On July 30, Buffalo Bills rookie safety Cole Bishop went down with an injury during practice with plenty of mystery. All we knew at the time was what was listed below.
On August 1 when the team returned to practice, updates were provided specifying the exact injury. The team classified him as having a shoulder injury and said that he was week-to-week.
The videos and pictures coming out after he suffered his injury suggested that the injury was not as bad as it could have been, potentially causing an AC joint sprain or even a labrum tear. Both would require rest and rehab but could return within a few weeks.
However, an unconfirmed report came out on Thursday afternoon that clarified Bishop’s injury as a scapular fracture, out for the next four to six weeks.
Disclaimer: While there is no official way to validate this report, I do know that the individual that this came from has obtained accurate information on injuries and schedule leaks in the past. I will work with the idea that there is some level of legitimacy in discussing the injury.
Below is a discussion on what the scapula is, its role in arm movement, where the scapula may be fractured, and the timeline moving forward. It’s worth noting that Bishop had a pretty clean injury history coming out of Utah this past season.
The Anatomy
The scapula is a triangular bone part of the shoulder girdle and is an attachment point for the rotator cuff, several other intrinsic and extrinsic muscles, and ligaments of the upper arm. It tilts and rotates to complete shoulder movement with the humerus, especially overhead activities. The scapula also connects to the clavicle, providing structural support for the shoulder girdle to connect to the thorax.
Scapular injuries are fairly rare, accounting for 1 percent of all fractures and 3-to-5 percent of upper extremity fractures. The reason a scapular fracture is so debilitating is because this is where the rotator cuff muscles originate that help connect the humerus to the scapula for shoulder movement.
Any instability within the anchor point of the muscles would result in pain and weakness when attempting to perform arm movements in any direction with the shoulder.
Mechanism of Injury
Mechanisms for injury include a direct blow to the back, a fall on an outstretched arm, or even a combination of abduction and external rotation in certain cases. In Bishop’s case, a direct blow due to falling out of the air appears to be the culprit.
Comparable Players
While scapular fractures are fairly rare, there are still a variety of cases over the last 10 years noted below.
2012 RB Michael Bush (CHI) Right shoulder, played through the season.
2013 FB Bruce Miller (SF) Suffered Week 15, season-ending.
2017 WR Kevin White (CHI) Suffered Week 1, missed rest of season.
2019 RB Josh Jacobs (LV) Right shoulder, suffered Week 7, missed last 3 games of season.
2020 CB Rachad Wildgoose (College) Right shoulder, season-ending, missed 5 games.
2021 QB Sam Darnold (CAR) Right shoulder, Week 9, missed 5 games.
2023 WR Deebo Samuel (SF) Left shoulder, Week 6, hairline fracture, missed 2 games.
2023 QB Deshaun Watson (CLE) Right shoulder, Week 10, season-ending.
2024 G Jonah Jackson (LAR) Left bruised scapula, expected to miss 6 weeks.
There are case studies of one player suffering two scapular fractures in back-to-back years, but even the article highlights how rare it was.
As you can see, there’s a wide variety of outcomes and timelines for the individual players listed. It comes down to where the damage in the scapula is. Hairline fractures or smaller breaks in the scapular body are not as severe as those that damage the glenoid fossa or the socket of the shoulder. Nearly half of the scapular fractures are within the body of the scapular (45 percent) followed by scapular neck (25 percent), and glenoid (35 percent). There are also acromion and coracoid, but they account for less than 15 percent of scapular fractures combined.
Based on Bishop’s presentation, it’s likely that he has a nondisplaced fracture in the body of the scapula. The scapular neck and glenoid, even nondisplaced, would require a sling to minimize movement as it’s close to or part of the shoulder socket. The body of the scapula is a thick bone and is surrounded by lots of musculature to help keep things in place. This is why the training staff looked at his back during the time of injury.
Often, scapular fractures are seen in conjunction with rib, clavicle, or other serious head or spinal cord injuries due to the location. Fortunately, Bishop’s appears to be isolated.
In most instances, surgery is not required unless there is instability within the bone such as was seen with Cleveland Browns QB Deshaun Watson with his injury last year.
I have treated several scapular fractures over my career in various settings with most due to trauma requiring surgery. The bone heals reliably well, it’s the range of motion of the shoulder and strength that can be tricky to get back over time. In Bishop’s case, he should not have these issues but he will have to slowly work to make sure he can maintain his shoulder range of motion and strength while he rehabs to not overstress the healing bone.
Timeline to Return
Most bones take roughly six weeks to heal, with smaller bones healing quicker with larger bones taking longer. The scapula could heal in between six-to-eight weeks which means with Bishop’s injury occurring on July 30, the six-week mark would be on September 10. This would come right after Week 1, but if the bone is healing well, it could be sooner. Once the training staff knows the bone is healing well, they can allow him to progress his rehab and begin lower body work such as running and conditioning. Once they know it is healed, initiating contact and tackling would be the next step to ensure no lingering issues or pain before being cleared.
There is a chance that Bishop could be placed on injured reserve to start the season, but with having over a month for the bone to heal, it would seem short-sighted. If he were to be placed on IR, he would miss a minimum of four games and not be able to practice with the team. They could do this from a purely roster management standpoint if they need to keep someone else.
Keeping him on the active roster and making him inactive for the first game or two while he rounds back into physical shape may allow him to miss minimal time. Add in the fact that players have played through the shoulder fracture, I would think the Bills could be a little more aggressive in returning Bishop with a month to heal rather than in the regular season.
Taking everything into consideration, I see Bishop making his regular season debut in Week 3 as that will give him nearly eight weeks to heal and get back into shape. Week 2 could have been in play but that game is on a Thursday and Week 3 is on a Monday, giving the Bills extra rest and practice time to get Bishop back up to speed. If he returns sooner, fantastic!
This shoulder injury that Bishop suffered was unfortunate, but in reality, a non-displaced fracture is one of the best outcomes for Bishop as there is minimal concern for it to fracture again. Once it heals, he can rapidly restore his function and return to play. If there was an AC joint sprain, an aggravation of the joint could set him back temporarily whereas a labrum tear could lead to further instability and potential surgery.
I wish Cole Bishop the best of luck in his recovery and to remain healthy for the rest of this season.
Top Photo: Jeffrey T. Barnes | Credit: AP
