From Injury to Return: Bob Korvas, Chicago North MSBL
| Bob Korvas, Chicago North MSBL
by Preston Wolin, MD
Shoulder injuries are part of baseball. Unfortunately too many players are affected. While many injuries can be prevented (See Hardball Summer 2010), some cannot. Once an injury occurs it is crucial that the player be evaluated and treated by a sports medicine doctor who understands the game. Sports medicine baseball knowledge has exploded over the past decade. As a result what were once thought to be career ending injuries do not have to be. Our sport is played by all level of players and at all ages. But as much as possible every player should have the same care as those "in the bigs.”
To understand a shoulder injury, one must first know the components involved. The shoulder is frequently referred to as a ball (humerus) and socket (glenoid) joint. An accurate comparison might actually be a golf ball on a tee. The shoulder has the largest range of motion of any joint in the body, but the ball has to stay on the tee to provide stability. The glenoid and humerus come together to form the glenohumeral joint. The glenoid fossa or "socket” is much smaller in size and shallower in depth than the humeral head or "ball” with which it articulates. Consequently, the body uses other soft tissue structures to create joint stability. The first of these is the labrum. This cartilage ring runs along the inner edge of the glenoid. In essence, creating a bigger and deeper socket with which the humeral head may articulate. The most recognizable stabilizing structure in the shoulder is the rotator cuff. This collection of four muscles (subscapularis, supraspinatus, infraspinatus and teres minor) wraps around the humeral head from the front, top and back. Acting together these muscles dynamically center the humerus in the glenoid, stabilizing the golf ball on the tee.
The act of throwing is basically the transfer of energy from the ground up: through the legs, into the hips and eventually the shoulder, elbow, wrist and hand. The body generates huge forces that eventually get transmitted through the shoulder and arm and into the ball. The static stabilizers (glenoid labrum and capsule) and dynamic stabilizers (rotator cuff) help to control those forces or else the shoulder would literally come out of joint on every pitch.
Background on Bob Korvas
Bob Korvas one of Men's Senior Baseball's best players as both a pitcher and catcher. He has been a part of multiple Chicago North MSBL and World Series championship teams. In the fall of 2002, Bob began to notice some problems in his own shoulder. However, it was not until Bob was pitching in a tournament in early 2003 that his symptoms increased enough to raise concern. Bob recalls these symptoms as being at their worst while he was pitching. Initially, Bob tried the traditional route of over the counter anti-inflammatory medication, ice and rest. But unfortunately for Bob, as he attempted to play through his pain, his symptoms only grew worse. By June of 2003, Bob decided to seek medical help. He came to see me.
Treatment: Office visits, injections, surgery
When Bob first came into the office, he reported a "crackling sensation” and pain that would travel along the outside of his right arm. Upon examination, it was suspected that Bob may have injured his rotator cuff and possibly his labrum as well. At this point additional images of Bob's shoulder were necessary to confirm a diagnosis. Bob underwent an x-ray, followed by an MRI. These images revealed a full thickness tear of two out of the 4 muscles in the rotator cuff and a labral tear. At this point, it was recommended that Bob undergo surgery to repair these injuries.
Bob recognized that his injuries would not heal entirely without surgery, but he wanted to try to get through the season. A Cortisone injection was discussed. Cortisone is a potent anti-inflammatory medication. If given multiple times, Cortisone can actually weaken the rotator cuff tendon causing further tearing. Bob understood that I would only give him one injection. He was able to finish the season with the combination of the injection and physical therapy. He also restricted himself to catching.
Five months after Bob's injection and almost a full year after he first began experiencing right shoulder symptoms, Bob underwent arthroscopic surgery. The term arthroscopic refers to a procedure within a joint where a surgeon is able to use very small tools and a camera to complete the repair. This type of a procedure is minimally invasive and only requires several ¼ inch incisions. In Bob's case, the two tears of the rotator cuff and the glenoid labrum tear were repaired.
