During locker clean-out day Monday after the playoff loss to the Cincinnati Bengals, DT Jordan Phillips revealed that he suffered a rotator cuff tear in his right shoulder. The injury was readily apparent on film due to the tape and bracing on the area when he did suit up.
He battled the injury for the last seven weeks of the season which cost him a total of three games. He originally injured it against the New England Patriots in Week 13 trying to chase down QB Mac Jones, falling onto his right arm. In addition to tearing his rotator cuff, he said he also tore some ‘other stuff’ which could imply that he also tore his labrum. Based on the mechanism of injury, it’s very likely that this structure was also involved.
Phillips had already stated that he would require surgery. Prior to this article’s publication, it was not known if he had the surgery.
Tuesday’s press conference with Brandon Beane at the NFL Combine confirmed that he did undergo the procedure at some point in the last month. This assists with establishing timelines for his recovery for the 2023 season.
To understand his timeline, below is the anatomy, how the injury occurs, rehab, and outlook.
The Anatomy
The rotator cuff is made up of 4 muscles that include the supraspinatus, infraspinatus, teres minor, & subscapularis. These muscles assist in shoulder flexion, abduction, and internal & external rotation. These motions are vital for a variety of activities that we perform daily from washing hair, putting a shirt on, throwing objects, reaching behind the back, & general overhead activities.
The rotator cuff also helps keep the humeral head depressed and against the labrum so that it can create enough space within the joint for the humerus to move & not ram into the acromion during elevation. There are other muscles that assist with all these functions, but these are primary movers for the above-mentioned functions.
The labrum is a fibrous layer of tissue in the shoulder that deepens the socket in which the head of the humerus articulates with the glenoid fossa of the scapula. This allows for the stabilization of the moving shoulder joint and prevents the joint from separating.
Mechanism of Injury
The mechanism for injury to the rotator cuff/labrum can happen in a number of ways:
-Result of landing on your arm outstretched, jamming the head of the humerus into the scapula. This was the way Phillips injured his shoulder as seen above.
-Fall directly onto the shoulder area.
-Throwing an object either with increased frequency or the object is too heavy.
-Sudden overload of the area such as a sudden pull on the area such as having the arm pulled against resistance.
-It can also occur over a period of time with impingement due to weakness in the area with altered biomechanics leading to a wearing down on the tendon insertion.
There are two types of rotator cuff tears that can affect any of the muscles in the cuff area: Partial thickness and full thickness. Based on the names, partial thickness is a partial tear to the tendon that can be small & can even heal on its own at times. Full thickness is when the tendon tears completely through & there is a significant loss of function noted in the area.
Any of the muscles in the rotator cuff can tear but the supraspinatus is the most commonly torn tendon following a rotator cuff tear. It is anchored at the top of the humerus head & is more likely to bear the brunt of an injury or become worn down.
Based on the mechanism of injury falling with the arm outstretched, Phillips likely suffered at least a partial thickness tear and likely a full thickness tear to at least the supraspinatus & possibly others as the rotator cuff does envelop the humeral head.
The reason that he could continue using the shoulder was due to how the deltoid muscle covers the underlying rotator cuff. The other muscles in the shoulder such as the biceps and trapezius among other muscles assist with shoulder movement, allowing the body to still use the arm.
Assessment and Surgery
Phillips himself said that if the injury was during the regular season, he would have gone onto injured reserve. During the assessment, he would have had profound weakness and pain with movement in the area and positive signs of several special tests. He would have a painful arc noted in the picture below. This is due to the activation of the rotator cuff muscles assisting in the elevation of the humerus during the range of motion from 60-120 degrees.
This would also explain why he had that ‘dead-arm’ look after he came off the field from tackling or blocking. The shoulder simply wasn’t strong enough to get the job done consistently. Performing those activities also were similar motions that led to the original injury which meant that he was possibly reinjuring the shoulder every time he used it in a game.
To add insult to injury, the rehab for a torn rotator cuff isn’t fun either. It’s roughly a 4-to-6-month recovery & in some cases, takes up to a year with severe tears. The labrum repair can be done at the same time and carries a similar timeline for recovery.
This is a tough surgery due to the variety of movement planes of the shoulder. With more mobility in a joint, the greater need for stability in all planes of motion. In addition, the area where the rotator cuff attaches to the humerus contains a poor blood supply which means that it does not receive the needed nutrients from the blood to heal as quickly as other parts of the body.
The surgery is typically done arthroscopically unless there is a massive tear & they need to open up the shoulder to fully address the issue. Once inside, the tear can be further assessed, cleaned out & repaired. The repair is done by placing anchors that reconnect the tendon back to the bone to allow for proper healing of the area. Based on the severity of the tear will determine how many anchors are required.
Rehab protocols dictating the specifics of the timeline for rehab can be accessed here & here, but to simplify it, it is tedious having worked on a number of these during my career.
The first 4-6 weeks are spent in a sling with PROM initiated to work on the motion but avoid any strengthening directly to the shoulder area. Motion is slowly progressed to stretch the tissue but not place stress on the healing area with the range of motion limitations set by the doctor.
Once the patient has been cleared to begin strengthening, isometrics are initiated which is when the muscle is turned on but is not actively moving, like pushing with all your might against a wall.
As strengthening progresses, higher-level activities are incorporated & stability in the joint increases. The rotator cuff has to improve with strength, but the surrounding muscles including the rhomboids and trapezius activate in order to help move the scapula up and out of the way in order to allow the humerus to elevate.
Eventually, the muscles are all moving properly with glenohumeral rhythm, there is full ROM and no pain, this allows the ability to return to sport-specific strengthening & return to activity.
Outlook
Rotator cuff repairs do have overall good outcomes, up to 95%, but they need a lot of patience to get there, taking 4-to-6 months. Looking at NFL players, nearly 80 percent return to play at their prior level of performance and stay at that level for nearly three years. The average time to return to play is 198 days which is 6.6 months.
Risks for re-tear are as high as 26% in the literature but are relatively lower in younger patients as the quality of the tissue is improved compared to older patients with more chronic tears. Furthermore, there is a correlation that for every 1 cm the initial tear increases in size, and the risk to re-tear increases two-fold. We don’t know how severe the initial tear was.
As Phillips was on a one-year deal, it’s not known if he will be coming back. He has been beaten up the last few seasons and this most recent campaign did him no favors. It would make sense to come back on a team-friendly deal as he was productive when he was healthy. Phillips won’t scare off any teams from signing him due to this injury alone, but his injury history and his asking price may have some teams hesitate.
The fact that he was mentioned during Tuesday’s press conference leads to the possibility that he could return. The team may try to leverage the injuries he suffered this season to re-sign him to a cheap contract, but there is still risk in bringing him back at all.
Update 3/29/23: Phillips was signed to a one-year, $3 million contract.
I do not expect him to participate in OTAs or mini-camp. Whoever he signs with, whether the Bills or someone else, his timeline could possibly lead him to start on the PUP list for training camp based on the date of his surgery. It will come down to how the rehab progresses and when he is cleared. Not having a clear date on when the surgery doesn’t help things. But surgery has at least been within the last month.
Update: the post below confirms he had the surgery sometime in late January/early February.
I’m not overly concerned about the shoulder heading into 2023. It’s more whether his body can hold up to the rigors of the NFL anymore. His injury history after he left Buffalo prevented him from living up to his last free-agency contract and this year’s injuries may have been a further warning.
He will have a long and tedious offseason of rehab but can return in 2023, ready to make another run at it with the Bills.
Photo by Brett Carlsen/Getty Images
