J. D. Drew has a reputation for being a wimp but an acromioclavicular joint sprain is not a walk in the park and the fact that he could play through such an injury (even with cortisone shots) is impressive--not very smart but still impressive.
The scapula is very much a three dimensional bone and, as such, is difficult to describe; there's a sort of crook (the coracoid process) that goes all the way toward the front of the body and can be felt as a bony bump just under the clavicle and there's the scapular spine that sticks out in the other direction (away from the body) and extends above and beyond the flat part of the scapula.
But the scapula as Africa is a good visual, as it's shaped sort of like Africa. On the left scapula, the glenoid fossa (the socket part of the ball-and-socket joint) would be near Morocco. If you started digging in northern Mali, then you'd be the right area for the coracoid process. But the main feature that we're concerned about is the scapular spine. If it was an African mountain range, then it would start in the Sudan and cut across the continent in a northwesterly direction. At the end of the spine, the bone sort of flattens out and forms a roof above the glenoid process. That section of bone is called the acromion process. The bone you can feel on the back of you shoulder is the acromion process.
The humerus is connected to the rest of the body at the glenoid fossa of the scapula. The scapula's attachment point to the rest of the body is at the clavicle or the acromioclavicular joint (AC joint). It's the scapula's only point of articulation. In the anatomical map, the Middle East doesn't exist.
The shoulder joint is flimsy. Between the two bones (the acromion process and the clavicle) there is a cartilaginous disc. The bones are held in place by the muscular structure--the anterior deltoid in the front and the trapezius muscle in the back--and by ligaments strapping the thing together. The important ligaments (for our purposes) are the acromioclavicular ligament (which connects the acromion process and the clavicle) and the coracoclavicular ligament (which attaches the clavicle to the coracoid process). They form a sort of triangle that stabilizes the joint. But it's not a perfect system and it's relatively easy (through direct impact on the shoulder usually by falling) to irritate the ligaments.
A sprain to the AC joint could be as simple as a stretched acromioclavicular ligament (Grade I) to completely tearing that ligament and the coracoclavicular ligament (Grade III)--this injury leaves the scapula (and, therefore, the humerus) unattached to the main skeleton. (There are three more severe grades of injury but they have to do with how far out of place the clavicle ends up.)
JD sprained his AC joint at the beginning of last season. Because they treated it with a cortisone shot (to reduce the swelling) and a couple of days off, one can assume that it wasn't a severe strain. The pain didn't go away and he got another cortisone shot in September. Obviously, the pain still hasn't gone away as he had surgery on the shoulder last Thursday.
Because AC joint surgery is major surgery (it involves either cutting off the end of the clavicle or, alternately, screwing it in place) and no one seems to think that this is a big deal, chances are this surgery was more of a cleaning than a fixing. Occasionally, patients with Grade II injuries (the acromioclavicular ligament ruptures but the coracoclavicular ligament is only sprained) will experience fraying and tearing of the cartilage between the acromion process and the clavicle. And it develops into an impingement. So they go in arthroscopically and smooth it out the best they can. Recovery from the procedure is maybe eight weeks.
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