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Injury Breakdown: Can Chris Young Shoulder His Injury?

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By Abby Sims
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Chris Young, Mets RH starting pitcher, is reportedly slated to return to the mound on Tuesday for his third start of the season. Young was placed on the DL, due to biceps tendinitis, earlier in the month after winning his first two starts with an impressive 1.46 ERA.  Of course, any soreness and inflammation in a pitchers throwing shoulder is cause for concern, and the oft-injured Young, who will turn 32 in May, will hopefully rebound successfully from this brief detour.  Let’s talk a bit about the role of the biceps and the impact of Young’s diagnosis.

Anatomy of the Biceps

arm Injury Breakdown: Can Chris Young Shoulder His Injury?The biceps is a two-headed muscle in the upper arm that acts to bend the elbow and turn the palm upward (supination of the forearm).   However, it can also act to assist with flexing the shoulder.  Both the long and short heads of the biceps attach to the scapula (shoulder blade) in different areas at the front of the shoulder region.  A secondary function of the long head of the biceps is to help stabilize and depress the head of the humerus.  However, other muscles act more prominently in this manner.   These actions are important in order to maintain good mechanics of the shoulder joint – especially crucial with overhead and throwing motions. Poor joint mechanics leads to the wear and tear of overuse injuries.  Imperfect pitching mechanics can do likewise.

The long head of the biceps also inserts at the uppermost (superior) aspect of the glenoid labrum, a fibrocartilagenous structure that lines the socket of the shoulder joint.   Detachment of the superior labrum is a fairly common injury in throwing athletes, but also occurs with relative frequency in the general population with a simple fall onto the shoulder.  These injuries, known as SLAP tears, can therefore impact the biceps.

Biceps Injuries

Tendinitis, technically defined as inflammation, is actually considered a misnomer. Generally there is wearing of the tendon, which is referred to as tendinopathy, or tendinosis.  Inflammation at the biceps tendon is often accompanied by rotator cuff inflammation/tears.  The tendons lie in close proximity and the subscapularis tendon (an inward rotator of the shoulder) is a prime offender

Is Young’s injury exclusively to the biceps or is the rotator cuff involved?  I’ve seen no reports of the latter, but an MRI might reveal more information.

The biceps tendon is also prone to rupture and can tear either in the shoulder region or at the lower attachment below the elbow.  Tears at the upper region are more common, and occur either within the shoulder joint or at the groove in the humerus where the tendon is housed.  Lower tears occur less often and are due to a traumatic event.  These generally occur in an older population.  Far less common is rupture through the belly of the muscle.

The tendon of the long head of the biceps may also become an issue due to subluxation or dislocation.  This occurs when the structure that holds the tendon in place no longer provides sufficient stabilization and the tendon glides out of position.

Tendinopathy versus Rupture – John Elway, a case in point

John Elway, legendary Denver Bronco’s quarterback, had a history of shoulder problems that included biceps tendinopathy when he had surgery on his throwing shoulder in the 1997 off-season.  The surgery, to remove loose bodies, revealed fraying of the tendon of the long head of his biceps.  Doctors reportedly opted not to repair the tendon. Elway’s tendon ruptured completely in an exhibition game before the season began and, amazing as it sounds, it was the best thing that could have happened to him.

The soreness from the inflamed and worn tendon was no longer an issue for Elway once it ruptured.   With the short head of the muscle still in play, and the triceps being more primary to the throwing motion, Elway won the Super Bowl that season.  Medical research has demonstrated that Elway’s experience was not unique.  So where does that leave Chris Young?  Stay tuned…

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