Category Archives: sports medicine

It takes more than Ankylosing Spondylitis to Keep Guti Down

One of the very few good things about my beloved Seattle Mariners this year, besides Nelson Cruz crushing the ball, has been the call up of Franklin Gutierrez. Guti has been one of my favorite M’s over the years, and to see him struggle with his health concerns since 2011 has been really sad and disappointing. For a long time it was not clear what exactly was wrong with Guti, but the diagnosis of ankylosing spondylitis was especially discouraging.
GutiRemembering Franklin Gutierrez as arguably the best defensive center fielder, and according to my wife the most handsome, now destined to be facing a life of increasing immobility seemed terribly unexpected and unfair.
For Mariner’s fans who are unfamiliar with ankylosing spondylitis, sometimes called “AS”, is one of the autoimmune class of arthritic conditions. Unlike rheumatoid arthritis and systemic lupus erythematosis, which are more common in women, AS affects young men more often. than women. Gutierrez is demographically a typical person to be diagnosed with AS. It most often affects young men in their late teens to 20’s and typically presents with back and hip pain and stiffness. The word “ankylose” means according the, “the union or consolidation of two or more bones or other hard tissues into one.” Typically in AS the vertebra develop abnormal bony growths on the edges that grow to meet each other and they become fused into immobile joints. This leads to initially, pain and stiffness of the back, and progresses to loss of mobility. The ribs that attach to the thoracic vertebrae can become involved also leading to difficulty taking deep breaths. One of the simple tests done is to measure the chest circumference at full expiration and again at full inspiration. Usually a difference of several centimeters is noted, but with AS little or no change may be noted
Other joints classically involved in AS are the hips and knees. Joint replacement can be needed, especially in the hips, to reduce pain and improve function. Treatment is typically with therapy to try to prevent loss of mobility, anti-inflammatory medications called NSAID’s that help with pain and inflammation, and when needed biologic agents like tumor necrosis factor inhibitors like Humira, Enbrel and Remicade can sometimes help.

The cause of AS is unknown but it is more common in persons who have a gene named HLA-B27.  For unknown reasons people with the HLA-B27 gene are more prone to develop AS and some other autoimmune disorders, but many people with the gene never have any known problems.  It’s one of the mysteries of medicine.
Typically AS is slowly and steadily progressive and it remains to be seen how Franklin Gutierrez will fare. In the meantime I for one am rejoicing in seeing him play, and am happy that the Mariners have found a way to allow him to play in MLB while getting him the rest he needs to stay functional. M’s fans everywhere celebrated his pinch-hit grand salami, and his two home runs last night are a testament to his courage and hard work to get back after missing much of the last 4 seasons. Go M’s! Hooray for Guti.

World Cup Science

As the US prepares to play its first game in Brazil at the 2014 FIFA World Cup, I had a chance to peruse the most recent Scientific American and several soccer related articles.  This is available online, and for the science oriented fan of the beautiful game it’s worth a look.  Here are a few… Continue Reading

Mike Zunino Swings, Misses and Fractures Hamate: Why Baseball Players Get Hamate Fractures

When Mike Zunino went on the DL for my beloved Seattle Mariners last week with a hamate fracture, the same type of injury Ken Griffey Jr. sustained in 1996, it prompted me to review how baseball players seem specifically prone to this injury.  When you look at the anatomy of the wrist, and the mechanism… Continue Reading

Lisfranc Injuries and American Football

Sports fans have heard a lot about football players with Lisfranc injuries recently. Maurice Drew-Jones, running back for the Jacksonville Jaguars and Santonio Holmes, receiver for the New York Jets, have been in the news.  Matt Schuab, QB for the Houston Texans missed last  season from a Lisfranc injury. Many of you may know that a Lisfranc… Continue Reading

Can Football Survive in the Age of Concussion Awareness?

I was talking with my son this week, watching the Monday Night Football game, and he asked if I thought football would be around in the future as we learn more and more about the impact of concussions on NFL and other high level football players.   The NFL is such huge business with over $9… Continue Reading

Is There Finally An Effective Tennis Elbow Treatment?

Tennis elbow, or lateral epicondylitis, is a problem that can be very difficult to treat and can try the patience of most patients.  Diagnosis is usually straightforward. If you have pain on the lateral side of the elbow, (the thumb side as you stand with your arms at your side, palms forward), over the bony… Continue Reading

Tony Romo’s Rib Injury

Tony Romo, the star quarterback of the Dallas Cowboys of the NFL sustained a fractured rib and punctured lung in last weekend’s game against the San Francisco Giants. On the way to work today on ESPN sports radio I heard a discussion about a “shot” that Romo might get to allow him to play with… Continue Reading