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June 13, 2024 13 mins
The Reds got some discouraging news this week about two players who are trying to come back from injury.

Dr. Trevor Wilkes from OrthoCincy joined us to discuss the injury issues of Christian Encarnacion-Strand and Brandon Williamson. 

We also discussed Emilio Pagan's recurring lat problems, and an NBA injury that reads like word salad.

Learn more about OrthoCincy by going here.

Listen to the show live weekday afternoons 3:00 - 6:00 on ESPN1530.

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Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
On Wednesdays we chat with one ofthe experts. We talked injuries with one
of the experts from Ortho Sinsey.The great thing about Ortho Sincy is they've
got specialists and locations throughout the triState and they also walk in orthopedic urgent
care during the week from nine am. To nine pm and on Saturdays
from nine am to one pm.And Edgewood and Anderson learn more at Orthosincy

dot com Ortho ci Ncy dot com. You never need an appointment. Joining
us this week is doctor Trevor Wilks. So. We got some bad news
yesterday about both Christian and carnasi onStrand and Brandon Williamson. Let me start
with Brandon, who he leaves astart during spring training, they put him

on the sixty day injured list.He makes four minor league starts in a
rehab assignment that began back in midMay. They shut him down for a
few days. He had been pitchingwell, looked like he was getting closer
to making a comeback, and nowhe is exploring the possibility of surgery because
he is dealing with a Bennett lesion. I've never heard of this. Let's

begin with that what is a Bennettlesion? Yeah, thanks, Bo,
that's actually a good one. Isthis is kind of in my wheelhouse as
a shoulder guy. But so aBennett lesion specifically refers to calcifications, so
calcium or bone that's in a placeit's not supposed to be in the back

of your shoulder. It is associatedwith tears of the labrum. So the
laborum's are a rim of cartilage thathelps hold the ball in the socket.
And and what happens MO, isthese pictures that have just thrown thousands and
thousands of reps, they begin toconstantly irritate the back of the labrum and
the back of their shoulder socket andthat creates inflammation. And in certain patients

that inflammation manifests as these as theselittle calcium deposits in the back of the
shoulder. And it's super interesting becauseif you just go grab one hundred high
level pitchers and X raym you cansometimes find one or two who have that
and don't even know it. Butin other people it causes constant inflammation and

can be an impediment to them andtheir pitching career. Is this related to
the strain that originally put him onthe injured list. Yeah, I mean,
it's obviously hard to know for sure, but you'd have to think that
it does have something to do withit, and you know, it is
likely related to why he was offsince the preseason and why he had the

trouble when he tried to make thosestarts coming back. So I would guess
yes, all right, So nowthey're trying to determine whether or not he's
going to need surgery. Is thisparticular issue, does it usually require surgery,
and if it does, what's thelong term and I guess also short
term prognosis? Yeah, so agood question. But so typically we will

try conservative treatment first, shutting themdown, anti inflammatories, throwing rehab.
But I would consider that this periodof time that he's likely had, they're
going to consider that a failure ofthat conservative treatment. So in those situations,
yes, it becomes a surgical issue. It's an arthroscopic surgery or a
minimally invasive surgery in which we removethe calcifications, repair the labrum, and

then rehab, and it is typicallya six to nine month rehab. All
right, So it's June. Let'ssay this were to happen here in the
next couple of weeks six to ninemonths means we're touching Marge. So is
this the sort of thing that couldpossibly prevent him from starting next season on
time? I think you may bea delay and he needs to be one

of those guys who's just a littlebehind the training schedule for next season.
I mean, obviously, I hopenot. We all want to see him
kind of fulfill his potential, butit could be. Yeah, all right,
let's talk about Christian and Carnassi onStraham. This has kind of taken
on a life of its own,unfortunately. So he's hit by a pitch
back in April. They do xrays negative, but they find an old

