by Abby Sims
Sam Bradford, 2008 Heisman winner and Oklahoma Sooner star quarterback, was virtually a sure thing to be the number one pick in this year’s NFL draft – At least that was the prevailing opinion until he sprained his right AC joint in September’s home opener. Optimism reigned when Bradford missed only three games, until he fell hard, re-injuring the same area, on the first play of the team’s second possession against Texas only six weeks later. Hopes for Bradford’s senior season came to a screeching halt with reconstructive surgery, performed by Dr. James Andrews on October 28th.
What is the difference between the AC joint and the shoulder joint?
The AC joint and the shoulder joint are not one and the same, though they are often referred to interchangeably in the sports pages. Both are a part of the shoulder girdle. The AC joint, or acromio-clavicular joint, is the connection between the outer end of the collarbone (clavicle) and the hood over the shoulder joint called the acromion. The acromion is an extension of the shoulder blade (scapula).The shoulder joint (also called the gleno-humeral joint) is the interface between the upper arm bone (humerus) and its socket (the glenoid fossa), which is also an extension of the shoulder blade. Though the shoulder is the more complex joint, and can therefore suffer a more extensive variety of injuries, the AC joint is also important to the overall mechanics of the shoulder girdle. An unstable (too loose) or restricted (too tight) AC joint can be a precursor to pain, a decline in function, abnormal movement and a number of shoulder pathologies.
FYI: There is one more joint in the shoulder girdle, and that is where the inner end of the clavicle is attached to the breastbone (sternum). It is called the sternoclavicular (SC) joint. The SC joint is more protected because of its central position; it is also less mobile and is rarely injured.
What is an AC sprain?
Ligaments connect one bone to another, providing stability at joints. In the case of any sprain, a ligament is stretched, sometimes to the point of tearing it completely. There are two sets of ligaments that stabilize the AC joint – one set securing the clavicle to the acromion (which is next to it and above the shoulder joint) and another securing it to a small bone below called the coracoid process. The coracoid is yet another (though smaller) extension of the shoulder blade.
Trauma, generally resulting from a fall onto the involved shoulder with the arm at the side, can sprain the clavicular ligaments. AC sprains come in several varieties – those that tear both sets of ligaments outright are the most dramatic and the clavicle becomes elevated because its anchors are ruptured. These are called AC separations. In Grade I AC sprains the ligaments are injured but remain essentially intact, while Grade II sprains result in tears of some but not all of the ligaments. That is why in a Grade II sprain there is no obvious deformity. Both Grade I and II sprains are treated conservatively, meaning that they do not require surgery. In Grade III sprains both sets of ligaments are ruptured and the stability of the AC joint is significantly compromised; the greater the instability, the more likely the need for surgery. AC injuries that are even more severe may result in the clavicle being displaced into the soft tissue behind it. These are Grade IV sprains (though in some rating systems Grades V and VI describe the most severe injuries).
Why didn’t Sam Bradford have surgery after his initial injury?
It was reported that Bradford’s opening game AC sprain was a Grade II or III. He returned to play faster than you or I might have (not that I’ve played football lately), but this course of action was not out of the ordinary for a serious athlete. Had a hard tackle to his midsection not forced him to land on that shoulder so soon afterward, Bradford would likely have recovered sufficiently to make it through the balance of the season relatively unscathed. Re-injury evidently exacerbated his condition so much so that surgery was the best option to move forward with confidence.
According to published reports, Bradford was cleared to throw only five weeks before his Pro Day earlier this week. General Managers and coaches were out in force to see if he could still put on a show, and that is exactly what Bradford did. Known for his passing accuracy, velocity and high completion to interception ratio, the consensus appeared to be that Bradford hadn’t lost a thing. The recycled and hard-working Bradford is also said to have added between 12 and 20 pounds of muscle to his upper body (accounts have varied) since his injury and with his rehab. Bill Devaney, GM of the soon-to-pick-first St. Louis Rams, was reportedly very impressed. The rest of us will have to wait and see if he was impressed enough.
Abby Sims is an orthopedic and sports physical therapist who has been in private practice in NYC for the past 30 years (you may be familiar with her husband, sportscaster & WFAN alum Dave Sims). Abby has a Masters of Science in Physical Therapy from Duke University and has extensive experience working with professional, collegiate and recreational athletes with musculoskeletal injuries – both non-operative and operative. She has also enjoyed lecturing at many medical conferences. Abby looks forward to responding to your questions or writing about topics that you suggest. For more information about Abby, or her practice, please check out www.RecoveryPT.com as well as www.AthletiSense.com.