Boston Sports Doc Injury Blog

Dr. Christopher Geary, your source for info on the latest sports injuries with a bit of a Boston slant…

 

Martellus Bennett, a.k.a. The Black Unicorn, a.k.a. Marty from the Imagination Station, was cut by the Packers earlier this week at least partly over the condition of his shoulder. Reports then surfaced that Bennett has a torn rotator cuff which might require surgery. Subsequent to this, Bennett was signed by the Patriots and passed a physical and practiced this week, a seemingly confusing sequence of events. So what’s the bottom line? Does Bennett have a torn rotator cuff? Does he need surgery? Could both of those things be true but Bennett still play for the Pats this year?

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Picture courtesy of BostonHerald.com

Martellus Bennett has always been a bit of an oddball in the NFL, with his penchant for writing kid’s books and his deep-rooted passion for bacon http://www.patriots.com/video/2016/12/29/martellus-bennett-shares-his-love-bacon (ok, there’s nothing weird about loving bacon, but that’s not the point here). This week he became a bit of a medical enigma due to the condition of his shoulder. The tight end played on the Patriots Super Bowl-winning squad last year (have I ever mentioned I was at that super bowl? I was, you should totally ask me about it sometime) despite multiple injuries including a shoulder injury which bothered him but did not cause him to miss any games. In the off-season as a free agent he signed a 3-year, 21 million dollar contract to play for the Green Bay Packers. Bennett had a minimally productive season for the Packers (24 catches over the first seven games for 233 yards and no touchdowns), and has not played or practiced for the past two weeks after apparently re-aggravating or worsening the condition of his shoulder in week seven. After some back and forth with the Packers and their medical staff, Bennett apparent opted for season-ending surgery on his shoulder, only to be released and then signed by the Patriots. Obviously the tight end did not have surgery, so how can he potentially be suiting up for the Patriots this weekend? Before we can answer this, we first have to consider what the rotator cuff is and what a tear of these tendons involves.

The rotator cuff is a group of four tendons ( the supraspinatus, infraspinatus, teres minor and subscapularis) which help to move the shoulder joint and ultimately to position the hand in space.

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Image courtesy of physio-pedia.com

When these tendons are normal and uninjured, they function in conjunction with the other shoulder muscles (including the deltoid, biceps, and pectoralis) to move the shoulder joint. Tears of these tendons are very common, as they see a great deal of stress even with normal use, resulting in a high number of “atraumatic” tears – tears which result just from normal day-to-day use or aging. Add in the additional stress seen when athletes are diving on their shoulders and sustaining high levels of trauma to their upper bodies from activities such as tackling or being tackled, and it is no surprise that these tendons might be torn at an even higher rate in contact athletes.

Some of the confusion with these tears comes from the fact that not all tears are alike – tendons can be torn in different places and the tears can be partial or full. I tell patients to think of the rotator cuff tendons like a piece of Velcro – similar to Velcro, you can peel off an edge (a partial tear) or rip the Velcro completely apart (a full tear).

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Arthroscopic surgical image of a partial thickness rotator cuff (frayed tissue in red circle with normal biceps tendon in background)

 

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Arthroscopic surgical image of full-thickness rotator cuff tear (torn tendon above metal probe, normal bone below)

While some of these tears are completely asymptomatic and require no treatment, most rotator cuff tears result in a loss of function and/or pain. Patients may report a sensation of weakness when using the arm overhead or in front of their body, and may complain of pain with use or even at rest. Many tears, especially partial tears or even full-thickness tears in older patients, can be treated without surgery with a combination of physical therapy and sometimes cortisone injections. Most symptomatic full-thickness tears, especially in younger patients and athletes, are treated surgically. The surgery is usually arthroscopic, in which we re-attach the tendon to the bone using specialized instruments designed to allow for less invasive surgery.

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Arthroscopic surgical image showing rotator cuff repair in progress, with sutures in place on the right and suture anchor being inserted on the left

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Arthroscopic image of completed rotator cuff repair, with sutures in place and tied down, reapproximating tendon to bone

Post-operatively patients are usually in a sling for 4-6 weeks, with physical therapy for 3-6 months after. Lifting and activity restrictions are usually in place for 6-9 months after the surgery depending on the extent of the tear and the patient’s progress with physical therapy.

With all that being said, where does it leave us with regards to Bennett and his shoulder? I obviously haven’t seen his MRIs, but it seems to me that he has either a full-thickness tear or a very symptomatic partial-thickness tear if surgery was even being contemplated. Despite that, if he is able to play through the pain and have a functional arm for football activities, even with a full thickness tear, he could play for the rest of the season. He will need a lot of time in the training room and may even need a cortisone injection at some point, but I would not be at all surprised to see him play the rest of the season for the Patriots and have surgery after the season. The mere fact that he is a carbon-based life form with opposable thumbs makes him a better bet than Dwayne Allen to contribute in the passing game for the Patriots, so the bar has been set pretty low for him. At the end of the day, it will come down to pain tolerance and functionality for Bennett with regards to his shoulder – given what he’s played through in the past, I wouldn’t bet against him.

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