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Rich Hill still has two arms for some reason.

 

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via www.midwestsportsfans.com


This is all Matt Clement's fault.

 

With the signing of Rich Hill, some of us declared that he would be a possible midseason candidate for the fifth spot of the Memphis rotation. He'd been signed for nothing, and that was fine, but there just wasn't any way he was going to become an impact player in anything but the long and optimistic term. He was fusion energy. He was a lottery ticket. A good sign that Mo was still rooting through the bottom of the TJ Maxx bin with all of the designer items, and a small thing that we could needle our Cubs friends about, but nothing more.

Small sample size warning, but Rich Hill just made himself a candidate for the 25 man roster.

So how in the bloody hell did that happen? Rich Hill had torn his labrum, and I'm pretty sure Will Carroll said pitchers with labrum tears should go die in a fire along with Justin Bieber and the cast of Jersey Shore.

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via profile.ak.fbcdn.net

The simple fact that Hill can throw a baseball today rather than six to nine months from today means his labrum tear probably couldn't have been higher than grade II. Labrum tears are graded, by the way, on a scale from I-IV.

I'm going to ramp up the terminology, so here goes. The labrum we are talking about is called the Glenoid Labrum. It's a ring of cartilage that expands to form the socket of the ball and socket joint that is the shoulder. It can be torn many ways (Aside: many, many god damn ways), most commonly through shoulder dislocations, however dislocation tears are much less serious than the tears suffered by pitchers. The difference is mostly location: Tears in the normal population affect the front and underside of the labrum- just above the inside of your armpit. Tears to throwers affect the top of the labrum, under the deltoid muscle, and they are called SLAP tears. The reason they are more serious, is that the pitcher uses their arm a lot more often than the average person, and the location of the tear (top and back of the labrum) involved the point that the biceps muscle connects to the larger connective tissue structure.

Still with me?

These tears (SLAP tears) are graded based upon severity, and based on the tissue involved. If the posterior (back) of the labrum is a bit frayed, but the biceps tendon is uninvolved, that's about as good as it gets. Avulsion is the term for an injury where one structure pulls away from another: Avulsion of the labrum from the scapula (the connective tissue pulling away from the bone) is another problem that arises in labrum injuries and causes a lot of the instability, increasing the grade of the injury from I to II. The worst thing you can find is a deep labrum tear that includes a tear of the biceps tendon (grade IV)- no pitcher that I know of has ever recovered from this injury.

When a doctor talks about "debridement" that means he was cutting away frayed and worthless tissue that was probably causing inflammation. When a doctor talks about repair, that usually means the reconnection of an avulsion injury to stabilize the joint, or suturing of the biceps attachment. I and III tears are usually only debrided, while II and IV grade tears are repaired.

Other findings in a labrum repair include bursitis, cysts, and joint capsule or rotator cuff problems. When the body attempts to repair the damage to the joint, it initiates a series of reactions that cause inflammation, which engorges the structures in the area with fluid, sometimes causing more problems. Cysts are formed by the body in reaction to tears and other problems to isolate areas of damage. Inflammation often causes joint capsule and rotator cuff problems because there is less space for these structures to move around one another.

Here's an article.

Some of the terminology used in the article doesn't sound right to me, and it's not just the thing about Hill being a Tony Robbins fan:


explaining how only a thread of the labrum had to be repaired and not the whole liner within the joint.


That's a very odd thing to say about the tissue, because the labrum doesn't exactly thread around  (except at the biceps attachment, a spot that Hill probably didn't tear or didn't tear very much if at all). This sounds more like Hill is talking about the joint capsule or misusing the word thread.


Since the procedure was limited to correcting the sliver of labrum causing impingement in his joint

This is also a bit odd. Labrum problems are bad because they usually cause a lot of instability and weakness (this is why it made sense that Hill lost all of his command: A labrum injury implied that his upper arm wasn't as tightly connected to his body as it had been)- not necessarily impingement. The term impingement applied to the shoulder almost always means bursitis or tendonitis. Bursitis does often present as part of the entire shoulder injury syndrome along with joint capsule tearing and labrum fraying, but they are different things that cause different problems.

 


In all, I'd say I'll be ecstatic if Hill proves me wrong and really tears it up this spring. A true contest for the back end of the rotation would be excellent. It seems obvious that he had a good surgeon and some good luck with his shoulder, but only time will tell if he is truly healthy and truly ready to pitch.

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