It's not the mostly timely of subjects, but I've been meaning to share some information about shoulder separations. I'm not a doctor, so hopefully the more medically inclined citizens out there can help clarify anything I misstate or explain poorly. I did have a chance to speak to a shoulder specialist recently, and he certainly helped clarify things for me. With Chris Paul likely to miss about another five weeks with his separated shoulder, this remains a vitally important subject in Clips Nation.
First and foremost, a separation is NOT the same thing as a dislocation. When Detective Riggs wins a bet by escaping from a straight jacket in Lethal Weapon 2, he is dislocating his shoulder, which involves the humerous (upper arm) becoming dislodged from the scapula (shoulder blade) at the glenohumeral joint -- the primary shoulder joint.
A separated shoulder occurs at the acromioclavicular (AC) joint. The AC joint attaches the scapula (shoulder blade) to the clavicle (collar bone).
As we were awaiting Paul's MRI results, we began hearing about the different levels of severity possible with a separated shoulder: a Type I separation is the least severe and is often called a sprained shoulder, Type II is more severe, etc. After having an MRI and consulting with a shoulder specialist, Paul was diagnosed with a Type III separation, which would not require surgery. So we breathed a sigh of relief because it could have been worse.
Wikipedia defines a Type III shoulder separation as follows:
In a Type III AC separation both acromioclavicular and coracoclavicular ligaments are torn without significant disruption of the deltoid or trapezial fascia. A significant bump, resulting in some shoulder deformity, is formed by the lateral end of the clavicle. This bump, caused by the clavicle's dislocation, is permanent. The clavicle can be moved in and out of place on the shoulder. A radiographic examination, will show the results as abnormal. Pain with motion can be severe.
Wait, what? The ligaments are torn? That sounds bad, right? Wouldn't this injury require surgery to repair the ligaments? Clearly there was something I wasn't understanding, so I turned to an expert.
Dr. Bradford Parsons is an orthopaedic surgeon and shoulder specialist and the Residency Program Director at the Icahn School of Medicine at Mount Sinai in New York City. Dr. Parsons has been recognized as one of "The Nation's Top Doctors" by New York Magazine. He has been interviewed extensively in national and local print, TV and radio outlets on professional athletes and their injuries. Dr. Parsons was nice enough to speak to me on the phone to help me understand the situation better. It's important to note that Dr. Parsons has not examined Chris Paul and has no direct knowledge of Paul's specific injury. He does know all there is to know about shoulders however, and was able to share his expertise on these types of injuries in general.
The most important concept that Dr. Parsons was able to convey to me is that a shoulder separation is exactly that -- the shoulder is displaced some amount, and the amount is more or less what the various type classifications are describing: Type I displaced a little, Type II a little more, Type III a little more, etc.
Type III is where doctors would typically begin debating rest versus surgery. The fact that the doctors in Paul's case opted against surgery indicates that the muscles around the AC joint and the fascia surrounding those muscles are most likely still in tact (that's the "without significant disruption of the deltoid or trapezial fascia" from the Wikipedia definition). So by stabilizing the joint, the body begins to heal with the shoulder in its new, slightly different location. There will be scar tissue that forms around the wound that will serve to stabilize it, and with proper healing and therapy, Paul should have the full function of his shoulder.
If he were a quarterback or a pitcher, creating more stresses on the shoulder than shooting jump shots, he might have required surgery. Fortunately the Clippers have Matt Barnes to throw the length of the court baseball passes.
Paul's not out of the woods yet though. You'll recall that Elton Brand likewise opted for rest when he separated his shoulder a few years back with the Sixers, but when he tried to return discovered that he needed surgery and was lost for the season. Pain and range of motion are two of the potential issues that could keep Paul sidelined longer than the estimated six weeks, or eventually require surgery. Once Paul's shoulder has stabilized some, they'll begin a therapy program to re-build strength and maintain range of motion. We're just going to have to wait and see how successful the rehab is.
Thanks to Dr. Parsons for sharing his expertise. The bottom line is exactly the same as ever: Paul will be out for six weeks, give or take -- he would have been out much longer had it required surgery, simply for the healing process from an invasive procedure. There's no guarantee that he won't require the surgery in the end, but the specialists in this case opted against it, and they know their business.
All we can do is wait. But at least we know a little bit more about why at this point.