I am continuing my “Injury Discussion” with Andrew Luck’s shoulder. The last post introduced a brief overview of the anatomy of the shoulder and what comprises the “Shoulder Complex.”
Today we’re getting much more practical in terms of what is actually involved with his injury. By all reports there is no AC joint or SC joint involvement and to an extent no scapulothoracic (ST) junction involvement either. And while they do play a role in the whole continuity of the shoulder complex it won’t be what we highlight today. The ST junction will be a focus in terms of what we look at with rehabilitation.
Andrew Luck tore the posterior labrum. What that means is that he had a subtype of a SLAP (superior labrum anterior to posterior) tear. Mike Reinold, DPT, had a great summary of the different categories of SLAP Tears.
SLAP I: Labrum attached some fraying of the superior labrum
SLAP II: Superior portion of labrum and Biceps Brachii tendon begin to detach from Glenoid Fossa
SLAP III: Bucket-handle tear of superior portion of labrum with no Biceps Brachii tendon involvement
SLAP IV: Bucket-handle tear of superior portion of labrum with Biceps Brachii tendon involvement
SLAP V: Anteroinferior Bankert lesion involvement that includes separation of Biceps Brachii tendon
SLAP VI: Unstable flap tears with separation of Biceps Brachii anchor
SLAP VII: Anterior extension of SLAP lesion beneath middle glenohumeral ligament
With Andrew Luck’s SLAP Lesion, he did have Biceps Brachii tendon involvement considering there was potential for Biceps tendon surgery to anchor the tendon, if he had not been progressing as expected.
In order to tear the posterior portion he would have had to suffer a traumatic incident (in which he did – getting tackled and taking shots over and over again as a Quarterback). A combination of taking hits to his shoulder and when being tackled to ground landing on his shoulder is a potential recipe for causing the type of injury he sustained.
Functions of the Labrum:
- Provide increased stability of the head of the humerus in the glenoid fossa via addition of surface area for contact of humerus and fossa
- Limit excessive motion of the head of the humerus in the glenoid fossa
The Biceps Brachii Tendon
The rule of the Biceps Brachii (in terms of the shoulder) is to help with shoulder flexion, shoulder abduction, and shoulder stabilization. The long head of the Biceps Brachii attaches to the superior portion of the glenoid fossa where it also anchors to the cavity, similar to the labrum.
With a more severe shoulder labrum injury Biceps tendon involvement is likely. With Biceps Brachii involvement symptoms usually may include (but not limited too):
- Dull and aching pain on the front of the shoulder
- Pain with initiation flexion of the shoulder
- Sensitivity to touch in the front of the shoulder where the tendon would attach
The next post will focus on the rehabilitation and exercises that could be a part of this treatment plan and somethings I could help with in his road to recovery.