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Understanding torn labrums and other shoulder injuries Dr. Congeni discusses increase in shoulder Injuries among athletes

Dwight Howard hurt his shoulder last week and will be sidelined indefinitely.

Dwight Howard hurt his shoulder last week and will be sidelined indefinitely.

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Many pro athletes, such as Lakers’ center Dwight Howard and the 49ers’ defensive lineman Justin Smith, have suffered torn labrums and other shoulder injuries lately. There’s been an increase in these types of injuries because athletes are pushing these muscles to extreme fatigue.

Dr. Joe Congeni, director of sports medicine at Akron Children’s Hospital, discussed these injuries yesterday with WAKR morning show host Ray Horner. Originally aired on 1590 WAKR-AM on Feb. 6, 2013. Transcript and audio below.

Horner: Dr. Joe Congeni from Sports Medicine Center at Children’s Hospital is in our studio to talk about sports-related injuries, things that are top of mind. He does a good job of really being topical for us. One thing that we’re seeing in (Los Angeles Lakers’) Dwight Howard and the NBA are these labrum shoulder injuries. Guys are still able to go, but how much does it hamper their ability, Joe?

Dr. Congeni: It depends on the type of tear. I know you hear me say that a lot, it depends on the injury, of course. It’s really the [popular] injury in the last 10 years, especially in young athletes. We don’t see cuff tears, people talk about the rotator cuff a lot, as much in younger athletes.

This glenoid labrum is the name of it. The shoulder joint is like — they call it ball and socket — but it’s really kind of a ball on a golf tee. It doesn’t have a deep cup to hold the ball in place, so there’s this thick, fibrous cartilage extension of that cup that kind of holds the ball on the golf tee. It’s like a bumper, you know, on a bowling alley so it doesn’t let the ball go in the gutter. It actually even has a suction-cup quality to it, and it helps keep the ball on the golf tee when people are moving the shoulder in different ranges of motion.

Unfortunately, when you dislocate the shoulder, very frequently you tear the labrum. That’s a significant tear called a Bankart tear, sometimes a big tear that blocks people from moving the shoulder.

The other type of tear that the pitchers get — and the swimmers and volleyball players get — is where the cartilage separates from the bone, but it doesn’t tear.

I was reading the other day, Howard is saying his is a separation, not a complete tear. If he has surgery now, he’s basically going to miss the playoffs and the rest of the season. They are trying to fix it with, you and I have talked here before about it, PRP, Platelet-Rich Plasmas. You take out the growth cells in the blood stream and inject them in the area to try and get a quick healing. They are injecting it into [Howard’s] labrum to see if they can get it to heal before the playoffs.

Horner: If you tear that labrum, how long is it to recover from something like that?

Dr. Congeni: If you tear that labrum badly, this Bankart-type tear from dislocating it, it’s like having a rock between two gears and you’re going to have trouble moving the shoulder. You’re going to end up having surgery. If you have one that we call a peel off lesion, or a separation, many people play with that.

In fact, Ray, people say when you [look at] high-level baseball players, and late high school, college pros, there may be 10 to 15 percent of people playing every day with small labral tears — fraying of the labrum, separation. So again, it has to do with how bad the tear.

If you have a big piece torn from dislocating the shoulder a lot, you’re not going to play very long. You’re going to need surgery to get it fixed. If you have a smaller tear, there’s many people playing baseball right now with small tears, or separation tears, or peel-back lesions, they call them, of the labrum. So, it’s totally dependent on how bad the tear is.

Horner: Joe, staying in the arm area, one injury that we see a lot — more than we used to 10, 15 years ago — is the tear of the triceps and biceps. I know Ray Lewis, we talked about it last week with his recovery, [had a torn tricep] and I know one of the 49ers Justin Smith had the same type of thing. Is it just me or are we seeing more of these types of injuries, and how long does it take to recovery from these?

Dr. Congeni: I think that you’re seeing more of these injuries. Athletes are really pushing these, [what we call] ballistic muscles, the ones you really use. The biceps and triceps are the two muscles that are really important push-pull muscles of the shoulder. And we’re pushing these to the edge, there’s no doubt about it.

As athletes are pushing to get as strong as they possibly can, they push these muscles to fatigue. So the times you’re going to see the ruptures of these are going to be very early in a game or very late when that muscle fatigues.

When you get a complete rupture of this muscle, many times in these high-level pro athletes it’s going to have to be fixed surgically. That’s why we were talking about Ray Lewis last week. It was really amazing how quickly he got back.

Typically, we’re going to tell you you’re done for the year and you’re going to need to have surgery. The fact that Ray Lewis got back that quickly, that was really surprising and unusual. You can generally count on four to six months, and he was back in six weeks with that injury. That was pretty remarkable.

Horner: I was reading the one guy on the 49ers, Justin Smith, he played with a triceps injury. He took three weeks off, came back and played. He had surgery yesterday. They said he’s out three to four months before he gets back.

Dr. Congeni: Yes, that’s the kind of thing. But, of course, they’ll try anything to get back in play. I don’t think Smith ever was as good later on in the season as he was mid-season. Sometimes they make these calculated assessments, “Hey, if I can get 80 percent of a guy like that … .” I honestly don’t think Ray Lewis was playing at 100 percent, but he knew it was his last ride.

Those muscles, they are pushed to fatigue and they end up tearing much more frequently. And in these high-performance athletes, it’s really hard to rehabilitate ‘em and get them back. You’re going to need to have surgery, four to six months on the shelf is basically what we’re looking at.

Horner: One final thought, we have about 60 seconds left, the blood clot thing with Andy Varejao, touch on that for me.

Dr. Congeni:  Yeah, the blood clot thing with Andy Varejao was really unusual. Sometimes these are post-op, but they said they weren’t sure if his was post-op or not.

What happens is if these blood clots break loose and go to the lungs, pulmonary embolism, that’s life threatening. So they have to put these clot busters in and [use] blood thinners, and there’s just no way you can be playing sports on these blood thinners. So, you’re out for six months to a year.

They are going to be waiting on Varejao because he’s going to be three to six months on blood thinners. Remember Jason Pinkston, we’ll see if he gets back at all for the Browns at a guard position.

Horner: Alright, Joe, good stuff this morning. Thanks for coming on in.

Dr. Congeni: Okay, Ray, good seeing you.