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UPDATED: Washington's a Grade III Sprain

Updated with New Information below - Paragon

Tell me about our depth at running back again...

Chauncey Washington is likely to miss the season opener as reported by the LA Times this evening. This is a painful injury don't kid yourself, the article doesn't state what grade of sprain the injury is but I would suspect that it is probably a Grade 1 sprain based on Washington being out possibly two weeks. It doesn't take much to get this injury and from what I have heard from those who saw the video it wasn't a real big hit that caused the injury.

Our guys continue to play hard and this is bound to happen no matter how much we want to wish it away. It is the nature of the environment at USC.

Here is a great write up on the AC Joint from the Southern California Orthopedic Institute (SCOI).

AC Joint
What is the AC Joint in the shoulder?

The top of the wing bone or scapula is the acromion. The joint formed where the acromion connects to the collar bone or clavicle is the AC joint. Usually there is a protuberance or bump in this area, which can be quite large in some people normally. This joint, like most joints in the body, has a cartilage disk or meniscus inside and the ends of the bones are covered with cartilage. The joint is held together by a capsule, and the clavicle is held in the proper position by two heavy ligaments called coracoclavicular ligaments.

How is the AC Joint usually injured?

The AC joint is injured most often when one falls directly on the point of the shoulder. The trauma will separate the acromion away from the clavicle, causing a sprain or a true AC joint dislocation. In a mild injury, the ligaments which support the AC joint are simply stretched (Grade I), but with more severe injury, the ligaments can partially tear (Grade II) or completely tear (Grade III). In the most severe injury, the end of the clavicle protrudes beneath the skin and is visible as a prominent bump.

What is the proper treatment for a sprained AC Joint?

When a joint is first sprained, conservative treatment is certainly the best. Applying ice directly to the point of the shoulder is helpful to inhibit swelling and relieve pain. The arm can be supported with a sling which also relieves some of the weight from the shoulder. Gentle motion of the arm can be allowed to prevent stiffness, and exercise putty is very helpful to improve function of the elbow, wrist, and hand, but any attempts at vigorous shoulder mobilization early on will probably lead to more swelling and pain.

How long does it take for a shoulder separation to heal?

Depending on how severe the injury is, it may heal adequately in two to three weeks. In severe cases, the shoulder may not heal without surgery.

Grade I Sprain

Grade II Sprain
Now, I said earlier that I thought that Washington would play. I wouldn't rule that out just yet. The miracles of modern medicine will surprise you.

Based on some information that I got from a surgeon today it would not be out the question if the training staff administered 30-60 mg of Torodol intramuscularly before the game. This is done pretty frequently I hear and it has some great effects. Guys play with pain all the time and from what I have heard this medication does wonders. It is also used in Hip and Knee replacement procedures to deal with pain post operatively. So this has a pretty good track record.

I would understand if he DIDN'T play in the opener. It is Idaho after all and the point spread is pretty high so I wouldn't get too alarmed if he didn't play.

Update [2007-8-28 9:6:39 by Paragon SC]:

Dan Weber of the Press-Enterprise noted in his article today that Chauncey Washington’s shoulder sprain is Grade III in nature the would indicate that Washington had a 100% dislocation of the AC joint, not the shoulder joint itself.

By definition a Grade III is defined this way: Emphasis Added

Grade III Sprain
Acromioclavicular ligaments and capsule (Which covers and protects the shoulder joint) are disrupted. Coracoclavicular ligaments are disrupted. Acromioclavicular joint dislocation with clavicle displaced superiorly(towards the head) and a complete loss of contact between clavicle and acromion.

Management of the Injury:

Type III injuries are usually evaluated on a case-by-case basis, taking into account hand dominance, occupation, heavy labor, position/sport requirements, scapulothoracic dysfunction, and the risk for reinjury.

Evidence supporting nonoperative treatment of type III AC dislocations has been provided by a meta-analysis.121 In a review of 1172 patients, 88% who were operatively treated and 87% who were nonoperatively treated had satisfactory outcomes. Complications included the need for further surgery (59% operative versus 6% nonoperative), infection (6% vs 1%), and deformity (3% vs 37%). Pain and range of motion were not significantly affected. The authors did not recommend surgery for type III AC joint injuries.

Another study showed that non-operative treatment leads to a 20% rate of suboptimal outcome and 17% decrease in bench press strength at one year, but 80% of people do not feel that it affects them[Schlegel et al]. Larson and Hede prospectively compared nonoperative and operative treatment with similar rates of persistent symptoms (8% in the operative group vs 10% in the nonoperative group).

Summary Taken From: The Shoulder Doc UK

So Washington’s injury was more severe than we first thought. It is not surprising that he won’t play, why take the risk. He extra week to 10 days will do him good but this till going to hurt like a bitch when he takes his first hit…Torodol anyone!