Carmelo Anthony played through the NBA playoffs with an injured left shoulder. The injury was a torn labrum, according to the New York Daily News. While Anthony is going to take a month to try to heal without surgery, the questions are: How likely is he to need surgery, and if he does, how long until he is back in action? Let's answer those and a few other key questions.
What exactly is this injury?
The glenoid labrum is a small ring of cartilage that sits between the upper arm and the cup of the shoulder. It adds stability and some measure of cushioning. It can be frayed, torn or even pulled away from the bone itself.
When did this injury occur?
The Daily News report says Anthony was first hurt on April 14.
During the playoffs, post-injury, Anthony averaged over 40 minutes per game, took 26 shots per game and increased his rebound totals, according to Pro Basketball Reference.
Anthony was seen throughout the playoffs with a sleeve over the left shoulder. At times, it appeared that there was tape or perhaps a light brace under the sleeve, though it is unclear in available photos and video.
I can find no evidence of Anthony wearing this sleeve prior to the suggested mid-April date. Anthony does wear a sleeve on his forearm and elbow, and has done so for some time.
What are the effects?
The major effects of a torn labrum depend on the type of tear. The most likely would be some pain, inflammation and often a "catch" or "click" during movement.
The pain is normally on deceleration, but can also be felt when the arm is pulled forcibly away from the midline of the body. Dwight Howard had issues with this when rebounding and blocking shots, occasionally showing severe pain.
For Anthony, it is the movement that is most worrisome. While the injury was on his nondominant side, both arms are necessary to the smooth flow of the shot.
If he was having any sort of catch in his motion, it is likely that it would manifest itself in either a slower release, a lower arc or a lower release point. None of those were apparent in the playoff series against the Pacers, though Anthony was often seen grimacing and rubbing the shoulder.
Why are they waiting on surgery?
As with any injury that could lead to surgery, an athlete is best to try and avoid extensive medical work. If Anthony has been playing through this injury for over a month, there has been no attempt to see if rest would help clear it up.
As well, the tear in the labrum may be small or could even be more accurately termed "fraying." If so, the rest could reduce the inflammation and make any pain or effect reduce or even go away entirely. The body does heal itself, and while cartilaginous structures seldom heal completely, they can heal well enough to remain functional and avoid surgery.
The Knicks and Anthony also have to consider timing. The delay is not one that will cost Anthony significant time by trying to avoid surgery, with the upside of having no loss of time possible. It's a gamble almost all teams will take given even a slight chance of success.
What would the surgery be like?
Surgery for a labrum tear is done arthroscopically. The surgeon would enter the joint space, examine the damage and begin to repair it. In all cases, the surgeon would be attempting to do as little as possible, so as not to alter the area's mechanics or create any changes inside the shoulder joint itself.
Ideally, it would be a cleanup, removing any fraying and associated debris. If there is a loose flap, it could shift as the arm moves, creating the pain, inflammation and resistance to movement.
A significant tear to the labrum would require either a repair (suturing) or a full anchoring back into the bone. These would be more involved and would be avoided if at all possible. So far there is no indication that these would be necessary from the available symptoms and function.
What would the rehab be like?
The standard rehab for a labral repair, which could include anchors, takes up to six months. Again, it is not thought that Anthony would need that significant a repair, but the lessons in the rehab protocol are there to be noted.
The focus is on allowing the area to heal, then getting the full unfettered range of motion back. There is a significant focus on strengthening the area, regaining the proprioception and protecting the labrum from further damage by giving it a strong support from other muscles and structural elements.
For Anthony, his keys would of course be getting back to a smooth shooting motion and using his arms defensively. Neither should be a major problem if no anchors are used. While six months of rehab may freak Knicks fans out, thinking Anthony could be out into December, we should note again that this is for the most invasive repair and that a conditioned athlete like Anthony should be well ahead of the schedule.
When would Anthony be ready to play?
In the most likely scenario, where no anchoring into the bone is necessary, the normal return time is about three months. That's if surgery is even necessary in the first place.
This would have Anthony ready at some point prior to the start of the season. On the long end, Anthony could be back as late as Christmas if a more extensive repair is necessary or if the rehab does not get ahead of the standard protocol, as is common for conditioned athletes.
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