Blueprint for Repair

By Richard P. Holm MD

We don’t always appreciate the wonderful healing capacity of our bones.

A few years back I was on call, and the ambulance brought in a young college gentleman who had fallen three stories off a roof onto the cement below. Apparently he landed first on his feet and fell forward. As he landed, he sequentially, like a row of falling dominoes, broke parts of his feet, legs, knees, hands, wrists, elbows, jaw, and nose. The orthopedist who came in to help when I called, counted something like 26 fractures, and my ENT specialist who also came in estimated the patient was going about 35 miles per hour when he hit the concrete.

We ended up sending the young man to the trauma center in Sioux Falls, but what was amazing was how his brain and vital organs had been protected. He had not lost consciousness, remained perfectly awake, and his heart, lungs, gut. and spine were just fine. But the best news came with how eventually, after a lot of rehabilitation, his bones repaired themselves. A year later he walked into my office, without a limp I should add, and shook my hand firmly to thank me for helping him that fateful night.

Most people have the concept that our bones and joints are continuously wearing out and deteriorating over time. It is common thinking that if we simply live long enough, we will end up as a slumped over pile of soft bones and frozen joints. This doesn’t have to be..

Instead, our bodies are constantly remodeling and repairing bones and joints; taking apart, breaking down, and then rebuilding anew. Small injuries are always happening along the way, and maybe it happens more so as we get older, but there is a continuous remodel-and-repair process always going on, throughout your whole life..

The key point to remember is that the blue print for the remodel comes from the daily motion and activity we ask our bodies to perform. Rehab is always going on, especially as we get older.

We shouldn’t have to fall three stories to realize the value of movement.

That All Important Shoulder

By Richard P. Holm MD

One moment I was jetting down the ski slope unbelievably free, on the edge of control. The next moment I saw a bare spot under a bunch of trees  right where I was headed, but I thought too late and was going too fast.

When my skis hit the dirt, I went for one of those head-over-heels flips, struck my right shoulder on an icy hard spot and, finally, came to a stop, a heap of body parts just like Beetle Bailey in an old comic strip.

When accidents happen like that, I find myself wishing in vain to go back five seconds and do that one differently. But of course there was no re-doing it. I felt a burning pain coming from somewhere near my right shoulder, and it was not subsiding.

The doctor in the emergency room examined my shoulder for rotator cuff injury by testing, with resistance, three movements: 1) bring bent arm with imaginary mug of coffee to the chest, 2) rotate the arm out again, and 3) with straightened arm to the side, empty the mug away from the body. Luckily my rotator cuff was fine.

He also reviewed the X-Rays with me and pointed out a separated shoulder blade-collarbone, or AC joint, which ties the arm and shoulder to the chest.

Days later, my orthopedic partner reassured me that although I had torn the AC joint, it wasn't unstable. The only real problem was that I should expect it to hurt for maybe six months, which it did. 

The whole experience helped me appreciate the sudden and long lasting consequences of a reckless choice, helped me empathize with others in pain from any cause, and helped me learn about the value of the shoulder and all its parts.

And it helped me to avoid those bare dirt spots too.

Take home message:
1. Accidents can happen in a flash, and can result in long lasting suffering. Therefore it is wise to make good choices to avoid accidents when possible;
2. The shoulder has many important parts, and because it is so very mobile, is also more at risk for becoming unstable if injured;
3. The three movements mentioned above test the Subscapularis, the Infraspinatus with the Teres Minor, and the Supraspinatus muscles.