One week ago, Oklahoma quarterback Sam Bradford was the first overall pick in the NFL draft by St. Louis, but less than a year ago his football career was almost derailed by injury.

After the 2008 season, Bradford became only the second sophomore to win the Heisman Trophy. He passed on the NFL and returned to campus with dreams of winning a national championship. But that all changed in the first game of the season when he was thrown to the turf, landing on his throwing shoulder and separating the acromioclavicular joint (AC joint).

An intensive rehabilitation program allowed Bradford to return about a month later, but almost immediately he re-injured the shoulder and was out for the year. Some questioned whether he would ever regain his velocity and strength.

So what’s so important about the AC joint, and why did it make Bradford such a long shot in this year’s draft?

Think of the shoulder as a tripod. The bone in the upper arm (humerus) sits on top of the tripod, and in order to throw, lift and have strength in our shoulders, that tripod has to have three solid legs. The collarbone (acromion) is one of those tripod legs, and the AC joint is its point of attachment to the shoulder.

Any time you throw a ball or try to lift your arm above your head, that AC joint has to support the weight. When Bradford’s was driven into the turf, a leg of the tripod in his shoulder broke off.

This injury is not unique to Bradford. Every winter I see many skiers and hockey players sprain their AC joint after falling on their shoulders. This time of year, it’s often cyclists thrown off their bikes. Like Bradford, they can’t use their arm as they go through rehab.

After allowing enough time for the tissues to heal the tripod leg back to its place (or for the stretched and injured acromioclavicular ligaments to reconstitute), the shoulder regains its integrity.

During this time, the athlete typically rests the shoulder in a sling. Next, a physical therapist teaches the athlete exercises to strengthen the shoulder. This gives that tripod leg some external support. It generally takes from 3-8 weeks for the healing to be complete.

In some cases, rest and rehab isn’t enough. If the AC injury is what’s called a third-degree sprain, then the ligaments are not just stretched but completely torn, leaving the clavicle unattached to the shoulder. Surgery can reattach the acromion to the clavicle, either with a screw or with suturing material like Bradford’s.

Over time, most shoulder joints heal. Occasionally, the ligaments remain torn and the clavicle can float around in the joint. This is uncomfortable and can result in weakness, especially when the arm is over the shoulder.

A faulty AC joint can be very difficult for an overhand thrower, but football scouts gathered on Oklahoma’s campus last month to see if Bradford would be able to throw with accuracy and velocity. He completed 62 of 63 passes.

Bradford will face all the challenges of an NFL rookie quarterback, from learning a pro offense to competing for a starting position. But how will that surgically repaired tripod leg hold up when he is driven into the turf on his right shoulder? We’ll see if he’s ready on Aug. 26 when the Rams face the Patriots in an exhibition.

 

Dr. James Glazer is a sports medicine physician for Coastal Orthopedics and Sports Medicine in Freeport. He serves as a consultant for the Portland Pirates and the U.S. ski team.