Our weekly NFL report evaluates injuries to players of local (Patriots, Giants and Jets) or national interest with commentary by a sports orthopedic specialist from the Bone & Joint Institute at Hartford Hospital. Sign up for automatic delivery to your inbox (click here and scroll to “Free email newsletters”).
Player: Tom Brady, New England Patriots quarterback.
Injury: Left shoulder (non-throwing), described as an acromioclavicular (AC) joint sprain, or shoulder separation.
How it happened: With the caveat that the Patriots are notoriously vague on injuries, Brady reportedly hurt the shoulder in a 33-30 loss to the Carolina Panthers Oct. 1, then aggravated it when sacked four days later in a 19-14 victory over the Tampa Bay Buccaneers. Brady also has been dealing with an unspecified Achilles tendon issue. Brady missed multiple midweek practices during the season because of one, or both, issues but has not missed a game. The Patriots, after a week off, play the Tennessee Titans in an AFC divisional playoff game Saturday at Gillette Stadium.
Dr. Clifford Rios, Bone & Joint Institute orthopedic surgeon and board-certified in sports medicine: “A mild AC sprain usually will be a non-issue within 4-6 weeks and most players could play within 2-3 weeks of the injury. A throwing shoulder would probably take longer because pain has be gone before you can start rehabbing throwing mechanics. Obviously, it depends on the level of sport and time of season. NFL, playoffs, Super Bowl . . . . he’s going to play.”
Will the Titans target Brady’s shoulder? Medically speaking, what is Brady’s risk?: “Of course a team would want to target it,” says Dr. Rios, “but I don’t think they would need to be that specific — not like a knee. Just getting him to crash down on his shoulder would be enough to aggravate it”
What’s the AC joint?: It’s the small joint, two bones, at the front the shoulder at the junction of the collarbone (clavicle) and the bone at the tip of the shoulder (acromion). Four ligaments hold the clavicle and acromion in place.
An AC joint sprain, or separation, occurs when the ligaments are stressed, either by trauma or overuse.
What’s the difference between a shoulder separation and shoulder dislocation?: A shoulder separation affects the AC joint. Your shoulder is dislocated when the bone in your upper arm pops out of the socket at the shoulder blade.
Types of AC joint injuries: Each of these most common classifications qualify as an AC joint sprain, or shoulder separation.
- Grade 1: A mild shoulder separation. Ligaments partially torn or stretched but no visible lump on the shoulder.
- Grade 2: A partial separation. The AC ligament is torn but the coracoclavicular ligaments, which stabilize the AC joint, are undamaged. A small lump is visible on the shoulder.
- Grade 3: A complete separation of the joint. The AC ligament and coracoclavicular ligaments are completely torn. A more pronounced bump is visible on the shoulder.
Whatever the severity, the injury rarely requires surgery.
“I see dozens of AC injuries each year,” says Dr. Rios, “usually around football, hockey and lacrosse seasons. The great majority are treated non-operatively. Even mild or moderate injuries are well tolerated, once the acute pain/inflammation resolve. The ones that need surgery have significant displacement (Grade 5) and can cause moderate dysfunction of the shoulder.”
AC joint sprain symptoms: Your doctor will suspect an AC joint sprain if you have:
- A visible lump above the shoulder.
- Loss of shoulder strength, movement.
- Swelling, bruising.
- Pain when lying on the injured side.
- A popping sound feeling that joint “catches” when moving the shoulder.
- Pain when lifting significant weight either overhead or across the body.
How could the injury affect Brady?: “Problems with the AC joint lead to pain with direct contact (like a collision to top of shoulder), reaching across body and reaching above shoulder level,” says Dr. Rios. “For a non-throwing shoulder in a quarterback, the biggest risk is taking a sack and falling on top of that shoulder. All other activities would be easily tolerated, particularly if he got a shot of some medicine pre-game (which would not be unusual). He can also position a little more protection under the shoulder pad, which may or may not help.”
Alternative view of Brady’s reported injury: Patriots gamesmanship: “Coach Bill Belichick is a master of the mind game,” says Dr. Rios. “Some Grade 1 sprains can cause some irritation, but I would not be surprised if this is just thrown out there to get the competition guessing. A sprain typically would resolve it, but someone may get post-traumatic inflammation of the joint.”
Treatment: An AC joint injury is treated initially with PRICE therapy.
Protection: Protect damaged tissue to prevent further damage..
Rest: Stop training. Take it easy and allow time for healing. Check with your physical therapist before resuming exercise.
Ice: The simplest and most effective treatment after the injury. It reduces bleeding and the risk of cell death. It will also reduce pain.
Compression: Reduces swelling.
Elevation: Drains fluid from the injury, reducing swelling and pain. Elevate the ankle above the hip.
An anti-inflammatory (example: ibuprofen) can reduce pain and swelling. Your doctor will recommend immobilizing the shoulder by placing it in a sling for up to three weeks — or four weeks for a Grade 3 sprain. A Grade 3 sprain might require surgery. Broncos quarterback Trevor Siemian missed one week last season with left shoulder (non-throwing) Grade 3 separation but chose off-season surgery.
Taping the joint for two or three weeks is also an option to provide support as it heals.
“Elite players are going to get treatment,” says Dr. Rios. “The AC joint does not contribute to mobility of the shoulder, so post-injury stiffness is not really an issue. Rehab goals will be stimulating muscles that do not cause pain so they don’t get weak while waiting for the injury to recover.”
Dr. Clifford Rios, a sports medicine surgeon with Orthopedic Associates of Hartford, is Site Director for orthopedic resident education at the Bone & Joint Institute. Click here to find out why the Bone & Joint Institute is the athlete’s choice, with a Motion Lab for performance analysis, the area’s most comprehensive sports rehabilitation facility and 30 fellowship-trained orthopedic surgeons.