Steer Clear of Shoulder Injuries
From the Monmouth Medical Center May 2009 edition Health Link & Monmouth Health & Life

FREEHOLD RESIDENT DAVID Silva well remembers the moment in 1985 that ended his baseball career. A pitcher in the Philadelphia Phillies minor-league system, he was shagging fly balls in the outfield before a game. As he tried to throw to home plate from deep center field, something went wrong.

“I felt an enormous amount of shocking pain,” he recalls, “as if someone had stuck a knife inside my right shoulder and twisted it.”

He had suffered a shoulder injury, just like thousands of other Americans do every year. As David Gentile, M.D., a Monmouth Medical Center orthopedic surgeon, explains, the shoulder comprises three bones: the clavicle (collarbone), the scapula (shoulder blade) and the humerus (upper arm bone). The shoulder joint is of the ball-and-socket type, though its “socket” is less complete than that of the hip joint. The ball is the top, rounded portion of the upper arm bone; the socket-like glenoid is a dish-shaped part of the outer edge of the scapula into which the ball fits.

The glenoid is like the concave surface of a golf tee, on which a golf ball sits and which it can slip off with relative ease. Because the bones provide little stability to the shoulder joint, it depends on surrounding soft tissues—mainly the ligaments, tendons and muscles known as the rotator cuff—to hold the ball in place. That instability is both good and bad: It makes the shoulder the body’s most movable joint, able to pivot in almost any direction. But it also makes the shoulder prone to injury.

In the 1980s, says Silva, now a 46-year-old real estate broker, shoulder surgery was seen as an ordeal with uncertain results, so he chose rehabilitation instead. But by last year, his shoulder had deteriorated. “I couldn’t even lift my arm over my head anymore,” he recalls. “I couldn’t sleep without pain, and I had to use my left hand to lift everything.”

After a failed operation elsewhere, Silva found Dr. Gentile. The doctor diagnosed a tear called SLAP—superior labrum, anterior (front) to posterior (back). (The labrum is a raised rim of ligaments that helps hold the ball in the socket.)

Last August, Dr. Gentile repaired Silva’s shoulder using arthroscopy, a minimally invasive approach that uses a scope inserted into the joint through a small incision. This time surgery worked—and today Silva is playing fast-pitch softball.

“I can throw 86 miles an hour with no pain,” he says. “I can bench-press 220 pounds, which I haven’t done since I was in my 20s. I feel like a kid again!”