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A Closer Look at the Bernard Injury

With Mike Riley's announcement that Yvenson Bernard "sprained" his shoulder, we'll take a closer look at the injury. Extra special thanks to Conquest Chronicles for the advice and information that made this post possible. We'll do this more often from now on.

Shoulder sprains can be a tricky injury. Without an x-ray or MRI it is hard to tell what the grade of injury is from Grades I through III. Grades IV through VI are fairly easy to spot because of the deformity to the shoulder that appears after the injury. Here is a great write up on the AC Joint from the Southern California Orthopedic Institute (SCOI).

AC Joint
What is the AC Joint in the shoulder?

The top of the wing bone or scapula is the acromion. The joint formed where the acromion connects to the collar bone or clavicle is the AC joint. Usually there is a protuberance or bump in this area, which can be quite large in some people normally. This joint, like most joints in the body, has a cartilage disk or meniscus inside and the ends of the bones are covered with cartilage. The joint is held together by a capsule, and the clavicle is held in the proper position by two heavy ligaments called coracoclavicular ligaments.

How is the AC Joint usually injured?

The AC joint is injured most often when one falls directly on the point of the shoulder. The trauma will separate the acromion away from the clavicle, causing a sprain or a true AC joint dislocation. In a mild injury, the ligaments which support the AC joint are simply stretched (Grade I), but with more severe injury, the ligaments can partially tear (Grade II) or completely tear (Grade III). In the most severe injury, the end of the clavicle protrudes beneath the skin and is visible as a prominent bump.

What is the proper treatment for a sprained AC Joint?

When a joint is first sprained, conservative treatment is certainly the best. Applying ice directly to the point of the shoulder is helpful to inhibit swelling and relieve pain. The arm can be supported with a sling which also relieves some of the weight from the shoulder. Gentle motion of the arm can be allowed to prevent stiffness, and exercise putty is very helpful to improve function of the elbow, wrist, and hand, but any attempts at vigorous shoulder mobilization early on will probably lead to more swelling and pain.

How long does it take for a shoulder separation to heal?

Depending on how severe the injury is, it may heal adequately in two to three weeks. In severe cases, the shoulder may not heal without surgery.

Grade I Sprain

Grade II Sprain
According to coach Riley's description of the injury and the pain that Yvenson says he's experiencing, its' probably a Grade II sprain. It's the Grade III sprain that really reduces mobility, so we know the injury is not that severe. I think it's safe to say that Grade IV, V, and VI are out of the picture unless YB hurts his shoulder even more. However, you can still find a description of these grades below.

However, I haven't seen an official report that said Yvenson's injury was a Grade II shoulder sprain. That is just my best guess at this point from the description, and I am in no way claiming ot know the extent of the injury.

According to some information Jim at Conquest Chronicles got from a surgeon, the training staff can administer 30-60 mg of Torodol intramuscularly before the game. Jim has some other notes on the use of Torodol: "This is done pretty frequently I hear and it has some great effects. Guys play with pain all the time and from what I have heard this medication does wonders. It is also used in Hip and Knee replacement procedures to deal with pain post operatively. So this has a pretty good track record."

By definition a Grade III is defined this way: Emphasis Added

Grade III Sprain
Acromioclavicular ligaments and capsule (Which covers and protects the shoulder joint) are disrupted. Coracoclavicular ligaments are disrupted. Acromioclavicular joint dislocation with clavicle displaced superiorly(towards the head) and a complete loss of contact between clavicle and acromion.

Management of the Injury:

Type III injuries are usually evaluated on a case-by-case basis, taking into account hand dominance, occupation, heavy labor, position/sport requirements, scapulothoracic dysfunction, and the risk for reinjury.

Evidence supporting nonoperative treatment of type III AC dislocations has been provided by a meta-analysis.121 In a review of 1172 patients, 88% who were operatively treated and 87% who were nonoperatively treated had satisfactory outcomes. Complications included the need for further surgery (59% operative versus 6% nonoperative), infection (6% vs 1%), and deformity (3% vs 37%). Pain and range of motion were not significantly affected. The authors did not recommend surgery for type III AC joint injuries.

Another study showed that non-operative treatment leads to a 20% rate of suboptimal outcome and 17% decrease in bench press strength at one year, but 80% of people do not feel that it affects them[Schlegel et al]. Larson and Hede prospectively compared nonoperative and operative treatment with similar rates of persistent symptoms (8% in the operative group vs 10% in the nonoperative group).

Grades IV, V, VI

While not common these injuries require surgical intervention.

The procedure is a Modified Weaver-Dunn procedure.

A complete AC joint dislocation that is still painful after about 6 months is usually an indication for stabilization of the joint. However, some acute dislocations that are very displaced are stabilized soon after the injury. The most widely performed procedure, with the best results has been the Weaver-Dunn procedure and modifications of this.

The procedure involves 3 main steps:

1. Removal of about 1cm of the end of the collarbone, as this is deformed and diseased.

2. Transfer of the coraco-acromial ligament to hold the collarbone down to the shoulder blade.

3. Reinforcement of the transfer with a suture or screw.

The aims are to stabilize and reduce the dislocation.

This is usually performed by open surgery, but can be performed through keyhole surgery (Arthroscopy).

Left to right: Grade IV, Grade V, Grade VI

Summaries and Illustrations Taken From: The Shoulder Doc UK

Again, thanks to Conquest Chronicles for help with this post.

We wish #26 a speedy and safe recovery.