Indianapolis Colts fans and anyone else concerned about quarterback Andrew Luck should read this entire piece before panicking. Once you understand the facts about Luck’s shoulder injury, the lingering effects, and the realities of the situation, you’ll actually feel better.
The problem is that the Colts, like many teams, feel it’s better to hide information than respecting the fans enough to explain things. The Colts may be a little gun-shy; injury statistics kept by Football Outsiders have shown them to be one of the teams hurt the most over the last decade in terms of Adjusted Games Lost.
During a game against Tennessee in Week 3 last season, Luck suffered a subluxation of his throwing shoulder. A subluxation is like a dislocation “light” — the shoulder comes out of it’s normal, stable position with the head of the humerus inside the glenoid fossa. This video demonstrates a lax shoulder:
With the movement of the humeral head, the glenoid labrum is often stretched. The labrum is a small disc of cartilage that helps with stability. When stretched, it can tear or fray. If you think of fraying as a small tear, you’re not wrong. However, unlike a tear (or lesion in medical terms), a fraying is often asymptomatic. Apart from seeing it on an MRI, the player/patient has no deficits or pain.
I asked Dr. Luga Podesta, a top orthopedist who formerly consulted with the Los Angeles Angels and Dodgers, if this was a common issue. “There is a high likelihood of asymptomatic labral fraying in most professional throwing athletes and NFL quarterbacks are no exception.”
This is what occurred with Luck. He missed the next game against the Jacksonville Jaguars after doctors that the Colts consulted with advised rest, adding that no surgery was necessary. These same physicians saw new MRIs at the end of the season and again did not feel that Luck needed surgery. Instead, Luck rested and did an offseason strengthening program designed to stabilize the joint.
Luck’s rehab program was widely reported, such as this report by Bleacher Report’s Jason Cole. I can confirm that Cole nailed the details here. I can also report that while the Colts were concerned, they felt that the rehab went well enough that he passed a physical before signing his big contract extension.
However, Luck’s asymptomatic labrum fraying didn’t magically go away. Labrums simply don’t heal well, and in cases where there is a significant lesion, surgery is required. However, this surgery is almost always avoided unless absolutely necessary. In athletes who throw a ball, there is a terrible rate of success. It has been getting better. I wrote an article for Slate in 2004 where I showed that only one of 39 pitchers had returned successfully from surgery. That rate is approaching 50 percent as of a 2014 presentation.
Dr. Podesta says there is risk of things getting worse. “It is difficult to predict if a frayed labrum will worsen. It is dependent of the number of throws he has to make and the position of his arm when he makes those throws. Throwing mechanics, rotator cuff and scapular stabilizer muscle strength around the also play a significant role in preventing injury. Unfortunately, as an NFL quarterback, there is a significant inherent risk of shoulder injury or worsening of an minor asymptomatic shoulder anatomical abnormalit
To keep Luck’s shoulder as healthy as possible, the Colts have taken to limiting both his contact and his throwing work in practice. On Wednesday, the Colts listed Luck as limited, and it was widely noted that it was due to his throwing shoulder.
So here's Luck throwing at practice. Listed as limited by his right shoulder. Looks fine to me but what do I know. pic.twitter.com/zTf906yAZ2
— Tricia Whitaker (@TriciaWhitaker) September 7, 2016
Whitaker is right, but that’s where the confusion starts. Luck can have a shoulder issue and not be limited at all in games. The Colts are taking a conservative approach, and that’s one that’s likely been agreed upon by the medical and coaching staff, as well as Luck’s agent. Colts general manager Ryan Grigson, however, went on Indianapolis radio and denied there was any problem with Luck’s shoulder.
The worry for Luck and the Colts is not in the short term. Luck’s frayed labrum is not likely to get worse unless he overtaxes it, which should be helped by the “pitch count” that the Colts have instituted with him during practices, or unless he takes another big hit. That’s the bigger concern, especially given the injuries and preseason play of the Colts offensive line.
In the longer term, this is concerning, but can be easily monitored. Again, Luck is having no symptoms; no weakness, no pain, no range of motion issues. In the worst case, Luck could end up like Drew Brees or Mark Sanchez, but both had significantly more damage. Brees had rotator cuff damage in addition to a major labrum tear, but Dr. James Andrews (who consulted on Luck) put his shoulder back together and Brees has been pretty good since. This also isn’t a chronic instability, which is what Braxton Miller had while at Ohio State.
Luck will start in Week 1, and while he was limited in practice by plan, I do not expect he will have any deficits. A frayed labrum does not take away strength. A frayed labrum does not take away velocity. A frayed labrum does not take away touch. A frayed labrum does not take away accuracy.
A frayed labrum is simply a reality, something that the Colts and Luck will have to deal with over the course of not just this year, but the rest of his career. For Colts fans, they’ll just need to take a deep breath and re-read this article if they’re still worried.