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DNNF
01-13-2004, 04:51 PM
EL SEGUNDO, Calif. -- Kobe Bryant is expected to miss at least five games and could be sidelined for several weeks with a sprained right shoulder. Bryant The Los Angeles Lakers' star was injured when he was fouled by Kedrick Brown late in the first quarter of a 89-79 victory over the Cleveland Cavaliers on Monday night.
Lakers coach Phil Jackson said Tuesday that Bryant won't need surgery but probably will go on the injured list. Bryant had an MRI exam Tuesday morning, and the results were not as bad as feared.
"In basic terms, it's a sprained shoulder," Jackson said. "I don't think there's any long-term effects to something like this."
Bryant's injury was the latest blow to the Lakers' star-studded lineup. Shaquille O'Neal and Karl Malone also are out with injuries -- Malone for the past nine games with a sprained knee ligament and O'Neal the last five games with a strained right calf.
O'Neal could return Wednesday night against Denver, although he didn't practice Tuesday. It's not clear when Malone will be back.

Psychedelic Fuzz
01-13-2004, 05:03 PM
I can hardly contain my disappointment.
So there are cracks in the armor after all.

WayOutWest
01-13-2004, 06:46 PM
Maybe with Kobe out Shaq will feel like playing again.

ReDIRKulous
01-13-2004, 08:06 PM
Did Kobe fail the rookie challenge?

If you ask me he was shown up by both Carmelo and LeBron. They both appear far more talented than Kobe. It doesn't even seme close really. Imagine Kobe facing these guys at 18.

kg_veteran
01-13-2004, 09:35 PM
Honestly, did the guy really hurt his shoulder, or can he just not stand being exposed without Shaq?

MavsFanFinley
01-13-2004, 11:55 PM
Too bad he might miss our game. I hate when we beat the good teams without star players.

Bayliss
01-14-2004, 12:01 AM
Too bad he might miss our game. I hate when we beat the good teams without star players.

I wouldn't call it a victory just yet. The way we've been playing Gary Payton and the non name misfits could beat us.

MavsFanFinley
01-14-2004, 12:06 AM
I wasn't chocking up a win already Bayliss. Good grief no, not when they have Shaq and possibly Malone by then.

I was meaning that if we were to beat them and Kobe didn't play we'd hear about how we didn't beat them at full-strenth, etc...

Kinda like our wins against the Spurs without Duncan/Parker, the win against the Lakers without Payton, and the win against the Kings without Webber/Peja.

Shaq Attack2
01-14-2004, 01:57 AM
Originally posted by: ReDIRKulous
Did Kobe fail the rookie challenge?

If you ask me he was shown up by both Carmelo and LeBron. They both appear far more talented than Kobe. It doesn't even seme close really. Imagine Kobe facing these guys at 18.

How could LeBron show up Kobe in less than one quarter, especially when Kobe's stats were better that quarter?

As for Melo, he showed up Kobe on like one baseline spin move. Wow, he must be better than Kobe...

rakesh.s
01-14-2004, 02:02 AM
Originally posted by: Shaq Attack2

Originally posted by: ReDIRKulous
Did Kobe fail the rookie challenge?

If you ask me he was shown up by both Carmelo and LeBron. They both appear far more talented than Kobe. It doesn't even seme close really. Imagine Kobe facing these guys at 18.

How could LeBron show up Kobe in less than one quarter, especially when Kobe's stats were better that quarter?

As for Melo, he showed up Kobe on like one baseline spin move. Wow, he must be better than Kobe...

melo obviously got under kobe's skin enough for him to throw an elbow..he's winning the physical battle and the mental battle...that sure says a lot

lebron was torching kobe in that game btw..3 times kobe tried to get all over him and in his face and lebron scored 3 times

ReDIRKulous
01-14-2004, 02:40 AM
How could LeBron show up Kobe in less than one quarter, especially when Kobe's stats were better that quarter?

As for Melo, he showed up Kobe on like one baseline spin move. Wow, he must be better than Kobe...

Don't take it personal Shaq Attack2. You are obviously an LA fan and I am not trying to insult you by saying this, it is just how I see it.

Just remember... these guys are ROOKIES, and at the very least they are right at Kobe's level -- right now! Not to mention that even without Shaq and Malone he still has a far superior supporting cast.. especially in the experience department.

IMO both Melo and LeBron have superstar written all over them. I believe Kobe is a very very good player but I don't think he is near that level. Like an iconic player like Magic, Jordan and Bird. I am 99 % sure LeBron will reach that level. If Kobe didn't play with Shaq he wouldn't be considered as good as he is. He is closer to a Penny Hardaway imo.

Shaq Attack2
01-14-2004, 03:57 AM
Originally posted by: ReDIRKulous
Not to mention that even without Shaq and Malone he still has a far superior supporting cast.. especially in the experience department.

Without Malone and Shaq the Lakers with Payton, Kobe and CBA players have a superior supporting cast to the Nuggets with Melo, Nene, Boykins, Camby, Miller, and Lenard?


Just remember... these guys are ROOKIES, and at the very least they are right at Kobe's level -- right now! IMO both Melo and LeBron have superstar written all over them. I believe Kobe is a very very good player but I don't think he is near that level.

Right now that statement doesn't really make all that much sense. Kobe has done and proven so much more than either LeBron and Melo it's not even a debate that Kobe is a better player, even now in his injured state. He's averaging 22-5-5 on a loaded Lakers squad, has won 3 separate games that I can think of with 4th quarter heroics this year, including a game winner. Etc. etc. etc. Once Kobe is back to 2002-2003 shape, I really don't see in what universe LeBron and Melo are better now.


Like an iconic player like Magic, Jordan and Bird. I am 99 % sure LeBron will reach that level.

LeBron and Melo very well could be that good (more likely LeBron IMO). But either way, it's all hype talk.


If Kobe didn't play with Shaq he wouldn't be considered as good as he is. He is closer to a Penny Hardaway imo.

