Ok, so Carlos went out and got either microfracture surgery or just got his knee scoped and cleaned up. We’re not sure at this point as far as I can tell, but how about a little bit on what a microfracture is and what microfracture surgery entails?

So the first point of clarification is that a microfracture isn’t actually a fracture in the true sense (i.e. a broken bone). It’s actually a surgical technique to repair cartilage (flexible connective tissue found between joints).

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(bumped from FanPosts. --eric)

David Wright’s recent injury (and of course Ryan Church’s debacle) put us Met’s fan front and center when it comes to sports related concussions. I thought I’d write a little bit about concussions.

Mild traumatic brain injurty (mild TBI) is often used to describe concussions by medical personal. According to neurologists, concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Its approximated that over 1 million people get concussions every year.

What actually happens in a concussion is the complex neuro network in our brains gets disrupted, either from swelling, direct shearing or even from free radicals generated after the injury (drink your antioxidants).

The symptoms are well known and include confusion, amnesia, headache, dizziness, ear ringing, vomiting, and slurred speech. Some symptoms only appear a little bit later, such as memory or concentration problems, sensitivity to light and noise, sleep disturbances, irritability and depression.

Some physicians will also evaluate something called the standardized assessment of concussion score. This takes into account orientation to place, immediate memory, concentration, delayed memory recall and actually a simple physical strength test. Using this score, physicians determine when patients can go back to play.

One major problem with concussion (again, as we found out with Church) is that there are significant sequelae that develop. These include (taken from UpToDate):

Postconcussion syndrome — These include headache, dizziness, neuropsychiatric symptoms, and cognitive impairment. These typically develop in the first days after mild traumatic brain injury (TBI) and generally resolve within a few weeks to a few months

Post-traumatic headaches — Headaches occur in 25 to 78 of patients after mild Headaches may represent a specific injury to the head or neck, may be nonspecific in character, and may have a symptom pattern indistinguishable from other nontraumatic headache syndromes such as migraine and tension headache

Post-traumatic epilepsy — Mild TBI is associated with a twofold increase in the risk of epilepsy for the first five years after injury. Prophylactic treatment with anticonvulsants does not prevent post-traumatic epilepsy and is not recommended

Post-traumatic vertigo is a substantial contributor to disability after mild TBI.

Certainly hope that David doesn’t have any of the above symptoms lasting for a while…unfortunately only time will tell.

Carlos Delgado’s undergoing arthoscopic hip surgery soon. Delgado has a bone spur and a torn labrum in his hip; more on these conditions at a later date.

What exactly is arthroscopic hip surgery? It’s actually really cool. The word is from arthros (joint) and scope (to look inside).

Basically think of putting a little slit in your side, slipping a tiny camera through, looking at all the insides and fixing whatever might be wrong. It’s all done through a small incision which means less time to recovery. If you take a look at the pictures below you can see a little more of what is going on. The arthroscope is the camera, the shaver is, well, a shaver. You can basically take little bites of bone to "shave" it down. If there’s a bone spur, there might be muscles getting "stuck" on there. Shaving that bone spur down will let those muscles not get caught up anymore and hopefully allow for full recovery. Recovery time is usually in a week or so. You can usually start walking right after the surgery. You can see exactly what the surgeon sees on that second image

Some problems can be treated great using this approach. If there are bone spurs, those can be shaved, if there is a torn labrum that can be fixed. Of course a lot of problems cannot be fixed through a tiny little hole. I know a lot of doctors who are really skeptical of knee arthoplasties for various pathologies. But I’ve honestly not read much research on outcomes from hip arthoplasties. I sure hope this works for Carlos…

via oporthopedics.com

via www.csosortho.com

Mike Pelfrey is reportedly missing his next start with forearm tendinitis. I’m sure some people out there are wondering what exactly is tendinitis and what this might mean for the Met’s starter.

First a primer: the forearm is actually made up of many different muscles with funny names like extensor pollicis longus and flexor digitorum superficialis. These muscles are possibly one of the most tedious parts of the human body for a medical student to learn. In any case, take a look at the picture below for an idea of all the muscles (if you think there are a lot here, wait till someone has a hand injury…). At the end of the muscles are tendons. These tendons are bands of connective tissue that usually connect muscle to bone (they are the white parts of the picture below)

via www.paddleball.com

So what is tendinitis? It’s an inflammation or small tear of these tendons (anytime you see –"itis", think inflammation). Usually it occurs in the shoulder, ankle and elbows. Tennis elbow (lateral epicondylitis) is a really common form of tendinitis. The reports of Pelfrey’s tendinitis are his "forearm", which could be any one of a number of tendons. The main symptom of tendinitis is pain which is usually worse with activity. As you probably figured, tendinitis occurs mostly because of overuse, but actually can happen in inflammatory diseases as well. Certainly Pelfrey’s injury is from overuse.

If you and I came down with elbow pain, we certainly wouldn’t need an MRI to diagnose it. But baseball players get MRIs like they are candy, and so Pelfrey got one and this seems to have confirmed that there was a weakening or tearing of one of the tendons or a change in the sheath around the tendon.

Really the best treatment is rest. Other options include corticosteroid injections (not the anabolic type!) which can reduce the inflammation by basically suppressing your immune cells around that area, or surgery, if there is a tear that can be repaired.

For Pelfrey, the best option I’d guess would be rest. You should usually rest for at least a few weeks to get the inflammation in check, but Pelfrey seems to have been playing with this for some time. Hopefully it doesn’t progress at all because we certainly need Pelfrey back to his ’08 form.