Pop pop! The new trend of shoulder dislocations in the NFL!

There were 14 games and 41 injuries in week 11. Let’s see what this week has in store! Week 12 by the numbers:

50 = Number of players who missed game time due to injury.

6 = Number of players placed on season-ending IR.

16 = Number of corner backs and safeties injured.

10 = Number of shoulder injuries.

Screen Shot 2014-11-26 at 6.42.06 PMHistory was made this weekend. And, thankfully, I’m not talking about history in terms of injury. I’m talking about Odell Beckham Jr. and what I will confidently call as “The Greatest Catch of All-Time”. If you were watching Sunday night football or have caught any sports highlights over the last week, you probably saw Beckham’s incredible, fantastic, mind-blasting catch. Kim Kardashian tried to break the internet but Beckham actually did. On an endzone route, he was interfered with by a defender but still managed to get three fingers on an Eli Manning pass, reel it in, land in bounds, and put up 6 points for the Giants. He literally caught a football with three fingers! I can’t even catch a ball with duct tape on my hands that is lobbed to me by my nephew. Let’s relive this magical moment over and over again. There is no limit to the amount of times you watch this. But please do not get too distracted and continue reading when you’ve had your fill of greatness.

 

 

 

 

Way back in week 7, we discussed a little bit of shoulder anatomy. Pectoral tears were the hot topic back then. And then we had a fine discussion over wine about clavicle fractures in week 9. But pectoral tears and clavicle fractures are so last fall. We need to keep trendy with winter fashion and move on to new things. So this week, we’re going to look at shoulder dislocations!

Our poor specimen this week are Michael Griffin,jamar-taylor-nfl-miami-dolphins-denver-broncos-850x560 of my beloved Tennessee Titans, and Jamar Taylor, of the Miami Dolphins. Both guys are defensive players, lining up as a safety and cornerback, respectively. Griffin was hurt after tackling a receiver and landing hard on his previously injured (dun dun dun!) left shoulder. And on the other hand, Taylor injured his right shoulder while being blocked at the line of scrimmage. Both men were in some serious pain as they clutched their damaged arm and walked off the field.

Quick little recap of the glenohumeral joint here folks. The humerus is your arm bone. By day, it’s works hard to let you high five your coworkers and by night, it’s a stand up comedian because it’s humourous (hehe). The scapula is the shoulder blade. Humerus, do you take the scapula to be your wedded husband to live together in marriage? Yes! And together, these two beautiful bones have a long-lasting marriage as a ball-and-socket joint. This marriage is known in the medical world as the glenohumeral joint! The head of the humerus is the ball and the glenoid cavity (on the scapula) is the chain – I mean, socket! For simplicity, I’m going to refer to the glenohumeral joint as the shoulder for the rest of this blog. Mostly because I feel very pretentious always saying glenohumeral joint. Glenohumeral joint! Glenohumeral joint! Hunoglemeral joint!

Because the shoulder is a ball-and-socket joint, it has a boat load of movement. To be exact, there are 6 different shoulder directions:

  1. Flexion = lifting your arm straight up in front of your nose.
  2. Extension = moving your arm straight back behind you.
  3. Abduction = lifting your arm straight up to your side.
  4. Adduction = reaching your arm across your body.
  5. External rotation = rotating your hand so your palm faces forward.
  6. Internal rotation = rotating your hand so your palm faces backward.

To make things even more complicated, the shoulder doesn’t operate in these specific planes when you recruit it functionally. It combines a lot of these movement patterns to produce actions like reaching for your best china or putting on your fur coat.

with-great-power-comes-great-responsibility-spider-manWith great movement comes great need for stability. We rely on a few different structures to provide shoulder stability. Labrum, ligaments, and muscles are the big three when it comes to keeping the joint intact. For now, we’ll focus on one in particular: ligaments! We don’t hear about “shoulder ligament” injuries because they are more commonly known as shoulder dislocations.

Ready for some fun physio facts? The shoulder is the most frequently dislocated joint in the body! 95% of shoulder dislocations come out anteriorly (forward)! If you’ve dislocated your shoulder once, you have an 85% doing it again! Holy piano tuners, Batman! Why is this joint so unstable? The cruel reality is that the glenoid cavity is quite shallow so the humeral head can easily slip out. Gee, thanks bones! photo-1Dislocations usually occur when the shoulder receives a direct blow or if a person falls on to their outstretched arm. When this trauma occurs, the humeral head is pushed out of the glenoid cavity. Anterior dislocations occur much more frequently than posterior dislocations. In posterior dislocations, the ball pops out the back of the socket. With anterior dislocations, the ball pops forward out of the socket and then sits in front and below its usual home. Ligaments are designed to keep the humeral head within the glenoid cavity. But sometimes an external force is too strong for ligaments to handle. So when the humeral head dislocates anteriorly, it tears through the glenohumeral ligament. This guy is pretty huge so we divide it into 3 different bands. From top to bottom, there are superior, middle, and inferior portions. With your standard anterior shoulder dislocation, the inferior band of the glenohumeral ligament is ruptured. Maybe it shouldn’t be so inferior to the other bands (teehee).Screen Shot 2014-11-26 at 11.39.33 PMYou don’t have to go to school for thousands of years to be able to recognize a dislocated shoulder. Subjectively, the injured person will be in a ton of pain and immediately will hold his or her hurt arm close to their body. Sometimes, numbness might be present if the humeral head nicks part of the radial nerve on it’s way out of the socket. Objectively, there is an obvious deformity of the shoulder. X-ray can be used to confirm the diagnosis but usually the aforementioned signs and symptoms are enough to determine if the shoulder is dislocated. Above are x-ray images of a left shoulder. The picture on the left shows what a normal shoulder should look like. But on the right, you can see an obvious dislocation where the humeral head is displaced out the socket. Yowzaaa…

Relocation of the displaced humeral head is alwaysa1ee2c72fbbbd7675f8dc5854031291caa2dcce5a72acb9799f9557c3022789d the first step. This technique is performed by a professional health care worker who can push the humeral head back into the glenoid cavity. Go home, ball! In NFL games, each team will have their own doctors on the sidelines who are trained to relocate  dislocations. After it’s back in place, the shoulder is put in a sling to give the ligament some time to heal.

Once out of the sling after a few weeks, the goal is to restore the range of motion. As range returns to normal, strengthening exercises can be slowly introduced. It’s important to work on both the muscles that stabilize the scapula as well as muscles that move the arm. As usual, once the normal mechanics of the shoulder are reestablished, it’s a matter of focusing on sport specific skills. As defensive players, Griffin and Taylor will work a lot on batting down balls and tackling. Rehab can take up to 3-4 months but NFL players are a different breed of human. It’s not rare to see these athletes return to play after a few weeks of physio. falcons-running-back-michael-turner-tackled-by-titans-safety-michael-griffinGriffin might take slightly longer to return to play because this is not his first dislocation. However, Taylor is expected to only miss 2-3 weeks of play. C’est incroyable!

Ta daaa! Hope you learned some valuable lessons from this week’s blog. The most significant being please avoid dislocating your shoulder if possible. And of course, that even Spiderman understands the importance of shoulder stability. Thanks, Spidey!

– Chris (5-7)


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