Jason Cole has two sources indicating that Ben Roethlisberger separated his shoulder tonight, with one source telling him that the injury is “unusual.” Roethlisberger has gone to the hospital for an MRI.
It’s difficult to speculate with much accuracy so soon after this kind of injury, but there are a few interesting factors in play here.
First, it was clear from the Twitter responses I received on the injury that the term “separation” remains confusing. Many read that to mean that Roethlisberger’s shoulder may have been subluxed or dislocated. If Cole's sources are using the term correctly, that’s not the case. A separation is generally considered to be another term for an AC joint sprain, an injury in which the shoulder does not come out of the socket.
However, a fall onto the elbow is not the most common mechanism of injury for an AC joint sprain. More often, those injuries occur when a player falls on the top of his shoulder. The less common mechanism could explain the reports that Roethlisberger’s injury is unusual or atypical.
(More on AC joint sprains and shoulder dislocations in this blog post.)
Unfortunately, his injury could also be termed unusual if it includes a fracture that is uncommon to an AC sprain – something that could’ve been seen on the x-rays done at the stadium. There may also be reason to worry about an aggravation of the rotator cuff injury that Roethlisberger minimized this summer. That would not have been noted on x-ray, but could have been suggested on exam. An AC sprain complicated by either issue could have prompted the immediate MRI.
Without a more specific diagnosis, it’s difficult to know how long Roethlisberger may be out. But, even though we’ve seen Roethlisberger play through thumb and rotator cuff injuries to his throwing side, overcoming an AC sprain of any grade in less than a week will be a lot to ask. If there are additional injuries involved, a prolonged absence is likely.
I’ll have more thoughts Tuesday morning if more details of the injury are reported.
12:45 AM ET
Adam Schefter and others are reporting that Roethlisberger has a sprained shoulder and may not have a separation. That may mean multiple things. As noted above, an AC joint sprain is a separated shoulder. But the ligaments that hold the shoulder in its socket can also be sprained. Given the mechanism of injury, one can also read Schefter's report as evidence that Roethlisberger subluxed his shoulder and that the AC joint is not involved.
The MRI will be read in the morning. Until the results are reported, all of the above remains speculation based on uncertain and incomplete information.
2:00 PM ET
This afternoon, Mike Tomlin told reporters that Roethlisberger has a sternoclavicular sprain.
That explains much of the initial confusion around the "unusual" shoulder separation. An injury to that end of the collarbone is more of a chest injury than a shoulder injury. It's also the reason for the immediate MRI last night given the number of critical blood vessels and other structures lying below the SC joint. While it's been a relatively uncommon injury in past seasons, this is the third SC joint sprain / injury in the 2012 season. Danny Amendola's injury was a SC joint dislocation and Kevin Kolb has missed multiple weeks with injuries that include an SC joint sprain.
The severity of Roethlisberger's sprain hasn't been reported. Tomlin wouldn't rule him out this week and there are some reports that Roethlisberger may only miss one game. I think that's -- as usual -- very optimistic. It's difficult to stabilize that joint, particularly in a quarterback, who will stress the joint with every overhead throwing motion. If reports that Roethlisberger also has rib injuries are accurate, his rehab will be further complicated. If Roethlisberger's rotator cuff remains a concern, the team may choose to bring him back more slowly to prevent possible changes to his throwing motion that could put strain on the shoulder joint.
I think a 2-4 week absence (or longer) is more likely than a 1-2 week absence given today's reports. However, we've seen Roethlisberger return earlier than expected (or not miss time at all) after a jaw fracture, fractured throwing thumb, syndesmotic (high ankle) sprain and rotator cuff issues in recent seasons. We'll know soon whether we can add this SC joint sprain to the list of Roethlisberger's speedy recoveries.
Follow me on Twitter @JeneBramel for the latest injury news, analysis and commentary. Questions, suggestions and comments are welcome by email at bramel@footballguys.com.