Hardly. Penny didn't step up at all in his lone Finals appearance in 1995, or for that matter anytime he played in the postseason. He has proven he is no where near as clutch or are fearless as Kobe has been in the playoffs. Penny can/could pass better than Kobe, that's about it.

Shaq Attack2
01-14-2004, 04:07 AM
melo obviously got under kobe's skin enough for him to throw an elbow..he's winning the physical battle and the mental battle...that sure says a lot

LMAO! Yeah, and I bet it also says a lot that Chris Childs got under his skin in 2001. And look how great Childs is today!


lebron was torching kobe in that game btw..3 times kobe tried to get all over him and in his face and lebron scored 3 times

No, 2 times actually. And that was all before Kobe helped force 3 TO's on LeBron and an offensive foul in the first few minutes of play.

SaltwaterChaffy
01-14-2004, 04:31 AM
Originally posted by: kg_veteran
Honestly, did the guy really hurt his shoulder, or can he just not stand being exposed without Shaq?

I don't know if you saw the replays KG, but you could see Kobe's shoulder popping out of socket. That's what it looked like to me anyway. He's definitely hurt.

And call me a bad person, because I still think it's funny...



Salt.

Shaq Attack2
01-14-2004, 04:47 AM
Originally posted by: SaltwaterChaffy

Originally posted by: kg_veteran
Honestly, did the guy really hurt his shoulder, or can he just not stand being exposed without Shaq?

And call me a bad person, because I still think it's funny...

You're a bad person. i/expressions/face-icon-small-wink.gif

And btw, Kobe's shoulder is not dislocated (as originally expected before the MRI), it's actually sprained. Big difference.

ReDIRKulous
01-14-2004, 04:48 AM
Without Malone and Shaq the Lakers with Payton, Kobe and CBA players have a superior supporting cast to the Nuggets with Melo, Nene, Boykins, Camby, Miller, and Lenard?

Absolutely. There is so much experience on that squad. And this was a big game... even though it was against the Cavs. And older players can get up for big games and play fantastic. All of those guys have seen some serious wars.


Right now that statement doesn't really make all that much sense. Kobe has done and proven so much more than either LeBron and Melo it's not even a debate that Kobe is a better player, even now in his injured state. He's averaging 22-5-5 on a loaded Lakers squad, has won 3 separate games that I can think of with 4th quarter heroics this year, including a game winner. Etc. etc. etc. Once Kobe is back to 2002-2003 shape, I really don't see in what universe LeBron and Melo are better now.

I am talking about just talent and their play in those games. Some people might say that that was just a weak game by Kobe. But I think that is how games would go for Kobe if he didn't have Shaq around all the time. If Kobe played a year of what Tmac has gone through it would wear so much on him. Kobe's world has been made incredibly easy by Shaq.


LeBron and Melo very well could be that good (more likely LeBron IMO). But either way, it's all hype talk.

No, it isn't hype imo. You can see it when he plays. He is 18 and a rookie and look at what he is doing. Compare that to Kobe's stats in his first year and remember who he was playing with at that time as well, comapred to LeBron!


Hardly. Penny didn't step up at all in his lone Finals appearance in 1995, or for that matter anytime he played in the postseason. He has proven he is no where near as clutch or are fearless as Kobe has been in the playoffs. Penny can/could pass better than Kobe, that's about it.

Penny wasn't playing next to the Shaq that Kobe came into the league playing with. Shaq was a much more experienced and dominant player by the time Kobe got to him... not to mention that Kobe is playing under Phil Jackson. I don't know what it is about Phil... maybe it is an aura that MJ gave him... but everyone is clutch that plays for Phil. And Kobe rests for three quarters before the fourth quarter as well. Something that most stars don't have the luxury to do.

Shaq Attack2
01-14-2004, 05:27 AM
Originally posted by: ReDIRKulousAbsolutely. There is so much experience on that squad. And this was a big game... even though it was against the Cavs. And older players can get up for big games and play fantastic. All of those guys have seen some serious wars.

We'll have to disagree there. I think the Nuggets' supporting cast is going to produce much much more consistently than the players the Lakers have, despite the Nuggets' young ages.


I am talking about just talent and their play in those games. Some people might say that that was just a weak game by Kobe.

The Denver game was one of his weaker games, it happens.


But I think that is how games would go for Kobe if he didn't have Shaq around all the time. If Kobe played a year of what Tmac has gone through it would wear so much on him. Kobe's world has been made incredibly easy by Shaq.

Since Shaq has been gone Kobe has averaged 30-7-7 and 3.5 steals, not including the Cavs game he injured himself in last night. Shaq makes things easier for Kobe on defense maybe, but more attention on offense is only going to get Kobe more assists when there are too many guys on him. He'll still score 30+ ppg, as he's proven time and again, without Shaq. And you have to be pretty talented to score 30+ ppg (to go along with 7 boards and 7 assists) shooting 45% from the floor while grabbing 3.5 steals on defense, no?


No, it isn't hype imo. You can see it when he plays. He is 18 and a rookie and look at what he is doing. Compare that to Kobe's stats in his first year and remember who he was playing with at that time as well, comapred to LeBron!

Kobe was in fact nearly 1.5 years younger than LeBron was when he entered the NBA. In addition, Kobe didn't get nearly the PT LeBron is getting this season. But assuming LeBron is better at 19 than Kobe was at 19, that doesn't prove a thing about who will end up being better. And for all intents and purposes, Kobe will improve, he is only 25 years old.


Penny wasn't playing next to the Shaq that Kobe came into the league playing with. Shaq was a much more experienced and dominant player by the time Kobe got to him...

That has nothing to do with Kobe hitting big shots. Seriously, it has nothing to do with it at all.


not to mention that Kobe is playing under Phil Jackson. I don't know what it is about Phil... maybe it is an aura that MJ gave him... but everyone is clutch that plays for Phil.

