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Common Injuries in Professional Football Quarterbacks

  • Jacob M. Kirsch
  • M. Tyrrell Burrus
  • Asheesh BediEmail author
Injuries in Overhead Athletes (J Dines and C Camp, section editors)
Part of the following topical collections:
  1. Topical Collection on Injuries in Overhead Athletes

Abstract

Purpose of Review

Professional football quarterbacks are at particular risk for upper extremity injuries due to the physical demands of their position coupled with the inherent risks associated with professional football. This review sought to evaluate current clinical literature to better characterize the injury profile unique to this athletic population.

Recent Findings

Shoulder injuries are the most prevented upper extremity injury among professional football quarterbacks. The quarterback position is disproportionately impacted by shoulder injuries when compared to professional athletes at other positions. Moreover, contrary to other professional throwing athletes, the majority of upper extremity injuries in the professional quarterback result from direct contact as opposed to the throwing motion.

Summary

The injury profile among professional quarterbacks is unique compared to other positions and other overhead professional throwing athletes. Overall, a paucity of high quality clinical evidence exists to support the management of injuries in this elite population.

Keywords

Professional football NFL Quarterback Upper extremity Shoulder Injuries 

Notes

Compliance with Ethical Standards

Conflict of Interest

All authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance ••Of major importance

