Arsenal left back and Scottish international Kieran Tierney suffered an “anterior right shoulder dislocation” on 12/9 vs West Ham and underwent surgery seven days later on 12/16.
In this article, I’ll explain Tierney’s shoulder injury, the surgical procedure, his return to play (RTP) rehab process and timeline, and risks moving forward. If you prefer a video format, I have that covered as well:
The injury
Anatomy
To understand the injury, we first have to understand a little anatomy.
The shoulder joint – known as the gleno-humeral joint – consists of the humerus (upper arm bone) with the ball shaped humeral head sitting into the socket-like glenoid fossa which is actually part of the scapula, or shoulder blade. Accordingly, it’s called a “ball and socket” joint.
The joint is extremely mobile and has the highest range of motion in the body and therefore depends highly on surrounding anatomy to provide stability.
To that point, the glenoid is surrounded by a thin fibrocartilaginous ring called the labrum which provides added stability and support to the joint. Further, there are multiple ligaments and muscles – namely the four “rotator cuff” muscles – that provide further stability to the joint.
Anterior dislocation
An anterior shoulder dislocation is when the humeral head (the ball) completely pops out of the socket in a forward direction.
This usually happens when the arm is in an abducted and externally rotated position – aka a “90/90” position with the elbow up and arm overhead – and then forced posteriorly (backwards), resulting in the humeral head popping out anteriorly.
In football, this can happen due to a fall and that seems to be the case with Tierney as he landed awkwardly in the 26th minute and immediately grabbed at the right shoulder.
Post injury assessment
He was placed into a makeshift sling while walking off the pitch and then left the grounds to the hospital in an actual sling for a full assessment with the medical staff particularly checking for any concomitant axillary nerve damage which is involved in roughly 40% of anterior dislocations.
The surgery
Key indicators
We’ll never know the specific procedure Kieran had but we can utilize key indicators to come to a hypothesis.
The fact that Arsenal’s medical staff continued to assess Tierney for roughly a week prior to deciding on surgery likely means he didn’t have what’s known as a “bony bankart” injury where the dislocation chips off a piece of the glenoid, with surgery indicated immediately.
Rather, he may have had damage to the labrum – termed a “Bankart lesion” – which is far more of a grey area in terms of whether the conservative route – physio – or invasive route – surgery to repair the labrum – is the first option.
However, the research indicates that for high demand athletes younger than 25 who suffered a first-time traumatic anterior shoulder dislocation with labrum damage confirmed by MRI, surgery is relatively indicated.
Arthroscopic bankart repair
The surgery is known as an arthroscopic bankart repair in which the surgeon uses tiny instruments to repair and re-anchor the affected piece of labrum.
It’s considered a relatively straightforward outpatient surgery with patients going home a few hours after completion.
Return & rehab timeline
Arsenal have announced a three month return timeline and if Tierney did indeed have the arthroscopic bankart repair, that timeline aligns with recently introduced accelerated rehab protocols for bankart repairs which have shown an average 11 week RTP compared to the typical 16 to 20 week RTP.
The accelerated program focuses on restoring shoulder range of motion quickly while minimizing muscular tightness from post surgery immobilization and defensive mechanism muscle guarding and then methodically building up strength in the surrounding, stabilizing shoulder and scapular muscles.
Risks moving forward
The major risk for Tierney moving forward is another dislocation as there’s inherent increased risk for reinjury after suffering an initial dislocation.
However, part of the rationale for surgery being indicated in a high demand younger athlete is to reduce those recurrence risks by manually repairing damaged anatomy.
Further, new accelerated rehab protocols are relatively uncharted waters as the research on their effectiveness and impact on anterior dislocation recurrence rates – albeit promising thus far – are still in their infancy with small sample sizes.
Key positives
That being said, Tierney benefits tremendously from having an elite medical team planning his return every step of the way with constant oversight – from rehab to gradually returning to the pitch to advanced strength and conditioning.
Additionally, Kieran also benefits from playing in a non-overhead sport which further reduces risk of reinjury. There’s always the risk of falling onto the shoulder or having it tugged but that risk is far lower compared to overhead sports such as basketball or volleyball.
That’s a wrap for this article. Thanks for reading. My goal is to provide you with in-depth, evidence based, narrative free analysis and you can always find me on IG and Twitter @3CBPerformance. Make sure to sub to the blog bellow and YouTube channel for all the latest updates. 3CB out.