Excuse me if I happen to call this a weak take. i/expressions/face-icon-small-wink.gif


And Kobe rests for three quarters before the fourth quarter as well. Something that most stars don't have the luxury to do.

How does Kobe rest for 3 quarters when he has routinely played 38-40 mpg the last few years?

grbh
01-14-2004, 10:44 AM
Kobe was in fact nearly 1.5 years younger than LeBron was when he entered the NBA.

Actually it is closer to 8 months.

I agree with the rest of your points though. There is no way to tell what these guys will end up being at 25.

If someone put a gun to my head and made me rank where they will all be at 25, I would probably go:

1. Lebron
2. Kobe
3. Melo

WayOutWest
01-14-2004, 11:46 AM
I think Shaq has done a good job at pointing out the pro-Kobe takes. I don't see how you can rate either one of those guys as good as Kobe let alone better than Kobe when those two don't play defense. Niether guy has had the opportunity to be a clutch performer on BOTH ends of the court. As far as today neither guy is close to Kobe.

As far as potential, I can understand why someone would make an argument for Lebron, he's already a top 20 guy. Melo is not in the same league as far as potential as Lebron and Kobe. IMO Lebron could someday be a bigger force in the NBA than Kobe, the rookie numbers don't mean much since Kobe didn't get much PT until EJ was gone. EJ was a rising star when Kobe joined the Lakers and at the time Kobe had to take a back seat so compaing rookie numbers doesn't make sense.

Lebron has much better court vision than Kobe and is a better passer than Kobe. Because of his size Lebron should be, and I believe he is, a better rebounder. Lebron also takes care of the ball better. Kobe is flat out just a better shooter AND scorer than Lebron. Lebron needs to work on his stroke, Kobe didn't have a stroke when he came into the league and now he's very respectable shooting the ball. That allows Kobe to take it to the rack, something else he does better than Lebron, and get to the FT line, he's ahead of Lebron there in attempts, makes and FT%. Once Lebron developes a respectable stroke he'll be as good as Kobe offensively.

That would still leave Lebron with the need for defense and some clutch play, although I'm not sure if he'll get any opportunities to prove he's clutch playing for the Cavs.

IMO Carmello will not be on Kobe's or Lebron's level, he may be his generations Alex English, Clyde Drexler or Adrian Dantley.

Drbio
01-14-2004, 11:48 AM
Originally posted by: WayOutWest
Maybe with Kobe out Shaq will feel like playing again.

haaa haaaa haaaa.......




kobe is a puss.

NBAFan7
01-14-2004, 01:38 PM
Kobe is heads and shoulders above both LeBron and Carmelo. Who in their right mind would argue otherwise right now? You can hate the guy for personal reasons, but come on its getting downright funny. Don't even mention the 3 in the same sentence at this point. Kobe outshined by LeBron last night? I think not, Kobe had 10pts in the 1st qtr alone LeBron finished with 16 total. Kobe was on pace for 40, come on folks put it to rest. LeBron also had a very poor 4th qtr, and that's when Kobe shines. He may be the best clutch player in the league, he definitely has my vote. LeBron and Carmelo both are very lousy defenders, not Dirk Nowitzki lousy but lousy nonetheless. Kobe is a 1st team all NBA defender and obviously 1 of thhe leagues best. The fact that Kobe came back and tried to play with the injury says a lot about the guys competitiveness. You don't see that in todays NBA, you got guys missing huge playoff games with sore ankles, etc. Kobe, LeBron, Melo in the same sentence? hahahaha

kg_veteran
01-14-2004, 01:44 PM
I don't know if you saw the replays KG, but you could see Kobe's shoulder popping out of socket. That's what it looked like to me anyway. He's definitely hurt.

I saw it when it happened. That's why I was asking. It didn't really look like a big deal to me, and for reasons outlined in another thread, I don't think the injury was all that serious.

Perhaps he did "sprain" his shoulder. Sounds pretty fishy to me.


As for the argument about Carmelo and LeBron vs. Kobe, it's silly to compare them at this point. Kobe's the better player. I also agree with WOW. Carmelo's going to be a really nice scoring forward. But his potential isn't up there with LeBron or Kobe. Personally, I see LeBron surpassing Kobe in terms of individual greatness, even if his ring total is never as high.

NBAFan7
01-14-2004, 02:00 PM
yea, kg_vet easily 1 of the most competitive players in the game goes out with an injury that's not serious. him goin on IL, really backs you up there wouldn't u say? gimme a break

WayOutWest
01-14-2004, 02:10 PM
Originally posted by: NBAFan7
yea, kg_vet easily 1 of the most competitive players in the game goes out with an injury that's not serious. him goin on IL, really backs you up there wouldn't u say? gimme a break

I think some 12 year old got a hold of kg's computer, kg is typically solid.

kg_veteran
01-14-2004, 03:12 PM
Going on the IR proves he's hurt?

Hardly. There were no objective findings to support injury that I can tell. If there were, point them out.

WayOutWest
01-14-2004, 03:17 PM
Originally posted by: kg_veteran
Going on the IR proves he's hurt?

Hardly. There were no objective findings to support injury that I can tell. If there were, point them out.

LMAO! Get off kg's computer kid before I tell on you!

kg_veteran
01-14-2004, 03:25 PM
Honestly, WOW, what were the objective findings?

I think it's funny you don't believe there's any possibility the guy is exaggerating.

WayOutWest
01-14-2004, 03:49 PM
Originally posted by: kg_veteran
Honestly, WOW, what were the objective findings?

I think it's funny you don't believe there's any possibility the guy is exaggerating.

You're just being silly.

