Monday, August 13, 2012
In NFL training camps and preseason games, the goal for the veteran starters is to survive without getting injured. For those who get hurt, the goal is to be able to return to play when the games actually matter, but making the healing process hurry up may be a challenge that even a pro athlete can’t overcome. While San Diego running back Ryan Mathews believes that he can be on the field after having surgery to repair a broken collarbone, it may require a definite leap of faith.
For all the elegance that is the anatomy of the human body, the collarbone or clavicle is less than well engineered. It’s an S shaped bone that connects the sternum or breastbone to the shoulder joint and acts as a strut so that the shoulder muscles can allow more range of motion and generate more power. The S curve is located in the middle third of the clavicle and is a weak spot that is at risk for breaking because of a fall onto a shoulder or outstretched hand. The bone isn’t very well padded either, lying just underneath the skin and making it prone to break from a direct blow like in car wrecks. Fortunately, clavicle fractures tend to be isolated injuries but the bone does protect the upper ribs, the upper part of the lung and the major blood vessels that supply the arm. Making the diagnosis is pretty easy but it’s important to make certain no disaster injury is lurking beneath the break.
Historically, most clavicle fractures have been treated by placing the arm in a sling and letting the bone heal on its own. Recently, the thinking has changed and for middle third clavicle fractures where the bones don’t align well, surgery may be a more appropriate option, especially for the active patient, like a football player. Canadian research compared patients who underwent an operation with those who were treated in a sling. Using x-rays, the operative group was completely healed in 16 weeks while the sling group took 28 weeks to get the same result. For that reason, the option to use screws and a plate to hold the bones together may allow faster and better healing.
Even though complete healing on x-ray takes four months, the bone becomes functionally better in 4- 6 weeks. Initial post op treatment protects the arm in a sling for a couple or three weeks, but during this time, physical therapy begins with muscle strengthening of the elbow and hand and passive range of motion begins for the shoulder. It’s always a balance between resting the shoulder to allow healing and moving it to maintain range of motion and prevent stiffness. Regardless, after two weeks, low impact training begins progressing to aggressive range of motion at 4 weeks as tolerated by the patient. The collarbone isn’t completely healed at 4 weeks but is structurally sound enough to withstand the stresses placed upon it by the surrounding muscles.
Unfortunately, there’s not much in the research literature that talks about running backs getting hit in the same spot by a helmet and while it may be that Mr. Mathews lines up at running back for the Chargers on opening day, it may be that his season may be delayed by one or two weeks. No matter much high tech doctors throw at a patient, there is still no rushing Mother Nature.
Dr. Wedro weighs in
“The difference between doctors who look after mere mortals and those who look after elite athletes may have to do with how many tests they can order, regardless of the cost.”