Reshad Jones has been the leader of our defense and a bright spot on the up and down first half of this 2016 football season. Reshad will be out for the rest of the season but I am here to explain why we should not be worried about his health for the 2017 season. The Rotator cuff tear is one of the most common injuries of the shoulder and while surgery is required, the recovery is simple and very systematic.
The ball and socket formation of the shoulder allows it to be one of the most mobile joints in the body. This motion allows for us to reach overhead and Reshad to make amazing interceptions; but it comes at the price of reduced structural stability. The rotator cuff is actually four muscles (supraspinatus, infraspinatus, teres minor and subscapularis) that run from the shoulder blade to the long bone of the arm (humerus). These muscles contract during different shoulder motions to keep the humerus attached to the glenoid fossa and prevent dislocation of the shoulder.
What Lead To This And What Does Surgery Entail?
While the rotator cuff consists of 4 muscles the most commonly injured according to American Academy of Orthopedic Surgeons (AAOS) is the supraspinatus1. This small muscle runs from above the spine of the shoulder blade and is attached to the very top of the head of the humerus. The supraspinatus is most active when the arm is moving between neutral and thirty degrees of abduction, which is the motion your arm goes through during a jumping jack. The common mechanism of injury is falling on an outstretched hand, which most likely occurred to Reshad during week six’s win against the Steelers.
With the diagnosis now confirmed Reshad is looking at going under the knife to have the supraspinatus properly re-attached. While there are three different approaches towards this procedure the most common is the arthroscopic variety. Arthroscopic surgery uses very tiny instruments to repair the damaged tissue while not bothering other muscles of the joint and leaving a small incision sight2.
The Journey Back After Surgery
After rotator cuff surgery the patient will be required to wear a sling for the first 4 to 6 weeks to minimize movement and prevent any re-injure of the surgical area4. After four weeks passive range of motion activities will begin to regain movement of the joint and prevent frozen shoulder syndrome3. These activities involve moving the arm without contracting any of the musculature around the shoulder. A physical therapist can also begin to utilize manual therapy techniques to break up any adhesions of the joint and increase production of synovial fluid.
Between 10 and 12 weeks the shoulder muscles attachment sites are healed and active exercises begin to improve their strength4. First, the exercises will be mostly isometric, which limited movement. Quickly the exercise program will progress to more functional overhead activities normally seen in any local gym. This progression continues under the watchful eye of therapists until the patient is getting near their previous level of strength. Any imbalances in strength that are not addressed at this time can lead to re-injure once they return to sport.
Finally, around three months after surgery, the patient will be released to begin practicing sport specific activities4. This timeline would have Reshad returning to football related activities around February. The only research paper I could find looking at recovery time for football players with rotator cuff injuries indicated that six months after surgery was the point in which players returned fully to practice while one year was needed to obtain full speed and function5. While he will certainly be missed this year, this timetable would put Reshad right on time to return for the beginning of the 2017 season.
- “Rotator Cuff Tears”. American Academy of Orthopaedic Surgeons. Orthoinfo.aaos.org. Accessed October 19th 2016.
- Gazielly, Gleyze, Montagnon “Functional and Anatomical Results After Rotator Cuff Repair. Clinical Orthopaedics and Related Research. 1994. 304.
- Warner J.J., Greis P.E. “The treatment of stiffness of the shoulder after repair of the rotator cuff”. Instr Course Lect. 1998. 47: p. 67–75
- Meijden et al. “Rehabilitation After Arthoscopic Rotator Cuff Repair: Current Concepts Review and Evidence Based Guidelines” International Journal of Sports Physical Therapy. 2012 7 (2): 197-218.
- Kaplan et al. “Prevalence and Variance of Shoulder Injuries in Elite Collegiate Football Players” The American Journal of Sports Medicine. 2005. 33. 1141-1146.