They took X-Rays to determine there was no fractures or dislocation, then an MRI was done and it was determined it was a sprain. If you're not going to take a team physicians word for it, or doubt his/her objectiveness, than you can cast doubt on practically every injury ever sustianed. Kobe doesn't wilt like a Dallas flower if the pressure is on, he'd be more than happy to step it up like he DID last year. Have you seen his numbers since it became the Fab 2? Kobe is as competetive as they come, not recognizing it or ignoring it makes this discussion pretty pointless. Why don't thow in some doubt about the surgery on that same shoulder while you're at it.

Kobe hate around here really does kill brain cells.

kg_veteran
01-14-2004, 04:10 PM
You're just being silly.

They took X-Rays to determine there was no fractures or dislocation, then an MRI was done and it was determined it was a sprain. If you're not going to take a team physicians word for it, or doubt his/her objectiveness, than you can cast doubt on practically every injury ever sustianed.

There is some truth to what you're saying about the team physician. Still, an MRI won't "show" a sprain; it will simply rule out other things like ligament tears. The diagnosis of a sprain is based upon the complaints of pain, any reduced range of motion, and the ruling out of more severe problems.

I really wasn't questioning Kobe's competitiveness. Maybe I am being silly. I just think it's entirely plausible that Kobe wants to take a break until the Laker machine can get rolling again with Shaq and Malone back.

Obviously, this is a "sore" subject for you. Not as sore as Kobe's shoulder, of course, but a sore subject nonetheless.

Drbio
01-14-2004, 04:33 PM
It was an AC joint injury. I can tell you from personal experience that you cannot lift your arm no matter how hard you try if the AC is seperated. That said....if Kobe hadn't been such a whiney puss over the years and drama queen his way through hundreds of minor noogies, he would be taken more seriously. He's such a whiney puss.

kg_veteran
01-14-2004, 04:39 PM
If Doc says the injury is legit, I believe it.

My apologies to Kobe and his overly devoted fans.

LRB
01-14-2004, 05:44 PM
Hopefully Kobe will get one of those cartoon bandaids to put on his boo boo. i/expressions/face-icon-small-disgusted.gif

Male30Dan
01-14-2004, 05:50 PM
I will just say that while many of you thought it didnt look that bad, it sure did to me... I watched it happen live, and then watched the game play it over and over... Right as he made contact with Brown I thought I could see it look as if it was dislocated somewhat, and then go back in... It looked really nasty, (they slowed it down pretty good)... I didnt think he was faking at all, but he sure has a history with being a drama queen... Maybe its his cockiness/swagger or the fact that he lived primarily in France... Who knows where he picked up such good acting from... But this injury I would definitely call legit.

OzMavs
01-14-2004, 06:56 PM
Originally posted by: Drbio
It was an AC joint injury. I can tell you from personal experience that you cannot lift your arm no matter how hard you try if the AC is seperated.

Yep, I dislocated (separated) my shoulder last year and could not lift my arm at all. Takes a lot longer to get the strength back too. But, I am guessing Kobe will have plenty of spare time on his hands to complete a proper rehab.

WayOutWest
01-14-2004, 06:59 PM
Originally posted by: Male22Dan
the fact that he lived primarily in France

Dam you Dan! I have to chose between my man-love for Kobe or my man-hate for everything French......there is no hope arguing that point!

IMO, Kobe is NOT hurt, he's just being a "cheese eating surrender monkey"! Big WUSS!

Shaq Attack2
01-15-2004, 06:38 AM
Originally posted by: Drbio
It was an AC joint injury. I can tell you from personal experience that you cannot lift your arm no matter how hard you try if the AC is seperated. That said....if Kobe hadn't been such a whiney puss over the years and drama queen his way through hundreds of minor noogies, he would be taken more seriously. He's such a whiney puss.

Yes, and Dirk is the toughest and strongest player in the league.

WayOutWest
01-15-2004, 10:36 AM
Originally posted by: Shaq Attack2
Yes, and Dirk is the toughest and strongest player in the league.

I heard a rumor that Dirk will be signing with Chris Webber's shoe company. Dirk's line of shoes will be revolutionary in that they will be made of glass to go along with his glass ankle's.

That 2-OT game vs. Philly last night was great, Finely stealing that ball from behind was the play of the game.

Murphy3
01-15-2004, 10:41 AM
Dirk legitimately has bad ankles that could end up threatening his career. Kobe legitimately exaggerates his injuries to make himself look better. However, there's a backlash that goes along with doing that. People catch and call him out as exaggerating his injuries for attention. Kobe is what's wrong with professional sports. He's all about himself.

Drbio
01-15-2004, 02:37 PM
The acromioclavicular (AC) joint is held together by a small band ligament. It hurts like hell when you pull or tear it. The diagnosis on the injury is to hold the patients arm straight out to their side and let go. If they cannot keep it up (most often they lean quickly over to the opposite side) then you have a tear. I did this waaaaaaaay back in high school. It is very painful.

Drbio
01-15-2004, 02:59 PM
Ignoring the "my daddy is bigger than your daddy" whining retort of some laker fans......I figured some of you might be interested in the injury. Here is everything you wanted to know and probably more about AC joint injuries.


*kisses*


Doc



---------------------------------------------


Acromioclavicular (AC) joint injuries are common among athletes involved in collision sports, throwing sports, and overhead activities such as upper-extremity strength training. Though AC injuries are common, the treatments for some of the specific injuries are subject to controversy. From the perspective of the sports medicine physician, the ability to distinguish the AC injuries that can be effectively managed nonoperatively from those best managed by surgical intervention is crucial to optimize the care of the injured athlete.


Anatomy
The AC joint (figure 1) is a diarthrodial joint that sometimes contains a fibrous disk. The inclination of the joint also varies, with a vertical orientation in about 36% of the population and an oblique orientation in 49% (1). The AC joint suspends the arm from the axial skeleton and transmits force from the upper arm to the rest of the skeleton.


http://www.physsportsmed.com/issues/2001/11_01/graphics/johnson1.gif

Stability is maintained through the acromioclavicular ligament that protects against posterior translation and axial distraction of the clavicle and through the coracoclavicular ligaments (the more lateral trapezoid ligament and the more medial conoid ligament) (2). The trapezoid ligament resists axial compression and, secondarily, superior translation. The conoid ligament primarily resists superior and anterior translation. Both the trapezius and deltoid muscles are dynamic stabilizers of the AC joint (3). Motion through the AC joint involves 5 to 8 of rotation (4).


