Jose Reyes, New York Mets’ infielder, left Sunday’s game against the Mariners in the fifth inning after being hit on the left forearm by a 98 mph fastball. X-rays were reportedly negative. Though Reyes noted by end game that he was able to move his fingers, something he wasn’t able to do in the immediate aftermath of the injury, the area remained very sore. Amazingly, reports noted that – due to the absence of fracture – Reyes hopes to return to the lineup as early as Tuesday. That seems unlikely.
The area of the impact to Reyes’ forearm was near the wrist, a region with little soft tissue to soften the blow. Since the injury was to his left and he throws right-handed, it is hitting that will clearly pose the greatest problem. Despite being a switch-hitter, everything from cocking the wrists at the early phase of hitting, to rotating the forearms (the upper pronates, while the lower supinates during the swing) could cause pain. Even simply having to absorb the impact of the ball on the bat – will stress the affected area. Whether he bats righty or lefty, demands will be placed on the extensor and supinator muscles that comprise the extensor (dorsal) surface of Reyes’ left forearm.
Though MRI findings were not reported, a bone contusion (in addition to more superficial bruising) is Reyes likely diagnosis. A bone contusion is a traumatic injury that is caused by forceful impact,
It entails disruption to the bone marrow that rests below the joint cartilage. Microfractures, hemorrhages and edema to the inner layers of the bone (known as cancellous bone) are the result. Since the outer, or cortical layers of bone and the cartilage that surfaces the bone (articular cartilage) are not affected, contusions are not referred to as fractures. MRI assists with diagnosis, as these injuries are not visible on x-ray. Interestingly however, even when initial x-rays are negative, fracture may not be definitively ruled out.
When nerves are involved, a contusion can result in tingling, numbness or burning sensations in the area of impact as well as distal to it (further away from the center of the body).
Time to healing varies and depends on the severity of the injury, the presence of other injuries and the demands placed on healing areas. Mild injury may heal sufficiently within three weeks, and almost half of sufferers have been found by some studies to exhibit no evidence of injury six weeks after insult. Other studies report up to six months to full healing after contusions. One in particular on the scaphoid (a bone at the wrist) demonstrated good outcomes for all patients studied, though eight of 41 subjects remained symptomatic at three months, four of whom continued to exhibit some degree of pathology. These also went on to complete recovery.
Returning to play too soon is likely to prolong recovery and may even result in concomitant pathologies. In the case of muscle contusions these can include excessive scar tissue formation and myositis ossificans. It isn’t worth it.