More news is dumped on each NFL fanbase just days before the 2019 NFL Draft. The latest news is Michigan DT Rashan Gary and his now revealed torn labrum. Ian Rapoport of the NFL Network reported that teams have been taking a closer look at his shoulder and are determining whether he could play through this upcoming season before eventually requiring surgery. Gary is projected to be a high first-round draft pick, but with concerns like this, there is worry that he may have issues in the future, potentially harming his development during his transition to the NFL. Today’s article will outline what the labrum is and, why this issue will affect Gary both in his play and in his draft stock.

Credit: http://gomidwestsports.com/surgical-procedures/labral-tear/

The labrum is a fibrous layer of tissue in the shoulder that deepens the socket in which the head of the humerus articulates with the glenoid fossa of the scapula. This allows for stabilization to the shoulder joint and prevents the joint from separating during movement. Other structures, including ligaments, muscles such as the rotator cuff, and connective tissue, allow for additional support. Finally, the long head of the biceps tendon feeds into the glenoid and serves as an attachment on which the biceps contract. All of these structures together help make up the shoulder joint and maintain stability through motion.

Credit: moveforwardpt.com

The labrum can be injured by a variety of mechanisms due to the structure of the shoulder. As with other joints, with increased mobility comes decreased stability. A shoulder can dislocate via a direct blow to the front of the shoulder or fall on an outstretched hand, also known as FOOSH, which can cause a posterior dislocation. In cases of anterior dislocation, an extreme distraction to the area such as sudden pulling or placing the shoulder in extreme end ranges in external rotation and abduction are possible mechanisms. To picture this movement, envision the cocked-back position of the arm when throwing an object.

About 97% of shoulder dislocations occur anteriorly, according to the literature. The remaining 3% are classified as posterior. It is unknown which way Rashan dislocated his, but probability suggests the former. When a dislocation occurs, the joint surfaces that articulate with each other become dislodged and remain separated until they are re-articulated manually. There are also instances where the joint partially dislocates and relocates by itself, which is defined as subluxation. In either instance, this creates damage and further instability, leading to the possibility of future complications.

Upon dislocating, there is a concern for damage to the nerves, blood vessels, and muscles surrounding the area. The head of the humerus could acutely pinch one of those structures, such as a blood vessel, and lead to tissue death due to lack of blood flow if not addressed immediately. Chronic dislocation could damage the brachial plexus, which is a bundle of nerves that passes through the shoulder, which affects all of the muscles required for movement in the shoulder, elbow, and hand. Damage to this area could cause weakness, loss of function, or paralysis to the arm. Once x-rays are taken and corresponding symptoms are assessed to identify any possible complications, the joint may be reduced and stabilized.

As a result of the shoulder dislocating, there is tearing of the labrum. There are various types of tears, including SLAP tears or Bankart lesions and Hill-Sachs lesions, but not knowing the mechanism of injury prevents us from identifying specifically what Gary is dealing with. The most significant information that we have to go on is what his mother stated back in October. She had stated he injured his shoulder prior to the Notre Dame game, which was the season opener. This also indicates that there is likely no video of the original injury.

Following the timeline she gives, Gary at some point significantly re-injured the shoulder during the win over Northwestern before missing three games over the next four weeks. Prior to that, he was unable to finish games against Nebraska and Northwestern. In addition, he also missed the bowl game against Florida to prepare for the NFL Draft. Looking at video and pictures from this past season, it did not appear that Gary wore a shoulder harness to help keep the shoulder in place and prevent further injury. During his time away from the team, he most likely performed rehab to improve the strength in his shoulder, which would improve stability and allow for healing. Reports are stating that he should be able to play through the season and wear a harness to protect the shoulder, deferring surgery until after the NFL season.

Credit: http://www.shouldersandknees.com/labrum-tear.html

It is possible to surgically repair the area if it tears multiple times due to dislocations. However, repeated tears to the labrum have been described to me as trying to sew water together by an orthopedic surgeon, as there becomes less and less tissue available to repair and anchor down to the socket. Chronic tears could lead to bone loss, which would require a bone graft and likely longer recovery time. Following surgery to anchor the labrum back to the socket, immobilization in a sling allows the tissue to begin healing. This is typically the first step for 4-6 weeks, with a focus on range of motion followed by strengthening of the area when cleared. Once the full active range of motion is restored, dynamic stability and strengthening with return to function begins with an overall recovery timeline of a 6-9 month period.

Regarding Rashan Gary’s decision to play his rookie season with this injury, I see two sides. Gary knows he’s a first-round talent, even with the labral tear. While I do not know the specifics of who would cover the surgery if he were to have it now, I would assume his parents’ insurance would pick up the surgery and rehab, which would likely be a large financial commitment with no guarantees from an NFL club of being drafted. If he gets through an NFL season, then he’s the property of an NFL club and his job will be to rehabilitate once he has surgery.

If he got the surgery before the draft, he would have missed the Combine and in turn would have probably dropped his draft stock, similar to what DT Jeffery Simmons is forced to go through with his ACL. His decision is a financial one, and while it does make sense, I question whether it will benefit him in the long run. Considering he had a down year statistically, missing several games as a result of the injury, it is not expected that he will get through the season healthy.

Playing during his rookie year, he will deal with repeated subluxations/dislocations like Bills CB Taron Johnson and Bears WR Anthony Miller dealt with during the 2018 season. Both were highly productive in their rookie years despite the injuries, but they were limited and missed time in either full games or series in games. Even when Gary is able to come back to play during the season, he will further injure his shoulder with every hit and tackle, wearing down the labrum and potentially putting him at risk for further damage to the shoulder as a whole. Teams are aware of the shoulder and know what they’re drafting, but one must wonder, who wants to take damaged goods?

The Bills already dealt with this in 2016 with the drafting of DE Shaq Lawson. He required surgery shortly after participating in offseason workouts, which cost him the first six games of the season and led to an overall disappointing rookie year. Even now, he still hasn’t lived up to his draft status, but that may be more a reflection of him as a player than his shoulder ailment. Strong parallels can be made between Gary, someone who showed great promise in college but never quite lived up to the hype coming out of high school, and Lawson.

Similar to what DE Montez Sweat is dealing with regarding his heart, this recent news was most likely leaked to create more drama for the draft and to facilitate a possible drop on draft night. Teams know what he can do with his shoulder and whether he is worth the risk. A GM drafting him must have a strong gameplan in place and a good surgeon ready to operate, an excellent training staff to keep him going during the season and rehabilitate after the surgery, and confidence in his job security, knowing that he can invest draft capital on a player destined for surgery. Former Bills GM Doug Whaley tried this approach with Lawson, and it did not end well for him.

Rashan Gary will be drafted, most likely in the first round, but I do not expect his rookie season to be a productive one. His best bet was to repair his shoulder prior to the draft in order to go into the NFL as healthy as possible. However, considering the financial ramifications if he did, I don’t think anyone could fault him for doing what he is doing now by putting it off.

Thank you to Cover 1 for allowing me to provide injury analysis on upcoming draft prospects prior to the draft. If you like what you read, make sure to follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, on Reddit at u/BangedUpBills, and online at www.bangedupbills.com. Thank you for reading and GO BILLS!