Dime Training, NBA / Aug 8, 2011 / 12:00 pm

Dime Q&A: Expert Surgeon Talks Rudy Gay & Shoulder Injuries

Rudy Gay

Rudy Gay (photo. Douglas Sonders)

Everyone loves to talk about the Thunder, how great they are already, how unreal they could be in another year or two, Kevin Durant, Russell Westbrook. But no one ever mentions that Memphis really should’ve beat them in the second round. They had their chances, probably could’ve been up 3-1 and yet ended up losing in a Game 7 that might’ve been theirs had Rudy Gay been around to create the offense they sorely lacked.

Gay was sitting on the bench in street clothes, his shoulder a mess after a left shoulder subluxation (which required surgery). Now heading into next year, if Gay is back to his old self, which by all accounts he appears on his way, then Memphis can beat anyone.

I caught back up with Dr. Bal Raj – who was named one of the “Top Orthopedic Surgeons in Los Angeles and a Leading Physician of the World” by the International Association of Orthopedic Surgeons, and someone who has a lot of experience with high-profile athletes – to talk shoulder injuries. Since they are so complicated, sometimes they’re tough to come back from. Gay will be back to 100% for the start of next season, but they’re different for everyone.

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Dime: With Rudy Gay, he had surgery earlier this spring with a left shoulder subluxation. His range of motion isn’t all the way back yet. What makes that injury tough to come back from?
DBR: One of the toughest things for orthopedic surgeons to deal with is instability issues. And subluxation means there is a minor degree of dislocation, means that there is an internal instability of the joints. Once your joint goes forwards or backwards to a point where it’s not functional, you start having pain and inflammation. What makes it tough for us is the shoulder is a multiaxial joint, meaning that it moves in (so many different ways). Surgically, we tighten up one area, what happens is you might have it tightened up in front but also increase the instability in the back. It’s multi-directional.

First of all, the most important thing is finding out exactly what direction his instability is in because it’s not usually just in one direction. It’s usually in two or more directions. Number one. And then number two, we single out as much as we can the best possible conservative treatment, meaning stabilizing their secondary…assessing their secondary stabilizers, namely our pecs, our deltoids in order to react quicker so once they’re back, it perfects them too. Your primary stabilizers, which is your capsule in your joints and your secondary is your muscles.

So in some instances, your secondary stabilizers can stabilize your joint enough that it just absolutely scars down and you don’t require surgery.

So it’s a top scenario…subluxation and instability but what we basically do is we create stability in the appropriate directions involving the ligaments that are responsible for causing the subluxation.

Dime: It seems like it’s kind of a complicated injury to come back with. Is that what you’re saying?
DBR: Yes, the second thing that can happen to is surgically, we want to create a stable shoulder. What happens frequently is we can recreate perfection, so once we stabilize it, it may cause stiffness in the shoulder. So that is one possible and probable side effect. As you know as an athlete, if you’ve got limits (if it’s not all the way back) you’re certainly not going to function at the level you did before.

In stabilizing shoulders, we try to recreate perfection. The problem is is that it’s hard to recreate perfection and more likely than not, we tend to stiffen the shoulder to prevent instability. By stiffening the shoulder and not having your full range of motion, you’re certainly not…as an athlete, you’re not going to function at the level you should be functioning at. If you get a quicker shot or a quicker release, it’s not going to happen as quick. That’s the tricky issue with shoulder injury.

Dime: In basketball, are shoulder injuries normally freak accidents? I know in baseball, they seem to come from overuse.
DBR: In baseball, it’s definitely overuse, especially with pitchers, outfielders, people who throw. In basketball it’s more acute, dramatic accidents and they’re more likely dislocations or subluxations. Definitely, just because of the dynamic nature when you take a shot or you’re struck in different positions. Definitely, you’re more at risk for acute injuries in basketball.

Dime: Is there any difference between the two injuries?
DBR: Yeah overuse is just basically increased inflammation overlying your rotation cuff because of some micro-instability from motion in your joints. Definitely a baseball player’s injury is a lot easier to deal with, entails rehab, physical therapy and possibly surgery, than a basketball player’s because it is an acute, dramatic injury.

What do you think?

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  • First & Foremost

    While reading the answer to the first question, I could imagine you tuning him out, waiting for a pause so you can ask the 2nd question.

    This is a good series by the way.