fracture. He misses a couple ofdays and then they say, well,
actually there's a new fracture that theyhave discovered in the same rist. So
he's been out since then, sinceearly May. He is progressing, I
guess nicely, and then they stop. He stops doing baseball stuff. He
doesn't exam in a couple of daysago June fifth, and they're trying to

figure out what the next steps areand he the player cees ops for a
second opinion, and then the specialistwho looks at him determines that there is
ligament damage on top of the owner'sstyloid fracture. So there's a lot here.
Let's go back and recap what isan owners styloid fracture, which I

guess was the original injury you old. Yeah, So if you feel your
own wrist, if everybody pinches theirown wrist on the pinky side of the
rest or your small finger, wecall it the ulner side of the rest,
there's a little bone that kind ofpops out and you can roll under
your finger. That's your owner styloid. So it's the it's the far end

of your ulna, the two bonesin your forearm, the radius and the
ulna, and it is and itreally serves no purpose mo other than to
be the attachment point for a littlecomplex of ligaments and cushioning on the outside
of your wrist. It's really commonlyinjured with a like a forceful fall into

an outstretched wrist. So you know, you trip and fall, you put
your hand out catch yourself. Andthere are a lot of people who have
old injuries from those kind of youknow, quote unquote sprains that they didn't
know about, but mixing in thehit by pitch and the old injury.
It's getting a little confusing with CES, isn't it? No big time?
Yeah, that's why you're here.So I mean, are we talking about

something here where maybe the fracture wasso severe that it perhaps made the ligament
damage hard to detect? Yeah?Agreed, Yes, hard to know.
Again, it seems like something whenyou got hit by the pitch, it
prompted you know, enough internal bleedingin inflammation that this and this is something
we see in sports medicine sometimes wheremaybe an old injury that an athlete is

quote unquote compensating for or living with, something new happens and pushes them over
the edge where they're no longer ableto compensate or live with that injury and
it's now symptomatic, you know,and it gets confusing to the athlete.
Well, why why did it notbother me before? Why does it bother
me now? But it seems tobe one of those situations. So I

kind of agree with your statement.Yeah, all right, So now they're
exploring the possibility of surgery because thisjust seems to have not gone well from
the get go. I'm I guessthe cynical part of me assumes he's just
gonna have surgery. Does this feellike that's the likely outcome here? Yes?
I mean I always hate to projecton these on these things about medical
stuff, but it does. It'sgiven the way things have gone. It

feels that way to me too.And again, this is a reasonably successful
surgery. It's typically done arthroscopically orwith the camera or of a minimum arthroscopic
and open assisted approach. It's apretty successful surgery, a pretty good track
record. I will Sam, I'mlaughing all of us in Cincinnati having our

favorite athletes having risk surgery getting alittle old, getting a little old to
us. But uh, but youknow, generally it's associated with with good
outcomes and return to sport. Allright, return like early next season on
time in twenty twenty five. Agreedhe should he should be on time for
spring training. Yes, a right, doctor Trevor Wilkson orthos, since he

one more read to talk about.And then I have the the injury that
I'm probably not going to be ableto pronounce coming up in a second,
but I know how to say,right, lad strain. Amelia Pegan is
dealing with that again. Let's let'sbegin with the lat. What is it?
How does it work in relation toother muscles. Yeah, so the
latissimus dorsey or your lad's a bigmuscle on the side of your back.

So if you pull your elbow outaway from your body and you feel that
big muscle that kind of wings outor in bodybuilders that kind of wings out,
that's your lat. It's really importantto shoulder function as it pulls your
arm down. So you could imaginedoing like a doing like a pull up
or a row, and your lap'sgoing to be pulling your your arm down.

