The Overly-Curious UnDoctor: Mike Lowell

		The Overly-Curious UnDoctor Is In! This week’s subject: Mike Lowell With the constant stream of bumps, bruises, owies and ouchies that the Red Sox encounter, it can all get a bit confusing for us non-medical types. What’s just a minor scrape that’s nothing to worry about? And what’s a severe four-alarm injury that warrants a true freakout?
That’s where our resident health professional, mhcranberry, MPH, is here to help. She’ll be stopping by on occasion to give you all the nitty gritty on the Sox DL. What exactly is going on with Mike Lowell’s hip? We’ve seen him grimace and play through pain, and we now know he’s going for an MRI. What’s this all mean? Follow me after the jump for all the questions you have but were afraid to ask…

For several months now, whenever a player of ours has come down with an injury– and oh, how many there have been– I have taken to my computer and sent out a missive to our dear Texy, usually including graphics (occasionally gross–though I’ll try to avoid those in the future). After watching poor Mike Lowell wincing and hopping through last night’s game, I wrote a quick note to Texy.

Why, you ask? Because I’m going to be researching them anyway out of sheer curiosity. So why not share? As opposed to the speculation and silliness that usually erupts at the slightest hint of an issue, I’d like to be able to debunk rumors and put out fires in the time before we hear the diagnosis, and/or provide some solid, realistic information after the fact.

***

Lowell’s MRIs have been shipped off to a million hip specialists for readings and opinions. Apparently his persistent hip pain has been significantly aggravated so they’re seeking outside help. He spoke to the press pregame:

“The medical term is that they believe that my labrum maybe popped in and out of the joint, they say.”

Note to number 25: with all my love, I don’t think “popped in and out of the joint” is actually the medical term. Whatever.

The point is, his labrum’s gone wonky and it hurts a lot. I’m not really sure how the entire labrum could have popped out of the joint without his hip being totally dislocated, so I assume they mean that a little corner of it got displaced and then corrected itself.

What our much-adored 3rd baseman is probably experiencing is a dull ache in his hip that doesn’t go away even with rest. When you see him wincing and grimacing during plays, it’s likely related to a clicking or catching feeling in the hip joint when he turns his leg a certain way.

My suspicion is that the tear that they announced a few days ago has things in there torn up and inflamed, and he turned his leg hard, and some sliver of tissue slipped into some crevasse it doesn’t belong in or went outside it’s normal positioning, inflaming tissue even further.

Torn hip labrums are actually not very common, and methods for diagnosis and treatment were really only developed in the 1990s. It’s an injury most commonly found in professional soccer players, though I guess that makes sense, since the act of kicking a ball really does use the hip an awful lot.

Lowell: “It looks like a baby scribbling, so I don’t know what they see.”

Pretty talented baby if this is true. These are MRIs that do the job though: the first shows a normal scan, then one that points out the torn tissues.

The labrum, in short, is the cartilaginous (I love that word) thing that grabs on to the long bone going into a ball-and-socket joint. (That’s what she said.)

There’s one in your shoulder– for reference, Papelbon’s are genetically very loose, allowing him to whip his arm around at those insane speeds. When they say the Sox had to figure out how to keep his arm from falling off, they’re not entirely exaggerating.

In your hip, the labrum cradles the head of the femur, gently cushioning it and allowing it to glide freely in the space in the pelvic bone. The site where I got this illustration describes the labrum as working like an o-ring and gasket for the joint. This is actually a really good way of describing it.

The “healthy cartilage” is of interest here– the brim of the socket where it attaches to the femur is the spot where tears can develop.

Obviously, this is going to be a problem if it gets torn. And, if a little corner of that labrum edge is torn, it can in fact slip out of the socket and get into all kinds of trouble.

The fact that Lowell said that the shots aren’t working as well is probably related to increasing aggravation of the tear and the build-up of all kinds of crud (that’s the medical term for it) in the joint.

And that’s really all they can do to manage it– try to control the pain and inflammation, both of which are self-perpetuating (inflamed tissues inflame nearby tissues and so on). He says he doesn’t need surgery, so maybe the labrum isn’t torn at all and it is just an issue of inflammation, but I’ll touch on it just in case.

The surgical treatment is pretty simple, especially for the calibre of surgeons hired by the Red Sox; in most cases, it doesn’t even require an overnight stay. They’ll put him under anesthesia, pull out the hip joint a little to get space to work, perform an arthroscopy and clean out all the gunk (a process called debriding), trim ragged edges, and if there is a clear site where something is torn, they’ll toss in a simple stitch or two to pull the pieces back together, close, and voila, clean hip. In all, the procedure can take under an hour.

Crutches for 4 or 5 days– which, to be fair, probably feels too long for an antsy professional athlete– and rehabbing within a few days. Professional soccer players generally are back at full performance within 12 weeks; I don’t know what this would be for a baseball player, for whom endurance and range of motion in the legs is less important.

On the other hand, Mikey said he wanted to spend the off-season on the beach with his kids– the good news is, as long as he isn’t running or playing beach volleyball or something like that, where his hip could twist, he probably can. Rehab will be necessary but he will be able to be mobile, active and independent. I understand the concern though.

Once fixed, he shouldn’t have any further issues… unless there’s a pre-existing problem that caused the injury in first place. I’ve heard rumors that the Orioles didn’t want him all those years ago because they had concerns about hip problems. Maybe this is a persistent nagging problem, maybe not.

Let’s just touch on causation because… well, because I’m a nerd and was curious. As you may expect, the biggest contributing factor to any injury is playing fatigued. This also could have been caused by getting banged up somehow (a bad slide? a clubhouse melee? I couldn’t think of anything, but we don’t see it all, of course), something maybe putting undue strain on weird places that aren’t built to hold it (an impingement), a loose joint capsule… but I think an actual medical source put it best:

“Sporting activities that require frequent lateral (external) rotation… have been thought to result in labral tears. Some tears also have been attributed to running and sprinting. Certain movements, including torsional or twisting movements, hyperabduction, hyperextension, and hyperextension with lateral rotation, all have reportedly led to labral tears. Despite all of these movements that are thought to bring about tears, a large percentage of labral tears… are not associated with any known specific event or cause. In these cases, the pain typically develops gradually and increases in intensity over time…”

In plain English, these injuries can be caused by almost anything, or nothing at all, hurts a little and/or hurts a lot. Awesome.

I personally can’t answer whether or not he should be benched. Obviously he’s in a lot of pain, and there’s only so much “playing through” that should be expected of him. As they told him, though, this can’t really get worse– the tissue damage has been done, what’s torn is torn and what popped out has popped back in; the only thing left to do is manage the state and health of the surrounding tissues. It appears to me that he’s pushing himself really hard to get through it, and he wants to be on the field. Impressive that he’s out there playing as hard as he is by sheer force of will.

***

If, dear readers, you are of the overly-curious sort and don’t mind medical jargon, there are two articles I found particularly useful (since a credible UnDoctor always cites RealDoctors and RealAncillaryProviders):

Binningsley, D. Tear of the acetabular labrum in an elite athlete. British Journal of Sports Medicine 2003;37:84-88.

Lewis, CL and SA Sahrmann. Acetabular Labral Tears. Physical Therapy 2006;86(1):110-121.

A patient education site from a highly, highly credible source, the Hospital for Special Surgery in New York.