Dwight Howard's Shoulder Injury: Why His Torn Labrum May Linger Until Offseason

Dave Siebert, M.D.@DaveMSiebertFeatured ColumnistJanuary 24, 2013

LOS ANGELES, CA - JANUARY 04:  Dwight Howard #12 of the Los Angeles Lakers reacts as he injures his shoulder during a 107-102 loss to the Los Angeles Clippers at Staples Center on January 4, 2013 in Los Angeles, California.  NOTE TO USER: User expressly acknowledges and agrees that, by downloading and or using this photograph, User is consenting to the terms and conditions of the Getty Images License Agreement.  (Photo by Harry How/Getty Images)
Harry How/Getty Images

The flare-up of Los Angeles Lakers center Dwight Howard's torn shoulder labrum added insult to injury—or injury to insult, rather—following the Lakers' Wednesday night 106-93 loss to the Memphis Grizzlies (h/t CBSSports.com).

On Thursday, however, the Lakers received some good news, as according to Eric Pincus of the Los Angeles Times, Howard received clearance to play in the team's next game on Friday against the Utah Jazz.

Nevertheless, this is likely not the last time Lakers fans will hear about Howard's shoulder.

Howard suffered his original injury on Jan. 4—also against the Memphis Grizzlies—and re-aggravated it two days later, forcing him to sit out three games until Jan. 13. His most recent setback marks the second time his injury has forced him to the bench.

It also might not be the last.

Labral tears—similar to hamstring strains—tend to linger throughout a season. Yet while hamstring strains persist because the hamstring muscles are used with every single step an athlete takes, labral tears linger because they simply do not heal.

The labrum—like the nose, ears and knee meniscus—is made up of cartilage. As cartilage, the labrum's primary function is to help stabilize the shoulder joint. It does so by forming a deeper socket in which the head of the humerus—the bone of the upper arm—can sit.

For a better picture, imagine a golf ball sitting on a tee. The ball represents the head (top) of the humerus, and the tee represents the shallow shoulder socket made up by the glenoid—a part of the scapula (shoulder blade).

As many golfers know, a golf ball is very easily knocked from a tee, which in this analogy would represent a shoulder dislocation. The labrum is essentially an extra ring of tissue around the tee resembling a washer. It protects against dislocations by extending the surface area of the tee up and slightly around the ball, thus making it much harder to knock the ball—the humerus, if you will—off.

The hip joint also includes a labrum. However, the hip's socket is much deeper than the shoulder's, making it much more difficult to dislocate.

Even with the protection of the labrum, shoulder dislocations still occur throughout sports, and certain motions can also result in labrum damage or tears.

For instance, if the arm is forcefully jammed upwards or inwards into the shoulder socket—such as by falling on an outstretched hand or receiving a direct body blow to the upper arm—the humerus can be impacted into the labrum, resulting in a tear. In the above example, imagine taking a hammer and hitting down on the golf ball into the tee.

The labrum can also be damaged by anything from simple chronic overuse—such as in a baseball pitcher—to single-event stresses that stretch or dislocate the shoulder joint—such as a gymnast improperly catching him or herself on the rings or high bar. In this scenario, a golf ball and tee previously glued together are forcefully pulled apart.

Despite the numerous ways labral tears occur, they all result in one common endpoint—a cartilage defect.

Cartilage and ligaments have very poor blood flow when compared to tissues such as muscle and skin, and as a result, tears or defects cannot be easily reached by the healing processes of the body. In fact, in some cases, labral tears may never heal on their own without surgical repair.

That is why Howard might be still feeling the effects of this injury for some time to come, despite the fact that his injury troubles started over two weeks ago. Eventually, the definitive treatment will likely be labral repair surgery—though this merely represents some educated speculation.

Unfortunately, surgical repair of the labrum can require up to three-to-four months or more of recovery and rehabilitation before an athlete can return to competition. The exact recovery time depends on the type and severity of the tear.

Two of the most common types of labral tears are the "SLAP" and Bankart tears. A SLAP tear—standing for "Superior Labrum Anterior to Posterior—is an injury to the uppermost portion of the labrum at which the biceps tendon attaches. It occurs when the arm is forced upward and inward in relation to the shoulder, causing the biceps tendon to pull on the top of the labrum.

The Bankart tear occurs when the humerus is dislocated and stretches the labrum downward and either forward or backward.

Though exact medical details are unavailable, Howard twice attempted to play through his tear, suggesting his tear is not serious. It appears that he will try to do so a third time, and frequently, conservative management—meaning non-operative strength training and conditioning—is the first step of treatment for a labral tear.

Nevertheless, until his shoulder fully heals—either on its own or with surgical assistance—his shoulder will be weaker and more prone to further injury. In addition, he may continue to experience pain with certain movements. If his shoulder injury continues to worsen, range-of-motion limitation may develop as well, limiting his effectiveness on the court. He can also become more prone to dislocations.

In other words, his shoulder will not be the same for some time to come.

This news comes at a terrible time for the reeling Lakers (17-25), a surprisingly disappointing team this season. It also represents just the latest in a rash of injuries to Lakers stars, including Pau Gasol's concussion and Steve Nash's fibular stress fracture.

That said, on paper, the Lakers certainly have the talent to turn their season around.

Whether or not they do so remains to be seen, but Howard's injury troubles certainly won't help.


Dave Siebert is a medical/injury Featured Columnist for Bleacher Report who will graduate from medical school in June. He plans to specialize in both Family Medicine and Primary Care (non-operative) Sports Medicine. Injury and anatomical information discussed above is based on his own knowledge with supplementation by Dr. Jonathan Cluett's article on labral tears.