Why Boyd Cordner should get shoulder surgery immediately — a run down of AC injuries and the risk he’ll take by playing

Dealing with an AC joint complaint. Photo credit Daily Telegraph

BC: Dealing with an AC joint complaint. Photo credit Daily Telegraph

Boyd Cordner is 20. He has been described as a cornerstone and a 10-year player by Roosters officials. He has a long career ahead of him.

He’s been through knee reconstructions and broken jaws. He loves the club and is desperate not only to establish himself in first grade but to play for the club he loves.

He is a future captain of the Sydney Roosters. I have no doubt about that.

And he should get surgery on that injured shoulder immediately, even if it rules him out for three months.

Cordner injured the shoulder in the Foundation Cup trial match against the Wests Tigers. According to Trent Robinson following that game: “He got an AC joint knock … It’s not a ligament and I am hoping he will play (against the Rabbitohs in round one). He is preparing to play.”

He was named on an extended bench after coming off and being placed in a sling, before dropping off mid-week and missing the game.

I wrote an article citing a source that said doctors were leaning towards him getting immediate surgery: surgery they initially thought they could hold off on until the end of the season.

He was named again in the squad for the round two clash against the Warriors, again on an extended bench and again in the number 18 Jersey.

I suspect the injury will again rule him out of this clash, which means the shoulder is still not right.

Playing with an AC sprain, if not fully healed, is a gamble. And I’m about to detail why — like the Wu-Tang Clan — shoulder injuries ain’t nuttin’ ta fuck wit. Especially in rugby league.

According to PhysioAdvisor.com.au:

An AC joint sprain is a relatively common sporting injury affecting the shoulder and is characterized by tearing of the connective tissue and ligaments of the Acromio-Clavicular (AC) joint.

The AC joint is responsible for connecting the shoulder blade with the clavicle and allows for some shoulder movement. During certain activities, stretching forces are placed on the AC joint. When these forces are excessive and beyond what the AC joint can withstand, tearing of the ligaments and connective tissue of the AC joint may occur. This condition is known as an AC joint sprain.

An AC joint sprain can range from a small sprain resulting in minimal pain and allowing ongoing activity, to a severe sprain resulting in significant pain, deformity and disability.

I’m assuming Boyd has an AC sprain. So the diagnosis, at the very least, must have been that the sprain was small, “allowing ongoing activity”. Fine in low contact, non-wrestling sports such as basketball I’m sure.

But rugby league? That’s another story.

From PhysioAdvisor again:

With appropriate management, most patients with a minor to moderate AC joint sprain can return to sport or normal activity within 2 – 8 weeks. Patients with severe AC joint injuries will usually require a longer period of rehabilitation to gain optimum function.

Now, Boyd Cordner has been spotted lifting weights at training this week. Here’s the image:

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However, notice the yellow bib in the below image, also from this week’s training?

00065615-Photo

That’s the non-contact training bib, meaning Boyd has been restricted to weights training.  So while you are able to lift heavy weights, you are restricting your movements to predictable motions. Up, down. Up, down.

According to Uptodate.com:

urlType II injuries usually cause greater pain and swelling than type I injuries. Initial treatment may include rest, ice, pain medication, and three to seven days of shoulder immobilization in a sling. Range-of-motion exercises can be started when tolerable.

Let’s assume Boyd Cordner has at the very minimum a Type II injury as he was immediately placed in a sling following the Tigers match, and was ruled out for the round one clash. Referring back to Uptodate.com:

After a type II AC injury, most people are able to return to full activities when full range of motion and strength are regained, usually after 2 to 4 weeks. Complete healing generally requires several more weeks.

If ruled out of the Warriors game, he’ll be sidelined for a total of two weeks in the highest of contact sports in the world this side of dodgeball.

