What’s Love Got To Do With It?

kevin-loveWhat’s Love got to do with it?

The odds on favorites to represent the Eastern Conference in the NBA Finals experienced a team setback with the injury loss of starter Kevin Love in the 1st round of the NBA playoffs.  Kevin Love sustained an anterior inferior dislocation of his right shoulder in what looked like a pretty innocuous play.  He got tangled up with Boston Celtic Kelly Olynyk, who yanked on his arm causing Love’s shoulder to come out of socket resulting in extreme pain and deformity.  So, why did it happen on that play with so little contact?

Let’s start by reviewing the anatomy and function of the shoulder.  The shoulder is made up of the head of the humerus (arm bone) and the scapula (shoulder blade).  The scapula has several parts that contribute to the function of the shoulder: the glenoid (socket), the acromium and the acromial-clavicular(collar bone) joint.  All these work together to make a psuedo-ball and socket joint of the shoulder.  If the shoulder were a true ball and socket joint like the hip, it would be much more stable, but with far less freedom of motion.   Therefore, we sacrifice stability for motion.  This allows the shoulder to perform like no other joint in the body, but it also makes it one of the most dislocated joints in the body.

Most dislocations of the shoulder are the result of an acute traumatic event.  Often times this occurs when the shoulder is externally rotated (away from the body) and a force is applied driving the head of the humerus out of the socket.  This results in the most common anterior inferior dislocation similar to what happened to Kevin Love.  So what’s the big deal? Put it back in place and get back out there….just like Mel Gibson used to do in Lethal Weapon.  Well the big deal is that the stability of the shoulder relies on a well working construct of soft tissue (capsule, labrum and muscles) that provide just enough stretch to allow a great degree of freedom of motion before failure.  When this construct is taken beyond that level of failure a dislocation occurs and the soft tissue envelope is compromised.

Once a dislocation occurs the first step is to relocate the joint and then assess what structures have been injured.   Depending on the severity of the injured structures a treatment plan can then be devised.  In the past, a period of rest followed by rehabilitation of the surrounding structures was the gold standard of treating first time traumatic dislocations.  We have since learned that the initial management of acute traumatic dislocations with primary arthroscopic surgery results in better long term function and reduced risk of recurrent dislocations.

Typically an athlete will undergo a history and physical exam to determine if there is an underlying condition that may have contributed to the shoulder instability.  Once this is ruled out, a MRI of the shoulder is performed to evaluate the damage to the shoulder joint.  At this point an Orthopedic Surgeon will advise the patient of their diagnosis, treatment options and long term prognosis.  In general, with the advances in arthroscopic repair of the soft tissues and rehabilitation,  the majority of athletes return to their preinjury level of activity.   This is great news for Kevin Love (and the LAKERS!), but not so good news for the Cavaliers, who will have to win their way out the Eastern Conference without the talents of their All-Star forward.

 

Dr Andrew Scott Martin

5546 S Fort Apache Rd. Las Vegas, NV 89148