  1. 1.
    Robinson TW, Corlette J, Collins CL, Comstock RD. Shoulder injuries among US high school athletes, 2005/2006-2011/2012. Pediatrics. 2014;133(2):272–9.  https://doi.org/10.1542/peds.2013-2279.CrossRefPubMedGoogle Scholar
  2. 2.
    •• Beaulieu-Jones BR, Rossy WH, Sanchez G, Whalen JM, Lavery KP, KJ MH, et al. Epidemiology of injuries identified at the NFL Scouting Combine and their impact on performance in the National Football League: evaluation of 2203 athletes from 2009 to 2015. Orthop J Sports Med. 2017;5(7):2325967117708744.  https://doi.org/10.1177/2325967117708744. This study evaluated 2203 athletes at the NFL Combine from 2009 to 2015. The authors note that quarterbacks were the most at risk for shoulder injury compared to other positions. Interestingly, the presence of a shoulder injury in quarterbacks compared to match controlled athletes did not effect games started, QB rating, yards per attempt, or touchdowns. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Brophy RH, Barnes R, Rodeo SA, Warren RF. Prevalence of musculoskeletal disorders at the NFL Combine—trends from 1987 to 2000. Med Sci Sports Exerc. 2007;39(1):22–7.  https://doi.org/10.1249/01.mss.0000241637.52231.18.CrossRefPubMedGoogle Scholar
  4. 4.
    Kaplan LD, Flanigan DC, Norwig J, Jost P, Bradley J. Prevalence and variance of shoulder injuries in elite collegiate football players. Am J Sports Med. 2005;33(8):1142–6.  https://doi.org/10.1177/0363546505274718.CrossRefPubMedGoogle Scholar
  5. 5.
    Kelly BT, Barnes RP, Powell JW, Warren RF. Shoulder injuries to quarterbacks in the national football league. Am J Sports Med. 2004;32(2):328–31.  https://doi.org/10.1177/0363546503261737.CrossRefPubMedGoogle Scholar
  6. 6.
    Fleisig GSER, Andrews JR, Matsuo T, Sattenwhite Y, Barrentin SW. Kinematic and kinetic comparison between baseball pitching and football passing. J Appl Biomech. 1996;12(2):207–24.  https://doi.org/10.1123/jab.12.2.207.CrossRefGoogle Scholar
  7. 7.
    Kelly BT, Backus SI, Warren RF, Williams RJ. Electromyographic analysis and phase definition of the overhead football throw. Am J Sports Med. 2002;30(6):837–44.  https://doi.org/10.1177/03635465020300061401.CrossRefPubMedGoogle Scholar
  8. 8.
    Rash GS, Shapiro R. A three-dimensional dynamic analysis of the quarterback’s throwing motion in American football. J Appl Biomech. 1995;11(4):443–59.  https://doi.org/10.1123/jab.11.4.443.CrossRefGoogle Scholar
  9. 9.
    Wick HDC, Werner S. A kinematic comparison between baseball pitching and football passing. Sports Med Updat. 1991;6:13–6.Google Scholar
  10. 10.
    Lynch TS, Saltzman MD, Ghodasra JH, Bilimoria KY, Bowen MK, Nuber GW. Acromioclavicular joint injuries in the National Football League: epidemiology and management. Am J Sports Med. 2013;41(12):2904–8.  https://doi.org/10.1177/0363546513504284.CrossRefPubMedGoogle Scholar
  11. 11.
    Brophy RH, Lyman S, Chehab EL, Barnes RP, Rodeo SA, Warren RF. Predictive value of prior injury on career in professional American football is affected by player position. Am J Sports Med. 2009;37(4):768–75.  https://doi.org/10.1177/0363546508329542.CrossRefPubMedGoogle Scholar
  12. 12.
    • Chambers CC, Lynch TS, Gibbs DB, Ghodasra JH, Sahota S, Franke K, et al. Superior labrum anterior-posterior tears in the National Football League. Am J Sports Med. 2017;45(1):167–72.  https://doi.org/10.1177/0363546516673350. This study evalauted the NFLISS database from 2000 to 2014. Of all SLAP tears, 75% occurred during contact with another player. Only 3/65 SLAP tears occurred in quarterbacks; however, 2/3 were treated surgically. CrossRefPubMedGoogle Scholar
  13. 13.
    Burkhart SS, Morgan CD. The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy. 1998;14(6):637–40.  https://doi.org/10.1016/S0749-8063(98)70065-9.CrossRefPubMedGoogle Scholar
  14. 14.
    • Gibbs DB, Lynch TS, Gombera MM, Saltzman MD, Nuber GW, Schroeder GD, et al. Preexisting rotator cuff tears as a predictor of outcomes in National Football League Athletes. Sports Health. 2016;8(3):250–4.  https://doi.org/10.1177/1941738116636602. This study evaluated data from the NFL Combine from 2003 to 2011. Preexisting rotator cuff tears were only found in 3/49 quarterbacks. Overally, preexisting rotator cuff tears were associated with a decreased likelihod of being drafted and playing fewer games in the NFL. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Tokish J, Shanley E, Kissenberth M, Noonan T, Eggert D, Thigpen C. Biceps pathology and its relation to humeral torsion in professional baseball pitchers. Arthroscopy. 32(6):e11–e2.  https://doi.org/10.1016/j.arthro.2016.03.058.
  16. 16.
    Canadian Orthopaedic Trauma S. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89(1):1–10.  https://doi.org/10.2106/JBJS.F.00020.CrossRefGoogle Scholar
  17. 17.
    Robinson CM, Goudie EB, Murray IR, Jenkins PJ, Ahktar MA, Read EO, et al. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am. 2013;95(17):1576–84.  https://doi.org/10.2106/JBJS.L.00307.CrossRefPubMedGoogle Scholar
  18. 18.
    McKee MD, Pedersen EM, Jones C, Stephen DJ, Kreder HJ, Schemitsch EH, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006;88(1):35–40.  https://doi.org/10.2106/JBJS.D.02795.PubMedGoogle Scholar
  19. 19.
    Banerjee R, Waterman B, Padalecki J, Robertson W. Management of distal clavicle fractures. J Am Acad Orthop Surg. 2011;19(7):392–401.  https://doi.org/10.5435/00124635-201107000-00002.CrossRefPubMedGoogle Scholar
  20. 20.
    Klein SM, Badman BL, Keating CJ, Devinney DS, Frankle MA, Mighell MA. Results of surgical treatment for unstable distal clavicular fractures. J Shoulder Elb Surg. 2010;19(7):1049–55.  https://doi.org/10.1016/j.jse.2009.11.056.CrossRefGoogle Scholar
  21. 21.
    Morrey BF, Tanaka S, An KN. Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res. 1991;265:187–95.Google Scholar
  22. 22.
    Hotchkiss RN, Weiland AJ. Valgus stability of the elbow. J Orthop Res. 1987;5(3):372–7.  https://doi.org/10.1002/jor.1100050309.CrossRefPubMedGoogle Scholar
  23. 23.
    Sojbjerg JO, Ovesen J, Nielsen S. Experimental elbow instability after transection of the medial collateral ligament. Clin Orthop Relat Res. 1987;218:186–90.Google Scholar
  24. 24.
    Dugas JR, Ostrander RV, Cain EL, Kingsley D, Andrews JR. Anatomy of the anterior bundle of the ulnar collateral ligament. Journal of shoulder and elbow surgery/American Shoulder and Elbow Surgeons (et al). 2007;16(5):657–60.  https://doi.org/10.1016/j.jse.2006.11.009.
  25. 25.
    Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med. 1983;11(5):315–9.  https://doi.org/10.1177/036354658301100506.CrossRefPubMedGoogle Scholar
  26. 26.
    Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995;23(2):233–9.  https://doi.org/10.1177/036354659502300218.CrossRefPubMedGoogle Scholar
  27. 27.
    Kenter K, Behr CT, Warren RF, O'Brien SJ, Barnes R. Acute elbow injuries in the National Football League. J Shoulder Elb Surg. 2000;9(1):1–5.  https://doi.org/10.1016/S1058-2746(00)80023-3.CrossRefGoogle Scholar
  28. 28.
    Dodson CC, Slenker N, Cohen SB, Ciccotti MG, DeLuca P. Ulnar collateral ligament injuries of the elbow in professional football quarterbacks. J Shoulder Elb Surg. 2010;19(8):1276–80.  https://doi.org/10.1016/j.jse.2010.05.028.CrossRefGoogle Scholar
  29. 29.
    Carlisle JC, Goldfarb CA, Mall N, Powell JW, Matava MJ. Upper extremity injuries in the National Football League: part II: elbow, forearm, and wrist injuries. Am J Sports Med. 2008;36(10):1945–52.  https://doi.org/10.1177/0363546508318198.CrossRefPubMedGoogle Scholar
  30. 30.
    Cain EL Jr, Andrews JR, Dugas JR, Wilk KE, McMichael CS, Walter JC 2nd, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010;38(12):2426–34.  https://doi.org/10.1177/0363546510378100.CrossRefPubMedGoogle Scholar
  31. 31.
    Dodson CC, Thomas A, Dines JS, Nho SJ, Williams RJ 3rd, Altchek DW. Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes. Am J Sports Med. 2006;34(12):1926–32.  https://doi.org/10.1177/0363546506290988.CrossRefPubMedGoogle Scholar
  32. 32.
    Thompson WH, Jobe FW, Yocum LA, Pink MM. Ulnar collateral ligament reconstruction in athletes: muscle-splitting approach without transposition of the ulnar nerve. J Shoulder Elb Surg. 2001;10(2):152–7.  https://doi.org/10.1067/mse.2001.112881.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jacob M. Kirsch
    • 1
  • M. Tyrrell Burrus
    • 1
  • Asheesh Bedi
    • 1
    Email author
  1. 1.MedSport, Department of Orthopaedic SurgeryUniversity of MichiganAnn ArborUSA

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