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August 29, 2009
Tom Brady’s “Sore Shoulder”
Redskins defensive tackle Albert Haynesworth crushed Patriots quarterback Tom Brady
late in the second quarter last night causing a blow to Brady’s throwing shoulder when it hit
the turf. Brady left the game with a “sore shoulder” and was seen on the sideline rotating his
arm overhead trying to keep it loose.
Video of Tom Brady Shoulder Injury
The mechanism of injury is a common cause of a 1. shoulder separation or 2. glenohumeral
joint sprain or subluxation. A shoulder separation (sprain of the ligaments of the
acromioclavicular joint – AC joint) should not be confused with a shoulder dislocation,
when the ball of the shoulder (glenohumeral head) pops out of its socket (glenoid fossa).
If the arm is not completed adducted lying close to the side of the athlete’s body but rather
is out abducted away from the body as Brady’s was, the shoulder joint (glenohumeral joint)
itself can be sprained (tearing or stretching of glenohumeral joint capsule, ligaments, and/or
labrum).
The glenohumeral head itself can sublux or shift out of joint but short of complete
dislocation. If it is a significant sprain, then the humeral head can hit into the glenoid fossa
(ball hit the socket) and cause a bone bruise and/or fracture or contusion/tear of rotator cuff
or labrum.
A sprain is a tearing of ligaments. A grade 1 AC sprain or separation results when the
acromioclavicular ligament is stretched or partially torn, which usually causes a sore
shoulder, tenderness to palpation of the AC joint, and pain with crossing the arm over in
front of one’s body (for example when touching your opposite shoulder with your injured
extremities hand). A grade 2 AC sprain results when the AC ligament is completely torn. A
grade 3 AC sprain results in a complete separation of the AC joint whereby the clavicle
pops up or displaces superiorly and the shoulder falls or hangs down; in a grade 3 sprain the
AC ligament and the coracoclavicular ligaments are completely torn. An athlete with a
grade 3 sprain usually requires a sling at the time of injury for comfort.
Physical exam can diagnose AC sprains and subluxations. An X-ray would be used to rule
out a fracture of the distal tip of the clavicle that may occur. Displacement and grading of
the AC sprain can also be confirmed with an x-ray. An MRI would be used rule out other
injuries such as rotator cuff contusion or tear, ligament tear, labral tear, bone bruise, or
impaction fracture; an MRI can also confirm a suspected transient shoulder joint dislocation.
Treatment: The majority of shoulder separations are treated non-operatively with pain
control, active early range of motion as pain allows, and a strengthening program of the
shoulder girdle. Some Grade 3 AC sprains with severe displacement may be treated
operatively. Another direct blow may hurt for up to 6 weeks in Grade 1 sprains and longer
for Grade 2 or 3 sprains.
In the absence of significant ligament or labral or tendon tear, most subluxations are treated
non-operatively as well with early active range of motion and strengthening program.
Stiffness, tightness, and weakness commonly occur in initially which can limit normal function
of the shoulder. Later, an athlete may complain the shoulder feels loose like it is going to
pop out of joint.
Return to play: Most athletes can safely return to play when they have full strength, full range
of motion, even with mild tenderness and pain. Shoulder separations: Grade 1 injuries can
return to play within one week, especially if not in the throwing arm. Grade 2 injuries may
take longer 2-3 weeks. Padding may help with pain control during the game. Lidocaine
anesthetic injections may be used for pain treatment at game time for Grade 1 injuries.
Grade 3 injuries may take up 6 weeks.
Shoulder subluxations: Return to play is similar for mild injuries usually within one week.
Moderate subluxations may take up to 3 weeks. Severe injuries would include tears that
require surgery.
Tom Brady’s “Sore Shoulder”
Redskins defensive tackle Albert Haynesworth crushed Patriots quarterback Tom Brady
late in the second quarter last night causing a blow to Brady’s throwing shoulder when it hit
the turf. Brady left the game with a “sore shoulder” and was seen on the sideline rotating his
arm overhead trying to keep it loose.
Video of Tom Brady Shoulder Injury
The mechanism of injury is a common cause of a 1. shoulder separation or 2. glenohumeral
joint sprain or subluxation. A shoulder separation (sprain of the ligaments of the
acromioclavicular joint – AC joint) should not be confused with a shoulder dislocation,
when the ball of the shoulder (glenohumeral head) pops out of its socket (glenoid fossa).
If the arm is not completed adducted lying close to the side of the athlete’s body but rather
is out abducted away from the body as Brady’s was, the shoulder joint (glenohumeral joint)
itself can be sprained (tearing or stretching of glenohumeral joint capsule, ligaments, and/or
labrum).
The glenohumeral head itself can sublux or shift out of joint but short of complete
dislocation. If it is a significant sprain, then the humeral head can hit into the glenoid fossa
(ball hit the socket) and cause a bone bruise and/or fracture or contusion/tear of rotator cuff
or labrum.
A sprain is a tearing of ligaments. A grade 1 AC sprain or separation results when the
acromioclavicular ligament is stretched or partially torn, which usually causes a sore
shoulder, tenderness to palpation of the AC joint, and pain with crossing the arm over in
front of one’s body (for example when touching your opposite shoulder with your injured
extremities hand). A grade 2 AC sprain results when the AC ligament is completely torn. A
grade 3 AC sprain results in a complete separation of the AC joint whereby the clavicle
pops up or displaces superiorly and the shoulder falls or hangs down; in a grade 3 sprain the
AC ligament and the coracoclavicular ligaments are completely torn. An athlete with a
grade 3 sprain usually requires a sling at the time of injury for comfort.
Physical exam can diagnose AC sprains and subluxations. An X-ray would be used to rule
out a fracture of the distal tip of the clavicle that may occur. Displacement and grading of
the AC sprain can also be confirmed with an x-ray. An MRI would be used rule out other
injuries such as rotator cuff contusion or tear, ligament tear, labral tear, bone bruise, or
impaction fracture; an MRI can also confirm a suspected transient shoulder joint dislocation.
Treatment: The majority of shoulder separations are treated non-operatively with pain
control, active early range of motion as pain allows, and a strengthening program of the
shoulder girdle. Some Grade 3 AC sprains with severe displacement may be treated
operatively. Another direct blow may hurt for up to 6 weeks in Grade 1 sprains and longer
for Grade 2 or 3 sprains.
In the absence of significant ligament or labral or tendon tear, most subluxations are treated
non-operatively as well with early active range of motion and strengthening program.
Stiffness, tightness, and weakness commonly occur in initially which can limit normal function
of the shoulder. Later, an athlete may complain the shoulder feels loose like it is going to
pop out of joint.
Return to play: Most athletes can safely return to play when they have full strength, full range
of motion, even with mild tenderness and pain. Shoulder separations: Grade 1 injuries can
return to play within one week, especially if not in the throwing arm. Grade 2 injuries may
take longer 2-3 weeks. Padding may help with pain control during the game. Lidocaine
anesthetic injections may be used for pain treatment at game time for Grade 1 injuries.
Grade 3 injuries may take up 6 weeks.
Shoulder subluxations: Return to play is similar for mild injuries usually within one week.
Moderate subluxations may take up to 3 weeks. Severe injuries would include tears that
require surgery.