If he comes back the next week, he won’t be 100 per cent, with the above websites claiming a type two injury requires “several more weeks” to “eight weeks” of healing before your AC joint is back to 100 per cent.

urlBut, consider again that the Roosters are thinking about putting him in for surgery, which is usually classified as a class III through VI injury. According to Web MD:

Treatment for type III injuries is controversial. Some doctors treat them with a sling and physical therapy, while others feel surgery may be needed.

Type IV through VI injuries should be evaluated for possible surgery.

A Type IV injury:

…may involve tearing of the muscle that covers the upper arm and shoulder joint (deltoid muscle) and the one that extends from the back of the head, neck, and upper back across the back of the shoulder (trapezius muscle).

I think it’s safe to up Boyd’s diagnosis to, at least, a Type III sprain; doctors must have classified it as a Type III injury as they’re considering surgery at the end of the season.

We can also assume this because, according to sportsmedicine.about.com:

There is some controversy among surgeons as to whether to use conservative treatments or surgery for a type III shoulder separation. Most patients with type III shoulder separations heal well with conservative treatment and return to sports faster than patients who have surgery. In addition, they avoid any risks of surgery. However, some patients may benefit from a surgical procedure. Those patients who are involved in heavy labor or play sports that require frequent overhead motions, such as tennis or baseball, may benefit more from surgical intervention due to the intensity of their activity.

But players play injured all the time, right? Remember Scott Sattler playing with a broken jaw in the Grand Final?

Sure, players play injured all the time. But playing on this injury is risky at the best of times. And where that risk becomes greater is purely in the high-contact environment of rugby league.

Again, from PhysioAdvisor:

An AC joint sprain typically occurs due to a specific incident such as a direct blow to the point of the shoulder. This commonly occurs in contact sports due to a collision with another player or following a fall onto the point of the shoulder.

Where it gets even riskier is when, according to Sports Injury Bulletin:

 (Following surgery on a Type VI injury) the arm is supported in a sling for up to 6 weeks. After the first 2 weeks, the patient is allowed to use the arm for daily activities at waist level. After 6 weeks, the sling or orthosis is discontinued, overhead activities are allowed, formal passive stretching is instituted, and light stretching with elastic straps is started. Stretching and strengthening are progressed gradually. The athlete should not return to sport without restriction until full strength and range of motion have been recovered. This usually occurs 4 to 6 months after surgery.

So by playing he is risking a season-ending surgery and recovery by causing further damage to the AC joint, elevating it beyond that Type III sprain.

You know what can cause a type III injury to become a Type IV to Type VI injury? A simple knock to the AC joint itself. According to Sports Injury Bulletin, this can be caused by:

Direct force: This is when the athlete falls on to the point of the shoulder, with the arm usually at the side and adducted. The force drives the acromion downwards and medially. Nielsen(5) found that 70% of acromioclavicular joint injuries are the result of a direct injury.

Indirect force: This is when the athlete falls onto an outstretched arm. The force is transmitted through the humeral head to the acromion, therefore the acromioclavicular ligament is disrupted and the coracoclavicular ligament is stretched.

..or what we call in rugby league, a tackle.

And according to Physioroom.com:

(Type IV to VI AC Sprains) account for more than 10-15% of total acromioclavicular dislocations and should be managed surgically. Failure to reduce and fix these will lead to chronic pain and dysfunction.

Because of the traumatic nature of Shoulder Separation injuries there is not a lot than can be done to prevent them.

Kurt Gidley tried to play through a shoulder injury last season. He took a risk and it backfired, leading to him being ruled out for the season. If given that time over, i’m sure — if the option was there — he’d select surgery and a  three month recovery.

Get the surgery Boyd. You’re far too young and far too important to the Roosters. Not just this year, but for your career.

We need you this year, but we need you for the next decade as well.

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3 responses to “Why Boyd Cordner should get shoulder surgery immediately — a run down of AC injuries and the risk he’ll take by playing

  1. Pingback: ROUND TWO PREVIEW: New Zealand Warriors versus Sydney Roosters | 26 Rounds·

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  3. Pingback: Cordner backed for Origin, but is he good — or old, or healthy — enough? | 26 Rounds·

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