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Breaking Down Doug Martin's Shoulder Injury, Labrum Surgery and 2014 Prospects

TAMPA, FL -  AUGUST 29:  Running back Doug Martin #22 of the Tampa Bay Buccaneers warms up for play against the Washington Redskins August 29, 2013 at Raymond James Stadium in Tampa, Florida. (Photo by Al Messerschmidt/Getty Images)
Al Messerschmidt/Getty Images
Dave Siebert, M.D.Featured ColumnistApril 4, 2014

Last season, a shoulder injury—specifically, a torn labrum—cut short Tampa Bay Buccaneers running back Doug Martin's much anticipated sophomore campaign.

After suffering the tear in October, it remained unclear for over two weeks whether or not Martin would return in 2013. Nevertheless, early the next month, the then 0-8 Bucs placed their star on injured reserve, and he underwent surgery soon thereafter.

His post-operative rehab seemingly proceeded uneventfully, as four-and-a-half months later, Martin himself announced his medical clearance on Twitter, obviously eager to bounce back strong in 2014. Just as importantly, from a medical standpoint, there is no reason to think he can't do just that.

 

The Anatomy

The labrum is a ring of cartilage that encircles the rim of the glenoid—or shoulder socket. It deepens the socket, allowing the head of the humerus—or upper arm bone—to sit more snugly at the point where it meets the shoulder blade.

The shoulder marks the point where the humerus—or upper arm bone—meets the scapula, or shoulder blade. It does so by resting within the glenoid—or shoulder socket.
The shoulder marks the point where the humerus—or upper arm bone—meets the scapula, or shoulder blade. It does so by resting within the glenoid—or shoulder socket.Wikimedia Commons with edits by the author.

For a better picture, imagine a golf ball sitting on a tee. The golf ball represents the head of the humerus, and the tee represents the shoulder socket. A shoulder labrum widens and deepens the tee's surface, thereby making it more difficult to knock off the golf ball.

In the above diagram, the golf ball represents the head of the humerus, and the yellow tee represents the glenoid. The curved blue line symbolizes the added support of the labrum.
In the above diagram, the golf ball represents the head of the humerus, and the yellow tee represents the glenoid. The curved blue line symbolizes the added support of the labrum.Wikimedia Commons with edits by the author.

 

The Injury

Sudden trauma—such as, in Martin's case, landing directly onto the shoulder—can forcefully jam the humerus into or out of the glenoid. Sometimes, the labral ring tears in the process, and it can do so in a variety of different ways. Pain, inflammation, shoulder instability and decreased range of motion may then follow.

Unfortunately, cartilage does not heal well on its own, as it carries a poor blood supply compared to, for example, the quick-healing tissues inside the mouth. As a result, the body's repair cells cannot reach the injury site in large enough numbers to repair the damage. As such, surgery frequently becomes necessary to assist in the healing process.

 

The Surgery and Rehab

Often, a surgeon will insert a tiny camera into the shoulder to directly visualize the labrum and assess the extent of the damage. Then, he or she may use small tools to suture the cartilage ring back into place on the glenoid.

The exact type of repair depends on the nature and amount of labral damage within the joint.

Following surgery, a player must slowly work his way through steadily intensifying range-of-motion and strength exercises. Often—as in Martin's case—the progression takes multiple months but many athletes eventually regain full function.

 

The Prognosis

If Martin played quarterback or pitched in Major League Baseball, his 2014 outlook might be a tad murky. Repetitive overhead throwing can place significant stress on a healing shoulder and some throwing athletes can have extreme difficulties returning to pre-injury shape.

That said, at his position—and with an entire offseason's worth of team activities and training camp at which to return to regular-season form—it seems likely Martin will be able to hit the ground running, literally, come Week 1.

 

Dr. Dave Siebert is a resident physician at the University of Washington, who plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine.

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