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Walshy’s World: “Streit” Talk On a Dislocated Shoulder
(Ed’s note: resident health and fitness expert Cameron Walsh takes a look at the shoulder injury suffered by Islander defenseman Mark Streit.)
By Cameron Walsh
As you can see from the video here besides the hit being from behind (contentious thing in itself) the way Streit hits the wall isn’t really any different than a player would hit the wall sideways many times in a game; with one exception. At the point of contact on the boards, Streit’s shoulder is higher than the dasher on the board before hitting the board. It appears that Streit’s shoulder hits through the ‘pointy’ head of his shoulder. Basically on the Acromion (A) (forcing his shoulder down) and the pressure from this pushed the head of his arm (D) against the coracoid process (B) (forcing his shoulder forward) out of the shoulder capsule. Looking at diagram A, the white material there is the rotator cuff (C) basically so you can see how it got torn as the arm popped out of the capsule.
Originally when I started writing this the Islanders were saying 2 weeks to 6 months, that is how hard it is to diagnose a shoulder injury, MRI’s are needed to see what is going on with ligaments. We now know for certain Streit has torn his rotator cuff, labrum and dislocated his shoulder (the cause of the previous two). It is rare to hear of all three occurring at the same time. The silver lining here is Streit can get everything tightened up at the one time in surgery and get along with his rehab and hopefully not have to worry about his shoulder again.
The severity of the dislocation is what has damaged Streit’s shoulder so badly in relation to his labrum and rotator cuff.
Dislocated shoulders can happen in three directions:
Anterior (forward) 95% are these and are sub-coracoid, sub-glenoid and sub-clavicular. They usually occur in contact sports. (Well duh!)
Posterior (backward), these are occasionally due to electrocution or seizures and may be caused by a strength imbalance of the rotator cuff muscles. These can often go unnoticed for over a year.
Inferior (downward) less than 1% of all dislocations are these, this condition is also called luxatio erecta because the arm seems to be permanently held upward or behind the head.
What most likely happened to Streit is the acromion (A) process acted like a fulcrum on the humeral head (D) of the upper arm (humerus) which broke through the weak anterior (front) capsule. This created the torn labrum from the glenoid (E). A simple look of an anterior dislocation is diagram B.
Diagram C shows a simplified view of the rotator cuff (C), if you want to see the names of the ligaments through the rotator cuff (C) go back and have a look at Diagram A. There are four ligaments that surround the head of the humerus (D) that create a capsule for the bone to sit in. Tendons are a lot like ligaments, except tendons attach muscles to bone.
Muscles move the bones by pulling on the tendons. One important tendon that travels through the shoulder joint is the biceps tendon (F). (In Diagram D, you can see the biceps tendon (F) sliding under the Rotator Cuff (C)). The biceps tendon actually begins at the top of the shoulder socket (the glenoid (E)) and then passes across the front of the shoulder to connect to the biceps muscle.
Hopefully this simplifies some of the Streit shoulder drama in relation to what happened. The rehab is really slow guys, the muscles around the shoulder are really hard to actually locate and isolate. Because they are so small you have to start light and really build it up slowly. The joint is a very finicky one that requires a lot of care, if you go ‘too hard too early’ you can tear something again and be right back on the operating table.
Thanks for reading and any questions fire away I hope I can help. Not long now until the season starts thank god, hopefully once we get 10 or so games into the season and bodies get used to the contact there wont be any injury updates until about 50-60 games in when bodies start to get tired.
Yours in fitness