Tuesday, May 13, 2008

Vernon Wells Has a Broken Wrist? Guess Again

Blue Jays outfielder Vernon Wells has been put on the disabled list for six to eight weeks after diving to catch a fly ball last week and supposedly "fracturing his wrist." Poppycock!

Since decorum prevents more appropriate exclamations too foul for this august company, poppycock will have to suffice since, evidently, initial X-rays were negative but the Blue Jays medical staff inexplicably ran the offending wrist (with Wells attached) through the MRI scanner and viola: a fracture.

"I knew it," spouts some trainer, becoming an instant hero for being smarter than every physician and textbook of medicine, finding Wells' injury and protecting the owners' investment and Wells' career while the Blue Jays season goes in the tank.

As has been repeatedly opined in this venue, the "gold-standard" textbook definition of a fracture is one found on plain radiograph, not a CAT scan or magnetic resonance image.

In only the most unusual of circumstances will a CT scan or MRI be indicated to look for a clinically important (read: important) fracture, and the wrist, friends, is not one of them.

Every physician knows that if every musculoskeletal extremity injury with a negative X-ray were run through the CT or MRI, numerous fractures would be "discovered." Pay attention now: Any fracture illuminated by the latter method has no more clinical utility nor significant clinical outcome than if the bony abnormality wasn't discovered at all. That's why the CT and MRI is not the right test for a fracture.

Hence, whatever the extent of Wells' injury (which is much more likely to be soft tissue in nature, not bony) will take a few days of rest and rehab, and he will be asymptomatic in seven to 10 days.

Doubtless, Wells will soon begin to wonder why, with no symptoms and full range of motion of the joint, he is not back in the batting cage, itching for his next opportunity against the AL East hurlers.

"Well, Vernon, you have a broken wrist, remember? You can't play until....hummmm...August?"

Even though he will soon be well on the way to recovery, Wells' wrist will no doubt be placed into a long arm cylinder cast for a month, and then a short arm cast for another month, and it's that medicalization of this ridiculous diagnosis that will do the most damage, resulting in stiff joints of the hand, wrist and elbow and atrophied musculature, necessitating several weeks of rehab to get him in shape just in time to hold his beer can in September while watching the Yankees fight it out with the Red Sox for top berth in the division.

Sorry, Vernon, you might have made the All-Star Game this year, but your so-called medical experts are gonna block that one. Oh, and by the way, here's the bill.