Drew Brees injured his throwing shoulder while in the pocket on Sunday last week. He was diagnosed with a rotator cuff bruise and surgery was ruled out at this time. He will rehab and return to play when his strength returns. This Sunday, he missed his first game in 10 seasons with the Saints.
So what is the significance of his rotator cuff injury? The main concern at hand is that Brees underwent major reconstructive arthroscopic shoulder surgery in 2006 after sustaining near circumferential tearing of his labrum. The surgery was a success and he has been one of the top quarterbacks ever since. The issue now is that his shoulder joint is unstable. His main stabilizer, the labrum, is allowing the humeral head (the ball in the ball-and-socket joint) to move in and around the joint. In this case the bone can push up against the rotator cuff tendon and can partially tear it from below.
Normally, the source of rotator cuff tendon injuries come from above by bone spurs or direct trauma. Labral tearing is a very common cause of rotator cuff injury or tear in the young and athletic population, so athletes often experience damage to the underside of the rotator tendon. Another cause of this partial tearing of the rotator cuff, in young athletic people, is multi-directional instability. This is when someone is loose jointed (sometimes called “double jointed”). Here the joint and capsule itself is loose and that causes the humeral head to push up against the rotator cuff.
In Drew Brees case, the question is whether that rotator cuff bruise is actually a partial tear. If it is, then is his reconstruction or recent injury to blame? Drew Brees has enjoyed exceptional success for the ten years following his surgery, but some wear and tear is inevitable in these circumstances.
The typical treatment for partial rotator cuff tears is rehab, physical therapy focusing on rotator cuff strengthening, scapular (wing bone) stabilization and range of motion. If conservative treatment fails then arthroscopic shoulder surgery is necessary. Brees should be back in the game soon if he has indeed sustained a rotator cuff bruise. If he has a partial tear, then we have to hope that conservative treatments will restore his shoulder for next season.