VOMG

A friend of mine passed away over the holiday weekend.
 
We had attended high school together, were distant friends through college, and spent two years as roommates back in the cities after that.
 
When we lived together, he was attending culinary school and the roommates would have the benefit of eating food that is normally not accessible to broke post-college kids trying to repay student loans. He would concoct four course meals and we were more than happy to be test subjects.
 
We’d declare it the best thing we’ve ever eaten and he, being his own worst critic, would inform us that it was garbage and would vow to make it better next time.
 
He modeled himself a bit after Anthony Bourdain. He had a beat up copy of Kitchen Confidential that he constantly implored me to read. I never did.
 
Eventually the house split up. We went separate ways and saw each other less. Everyone my age or older likely has friendships like that. I had a growing family and he was launching a culinary career that took him to Central America and Alaska for work.
 
The relationship became just a bi-yearly message to each other on Facebook, randomly sharing a couple inside jokes and stupid obscure pop culture references. We exchanged one just the previous week.
 
He sent a one-liner: What are we going to do about this hand twin thing?
 
It came from a Friends episode we watched years ago. He had an ability to bring groups of people together and our house used to host viewing parties during the final seasons. The line, delivered by Joey Tribbiani in the bathroom of a casino, always cracked us up. Sharing innocuous lines like that over the years just let each other know you were thinking about them.
 
I spent most of Sunday night reflecting on our time. I spoke with another roommate of ours who had moved out of state as well. We shared memories of the years we all lived together.
 
I realized how much baseball fandom can imprint on our lives.
 
He once hosted a weekend-long party at his college house in Duluth. It was epic, as the kids would say. Thinking back to the revelry, I also remember slipping away to see Matt Lawton hit two home runs in Cleveland.
 
Another time he went to visit a girl in New York City. He returned with a small panoramic of the old Yankee Stadium that he got at a secondhand shop because he knew how much I despised the Yankees. I still have that picture and I still hate the Yankees.
 
His family would host gatherings at their cabin in northern Minnesota. They were amazingly hospitable people. His mom legitimately made the best sloppy joes. When my daughter wasn’t even a year old, he invited us for a low-key weekend of boating and bonfires. On the drive home, as my little girl slept in the back, I listened to Johan Santana’s 17-strikeout performance on the radio.
 
When the Twins had a weekend series at Wrigley Field, we ran into each other at the Cubby Bear, the bar across the street from the stadium. We took time to share a Cubby Blue Bomb together, update each other on our current lives, and then went back to the separate group of friends we came with into Chicago.
 
The last time we saw each other in person I was handing off tickets to him before a Twins game.
 
We met at The Depot Tavern and played catch up. His seats were on one side of the ballpark and ours were on the other. We vowed to meet on the concourse or somewhere after the game but neither of us followed through.
 
You are not supposed to live with regrets yet we do. I regret not reaching out more, not making an effort to stay connected. I regret not checking in more frequently to hear about his family, fiancee, and other adventures.
 
Thirty-nine is way too young. You feel like you always have more time: There will be some other opportunity to catch up, there will be some other chance to reconnect, or some other time to say those were amazing memories.
 
Looking back, I admired how he followed his passion. We were just becoming functioning adults and he already knew that he wanted to run kitchens and make people happy through food. Someone shared a video of him teaching a culinary class in a Facebook remembrance, making the room laugh in doing so. In a way he did become a version of Bourdain, traveling the world and experiencing cuisine in parts unknown.
 
Maybe now I’ll listen to him and read that book.

Hello all. My name, as you could see from the byline, is Lucas Seehafer and I am a Doctor of Physical Therapy and strength and conditioning specialist working in the greater Minneapolis-St. Paul area. I've been a fan of the Twins since the early 2000's and figured the Twins Daily community may enjoy some insight into the field of sports rehabilitation and performance. If this is the type of content you enjoy, I can be found on Twitter at @sportkinematics and many other sites, including A Wolf Among Wolves, The Step Back, and (soon) Forbes, where I cover athlete health and performance.
 
