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NFL Injuries

Dr. Flynn takes a closer look at rotator cuff injuries

Photographer: Cliff Welch/Icon Sportswire

Carolina Panthers quarterback Cam Newton is having rotator cuff surgery on his throwing shoulder this week. The injury likely occurred in a game against the San Diego Chargers in Week 14 of the regular season. While Newton was able to finish the game, he continued to have pain and an MRI confirmed a partial tear in his rotator cuff.

We all know that the rotator cuff sounds “bad,” but what is it? (And isn’t it called the “RO-ter cuff?”) Many people who are reading this – yes, I’m looking at you weekend warriors – have been told that they have rotator cuff injuries. Here’s why the rotator cuff is a vulnerable and commonly injured structure:

The shoulder joint is a ball and socket joint. So is the hip. The difference between the 2 is that the hip (on the right) has a very deep socket, while the shoulder (on the left) has a very shallow socket.

Because the shoulder has such a shallow socket (as seen in the X-ray on the left), the shoulder joint is mechanically much less stable than the deeper hip joint shown on the right. With instability comes some good, however – think about how much more range of motion you have in your shoulder compared to your hip joint. Because the bones don’t stabilize the shoulder well, the shoulder has to depend on other structures to support it. The rotator cuff is one of these supporting structures. The rotator cuff is a set of 4 muscles (and their rope-like tendons) that at a most basic level attach the arm bone (humerus) to the socket.

When the bigger muscles that you can see in a mirror (pecs, deltoids, etc) are pulling the arm in different directions, the much smaller rotator cuff muscles are trying to keep the ball in the shoulder socket. The cuff muscles are also responsible for some movements in the shoulder, including lifting your arm above your head. If you have a cuff injury then you know how painful it can be to try to lift your arm to grab something from a high shelf or wash your hair.

When the rotator cuff tears, either partially or completely, it will not heal itself. With a partial tear, many athletes are still able to compete with varying degrees of discomfort. Often, strengthening the muscles around the shoulder and quieting down the acute inflammation in the joint is all that is needed. However, in Cam Newton’s case, this did not seem to be enough.

Head athletic trainer for the Panthers, Ryan Vermillion, said recently “We developed a plan for Cam to take a period of rest, a period of rehabilitation and treatment, and then start a gradual throwing program the first part of March…Cam started his program, and the early parts of his rehab had been going well. However, as we worked to advance him into the next stage – the strengthening stage, the throwing stage – he started to have an increase in his pain level and started having pain while throwing.” This was a sign that the quarterback’s rotator cuff was likely going to continue to be an issue, particularly once the increased intensity of training camp hit. Ultimately, the decision was made to repair his rotator cuff tear.

Surgery is often done arthroscopically, with a camera inserted into the shoulder through tiny incisions. Sutures and bone anchors are used to stabilize and repair the torn portion of tendon. After surgery, athletes are generally immobilized in a sling for a period of time, the exact number of weeks can vary depending on the location and size of the tear.

When asked about Newton’s planned post-op rehab, Vermillion said, “The thing we need to stay away from the most is throwing, but he will start immediately with range of motion and rotator cuff exercises. The positive thing, unlike when he had ankle surgery, is that he will still be able to work on his conditioning, work on his core, work on the rest of his body. Twelve weeks following surgery, Cam will begin an early throwing program with me. If he progresses well he will start throwing with the team at 16 weeks after surgery and we’ll go from there. Our goal is to have him back at the start of training camp.”

12 weeks from his surgery is June 22nd, when he will plan to start throwing with trainers. 16 weeks from surgery is July 20th, when the quarterback hopes to be starting to throw with his team, likely with limited reps.Panthers training camp is set to open at Wofford College in Spartanburg, SC on July 27th.

It is reasonable that Cam Newton may be ready to throw, albeit at a limited number of reps, at the start of training camp. As long as everything goes well with his rotator cuff surgery, I am hopeful that Newton will be ready for the start of the regular season.

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