AC Separation
Most AC injuries occur from falling directly on the adducted shoulder. The force of the fall dictates the degree of injury. If the history involves a direct blow to the adducted shoulder, the physical exam is likely to confirm the diagnosis. Radiographs are helpful in clarifying the type of injury. The series should consist of an anteroposterior (AP) view, lateral Y view, and an axillary view to determine AP displacement and associated shoulder injuries. When an AC joint injury is suspected, a 15 cephalad AP view is useful (3). Weighted views are generally of little value and are no longer recommended.

AC dislocations have been divided into six classifications (5) (figure 2). The most commonly used system is the one modified by Rockwood (6). The importance of identifying the injury type cannot be overemphasized because the treatment and prognosis hinge on an accurate diagnosis. Typically, type 1 and 2 injuries are easily managed by the primary care physician. Early recognition of types 4, 5, and 6 is essential because these patients benefit from early surgical consultation and intervention. Management of type 3 injuries remains somewhat controversial.

http://www.physsportsmed.com/issues/2001/11_01/graphics/johnson2.gif

Types 1 and 2. The patient with a type 1 injury will demonstrate local tenderness but no anatomic deformity. All the other types of AC dislocations are characterized by localized tenderness with a deformity or asymmetry to the uninvolved AC joint. Active adduction of the injured shoulder (patient reaches across the chest to grasp the uninjured shoulder) with additional passive adduction by the examiner (crossed-arm adduction test) usually exacerbates the pain.

Type 1 and 2 injuries are treated nonoperatively. An arm sling, ice, and analgesics for comfort are the usual initial treatments. Range-of-motion exercises and strength training to restore normal motion and strength are instituted as the patient's symptoms permit.
Return to sport is allowed when the patient reestablishes nearly normal range of motion and strength, typically within 2 to 3 weeks of injury. When a patient returns to practice and competition in collision sports, protection of the AC joint with special padding is important. A simple "doughnut" cut from foam or felt padding can provide effective protection. Special shoulder injury pads can be placed beneath the regular shoulder pads, or off-the-shelf shoulder orthoses can be used to protect the AC joint after injury.

Type 3. The treatment of a type 3 injury is less controversial than in past years. In the 1970s, most orthopedists recommended surgery for type 3 AC sprains (7). By 1991, most type 3 injuries were treated conservatively (8). This change in treatment philosophy was prompted by a series of retrospective studies (9) that showed no outcome differences between operative and nonoperative groups. Furthermore, the patients treated nonoperatively returned to full activity (work or athletics) sooner than the surgically treated groups (10,11). The exceptions to this recommendation include those who perform repetitive, heavy lifting, those who work with their arms above 90, and thin patients who have prominent lateral ends of the clavicles. These patients may benefit from surgical repair (12).

Nonoperative treatment of a type 3 AC sprain involves the use of a sling for comfort followed by range-of-motion and strengthening exercises when tolerated. The time to return to full activity, typically 6 to 12 weeks, is much longer than for type 1 and 2 injuries. Upon return to practice and play, the AC joint should be protected as suggested for type 1 and 2 injuries. Protection may be used as long as the athlete or athletic trainer feels its use is warranted.

Types 4, 5, and 6. Radiographic findings are the primary method used to diagnose type 4, 5, or 6 fractures. When the injury is diagnosed, an orthopedic surgeon should be consulted for surgical reduction and stabilization. Return to athletic practice and play depends on healing and restoration of near-normal strength and range of motion.

Distal Clavicle Fractures
Fractures of the distal third of the clavicle are much less common than midthird clavicle fractures. Estimates range from 10% to 20% of all clavicle fractures (9). The usual mechanism of injury is a lateral force directed against the point of the shoulder.

When a distal clavicle fracture is suspected, appropriate x-rays include a standard shoulder series (AP view, axillary view, and scapular Y view). Anterior and posterior 45 oblique views and/or a view with 20 to 45 cephalic tilt are recommended to more effectively assess anterior-posterior displacement (9).

Understanding and applying fracture classification is essential for making treatment recommendations and timely, appropriate orthopedic consultations. The classification originally made by Neer was later modified to include four distinct injuries (9).

Type 1 fractures involve the clavicle that is lateral to the coracoclavicular ligaments and thus remain stable and nondisplaced. Treatment involves use of a sling until clinical and radiographic evidence of healing is seen. Rehabilitation is best supervised by a physical therapist or athletic trainer and should include range-of-motion and strengthening exercises that target the rotator cuff and scapular stabilizers. After proper rehabilitation of the shoulder, the athlete can return to play, including collision sports.

Type 2 fractures are more controversial. They have been divided into two subsets, 2a and 2b. Type 2a fractures occur medial to the coracoclavicular ligaments and usually result in fragment displacement. Type 2b fractures occur between the conoid and trapezoid ligaments and also tend to displace, leading to a high incidence of nonunion (22% to 44%) and delayed union (45%) after more than 3 months (9). Since the results of open reduction and internal fixation have generally been favorable, most orthopedic surgeons recommend surgery for type 2 fractures. Since several treatment strategies exist for the management of type 2 clavicle fractures, I encourage discussion of these fractures with an orthopedist.

Type 3 fractures include intra-articular fractures that leave all stabilizing ligaments intact. This fracture can be treated in a manner similar to type 1 fractures. Other fracture types have been described, but their infrequent occurrence does not warrant discussion.