In what can only be seen as encouraging news, Minnesota Twins centerfielder has been cleared to begin swinging again, according to The Minneapolis Star Tribunes' Phil Miller.
 
Miller reports, "[buxton] will be limited to hitting off a tee or doing other basic drills while his shoulder gains strength, but the Twins expect Buxton to progress to hitting off a pitching machine by early next month. He could be ready to hit live pitching when the Twins hold their first full-squad workout on Feb. 17."
 
Buxton has not been able to swing since undergoing surgery in early September to repair a torn labrum in his left shoulder, which he originally injured after crashing into the centerfield wall.
 
The labrum is a ring of cartilage found in the shoulder - also known as the glenohumeral joint - that serves to deepen the socket; the labrum improves the stability of the shoulder by increasing the surface contact area between the bones of the shoulder - the humerus and the scapula - as well as by creating a vacuum that keeps the head of the humerus in contact with the socket of the scapula.
 
The labrum is often torn in one of two areas: the superior - or top - aspect or the anteroinferior - or bottom front - aspect.
 
The first kind of tear is known as a SLAP lesion; SLAP is an acronym for superior labrum anterior to posterior. This type of labrum tear is commonly seen in the dominant shoulder of overhead athletes as the primary mechanism of injury is repeated, forceful throwing.
 
The second kind of labral tear is known as a Bankart lesion and these are most frequently seen after an anteroinferior dislocation of the shoulder, the most common type of shoulder dislocation. It is likely that Buxton suffered a Bankart tear as his injury was originally - and erroneously - reported to be a partial separation; a separation of the shoulder involves the acromioclavicular joint, whereas a dislocation involves the glenohumeral joint.
 
Overhead athletes are usually cleared to return to higher-level, sport-specific activities by about four months post-Bankart repair, regardless of which shoulder, their dominant or non-dominant, was operated on; Buxton is almost exactly four months post-op.
 
The reason for this is pretty simple: the repaired labrum needs to be protected as much as possible while it is healing and the strength of the rotator cuff - the group of four muscles near the shoulder that assist the labrum in stabilizing the shoulder, amongst other things - needs to be sufficiently built up.
 
Throwing a baseball places a great amount of stress on the labrum of the dominant arm and, depending on the players handedness while batting, so does swinging (see the main image of this article).
 
All of this is to say that Buxton is right on track in his recovery process, which is good news for the Twins and Twins fans alike. Buxton will be brought along further in his recover program as his rotator cuff strengthens further and the Twins along with Buxton are able to determine how increasing the intensity of his workouts impacts his shoulder. As Miller states, barring any setbacks, Buxton should be able to progress to swinging at full-speed by mid-February and partake in game action during Spring Training or, at the very least, the beginning of the regular season.

Byron Buxton Shoulder Injury Q&A
heezy1323
 
 
Byron Buxton, as we all know, is an outstanding center fielder for our Twins. Unfortunately, he has dealt with a variety of injuries that have cost him significant time over the past few seasons. This weekend he sustained an injury to his left shoulder that was termed a ‘subluxation’ and is headed back to the IL. By the sound of things, he is likely to be away from the big club for at least a few weeks. This is a tough blow for the Twins as the Indians make a push to catch up to a team that has led the division essentially all season.
 
Medical terminology can be confusing, so I thought a post about shoulder subluxations might be of interest to TD readers. As usual- my disclaimer is that I am not a Twins team physician. I have not examined Byron nor seen any imaging of his injury. I am not speaking on behalf of the Twins. I am only hoping to familiarize TD readers with some of the concerns that may be ahead regarding injuries similar to Buxton’s.
Question 1: How does the shoulder normally work?
The shoulder is considered a ball-and-socket joint. The round ball (humeral head) sits in the socket (glenoid) similar to how a golf ball sits on a golf tee. Around the perimeter of the golf tee is a strong cartilage tissue called a labrum. The labrum surrounds the socket similar to the red gasket on a mason jar lid. Its function is to help act as a ‘bumper’ to hold the golf ball on the golf tee. It is also an attachment point for ligaments around the shoulder that also contribute to shoulder stability. The ligaments make up the ‘capsule’ of the shoulder joint. I often tell patients that the capsule is like a water balloon that surrounds the joint. The ligaments that make up the capsule form the connection between the ball and the socket.
 
