With the tit for tat between Vancouver’s GM Mike Gillis and Ryan Kesler’s agent Kurt Overheardt, I wanted to cover more on what Kesler’s injury could involve and explain the issues behind the surgery and his recovery. I am going to leave the wrist out of it, as I have not been able to compile enough information on the reasons for the surgery.
From reports Kesler had a torn labrum in his shoulder; you can still play with a torn labrum, like Kesler did, but you will have restricted range of motion and depending on the severity of the tear, loss of strength. The labrum can heal without surgery, however when left to its own devices it often reattaches itself in a position on the shoulder that greatly reduces range of motion. That is what the surgery is for, to make sure the repair does not restrict range of motion and still creates stability in the joint.
If what assistant GM Laurence Gilman said was true however and Kesler had tendon issues along with the torn labrum then the procedure would also be looking at the bicep tendon as it attaches under the labrum and could have damage also.
The labrum has basically two functions, the first is to deepen the socket so the ball stays in place. The socket of the shoulder is extremely shallow, and very unstable. The best analogy is to picture the shoulder joint as a beach ball on a dinner plate. The ball of the humerus(upper arm) (the “beach ball”) is much larger than the flat socket (the “dinner plate”). One thing that keeps the ball in the socket are the ligaments; these are the tethers that go from bone to bone which hold the bones together. The labrum circles the shallow shoulder socket to make the socket deeper. This cuff of cartilage makes the shoulder joint much more stable, and allows for a very wide range of movements.
The second function of the labrum is as an attachment of other structures or tissues around the joint. For example, the ligaments that help hold the joint together attach to the labrum in certain key locations. If there is an injury to the shoulder that tears the ligaments, sometimes the labrum is pulled off of the rim of the bone as well.
(below, a video covering the anatomy of the shoulder, I recommend you have a look)
Common Labral Tears and Procedures
SLAP Tears: A Superior (top part of the labrum) Labrum from Anterior to Posterior (SLAP) tear is most commonly seen in overhead throwing athletes, such as baseball and tennis players. labrum tear is in the area where the biceps tendon attaches to the upper end of the socket. The socket can be divided into four regions: anterior (or front), posterior (or back), the upper end near your head (or superior), and the lower end (or inferior) which is toward the elbow. The biceps tendon attaches at the superior end where it blends in with the labrum. The labrum runs from there around the joint, both in an anterior and in a posterior direction. In a more severe injury the whole labrum is pulled off of the bone along with the biceps tendon.
Bankart Lesions: A Bankart lesion occurs when a shoulder dislocates. When the shoulder comes out of joint, the labrum is torn, and makes the shoulder more susceptible to future dislocations. When the labrum of the shoulder joint is torn, the stability of the shoulder joint is compromised. As the shoulder pops out of joint, it often tears the labrum, especially in younger patients. The tear is to part of the labrum
called the inferior glenohumeral ligament.
Posterior Labral Tears: Posterior labral tears are less common, but sometimes seen in athletes in a condition called internal impingement. In this syndrome, the rotator cuff and labrum are pinched together in the back of the shoulder. The success rate of treating isolated symptomatic posterior labral tears without surgery is unknown. Many professional athletes including swimmers and baseball pitchers have large tears and function at a high level without pain. Therefore, most shoulder specialists recommend a trial of rest, ice, activity avoidance, and physical therapy. If pain persists following nonoperative measures, an individual can live with the discomfort or choose to undergo surgical treatment. Individuals continuing to dislocate despite physical therapy should proceed with surgery. The one group of athletes where initial surgical treatment should be contemplated are football lineman. Surgery is very successful in preventing repeat subluxations and dislocations and eliminating pain. This procedure must be done arthroscopically. The success rate of surgery is approximately 90%.
Through the arthroscopic surgery, the surgeon will remove any torn tissue debris and try reattaching torn labrum tissue to the bone using small anchors. Sometimes, if the labrum tear is significant and arthroscopic surgery can not correct all the problems, the surgeon will go for an open type of surgery. Open surgery in some cases is associated with better final results because it provides better access and visibility for the surgeon to perform repairs. This type of surgery can take anywhere from 2 to 6 months to repair. The open surgery if used, almost all the time in the case of labrum tears, it offers stronger repair onto the shoulder.
The recovery depends upon many factors, such as where the tear was located, how severe it was and how good the surgical repair was. It is believed that it takes at least four to six weeks for the labrum to re-attach itself to the rim of the bone, and probably another four to six weeks to get strong. Once the labrum has healed to the rim of the bone, it should see stress very gradually so that it can gather strength. It is important not to re-injure it while it is healing. Physical therapy exercises usually begin anywhere from 2 to 3 weeks after surgery, light motion and strengthening exercises.
Because of the variability in the injury and the type of repair done, it is difficult to predict how soon someone can to return to activities and to sports after the repair.
After taking all of that in, you can see why Kesler’s play dropped off, his lack of stability in his shoulder would have been causing him a lot of pain and a lack of mobility. For a player who can play with a little bit of a physical edge, the shoulder injury would have severely restricted his ability to make a solid body check without fear of totally dislocating the shoulder on impact.