Getting Them Back in the Game

Griffin Laird in action last Fall for the University School of Jackson prior to injuring his right shoulder. PHOTO: Angela Spencer Photography

Shoulder and elbow reconstruction specialty getting Adam Smith, MD, noticed by his peers

It may be considered America's pastime, but for Adam Smith, MD, baseball is far more. In fact, it has been a huge part of his life. He grew up playing the sport and even went on to play at the collegiate level. When an injury threw a curveball at his dream of playing beyond college, it did not take him out of the game completely - it just moved him from the field to the sidelines. As an orthopedic surgeon with West Tennessee Bone and Joint Clinic, Smith specializes in shoulder and elbow reconstruction. His research and work has been recognized by his peers and led to his selection to the American Society of Shoulder and Elbow Surgeons.

Adam Smith, MD

While he isn't a coal miner's daughter like Loretta Lynn, Smith does have two things in common with the country star. They are from the same small home town in Eastern Kentucky, and his father was also a coal miner. The coal mining town of Paintsville is also home to Chris Stapleton and some famous athletes.

Smith left Paintsville to play baseball at Morehead State University in Morehead, Kentucky. "About midway through college, I realized I had better figure out what I was going to do with my life because professional baseball was not going to be it," said Smith. "An injury had forced me to sit out part of a season and it made me think medicine would be a good fit, specifically orthopedics since that is who typically takes care of athletes. As a math major, I have to admit I was a bit naïve about medical school but I got accepted to the University of Kentucky College of Medicine and did well enough to land an orthopedic residency at Wake Forest University."

While orthopedics was his passion, it was his time on the baseball diamond that fueled Smith's desire to take care of athletes - primarily throwing athletes. After his residency, he completed a one-year fellowship in shoulder and elbow reconstruction at The Mayo Clinic in Rochester, Minnesota where he learned about treating complex shoulder and elbow problems.

Smith joined the staff at the University of Tennessee - Chattanooga's academic program where he did research as well as treated patients. He returned to his home state to join Kentucky Sports Medicine in Lexington which was eventually bought out by the University of Kentucky. When practicing in a University setting proved to not leave much time for his growing family, Smith jumped at the chance to join his close friend Dr. Jason Hutchinson at West Tennessee Bone and Joint. "Jason and I had been in practice together in Chattanooga," said Smith. "At the time, the invitation was a huge opportunity for me since there was one shoulder specialist at Vanderbilt and one coming to Memphis, who I had trained with at Mayo Clinic. The service area was huge and ripe for someone to take on shoulder and elbow cases that were difficult. Although I have been here ten years, it has taken quite a bit of effort, patience and word of mouth to develop a practice that is primarily shoulder and elbow. I owe a lot to my partners who are so supportive of my practice and send me the complex elbow and shoulder cases."

While the bulk of his patients are not athletes, Smith still has a tremendous interest in athletes, especially throwing athletes and his research focuses on that population. "I had a paper accepted into the Journal of Shoulder and Elbow Surgery," he said. "It dealt with injuries in female softball players, a population of athletes that has been overlooked and under researched. It has just become apparent, through research, that female softball pitchers, primarily high level players, get injured just as frequently as male pitchers. These girls play ball nearly all year round and we noticed a spike in injuries in the last five to seven years."

Smith says that throwing athletes' issues can lead to surgical intervention. For younger throwers, ages 10-14, most injuries are growth plate related. During a growth spurt, the growth plate is softer and more prone to injury. Older athletes tend to face more rotator cuff injuries and dislocations.

For one area high school athlete, a football injury led to him missing his junior season of baseball. Griffin Laird who plays for the University School of Jackson Bruins, dislocated his right shoulder in a game last fall which resulted in a torn labrum. The labrum is a piece of fibrocartilage (rubbery tissue) attached to the rim of the shoulder socket that helps keep the ball of the joint in place.

"Griffin is one tough athlete. He actually kept playing after the initial injury and ended up doing more damage as he landed on it a couple more times," said Smith. "After football season, when he started throwing for baseball he was in a lot of pain."

"Dr. Smith laid out our options and while Griffin did not want to miss baseball it became apparent that we could not put off surgery," said Taylor Laird, Griffin's mother. "Griffin had surgery in early February so he could do the six months of rehab needed after surgery and still be ready to play football this fall."

"For throwing athletes, surgery is the easiest part because rehab takes between six and nine months," said Smith. "Griffin is a trooper and an excellent athlete who was very dedicated to the rehab process. He started physical therapy the first week after surgery. He was released to participate in seven on seven competitions and should be released for full contact by the time the season starts."

While he may be back on the football field, Griffin has more work to do before the baseball season starts. "After this type surgery, you cannot even begin to throw for six months," said Smith. "And then you have to go through a three-month throwing program before you can even start to really throw. The program follows the Andrews protocol and gradually has the player tossing the ball longer distances. They do a certain number of throws every three days and stay at the same distance for two weeks before progressing out further."

In high school, a parent, coach or trainer oversees the program. "It takes a lot of outside support, so while the athlete is in their initial PT, I try to gauge how much support they have or will require and follow-up with their coaches as needed. Every kid is different," said Smith. "Griffin is smart, dedicated and has a tremendous support system. It is the kids who don't follow a program that have the hardest time getting back into sports."

Injuries are going to happen, says Smith and sometimes it is just from bad luck. "For a young player, it may be a matter of timing as it is the number of throws or plays. If they hit a growth spurt during the season, they may be more prone to injury since the growth plate may be softer," he said. "We always see injuries go up during football - it is just a fact. In high school, it is more a matter of being prepared for their season. Overuse issues can contribute if you are pitching for your school then also playing for a showcase team."

Though he never thought he would land in West Tennessee, Smith knows it was the right decision. "I love taking care of these kids, especially the throwing athletes, and being involved in sports."


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