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Dee Milliner's Torn Labrum: Does It Threaten His Draft Stock?

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Dee Milliner's Torn Labrum: Does It Threaten His Draft Stock?
Wesley Hitt/Getty Images

In February, ESPN's Adam Schefter reported Alabama cornerback Dee Milliner will require surgery to repair a torn labrum in his right shoulder, news that immediately led to questions about how the procedure would affect him at April's NFL draft. Milliner is scheduled to undergo the operation March 12, and he expects a full recovery following two months of rehabilitation (h/t Kareem Copeland, NFL.com).

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Former USC quarterback Matt Barkley is also a player whose first-round prospects may partly rely on his recovery from a shoulder injury. He suffered a shoulder separation in November.

According to Schefter, Milliner suffered the injury during the 2012 college football season. However, the injury did not force him to miss any time and he took part in all NFL Scouting Combine events—except for the bench press—despite the known injury (h/t official 2013 NFL Scouting Combine results).

In a draft season marked by numerous medical headlines—such as Matt Barkley's shoulder, Star Lotulelei's heart, Marcus Lattimore's knee and Jarvis Jones' spine—Milliner's injury probably represents the least risky of the bunch. Assuming all goes well, teams should feel safe keeping the former Crimson Tide defensive standout at his current draft position.

Though no specific medical details are available, the fact that Milliner played and worked out through the injury suggests the tear is minor, as does a projected two-month recovery.

So then why does he need surgery at all? To answer that question, it helps to look at the shoulder labrum more closely.

The above X-ray is of a normal, healthy shoulder. The humerus (upper arm bone), scapula (shoulder blade) and glenoid (shoulder socket) are labeled. Photo from Wikimedia Commons and labeled by the author.

A ring of cartilage that encircles the shoulder socket, the labrum helps stabilize the shoulder joint. It does so by increasing the amount of surface contact between the top of the humerus—the bone of the upper arm—and the shoulder socket, called the glenoid.

For a better picture, imagine a golf ball sitting on a tee. The golf ball represents the top of the humerus, and the curved surface of the tee represents the glenoid. Similar to how it is very easy to knock the golf ball off the tee, very little force is required to pull the humerus off the glenoid and cause a shoulder dislocation.

Continuing with the metaphor, the labrum is best represented by a circular, metal ring attached around the top of the tee. In that position, the ring extends outward and up from the tee, thereby helping the ball stay in place.

The above X-ray is of the same healthy shoulder. Here, the surface of the yellow "tee" represents the glenoid, the golf ball represents the head of the humerus and the blue curved line represents the added support of the labrum. Photo from Wikimedia Commons and edited by the author.

Just as a bent or deformed metal ring might make it easier for the golf ball to fall off, some types of labral tears can predispose to shoulder dislocations. Others can lead to decreased shoulder range of motion.

Exactly what symptoms a player has depends on the precise location, nature and severity of the labral tear. Injury types can range from "wear and tear" fraying of the cartilage ring to a break in the ring itself. After very serious shoulder trauma, the ring can even become completely separated from the glenoid—imagine forcefully pulling up on the metal ring and removing it from the tee.

Minor labral tears often produce no symptoms at all. In fact, in an experiment to assess the utility of MRIs, renowned orthopedic surgeon Dr. James Andrews found labrum damage in 90 percent of 31 entirely asymptomatic, pain-free baseball pitchers.

While Milliner is probably not asymptomatic—he likely feels mild pain with certain motions such as reaching overhead—neither he nor team physicians imposed any limits other than foregoing the combine bench press. In other words, his tear is likely on the minor end of the severity spectrum. A more serious tear—such as the aforementioned ring break or separation injuries—would likely have sent him to the sidelines during the season.

It is impossible to know the exact nature of Milliner's tear. However, he is far too young for a "wear and tear" injury. As such, speculation suggests he may have a small tear at the point where the labrum and biceps tendon meet—at about the 12 o'clock position on the labrum ring. This type of injury is known as a SLAP tear and can be due to overuse or sudden shoulder trauma.

This video shows the surgical technique used for one type of labrum repair. In the video, part of the labrum can be seen detached from the glenoid. To repair the injury, the detached portion is sewn back into place using sutures sewn through holes drilled in the bone.

Unfortunately, even minor tears can be at risk for further injury with repeated or prolonged use of the arm. Additionally, when compared to tissues such as skin and muscle bodies, cartilage, ligaments and tendons sport relatively low blood supplies, preventing efficient healing. In reality, many labral tears will never heal on their own.

Fortunately, surgical repair of a minor tear often allows for complete healing. Following surgery, the labrum will typically take about four to six weeks to fully reattach itself to the bone. After an additional four to six weeks, it will be back to full strength.

More significant tears, however—such as a partial or complete detachment of the labrum from the glenoid—can require between four to six months to heal following surgery. In the case of New York Yankees pitcher Michael Pineda, it took nine months before he returned to the pitcher's mound.

That almost certainly won't be the case with Milliner.

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Barring complications with the surgery or any discovery of more significant injury, Milliner's expectation of a two-month recovery before returning to action is reasonably realistic. That time frame would put him back in action by mid-May and leave plenty of time to prepare for the 2013 season.

How does this all affect Milliner's draft stock? Quite simply, it doesn't. There is nothing to hint that he won't quickly bounce back to full strength.

Bleacher Report's NFL draft lead writer Matt Miller remains confident about the defensive back's first-round prospects. Miller said, "Milliner is the unquestioned top CB in this year's class. He could be drafted anywhere between No. 2 and No. 6. A strong combine helped."

Medical details about the March 12 procedure should be available to teams well before the first draft day. Assuming there are no surprises, Milliner will likely become the most recent Alabama product to be taken in the first round.

 

Dave Siebert is a medical featured columnist for Bleacher Report who will graduate from medical school June 15. He plans to specialize in both Family Medicine and Primary Care (non-operative) Sports Medicine. Injury and anatomical information discussed above is based on his own knowledge, and quotes were obtained firsthand unless otherwise noted.

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