On Saturday, March 11th, Tribe infield prospect Mark Mathias dislocated his left shoulder while making a diving attempt to stop a ground ball hit to second base. The injury occurred during the ninth inning of the Tribe’s 7-6 Cactus League victory over the Kansas City Royals. Mathias was unable to finish the game and was carted from the field to the Indians’ clubhouse; he will receive an MRI in the coming days.
What is it? The glenohumeral (shoulder) joint is compromised of a ball and a socket; the ball is the head of the humerus (upper arm bone) and the socket is the glenoid (part of the shoulder blade). The shoulder is a unique joint because it is very mobile in all planes of motion and this makes the joint vulnerable to dislocation. A complete dislocation of the glenohumeral joint occurs when the ball comes out of the socket and does not go back in to place. A partial dislocation, or subluxation, occurs when the ball comes out of the socket partially, and then goes back into place on its own. A complete dislocation must be put back into place manually in order to realign the shoulder in its proper position. The cause of shoulder dislocations can be any number of things and can occur as a result of direct trauma to the arm, as in Mathias’ case, or due to high velocity movements of the arm. The shoulder primarily dislocates in one of three directions, anterior (forward), posterior (backward) or inferior (downward); with the anterior direction being the most common. Shoulder dislocations cause an over stretching of the joint capsule, muscle and ligaments that surround the shoulder. Depending on the individual and the number of dislocations they have experienced, tearing of soft tissue structures or breaking of the ball or socket bones may occur.
How is it fixed? If no structural damage occurs, conservative management via rest and rehab will be the usual choice to “fix” a dislocated shoulder. A period of immobilization of the shoulder may be utilized initially via use of a sling; rehab efforts will focus primarily on pain reduction and stabilization of the shoulder. The individual will be shut down from sport specific activities until they can demonstrate strength, range of motion and pain levels within normal limits. In the event structural damage to the rotator cuff, glenoid labrum, joint capsule, humeral head or glenoid cavity occur, surgery may be indicated. Structural damage as a result of dislocation include but are not limited to rotator cuff tear, labral tear, Bankart lesion and Hill-Sachs lesion. Return to sport following shoulder dislocation or subluxation without structural damage will vary based on the individual and severity but can take anywhere from two to six months. Rehab times will be prolonged if structural damage occurs and surgery is performed.
My take. Mathias is scheduled to receive an MRI in the coming days. The MRI will give the Indians a better idea of the severity of the 22-year-old’s shoulder dislocation and indicate whether any structural damage has occurred. At this point in time it is difficult to discern the length of time Mathias will miss, however, I don’t expect to see him back out on the diamond any time soon.
We will continue to monitor the status of Mark Mathias and will provide the most up-to-date injury breakdown and analysis as new information becomes available.
Brandon Bowers, PT, DPT, is a graduate of the University of Toledo, Doctor of Physical Therapy Program and currently practices in Columbus, Ohio. He is an avid Cleveland sports fan and has experience rehabbing athletes of all levels and from a variety of sports. Follow Brandon on Twitter for more Cleveland Indians injury insight and analysis: @blbowers12
The information provided is the professional opinion of Brandon Bowers, PT, DPT and is based on his clinical experience and the most current clinical evidence available. This information should not be interpreted as or substituted for medical advice for a specific condition or diagnosis.