Bob started physical therapy immediately after the surgery and continued three times a week for the next 6 months. The rehabilitation process requires both dedication and patience. Bob Korvas proved himself to be one of the hardest working athletes I have ever treated. In fact he worked harder than many of my professional athletes. During his rehabilitation he progressed through each phase systematically. For the first two weeks, he wore a sling and simply worked on reducing the pain and swelling that accompanies any surgical procedure. The therapist immediately began passive motion. The therapist moved the shoulder but Bob did not do so himself. The helps prevent stiffness while not stressing the repair. By week three, Bob had graduated to only wearing the sling at night.
Months two through four focused on progressive strength development and stabilization as well and continued progress in range of motion (ROM). Bob used numerous techniques and pieces of equipment to aid in this process. Once sufficient ROM and base strength was established, Bob began using progressive elastic tubing to provide resistance to his shoulder motions. Elastic tubing is used to strengthen motion in multiple joints, but especially the shoulder. One product that is particularly useful for baseball players is the MVP Band. The Velcro wrist straps, a built in door stopper and metal attachment clip allow patients like Bob to use these bands at home in the doorway or clipped to the fence at baseball practice. It's compact and easy to toss into a gym bag but so versatile it can be used for countless strengthening goals. Bob used bands both at home and in physical therapy to regain strength in all motions of the shoulder. Several of the exercises are depicted. Throughout this process, Bob's physical therapist also ensured all the supporting musculature around the shoulder (namely core abdominal, back, and scapular stabilizers) was developing accordingly. It is important that the body mechanics are monitored and trained correctly.
Return to play
The details of any athlete's return to play will vary from one individual to the next. Of course a doctor can estimate a timeline, but each individual's prior history, specific injury and course of treatment will all factors in this equation. At four and a half months, Bob was given the go ahead to begin batting and swinging a golf club. However, throwing was still to come. Bob began batting off a tee, and then progressed to soft toss, a pitching machine and finally a live pitcher. Bob tolerated each of these new activities well and continued attending physical therapy. At his six month follow-up visit, Bob was given a throwing progression to begin. It is important to monitor the throwing speed, distance and repetitions during this progression as they create an additive volume of work done by the shoulder. The progression Bob was given along with all rehab exercises can be found on our website (www.athleticmed.com).
Over the course of the next 3 months, Bob increased the sport specific nature of his physical therapy, transitioned to a home exercise program and continued his throwing progression. He would often find his right shoulder felt "stiff” at the beginning of his work outs but would relax or "let go” once he was warmed up. This is a very common hurdle in returning to play and illustrates the importance of a proper warm up. By warming up, the body is able to increase blood flow to the area and increase soft tissue elasticity often preventing injury. By nine months, Bob was throwing from home plate to second base. He returned to full game and practice participation as a catcher shortly before his 1 year anniversary.
How's BOB doing now?
Since his injury and surgery, Bob has been able to return to full participation in the game he loves both as a catcher and as a pitcher. True to his dedication to the game, Bob maintains his strength and range of motion with the home exercise programs he was given by his physical therapist. He is diligent about warm up before games and icing afterward. His hard work has allowed him to return to the game as an elite MSBL player.
ABOUT THE AUTHOR
Dr. Preston Wolin is the Director for the Center for Athletic Medicine in Chicago and Assistant Professor of Orthopaedic Surgery at the University of Illinois-Chicago. He plays baseball in both the Chicago North and Central Suburban MSBL and performs a free injury evaluation for players in the Chicago North MSBL each year.
Dr. Wolin has served as a team physician for DePaul University, Loyola University, University of Illinois-Chicago, the Chicago Fire of Major League Soccer, United States Soccer National Men's and Women's Teams, the Chicago Red Stars of Women's Professional Soccer, and the Windy City Thunderbolts of the Frontier League in professional baseball, among many other duties.
For more information see Dr. Wolin's website at www.athleticmed.com