Osteoarthritis
Osteoarthritis of the AC joint may be traumatic or atraumatic, but its true incidence is unknown. Fractures of the distal clavicle and AC dislocations may predispose this joint to osteoarthritis. Repetitive upper-extremity activity can cause mechanical wear of the articular cartilage. Also, age-related deterioration of the articular disk has been associated with osteophyte development at the acromion and bony changes of the distal clavicle (13). Narrowing of the joint space by about 50% appears to be a part of the normal aging process (14).

Radiographic changes have been observed in 10% to 23.4% of the nondominant arms of those who do not use their upper extremities excessively. Changes are noted in almost 62% of the dominant arms of those who participate in occupations and sports that require extensive shoulder use (9). Fortunately, despite the frequency of degenerative changes, few people become symptomatic.

Common clinical complaints of those who have AC arthritis are diffuse, lateral shoulder pain and/or local AC-joint pain. Nocturnal exacerbation is common. Upper-extremity activity and activities of daily living involving the shoulder aggravate the symptoms (9). The physical exam commonly reveals local tenderness to palpation of the involved joint. Active and passive range of motion of the shoulder may intensify symptoms. Crossed-arm adduction of the involved shoulder with additional passive adduction by the examiner also aggravates pain. X-rays of the painful shoulder demonstrate typical degenerative changes of bony sclerosis, subchondral cysts, osteophytes, and joint-space narrowing (15).

Treatment of osteoarthritis of the AC joint parallels that for other degenerative joints. Common recommendations include activity modification, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs) or other analgesics, and corticosteroid injections. Although not widely investigated, corticosteroid injections of the AC joint provide symptom relief for 20 days to 3 months (16). Injection of the AC joint is performed from a superior approach using a 23- or 25-gauge needle (figure 3: not shown) with 1 mL of local anesthetic mixed with 1 mL of an intermediate- or long-acting corticosteroid. Most experts recommend limiting injections to the AC joint to three over 3 to 6 months.

When conservative therapy fails, options include arthroscopic or open excision of the distal clavicle.

Osteolysis of the Distal Clavicle
Atraumatic osteolysis of the distal clavicle occurs in various disease states such as rheumatoid arthritis, hyperparathyroidism, infection, multiple myeloma, and scleroderma (9), and in patients who do extensive upper-extremity weight training. The pathophysiology of osteolysis is unclear. One hypothesis involves a stress fracture-like phenomenon in which repetitive stress leads to bony resorption (17).

Clinically, the symptoms reported by athletes who have osteolysis mimic those reported by patients who have osteoarthritis. Pain over the AC joint or pain in the deltoid region is common. Push-ups, dips, and bench presses often aggravate symptoms. Throwing also triggers pain. On physical exam, pain with crossed-arm adduction and palpable tenderness at the AC joint are consistent with osteolysis. When present, loss of the subarticular cortex and demineralization at the clavicle tip appear before obvious characteristic erosion of the distal clavicle. Erosion of the clavicle tip results in the loss of 0.5 to 3 cm of bone (9). Clavicle erosion may be accompanied by erosion of the acromion.

X-ray changes may take weeks to months to occur. A bone scan performed to confirm the diagnosis demonstrates increased uptake over the distal clavicle and, occasionally, increased uptake in the acromion (18). Magnetic resonance imaging exhibits altered signal intensity in the distal clavicle but is not necessary to make a definitive diagnosis.

Treatment options are virtually identical to those recommended for osteoarthritis--modification of activities, NSAIDs or other analgesics, and rest. Reparative processes may occur over 4 to 6 months. Joint widening may persist. Over time, the distal clavicle remineralizes but takes on a tapered appearance compared with the normal architecture (9). When symptoms develop, the athlete should be instructed to discontinue the pain-provoking exercises. Weight lifters should avoid locking the elbows during the bench press, use a narrower grip on the bar, and avoid bending the elbows below horizontal. For patients whose pain is not responding to exercise modifications and conservative treatment, distal clavicle resection may be a necessary next step.


Ready to Respond
Both traumatic and atraumatic AC joint injuries are commonly seen by physicians on the sideline, in the training room, and in the clinic. Understanding the spectrum of injury in the context of acute trauma or repetitive activity enables the clinician to correctly diagnose, treat, and, if indicated, refer for orthopedic consultation. This strategy ensures optimal care for active patients.


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Want more? Read on.....

Disorders of the acromioclavicular (AC) joint are a common cause of shoulder pain and generally involve the ligaments, bones, or articular surfaces. Isolated involvement of the articular surface can result from arthritis or osteolysis. Osteolysis of the distal clavicle is typically associated with AC pain and, on radiographs, a loss of subchondral bone detail, AC separation, and cystic changes.

Cahill credited Dupas with the first reported case of osteolysis of the distal clavicle. In 1936, Dupas reported a case of progressive osteolysis following a traumatic episode. Since that time, several others have reported similar traumatically induced cases. In 1959, Ehricht reported the first case of atraumatic osteolysis of the distal clavicle, occurring in an air-hammer operator. Others subsequently reported osteolysis of the distal clavicle in a deliveryman, a judo artist, and a handball player.

In 1982, Cahill reported the first series, which included 46 patients with atraumatic osteolysis of the distal clavicle. He noted that all of the patients were male and involved in weight training. Since this report, there have been more than 100 cases reported, most of which involved male weight lifters. More recently the condition has been reported in a female bodybuilder. Regardless of the cause, physicians need to have a firm grasp of the anatomy, etiology, and diagnostic findings to optimize treatment.

Anatomy of the AC Joint
"Shoulder" is a general term used to describe a complex structure that includes the clavicle, scapula, and humerus as well as all of the muscles and ligaments that connect these bones (figure 1). The AC joint is a diarthrodial joint connecting the convex distal clavicle with the flat or slightly concave acromion. The degree of congruence between these two surfaces is highly variable, as is the amount of medial inclination. A fibrocartilaginous meniscal disk separates the two hyaline-covered articular surfaces in adolescence. In adults the disk is often small or ill-defined. The joint is stabilized by the coracoclavicular ligaments (conoid and trapezoid), the AC ligament, and the AC capsule. These ligaments limit the amount of motion allowed at the AC joint to about 10 of rotation as the arm is taken into full elevation.

