Plaxico Burress' Torn Rotator Cuff: Could It Really End His Career?

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Plaxico Burress' Torn Rotator Cuff: Could It Really End His Career?

According to Adam Schefter of ESPN, Plaxico Burress joined a long list of big-name injuries last week after he suffered a torn rotator cuff in practice Thursday. On Monday, Schefter tweeted that Burress underwent season-ending surgery to repair the tear.

Soon after the injury, Fox Sports' Mike Garafolo reported that the injury could mean the end of the line for Burress, mentioning that the wide receiver had said "this season would be his last no matter what happened on the field."

Whether or not that comes to pass remains to be seen, but a torn rotator cuff certainly doesn't help. A closer look at the anatomy of the shoulder explains why the injury could end up closing the book on a long but often troubled career.

The "rotator cuff" is actually a group of four muscles—the supraspinatus, infraspinatus, teres minor and subscapularis—responsible for many of the movements of the arm. They also help stabilize the shoulder joint itself.

To perform their jobs, rotator cuff muscles attach the scapula—or shoulder blade—to the humerus, or upper arm bone. Each muscle has its own individual function, but in a general sense, they work in tandem to rotate the arm inward, outward and upward.

The above diagram shows the bony anatomy of the shoulder as it relates to the rotator cuff. Photo from Wikimedia Commons and edited by the author.

Like many sports-related injuries, rotator cuff tears occur when players sustain direct trauma—in this case to the shoulder. Often, tears occur following a fall onto an outstretched arm.

By reading between the lines, it seems that's exactly what happened to the Pittsburgh Steelers wideout.

Garafolo reports that Burress attempted to catch a pass over Da'Mon Cromartie-Smith, resulting in an awkward fall—presumably onto his right arm or shoulder.

Just as an ill-timed tackle can over-stretch or tear a knee ligament, falling onto an arm or shoulder can stretch or rupture one or more rotator cuff tendons. Without an intact tendon, a muscle cannot pull on its target bone.

The above digram shows the supraspinatus muscle. The red area represents the muscle body, and the white strip represents the tendon. The bone on the left is the humerus, and the bone on the right is the scapula. Photo from Wikimedia Commons.

For a clearer example, let's look at one of most frequently injured rotator cuff muscles—the supraspinatus.

The supraspinatus connects the shoulder blade to the greater tuberosity of the humerus—or the upper and outer-most portion. To do so, it originates from the top of the scapula, runs up and over the top of the shoulder and finally attaches to the humerus itself.

When the supraspinatus contracts, it pulls on its attachment point—the greater tuberosity—back in the direction of its origination—the scapula. The result? Lifting of the arm upward and out to the side of the body.

If the supraspinatus tendon is partially torn, raising the arm to the side is possible but also painful and weaker than normal. If it's completely torn, the motion is impossible. Either case makes functioning as a wide receiver in the NFL impossible.

Unfortunately, rotator cuff repair surgery is no walk in the park, and rehab can prove even more difficult.

This video shows a simulated arthroscopic repair of a rotator cuff tear.

Surgical repair of a rotator cuff tear involves reattaching the torn tendon or tendons to their proper place on the humerus. Surgeons can do so arthroscopically—by using cameras and small tools inserted into the joint through tiny incisions—by completely opening the joint or by using a method resembling a hybrid of the arthroscopic and open techniques.

Recovery time from surgery depends on the extent of damage as well as the presence of any other associated injuries—sprains or fractures, for example.

However, a safe estimate for a completely torn tendon is four to six months, and in the case of the 36-year-old Burress, nothing is a guarantee.

Though exact details are unavailable to the public, if Burress' injury was indeed "significant" as Garafolo reports, a full tear—and possibly other damage—seems likely. Then again, even a partial tear could necessitate surgery, as NFL players must maintain peak physical condition in order to remain effective.

What's more, even with the best doctors practicing the best medicine—which is surely the case with the care Burress will receive—persistent shoulder stiffness, re-injury and other complications are possible.

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Nevertheless, surgery provides Burress with the best possible chance to return to the field, and a rotator cuff tear isn't necessarily career-ending in and of itself.

That said, the length of time required for proper rehab—coupled with the wideout's age and previous statement that this year would be his last even without the injury—suggests the possibility that the NFL may not see him on the field ever again is a very real one.

Dr. Dave is a resident physician at the University of Washington with plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine. Medical information discussed above is based on his own knowledge.

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