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Thursday, March 5, 2009
A-Rod could face hip surgery


The Alex Rodriguez story has taken a few twists and turns since ESPNdeportes.com first reported that Rodriguez would have surgery on his injured hip. In an interview with ESPN's Karl Ravech on Baseball Tonight, A-Rod's agent, Scott Boras, confirmed that Rodriguez has a torn labrum in his hip. Boras also said that doctors aspirated (withdrew fluid from) the previously-disclosed cyst as a first step in the All-Star's treatment. Yankees general manager Brian Cashman said Thursday afternoon that the three-time MVP will be treated conservatively in the hopes of avoiding surgery. Assuming the aspiration is successful at relieving Rodriguez's symptoms, the next step would be rehab to strengthen the muscles around the hip, with the goal of getting Rodriguez back on the field in the near future. However, surgery may ultimately be necessary.

For the Yankees and fantasy players, the major concern is that if Rodriguez does need surgery to repair the torn labrum, the recovery time would very likely be longer than the initially-reported timetable of 10 weeks, and perhaps something closer to four months, as Cashman suggested Thursday. Labral tears of the hip are usually the result of repetitive trauma, and in the case of a power hitter the rapid torsion that the hips are repeatedly subjected to during the bat-swinging process is the likely culprit. So while many rushed to link Rodriguez's admitted past use of performance-enhancing drugs to the discovery this week of a cyst in his hip, there is a less sinister explanation. To fully understand the possibilities, it's helpful to first understand cysts.

We certainly have a broader wealth of information when it comes to examining cysts in the shoulder, a more common occurrence with overhead athletes. In many cases involving the shoulder, the presence of a tear in the labrum (the cartilage ring that helps deepen the shoulder joint and enhances overall shoulder stability) will lead to fluid accumulation that results in the formation of a cyst in the soft tissue. These cysts can irritate the muscles around them, such as the rotator cuff in the shoulder. In the case of the shoulder, a cyst can also cause nerve entrapment, which then leads to weakness of the surrounding muscles as a secondary effect. It is quite possible then that a tear in the hip labrum, a type of injury seen in power hitters, could lead to similar soft-tissue cysts, which could then result in weakness of the surrounding muscles, affecting performance.

In the presence of a soft-tissue cyst, the patient may experience pain, but more often than not, the primary symptoms are weakness, stiffness and/or tightness as a consequence of the muscles' not functioning properly. According to ESPN, Yankees manager Joe Girardi indicated that Rodriguez, who has been bothered by the hip somewhat since last year, "expressed a little stiffness. There was really no pain." Newsday reported that Rodriguez told the Yankees that the hip was limiting his bat motion and affecting his power. This combination of symptoms certainly hints at a weakness in the hip muscles that would affect his performance at the plate.

Treatment may involve addressing the cyst directly -- for example, aspiration (withdrawal of the fluid) or pain-relieving injections. Such treatment may prove effective, particularly in the short-term management of the problem. Ultimately, treatment may require repair of the primary tissue (the labrum), as this eliminates the source of irritation responsible for creating the cyst in the first place. In cases of such paralabral cysts in the shoulder, primary treatment to repair the labrum has been shown to be effective in restoring normal strength to the surrounding muscles.

Recently we have seen other high-profile baseball players undergo surgery to address labral injuries, including Phillies second baseman Chase Utley and Red Sox third baseman Mike Lowell. Utley, for one, had labral surgery in late November and is optimistic that he'll be ready for Opening Day. "Optimistic" is not "certain," though, and the time lapse between Utley's surgery and Opening Day will be about 19 weeks.

Stephania Bell is a physical therapist who is a board-certified orthopedic clinical specialist and a certified strength and conditioning specialist. She received her Master of Science degree in Physical Therapy from the University of Miami (Fla.)