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Etiology of Osteolysis
The mechanical cause of atraumatic osteolysis appears to be repetitive microtrauma to the shoulder (eg, caused by weight-training exercises), whereas traumatic osteolysis is induced by a single blunt trauma to the shoulder. The pathophysiology for both mechanisms remains unclear. Several hypotheses have been proposed, including vascular compromise, nervous system dysfunction, microfracture, and stress-induced osteoclastic resorption.

Madsen postulated nerve dysfunction after noting anisocoria in four of eight patients. Cahill found 50% of the distal clavicles that he surgically removed for osteolysis had microfractures. He postulated that these microfractures initiated an osteolytic process. Brunet et al described the histologic findings in one case of atraumatic osteolysis. They found inflamed synovial tissue extending from the surface into the bony distal clavicle with fibroblastic proliferation and inflamed synovial tissue filling the bony voids.

Clinical Presentation
In both traumatic and atraumatic osteolysis, the patient usually reports a dull ache that localizes over the AC joint. It may radiate to the anterior deltoid or the trapezius. With posttraumatic osteolysis, the patient will relate the onset of the pain to a direct blow to the shoulder. The traumatic episode may be as recent as 4 weeks, or it may have occurred years prior to the patient's presentation. These patients may or may not be involved in repetitive physical activities with the affected shoulder.

With atraumatic osteolysis, the patient has an insidious onset of pain in the region of the AC joint. These patients are usually weight lifters or heavy laborers who do not recall a specific incident that precipitated their symptoms. Weight lifters often have the most pain while performing bench presses, push-ups, and dips. Night pain is not often a complaint, but the patient will have difficulty sleeping on the affected side. Activities of daily living may become painful as the patient's symptoms progress.

On physical examination, patients consistently exhibit point tenderness over the AC joint and pain with cross-body adduction. Patients generally have well-developed shoulder musculature and full range of motion, but they can have pain with the impingement test, making diagnosis difficult. In this situation, 1 mL of 1% lidocaine hydrochloride can be injected directly into the AC joint. Patients with isolated distal clavicle osteolysis will have a temporary resolution of their symptoms after injection, whereas patients with other shoulder pathology will continue to have pain with provocative testing.

Investigative Studies
Radiographic evaluation should include an anteroposterior (AP) view and a 10 to 15 cephalic tilt AP view. X-rays taken soon after the onset of symptoms may appear normal; however, months or years later, loss of subchondral bone detail in the distal clavicle, microcystic changes in the subchondral area, and widening of the AC joint may be visualized. The acromion in osteolysis reveals no pathologic changes, differentiating it from AC arthritis(figure 2). Joint scintigraphy with cone-down views of the AC joint demonstrates marked uptake in the distal clavicle, and it should be used if x-rays are normal (figure 3). Although rarely indicated for isolated osteolysis, magnetic resonance imaging (MRI) consistently shows a bright signal in the distal clavicle on T2-weighted imaging, signifying edema (figure 4). Atraumatic and traumatic osteolysis have similar MRI findings.

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Differential Diagnosis
Other shoulder problems that specifically affect the AC joint, such as AC separation and arthritis, can mimic osteolysis. Patients with glenohumeral pathology may also have pain referred to the AC joint; therefore, glenohumeral instability, labral tears, and rotator cuff pathology should be ruled out. Multiple myeloma, Gorham's massive osteolysis, steroid arthropathy, and aggressive rheumatoid arthritis are problems that can occasionally produce similar clinical and radiographic findings.

Treatment
Treatment of the patient with osteolysis needs to be individualized. Factors to be considered include the extent of disability, hand dominance, activity level, and age.

Nonoperative treatment. Patients are initially started on a nonsteroidal anti-inflammatory drug (NSAID) and instructed in activity modification. Specifically, weight lifters should avoid bench presses, dips, flies, push-ups, and other lifts that elicit pain. Most patients will respond to activity modification; however, symptoms often recur if the previous weight-training schedule is reinstituted. Intra-articular corticosteroids can be considered for short-term symptom relief, but studies to date have not shown any long-term benefits. Because patients generally retain normal shoulder function, formal physical therapy is generally not initiated unless there is concomitant shoulder pathology. Patients whose condition does not respond to conservative management or who cannot limit their activities require surgery.

Operative management. Both open and arthroscopic distal clavicle resection have been successful in alleviating pain and returning patients to previous activity levels. Open resection is a relatively simple procedure, but a 4- to 5-cm incision is required. It also entails at least partial detachment of the deltoid; therefore, patients must avoid strenuous use of the arm for 3 to 4 weeks. The arthroscopic technique is technically more demanding, but it is more cosmetically appealing, and patients return to activities as soon as they are comfortable.

The amount of distal clavicle that needs to be resected remains controversial. The early open procedures advocated resecting 10 to 20 mm, but the need for such a large amount of resection has been questioned. A recent study reported that arthroscopic resection of only 4 mm was effective. The amount resected should prevent impingement at the AC joint as the shoulder is brought into flexion and adduction (figure 5).

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Positive Prognosis
The patient with osteolysis of the distal clavicle usually reports a dull ache over the superior aspect of the shoulder. The pain is exacerbated by activities involving shoulder flexion and adduction. History, physical exam, and plain x-rays usually suffice to make the diagnosis. Modification of activities is the mainstay of conservative treatment, but NSAIDs and corticosteroid injections can provide short-term relief. When conservative management fails, operative resection of the distal clavicle provides good to excellent results with few complications.

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Still not satisfied? Whoo Hooooooo!!!!!!