Question 2: What is a shoulder subluxation?
 
The term ‘subluxation’ is typically used in situations where a joint partially (or nearly) dislocates. This is not specific to the shoulder and can happen in a number of other areas of the body as well (such as the kneecap, for example). This is distinct from a true ‘dislocation’ where the ball comes completely out of the socket and then goes back in.
 
If someone dislocates their shoulder and it stays dislocated, it is typically clear what has happened. Xrays will show the ball dislocated from the socket and the shoulder will be manipulated to ‘reduce’ the ball back to its normal position. However, in some cases cases the ball can completely dislocate and go back in on its own very quickly. In these cases, an xray would often look normal. In most cases when there is concern about an injury of this type, an MRI is ordered. This of course shows additional details of the bone and soft tissue that cannot be seen on an xray alone. Usually an MRI will allow for a pretty solid conclusion as to whether the injury that occurred was a ‘subluxation’ (less severe) or a true ‘dislocation’ (more severe).
 
There is, of course, a spectrum of damage that can occur with any injury and this is no exception. It’s possible that there was some minimal stretch to the ligaments around the shoulder and no other significant damage (best case). It’s also possible that there was more significant damage to the ligaments and potentially even a tear of the labrum (more worrisome). The MRI would typically give a good approximation of these issues. In most cases, the damage that occurs with a subluxation is less significant than that which occurs with a dislocation.
Question 3: Does it make a difference that the injury is to his left shoulder rather than his right?
 
In my opinion, absolutely. Because it is his non-throwing shoulder, the stresses placed on it are less. Even small issues with the ligaments can be problematic in the throwing shoulder- particularly someone who can approach 100mph on throws from the outfield.
 
That said, the left shoulder is Byron’s front shoulder when hitting. In most hitters it is the front shoulder that is more stressed. It is possible that Buxton’s recovery is more affected at the plate than in the field (though that’s impossible to predict with certainty, of course).
 
Question 4: Does this injury make it more likely that Byron will dislocate his shoulder in the future?
 
Possibly. As discussed above, there is a spectrum of damage that can occur with this injury. If the damage is near the minimal end, it probably doesn’t have a significant effect on his likelihood of injuring this shoulder in the future. If there is more significant structural damage, it may place him at higher risk.
 
Question 5: What is the purpose of the rehab?
 
In addition to the capsule and labrum discussed above in question 1, the muscles around the shoulder also contribute to stability. I often tell patients to imagine that there is canopy over the top of the golf ball pulling it down onto the golf tee and helping to hold it in place. This is similar to the way your rotator cuff functions. I suspect rehab for Buxton will include strengthening exercises for a number of muscles around the shoulder that contribute to stability.
 
Also, these muscles can be strained during the injury, so they can sometimes need additional time to recover along with the ligaments.
 
Question 6: Will Buxton need surgery?
 
This is essentially impossible to answer right now, likely even for the physicians and training staff involved in Byron’s care. As I sometimes tell my patients, “The crystal ball is a little murky.” Without knowing the extent of any structural issues in Byron’s shoulder, I would say that it is somewhat unlikely this will require surgery. I would expect that even if surgery is required, it would only occur after an attempt at non-surgical treatment has been unsuccessful.
 
Question 7: How long will it be before he is able to return to play?
 
This is also a difficult question to answer. The fact that the early word is that he will be out a few weeks is consistent with what I would expect from an injury like this. The rehab often takes time to regain full motion and strength. I would hope he can be back patrolling center field before the end of August, but it’s certainly possible this lingers into September. It seems unlikely that this would be a season-ending injury, but only time will tell.
 
 
Clearly this Twins team is better when Byron is on the field rather than on the IL. Let’s hope he heals quickly and can help the Twins down the stretch. GO TWINS!