And so it's important in throwing obviously, because it helps you to generate
the rotation to throw the ball andit helps you to control what you're doing
with the ball. Bast only knowabout Emilia it does. I mean,
they're they're talking about the likely outcomeis he's available in the second half of
the season. Now that's that's alarge swath of time. So kind of

walk me through the likely timeline here. Yeah, And I guess just for
the audience, the relevant thing isthese muscle injuries are really tricky mode.
You know, by strain, whatthey mean is internal damage to the muscle,
and this would be really similar toour reds athletes with hamstrings or obliques
or different muscle injuries, and athletesare so different in the way they respond

to that injury, and we hateit as at athletic trainers or doctors because
predicting timelines is so challenging and you'rejust going to take it as Amelia progresses
in the training room, which iswhy I think they left such a wide
scope of injury. And then thesecond to last point I'll make is just
they're prone to re injury. Soif you're going to make a mistake,

you want to miss you want toair on the side of caution so that
he doesn't reinjury it. All right. So usually when I get you or
one of your colleagues on, Iat least have heard of the body part
that we're talking about here, orI've heard of the injury, even if
I need your background and expertise tokind of explain what the next steps are.
So, the NBA Finals are happeningright now. Chris tops Porzingis plays
for the Boston Celtics. He justmissed about five weeks with the soliest strain,

and so yesterday I see all theNBA writers on Twitter they tweet about
his latest injury, which may ormay not keep him out of the lineup
tonight. I'm going to read thatverbatim and pardon me if I screw it
up. But he is dealing inwith an injury to his left leg.
It's a torn medial retinic calum allowingdislocation of the posterior tibulus tendon. That's

a lot of words, solid there, doctor Wilkes, what is that.
Yeah, you did a good job. You did a really good job.
Yeah. So so that is sounusual injury. And I want to make
a quick tie in just for funhere at the end. But so you
know, Christops has had a lotof injuries. But so this is at
your ankle. So on the insideof your ankle, you're going to feel
a bump. That bump is calledthe medial malialis so that's bone, go

behind it and behind it there's aseries of tendons. So tendons are what
connect muscles to bone so that themuscles can do their action. And these
little tendons, we need things tohold them in place so that the tendons
don't go snaping back and forth andgoing in places they're not supposed to.
The retinaculum is the name of astructure that holds the tendons behind that bump.

So the muscles kind of up inyour lower leg, kind of on
the inside of your calf, andit helps me move the ankle and footbones.
And so this retinaculum is torn,and now it is torn, the
tendon can actually slide in and outfrom behind that bump, causing tendon irritation.
So that's the injury, all right. Is it a severe injury like

they say he could play tonight?I mean, to me, the more
verbiage in an injury, the moresevere I think it is. Play through
this. Yeah, yes, there'sactually a fun back. So the short
answer is yes, absolutely if thetendon. If the tendon will stay behind
the bump, the medium malilas andsometimes we can do tricks like we can
tape it, wrap it. Youknow in basketball you can even get away

with some pretty bulky braces. Andif the tendon will stay in place,
then he's going to be able toplay a really awesome tie and just you're
off for your audience. But ifyou remember the Kirk Shilling story when they
sewed the tendon, so this isthe other side of the ankle, most
so in Kirk Shilling on the outsideof his ankle. He had the same

injury, but the perenial tendons weresnapping out of place, and the team
doc for Boston sewed the tendon tothe skin so that it wouldn't come out
of place. That was the wholebloody sock, right, saga. That
was such a great story. Butit would be if Boston gets another bloody
sock story, it would be classic. It would really be great. Years

later, that's right in the NBAfinals. Yeah, we'll see. We'll
see what happens tonight. I appreciatethe time as always, awesome expertise,
lots of talk about we'll do itagain, man, thanks so much,
thanks crowd. All right, thereyou go. That's our guy, Doctor
Trevor Wilke's Ortho Sincy. I sayit every week. The great thing about
the people at Orthos Sincy is theyhave specialists of locations across the tri State
including walk in orthopedic urgent care weekdaysnine a to nine p Saturday's nine eight

to one in Edgewood and Anderson.It's easier than going to an er and
it's cheaper than going to an er. When you have an urgent orthopedic injury,
go to Orthosinc. Dot com,Ortho c I n c Y dot com

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