WHAT TO DO ABOUT AC INJURIES
The muscles, joints, and bones of the shoulders form a base of support that allows your arms to swing, lift, or throw (figure 1). One of these bones, the collarbone, is also called the clavicle. Above your arm is an extension of the shoulder blade called the acromion. Where these two bones meet at the top of the shoulder is the acromioclavicular (AC) joint. The AC joint is not the shoulder joint. The shoulder joint is where the bone of the upper arm (humerus) meets a shallow socket that is also part of the shoulder blade.

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Q. What is a 'separated shoulder'?

A. A separated shoulder is a dislocation of the AC joint that can be caused by a direct or indirect blow to the shoulder. The ligaments that keep the clavicle in proper position become stretched or torn.

There are six different types of AC joint separations. The most common types can be treated by your doctor without a cast or surgery. Because some shoulder separations may need surgery, you should see your doctor for diagnosis and treatment. If surgery is not necessary, most separated shoulders can be treated with an arm sling followed by special rehabilitation exercises, such as those described on the next page.

Q. Does an AC joint separation show on x-rays?

A. X-rays are necessary to show if the clavicle is broken. They can also help distinguish which of the six types of AC joint separation may have occurred.

Q. What other injuries can happen to the AC joint?

A. The end of the clavicle can break. The broken bones may need surgery because the ligaments can't hold the broken parts of the bone in proper position. Your doctor will carefully examine the injury to decide whether surgery is necessary.

Q. Is arthritis a concern?

A. Arthritis can affect the AC joint just like any other joints. A separated shoulder or a broken clavicle may increase your future risk of developing arthritis of the AC joint. Weight lifters and people who do upper-body workouts or play sports that involve shoulder strength or throwing may also be more likely to develop AC joint arthritis. Arthritis can also develop with normal aging.

Q. What can I do to minimize joint damage?

A. Once symptoms develop, discontinue any pain-provoking exercises. Weight lifters should avoid "locking out" the bench press, use a narrower grip on the bar, and avoid bending the elbows below horizontal. Follow your doctor's instructions for care after injury, and be sure to do the recommended exercises to regain strength and range of motion. Your doctor or physical therapist will show you how to do the exercises and tell you how often to do them.

Q. Which exercises help?

A. Unless your doctor tells you otherwise, perform the following exercises two or three times a week. Do 12 to 18 repetitions per set, and do three sets of each. Begin by using 1- or 2-pound hand weights, and gradually increase the weight to 8 pounds as you are able. Consult your doctor if you experience more than mild discomfort when doing any of these exercises.

The first three exercises (figures 2 through 4) increase strength and flexibility. In addition, two exercises help stabilize the scapula. The "push-up plus" (not illustrated) is just like a regular, full-length push-up except that as you come up, you emphasize pushing your back toward the ceiling as high as possible. (Bent-knee pushups do not work as well for this exercise.) The seated press-up (figure 5) is another scapular stabilizer.

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Want More???? Go to Med school. I'm tired.

WayOutWest
01-15-2004, 08:17 PM
Originally posted by: Drbio
Ignoring the "my daddy is bigger than your daddy" whining retort of some laker fans......

I'm surprised you could hear the whinning over the sound of "I sooooo wish Kobe was on our team so we wouldn't be the Lakers bitch" X-Files conspiracy babbling of some Mavs fans. i/expressions/face-icon-small-wink.gif

Drbio
01-15-2004, 11:13 PM
I would cease to be a Mavs fan if that ass ever joined my beloved Mavs. There is no room in Dallas for showbe the rapist.

ReDIRKulous
01-16-2004, 12:02 AM
Originally posted by: Drbio
It was an AC joint injury. I can tell you from personal experience that you cannot lift your arm no matter how hard you try if the AC is seperated. That said....if Kobe hadn't been such a whiney puss over the years and drama queen his way through hundreds of minor noogies, he would be taken more seriously. He's such a whiney puss.

Kobe did lift his arm to shoot 3 freethrows, and made the freethrows. He also lifted his arm when he was playing defense... that is why I think he was faking it. When my shoulder was dislocated I couldn't even move it. And leaving it hanging was excruciating so I instinctually would hold my arm as if it was a baby or as if it was being held up by a sling.

Kobe probalby has a lot of injuries... and probably even tweaked his shoulder the way Dirk has tweaked his shoulder... but rather than gutting it out like Dirk did... Kobe dramtizes the situation and acts like he can't even use that shoulder and shoots with his other arm and all that nonsense. I think he probably could have continued to play but because of other "mild" injuries didn't want to humiliate himself facing LeBron.

Every word out of Kobe's mouth is like the exact opposite of the truth. I think he picked that up from Phil Jackson to be honest.

Drbio
01-16-2004, 12:51 AM
Re-Dirk- I certainly agree with you about showbe being well known for his acting and over-reacting, but his response on court was consistent with an AC sprain. I think the injury is legit but I still hate the bastard.

ReDIRKulous
01-16-2004, 02:42 AM
Originally posted by: Drbio
but his response on court was consistent with an AC sprain. I think the injury is legit but I still hate the bastard.

I thought you said you can't raise your arm if your shoulder is seperated?

Drbio
01-16-2004, 02:47 AM
As I correctly stated in my previous posts, the level of the AC injury varies. If the ligament was torn he would not have been able to raise his arm out to the side. If it was sprained (as was reported in this case), you can raise it with excruciating pain, but most will drop their arm immediately. Kobe did that several times.

ReDIRKulous
01-16-2004, 02:52 AM
Originally posted by: Drbio
The level of the AC injury varies. If the ligament was torn he would not have been able to raise his arm out to the side. If it was sprained (as was reported in this case), you can raise it with excruciating pain, but most will drop their arm immediately. Kobe did that several times.

"I can tell you from personal experience that you cannot lift your arm no matter how hard you try if the AC is seperated."

Does "seperated" mean torn? Or does it just mean sprained. Because when I had the injury they said it was seperated but I don't remember them saying it was torn. If it was torn wouldn't it need surgery?