, but I don't thinkthat we've studied the you know, the
implication like the the you know,kinematics and you know, using motion sensors
and tractors to look at what exactlyis uh loading and where during our hitting
motion. So in my mind itcould be trutrum and unrelated just that that
they're left you know, left handedbatters, right handed throwers. But certainly

(08:26):
it's not a surprise. I meanyou look at you know a lot of
these players, like outfielders, Imean they're throwing the ball one hundred miles
an hour, uh, you know, down the you know, down to
the home plate, and you knowthat's obviously a significant torque. Now,
granted, they're you know, crowhopping and different things, so they're using
a little bit more of their bodythan pitchers tend to be. But you

(08:46):
know, I think that all theseplayers across the board, when you're throwing
that hard, you know, you'reexperiencing super physiologic forces across that elbow.
And as soon as you get alittle bit of what we call Fletcher pronator
you know kind and I is,and then they're you know, they're not
you know, they're relative stablizers orsecondary stabilizers. Elbow are not functioning as
well. Now your primary stabilizers,like the ligament are absorbing a lot of

(09:09):
that stress. And this is whenyou get you know, you're subjected to
these injuries. So you know,obviously at year and a year out we
see people you know, hurting theirtheir elbows and they get shut down and
ultimately undergo Tommy John. So butit is a good thing and a good
question. Why these left handed hitters. That's just something I'm not quite sure

(09:30):
about. Let me throw one morething at you the second time for Tommy
John for for show. Hey,will it affect him or can he come
back fully from that? Yeah?I think that's a good question. You
know, the revision Tommy John surgeryis definitely no home run. And I
think that the study, the lateststudies out there, a lot of these
guys doctor Andrews shicken Dance and FranziMoore of the Cleveland Fans that's studying a

(09:56):
lot of this stuff show that certainlyafter revision Tommy John surgery, the return
to sport and return to prior performanceis not nearly as good. You're looking
at numbers like fifty sixty percent.Now that being said, there there are
looking at things and certain to studysome things to see if they can you
know, get better outcomes. Youknow, when you talk about UCL injuries,

(10:18):
there's a you know, you canattempt to repair the ligament if it's
an acute injury and use what wecall an internal brace where it's a very
heavy, thicked future kind of braidedtogether to serve as an internal splint while
the ligament fields, so you're kindof uploading that area versus a reconstruction where
the you know, there's a chronicinjury, the ligament is you know,
it's no longer good, it's goodquality and it's not worth repairing, so

(10:41):
you go and reconstruct. The latestthing is is you know, doing a
reconstruction and augmenting that with a repairand and augmenting it with an internal brace.
And the hope is that you know, you're adding that extra support and
stability to the you know, theligament while the ligament or the that a
reconstruction, the tenant allergraph is healingin. So, you know, I'm

(11:05):
curious to see if you know,if that's something that they would do with
him. Obviously it's hard to findout the specific details of these, you
know, high profile athletes, butyou know, that would be my my
guy is that they would try somethingdifferent in a in a in a player
who has a lot to offer tothe sport, a high profile player who
you know, teams are willing toinvest a lot of money into obviously want

(11:26):
him to get the best outcomittee can. So that's that's my sense of,
you know, what's probably going tohappen in his instance, teach us more
about this internal brace, because whenDibbs and I first discovered it, it
was Trevor's story that I think hewas the first athlete we have heard that
got this, and then in turn, that was the first time we had
heard the phrase internal brace. Nowin my mind, I'm imagining it's like

(11:50):
this woven like sheath or something thatsomehow you slide on top of the bones
while you got everything ripped up inthere on surgery. But I feel like
I'm way off on that. Whatexactly is this internal brace that they're putting
on and how successful has it been, because it seems like it hasn't been
around for that long it hasn't,you know, And you know, I

(12:13):
would say, I don't know theexact timing, and I'd say it's probably
been around for at least the lastten, if not fifteen years. Now
it's become it's definitely become more popularizedin recent time. You know what it
is, and there's different ways thatyou can execute it, but you know,
the common is, you know,two anchors that are made of plastic
type material and coming from that isthis material and it's it's a it's basically

(12:39):
a woven suit heavy suture that's prettystrong and typically you know, it's with
the forces that the elbow feels,is usually able to withstand those much more
than the human tissue. This wasoriginally looked at with you know, younger
athletes who hadn't been throwing, youknow, for as long, but may

(13:01):
have had that acute pop and painwhere they weren't having any pain begin leading
up to that. And you know, when you get in there, you
go into your surgery, you findthat the ligament actually evolses off of the
bone rather than like a nutritional degenerativetear. And then so those instances you
can use one of the suit theseparate suiture lens to repair the ligament back

(13:24):
down to the bone, and thenthe brace overlays or on layers onto that
the native ligament to kind of shieldit from the stresses that it typically you
know, the typically feels or experiencesduring the throwing motion. So now people
like I was talking about are tryingto get into this hybrid technique where you

(13:46):
know, they're kind of combining youknow, reconstruction with an allograph tendon and
using the brace. The reason forthat is, you know, with a
with a tenant allergraph, this ittakes a long time to feel and remodel
and incorporate to the you know,the native bone. And so that's why
the recovery tends to be about youknow, twelve or fifteen months compared to

(14:07):
the you know, four or fivemonths that they're seeing with the repairs and
internal brace. But it's all predicatedon needing a very healthy looking ligament where
you can it's amenable to repair,because otherwise it's it's it's futile, it's
just going to sail. Doctor Rolson, you're outstanding. Thank you so much
for a few minutes of your time. I know you're very busy, and

(14:28):
Ben and I really appreciate you comingon and talking some of these injuries with
us. Absolutely, thank you.Always happy to do something with you,
so let me know in the future
Advertise With Us

Popular Podcasts

Stuff You Should Know
The Joe Rogan Experience

The Joe Rogan Experience

The official podcast of comedian Joe Rogan.

Dateline NBC

Dateline NBC

Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.

Music, radio and podcasts, all free. Listen online or download the iHeart App.

Connect

© 2025 iHeartMedia, Inc.