Playoff Injury Update: Ben Roethlisberger

I’ve had some questions this week about Ben Roethlisberger’s radio show comments that his throwing shoulder has a sprained AC joint and ‘torn ligaments.’ The question is whether or not his shoulder (the ball and socket glenohumeral joint) has ligament damage in addition to his AC joint injury.

While I obviously haven’t spoken to Roethlisberger, examined him or seen his imaging studies, I believe that the answer is a firm “no,” and that he’s just confused about what his physicians told him. I think I’m on firm ground if I assert that Roethlisberger is no MD or PhD in human anatomy.

The term “sprain” refers to ligament damage. The traditional grading system is: Grade 1 = true “sprain,” with no structural damage. Grade 2 = partial tear. Grade 3 = complete tear. It’s the same grading system for “strains,” which refers to muscle-tendon damage, such as a hamstring strain.

Injuries to the AC joint (note that we’re using a different grading system) are: Grade 1 = no significant structural damage. Grade 2 = The AC joint is subluxed (partially dislocated) because the AC ligaments (between the acromion and the clavicle, noted in the diagram as ‘superior acromioclavicular L (for ligament) are torn. However, the more important coracoclavicular (CC) ligaments (noted on the diagram as coracoclavicular L) are still intact. Grade 3 = The AC joint is dislocated, because both the AC and CC ligaments are torn. Grade 4, 5, and 6 injuries are rare and need not be discussed here.

There is no way that Roethlisberger tore the ligaments of his ‘shoulder proper’ (glenohumeral joint), which would have meant that he dislocated his shoulder, and then returned to play. On the diagram these are referred to as ‘Capsular ligament.’

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So his physicians probably told him, ‘You tore a ligament’ in your shoulder, and he got a little confused. It’s probably just a matter of terminology/ semantics. The ‘torn ligaments’ in his shoulder are almost assuredly those about his AC joint, meaning that he probably has a simple grade 2 AC joint subluxation. A grade 3 AC joint dislocation would have been much tougher to have returned to play with.

His physicians and trainers will manage Roethlisberger this week with rest, ice and anti-inflammatories and give him a numbing injection into his AC joint before this weekend’s game. Roethlisberger has demonstrated a very high level of pain tolerance in the past, and I think he’ll play this weekend. He won’t be at 100 percent, and I think his ability to throw for distance accurately will be compromised, but I think he’ll play.