Judge's shoulder surgery, timetable explained

Yanks slugger has arthroscopic procedure, should be ready for Spring Training

November 23rd, 2017

On Tuesday afternoon, the Yankees made an unexpected yet not entirely surprising announcement about their mighty right fielder, newly anointed American League Rookie of the Year Award winner .
The team said in a news release: "Aaron Judge underwent arthroscopic surgery on his left shoulder yesterday. The procedure involved a loose-body removal and cartilage clean-up, and was performed by Dr. Neal ElAttrache in Los Angeles at the Kerlan-Jobe Orthopaedic Clinic. The anticipated recovery time will be completed in advance of the start of Spring Training."
Most fans know Judge's 2017 story: .329 batting average prior to the All-Star break, .185 batting average in August, ice packs on the left shoulder in postgame scrums beginning in the middle of that month, two days on the bench in late August, rumors of a cortisone shot, which were denied by both Judge and the Yankees, a return to play, an improbable run in the postseason and then the AL Rookie of the Year Award.
What most fans don't know, however, is anything at all about a "loose body."
Simply stated, a loose body is a piece of cartilage or bone that has torn away from its original location and is floating in the joint space. In the shoulder, loose bodies are typically composed of damaged articular cartilage, which lines the head of the humerus (the long bone in the upper arm) and the glenoid cavity of the scapula (shoulder blade) where they come together to form the ball-and-socket shoulder joint.
To further complicate matters, the cells of the cartilage or bone making up the fragment feed on the synovial fluid in the joint, form more layers and can enlarge over time. Or, more damaged cartilage on the inside of the joint can break off, creating more loose bodies.
"The most important thing to understand about the loose body is what it does to the joint," says Dr. Armin Tehrany, board certified orthopedic surgeon and founder of Manhattan Orthopedic Care. "Why not just leave it? The reason to take it out is because it can be like a small dime floating around in the joint, and that's bad, because when it hits either the humerus or the glenoid, it damages it. Or, during rotation, it can get caught in the joint and can cause pain and inflammation. It is because the loose body is unstable that it is a problem, because it can affect normal rotation and, under bad circumstances, cause more cartilage damage."
Judge, ever stoic and unwilling to make excuses, insisted all summer that his shoulder was fine and he simply wasn't getting the job done.
"It's not affecting me at all," he said.
Still, those ice packs prove he was at least feeling something, be it tightness, pain, clicking or locking in the joint.
During Game 3 of the AL Championship Series, Judge slammed into the right-field wall, his left shoulder absorbing much of the impact, while robbing Astros designated hitter Yuli Gurriel of an extra-base hit. It is possible that trauma could have caused more damaged articular cartilage to break loose in Judge's shoulder joint. But either way, the chain of events led to his surgery this past Monday.

Why, though, the month-long wait following the end of the Yankees' season? It could have simply been for scheduling reasons with the in-demand ElAttrache, or because Judge wanted to be home for Thanksgiving post-surgery so his family could take care of him. Or, it could have been to give his shoulder a month of rest to reduce some of the inflammation in the joint prior to surgery, which would accelerate his post-op recovery.
During the surgery, small keyholes are made at the front and back of the joint. One is for a camera, so the surgeon can see inside the joint, and the others are for the instruments used to perform the procedure.
"I find the loose bodies with the arthroscope, and then through another portal, I put in an instrument that is like a grasper," says Tehrany. "It's like a claw that is put around the loose body to hold it and pull it out. It's a little like that game that kids play in the arcade, where you put in a quarter and you move the claw over a toy and pull it out."
Tehrany explained that he would then use an arthroscopic shaver to remove the smaller fragments that don't require a grasper.
"Then, I use it to smooth out any rough or damaged cartilage edges on the ball or socket," Tehrany says. "When the cartilage is unstable, it needs to be smoothed out to be stable."
Following the surgery, a patient will often wear a sling for a few days to allow the incisions to heal and the joint to adapt to the surgery before moving on to physical therapy.
"When there are no labrum or rotator-cuff issues and the procedure is simply a loose-body removal, it's a very easy procedure and the rehab typically goes very well," says John Gallucci, president of JAG Physical Therapy in New York and New Jersey.
Gallucci explained that physical therapists will progress patients quickly into their normal range of motion, then slowly begin strengthening the shoulder in all planes of motion. Once a patient demonstrates functional strength capacity, he or she can begin sport-specific activities.
"After a loose-body removal, a patient can be rocking and rolling within six weeks, with full range of motion and strength," Gallucci says.
That means Judge should be back to 100 percent by early January. And that is excellent news for Judge, the Yankees and their fans.