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Shoulder Sports Injuries – A Long Road Home.

Shoulders are complex. So shoulder sports injuries in elite athletes are also notoriously difficult to treat, whether due to trauma or overuse. Along with an article in Slate Magazine ( ) that outlined the unpredictable and historically poor results of shoulder surgery for professional baseball players, a recent article in the Wall Street Journal again highlights these difficulties.

VIERA, Fla.—The former ace of the Yankees arrived here a broken pitcher. This was two years ago, when Chien-Ming Wang was just six months removed from shoulder surgery.

The Washington Nationals had signed him for $2 million, and already, it seemed like a wasted investment. His shoulder was untenably weak. He threw as if he had never thrown before, lobbing the ball as if it were a hand grenade

“The first few weeks I was working with him, I saw a guy that I didn’t think would make it shoulder sports injuriesback,” Nationals pitching coordinator Spin Williams said.

But Wang did make it back, eventually. He made it back last summer from the same shoulder injury—a torn anterior capsule —that Johan Santana is trying to recover from, which makes him something of a case study for the Mets.

As Wang vies for the last spot in Washington’s deep starting rotation, he offers both reason for optimism and reason for tempered expectations for Santana, whose recovery is essential to the Mets’ quest for relevance in 2012.

Santana said he has not followed Wang’s progress. He believes he can come back faster and stronger than Wang, who took a full two years to return. But Wang was curious about Santana, who is 18 months removed from his last major-league game.

“He’s not back yet?” Wang asked. If Santana asked for advice, Wang said he would offer this: “Be patient.”

Dr. Craig Levitz, the chief of orthopedic surgery at South Nassau Community Hospital on Long Island, likened the anterior capsule to a piece of saran wrap that protects the shoulder. It is what allows a pitcher to cock his arm back without his arm sliding out of the shoulder socket.

Wang tore his in 2009, his fifth season with the Yankees. Santana tore his in September 2010. At the time, the only other known major leaguer to undergo surgery for such an injury was Mark Prior, who has yet to make it back to the majors.

There is no road map to recovery, but Wang’s journey is the closest thing to it. It was a path marked by numerous setbacks and revised timetables, of inklings of progress erased by sudden pain.

One year ago, Wang was roughly where Santana is now. A year and a half after his surgery, the end of his rehab was seemingly in sight. He threw off a mound without incident. But he made it through only 16 pitches in an intrasquad game before leaving with tightness in the shoulder. So it went for a while.

“Sometimes, in the rehab, you have pain, then you shut it down, then you go back on the field, throw, feel pain,” Wang said. “Sometimes you feel like you’re not going to make it back.”

Santana can relate. After his first minor-league rehab game last summer, he reported fatigue in his shoulder. The Mets shut him down for a few weeks, effectively eliminating any chance he had of pitching in the majors in 2011.

The setbacks are indicative of the challenge the Mets still face with their ace: building up his shoulder strength without giving him a heavier workload than he can handle. The ideal balance is difficult to find.

“It’s hard for doctors, hard for trainers and hard for patients,” Levitz said. “There’s no green or red light that goes on when you try to do too much.”

What makes Santana’s recovery especially difficult to forecast—and what sets him apart from Wang more than anything else—is that his injury required open surgery. Most shoulder surgeries, including the one performed on Wang, can be done with a minimally invasive arthroscope. But doctors couldn’t reach Santana’s injury with a scope, so they had to make an incision in the area of the tear. As a result, he has also had to rehab the tissues and muscles that were cut in order to reach the tear.

“It’s an area of unknown,” Levitz said. “There has not been a pitcher of his level that has had open surgery since 1970.”

So far, Santana’s spring training has been encouraging. He plans to face hitters in live batting practice for the first time Thursday and is scheduled to make his first Grapefruit League start Tuesday.

Even if he is ready for Opening Day, Wang’s experience suggests Santana will still need time to regain his velocity. Wang said he throws his signature sinker in the low 90s now, down a few miles per hour from before surgery.

But Wang continues to get stronger and more effective. That should give the Mets hope that even if Santana is a shell of himself when he returns, he will get better over the course of the season.

“They used to say in two years, you really knew what you had in a guy after surgery,” Williams said. “But I think it’s even longer than that, especially with major shoulder surgery. You get a feel for what you have in two years, but if they continue to make progress, you’re still going to see a better product down the road.”

Along with a greater understanding of the kinetic chain and each athletes unique patterns of coordinating the body for compound movements like throwingshoulder surgery has also advanced significantly. As the most mobile joint in the human body, it took great advances in medicine and arthroscopy to understand that the shoulder is a circle and that a tear or injury in one part of the joint means there is obligate injury in other areas of the joint as well, see unstable shoulder. In practice, this means developing a surgical technique that allows comprehensive evaluation and treatment of the entire shoulder joint and not just focusing on a small area of the labrum or rotator cuff , see shoulder dislocation. The materials used to perform the repairs have also improved greatly see video below:

Click here to watch a video about Shoulder Surgery Complications. 

Along with your own resolution to succeed, a shoulder specialist can help swing the odds of making a successful recovery in your favor.

Vivek Agrawal, MD

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