By Abby Sims
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Thirty-seven year-old Yankees outfielder Carlos Beltran has opted for a second cortisone injection as well as a second opinion on his right elbow.

Out of action due to pain from bone spurs in the joint, Beltran evidently played through pain until it became untenable. Though Beltran’s condition reportedly improved after receiving another shot, that may have been expected, at least as long as he also refrained baseball activities. However, the fact that he had another injection so soon after the first is an indication that the initial one did little to ameliorate his symptoms. Now what?

Clearly, a cortisone injection has no curative impact on the spurs themselves. As with the degenerative articular cartilage in Sabathia’s knee, additional treatment is required in order to address the condition that is causing the inflammation. Treating the inflammation alone is of little long-term benefit.

Beltran has acknowledged that if he is unable to play through the pain any longer, surgery is an option. The likelihood is that if he does give it a go, it won’t be for long. Continued throwing as well as hitting would undoubtedly result in symptom recurrence. Not only that, but if Beltran pushes himself to compete, he may suffer from compensatory injuries in the arm as well.

The overhead athlete’s elbow is subject to great forces during the throwing motion, all of which can lead to a number of pathologies.

Bone spurs – or osteophytes – are a sign of osteoarthritis. They develop over time from degenerative wear and tear, primarily at the ends of bones. Spurring creates irregularities in the contours of the bones at the joints, which then compromises the space between bones. Though they may be undetected when mild and asymptomatic, when severe, bone spurs can cause pain and inflammation as well as a loss of range of motion. All these can then contribute to a loss of strength in the muscles of the region.

One possibility for Beltran should he continue to play with the spurs is that they may break off from the bone and become loose bodies in his elbow. Once loose in the joint, they can shift in position, further obstructing movement, causing the joint to lock. Loose bodies can also get stuck in the lining of the joint capsule, known as the synovium. This can incite a more acute and painful inflammatory response.

The bottom line? No amount of cortisone or rehab will address the cause of Beltran’s pain and there are calculated risks in playing through pain. Surgery will keep him out for a minimum of six weeks, possibly more. We’ll know more about his plans once he sees Dr. Andrews.

Follow Abby on Twitter @abcsims.

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