When Indianapolis Colts QB Andrew Luck had right shoulder surgery this past January, the goal was for him to have plenty of time to heal up for the 2017 season. With the announcement today that he would be placed on season-ending injured reserve without having taken a snap all year, the natural questions arose: what didn’t go according to plan and what does it mean for Luck’s future?
Over the course of the 2016 season, it became known that Colts QB Andrew Luck was dealing with an injury to his right (throwing) shoulder. Luck was listed on the injury report for the shoulder throughout the year and missed some practice time in an effort to manage the condition. Once the season had ended, Luck elected to have surgery on his shoulder with the goal of having a pain-free 2017 season. Luck underwent a shoulder arthroscopy with a repair of a posterior labral tear. The labrum is the ring of fibrocartilage which surrounds the glenoid (socket bone) of the shoulder.
The labrum can be torn in several different areas. When it is torn in the front of the shoulder – usually because of a shoulder dislocation – it can cause recurrent instability (repeated dislocations). When it is torn at the top (known as a SLAP tear) or in the back (posterior labral tear) it usually results in pain. In a young athlete such as Luck, these tears are usually the result of one discrete injury (a fall onto the shoulder, as in a sack) or repeated trauma (not uncommon in offensive lineman, with repeated blows to an outstretched arm while blocking resulting in a tear of the posterior labrum). In many patients this can be managed with activity modification, physical therapy, and sometimes cortisone injections. In younger active patients, and especially in overhead, throwing athletes such as Luck, however, this condition frequently necessitates surgical intervention to repair the tear and allow for pain-free function. Labral tears are remarkably common in football players – a recent study in the American Journal of Sports Medicine – https://www.ncbi.nlm.nih.gov/pubmed/28974332 – revealed that over the years from 2012 to 2015 132 participants at the NFL combine had undergone prior shoulder labral repair. The study also showed a high rate of continued ability to play in these players, which should, in theory, have been a good prognostic indicator for Luck. So what went awry for the Indy QB?
The root of the issue for Luck is that soft tissue repairs of the shoulder (labrum, rotator cuff) in throwing athletes is a delicate business. During surgery, the labrum is arthroscopically sewn back down to the bone to allow it to heal in an appropriate, hopefully pain-free, position.
The difficult part from a surgical standpoint is to get the tension of the soft tissues just right. It is important to get a tight repair so the tissue will heal, but too much tension can cause the tissues such as the labrum and capsule of the shoulder to be too tight, which can result in a solid repair but a loss of motion. In an offensive lineman a slight loss of motion would not be a significant issue, as lineman use their arms almost exclusively in front of their bodies and not overhead. In an overhead or throwing athlete, such as a pitcher or a quarterback, even a slight loss of motion can present significant problems, as the athlete may not be able to regain his normal throwing motion or may struggle with pain in trying to work back to a normal range. This can be due to overtensioning of the tissues at the time of surgery or can be due to difficulties in rehabbing the tissue if the athlete becomes stiff due to his own anatomy or biology. Through no fault of the athlete or their surgeon, some people are more prone to stiffness due to their own individual genetics.
So, what, then, happened to Luck to keep him out for the whole year? Although I obviously was not directly involved in his care, it certainly seems from the information available that Luck had his posterior labrum repaired and during the course of his rehab he has been struggling with ongoing stiffness, resulting in persistent pain. He has attempted several times to advance his throwing only to be shut down each time, and recently received a cortisone injection into the joint in hopes of decreasing inflammation and pain. When this was unsuccessful, Luck and the team made the decision to shut him down for the rest of the season. He has had several second opinions and doubtless a repeat MRI, and the consensus seems to be that no additional surgery is needed – he will rest the arm from throwing for the next few months and work on physical therapy and stretching before attempting to resume throwing. The hope and expectation is that Luck will be able to return in 2018, but Colts fans will have to hold their breath until they see him back on the field. While the odds are in Luck’s favor based on the statistics of labral repairs, it is by no means guaranteed that Luck will be able to return at his previous level, if at all.