Physician's Playbook

Dr. Sergio Ulloa, DO

It’s been a bumpy ride for Pittsburgh Steelers fans lately. Watching star players leave for other teams in the off season is never easy, but watching active players who suit up to play and go down with an injury is painful for everyone with a rooting interest.

Last Monday night that trend continued with star running back James Conner. While he rumbled for 145 rushing yards and one touchdown over the Dolphins, it was the final rushing play of the game that fans might remember going forward. Conner was tackled near the sideline and didn’t immediately get up. It would later be announced that he suffered and AC joint injury — essentially a shoulder separation. Cleveland Browns and Cincinnati Bengals fans aren’t likely to feel bad for the Steelers faithful as they have endured their fair share of shoulder injuries over the past years.

Shoulder separations differ from shoulder dislocations, which we covered last week. So we’ll close out our Football Blitz series for this season by looking at three other shoulder injuries.

AC JOINT/SHOULDER SEPARATIONS

To reiterate, a shoulder dislocation happens when the upper arm bone (humerus) is forced out of the shoulder socket (glenoid). A shoulder separation is different as it is a ligament injury to the joint above the socket, known as the acromioclavicular joint or AC joint. It is where the collarbone or clavicle meets atop the acromion, or what we commonly refer to as the shoulder blade.

Separations often occur in the same way as dislocations, which is through force — which can be in the form of a tackle, a fall, or the pressure and weight of another player driving a shoulder into the ground. The difference is whether the AC joint is affected, resulting in a separation atop the shoulder. It really depends on where the athlete lands if it ends up affecting the AC joint or clavicle.

As of this writing, James Conner might only be sidelined briefly after suffering an AC joint injury. If you’re wondering how can he have a shoulder separation and hardly miss any time, it’s a matter of severity or how much is injured to determine a timeline for return.

Shoulder separations are graded on a scale from one to six based on the severity of the injury. Grade 1 and Grade 2 separations are nonsurgical injuries. With Grade 1 injuries, the ligaments haven’t experienced a tear but are strained or pulled. Icing the injury along with prescribed medication is sufficient for recovery and a return to play depends on rehabilitation progress and mobility. Players could return to the game in a matter of days or weeks once cleared for activity by their physician, which is what is fueling the hopes of Conner and the Steelers. Many athletes have injured their AC joint but the shoulder pads help to protect them from other injuries.

Grade 2 represents a partial tear and will require a similar treatment and rehabilitation regimen, but return to play can take up to four to six weeks. Grade 3 through Grade 6 separations are complete ligament tears. Each increase in grade signifies a more severe tear and a full shoulder separation, and much longer recovery times especially if surgical repair is necessary. We have found that higher grade injuries are less likely to allow athletes to return to sport without surgery.

ROTATOR CUFF

INJURIES

While many people associate rotator cuff injuries with athletes who play baseball, tennis or swim because of obvious repetitive shoulder motions, it is also a common injury with football players. The rotator cuff consists of a series of four tendons that come together to cover the top of the upper arm bone and keeping it in the shoulder socket. Covering those tendons and serving as buffer between the rotator cuff and shoulder blade is the bursa, a lubricated sac that affords a smooth and full range of motion of the shoulder.

When a rotator cuff injury occurs, it is a result of a tear in one of the four tendons. Just like tendons elsewhere in the body, those can be partial tears of varying degrees or full tears. The pushing, pulling and lifting that occurs in the game along the line of scrimmage is one scenario when a tendon in the rotator cuff can be damaged. Another is in the weight room or when lifting any heavy weight. These are known as acute tears causing sudden damage, which differ from degenerative tears that occur slowly over long periods of time.

According to the American Academy of Orthopaedic Surgeons, upward to 80 percent of patients can avoid surgery through rest, pain management, strengthening exercises and limiting overhead motions. However for athletes who have recurring pain that lingers for six months or more, experience significant weakness or have experienced an acute tear that is larger than 3cm, then surgical repair might be necessary with a full recovery time lasting up to six months.

IMPINGEMENT

Shoulder impingement is best described as shoulder pain that occurs when raising the arm to at least shoulder height. While nothing is broken or out of place with impingement, as the arm moves up the space between the acromion and the rotator cuff narrows, and the acromion can rub (or impinge) on the rotator tendons and the bursa causing pain and irritation. It can be treated with rest, anti-inflammatory medications and physical therapy, with surgery only needed on cases that don’t heal naturally over time or when pain doesn’t subside.

The shoulder, with all of its functionality and moving parts, is highly susceptible for injuries and breakdowns. Add to that football’s hard hits and falls and it’s no wonder the shoulder is going to be in harm’s way at some point. However, a focus on strength training and conditioning, sound football fundamentals on blocking, tackling and understanding how to fall when it is in a players ability to control, can go a long way to stave off serious injury.

At the end of the season, our goal is for all of our athletes to be able to walk off the gridiron, free of pain, head held high and with the ability to raise both arms and wave in appreciation for those who have supported them throughout the season. That in itself is a victory in this physical game. We look forward to continue doing our part — through education like this series and personal treatment — to help athletes and non-athletes alike remain healthy and engaged in the activities that matter most to them.

Dr. Ulloa, of OhioHealth Physician Group Heritage College, is a native of Athens who graduated from Ohio University medical school. During a fellowship at the Cleveland Clinic, he served as an assistant team physician for the Browns, Indians and Cavaliers, went to spring training with the Indians and attended the National Football League Scouting Combine in Indianapolis. He presently is a board-certified orthopedic surgeon for the Ohio University Athletic Department.

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