Common Injuries in Professional Football Quarterbacks

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.

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References

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  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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  Google 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.

    Article  PubMed  Google 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.

    Article  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  Google 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.

    CAS  Article  PubMed  Google 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.

    PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  Google 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.

    CAS  Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    CAS  Article  Google 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.

    Article  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    CAS  Article  Google Scholar 

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Correspondence to Asheesh Bedi.

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All authors declare that they have no conflict of interest.

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Additional information

Investigation performed at the University of Michigan, Ann Arbor, MI, USA

This article is part of the Topical Collection on Injuries in Overhead Athletes

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Kirsch, J.M., Tyrrell Burrus, M. & Bedi, A. Common Injuries in Professional Football Quarterbacks. Curr Rev Musculoskelet Med 11, 6–11 (2018). https://doi.org/10.1007/s12178-018-9453-8

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Keywords

  • Professional football
  • NFL
  • Quarterback
  • Upper extremity
  • Shoulder
  • Injuries