What is up with Anthony Davis’ shoulder?

Los Angeles Lakers superstar Anthony Davis has been dealing with a right shoulder problem since the team’s win against the Charlotte Hornets on October 27th where he hit front rim on a dunk attempt while his arm was fully extended out in front of him..

At shootaround on Tuesday, Davis told reporters that “everything is recovering better” and that he’s “getting back to 100%,” but he’s clearly been bothered by the injury — grabbing at the shoulder after specific plays, and often placing a heating pad over the area while on the bench — and the team hasn’t given more specifics.

In this video that I made for the “Laker Film Room” YouTube channel, I explained the injury possibilities, how the team is managing it, and how Davis can avoid re-aggravation.

What might be injured?

As I said above, the team hasn’t released injury specifics, and I’m not privy to examining Davis myself, but we can utilize available indicators to draw a reasonable hypothesis.

Based on the mechanism of injury (how the injury happened) with Davis’ right hand and arm hitting front rim and jamming the shoulder — specifically, the movement applied a “radial force” to the shoulder — and how end-range overhead movements such as going full stretch to grab a rebound or block a shot have aggravated the shoulder, and with Davis stating that he initially had a high level of pain but it’s become progressively less, there’s two likely injury possibilities.

1) A labral tear (more likely)

The labrum is a fibrocartilaginous ring that sits around the glenoid cavity (shoulder socket) to create a suction effect, increase the depth of the socket, and absorb shock. It’s a key stabilizer of the gleno-humeral (shoulder) joint.

When Davis’ went up for the dunk, the specific position of his arm (flexed, adducted, and internally rotated) naturally shifts the humeral head (head of the upper arm bone) posteriorly (backwards) within the joint. The ensuing jolt and radial force from hitting front rim applied an extra posterior force which may have pushed the humeral head into the labrum, creating a tear.

The fact that Davis’ re-aggravations were caused by end-range movements that also apply a similar pressure onto the labrum is a key indicator that the labrum is the source of pain, specifically the posterior labrum.

2) Rotator cuff strain

The rotator cuff is a set of four muscles — the supraspinatus, infraspinatus, teres minor, and subscapularis — that surround the shoulder joint to provide stability during movement.

The sudden force on the shoulder along with AD gripping the ball which creates further activation of the rotator cuff — termed the “irradiation effect” — may have caused enough stress on the musculature to create an overt strain.

Even if the rotator cuff wasn’t strained, it very well could have some secondary irritation that contributed to Davis’ symptoms.

What’s the prognosis?

Labral tears are graded into mild (grade 1), moderate (grade 2), and severe (grade 3) tears. The latter typically requires immediate surgery because it compromises shoulder joint stability but a grade 1 and 2 can frequently be managed in-season, with the latter possibly requiring surgery.

In those cases, there are numerous examples of a player managing it during the season and having surgery at a later date. For example, Kobe Bryant in 2003 played through a moderate labral tear which he had repaired over the summer. Davis himself played through a labral tear for nearly three years until finally having surgery.

We obviously don’t know exactly what Davis’ case is, but there are multiple good indicators present that indicate it’s a lower severity issue:

1. The medical staff has decided it’s safe to manage and has likely been doing so via constant treatment, strengthening, and taping, the latter of which Davis has specifically mentioned on multiple occasions.
2. Davis has stated that his overall pain level has been decreasing, which is common with lower severity labral tears and rotator cuff irritation. In the case of a labral tear, there is some evidence with certain tears that it will actually just scar down over time and not require any further intervention.
3. He hasn’t had a heating pad on the shoulder in the last two games.

All in all, if the injury is what I believe it to be, it’s quite manageable — albeit painful early on — when treated appropriately, and that’s exactly why the Lakers went out and hired Judy Seto, who is extremely experienced and adept at handling things in-season due to her time as Kobe’s lead therapist.

Davis will probably have some re-aggravations as the season goes on, but they’ll likely be more intermittent and cause less pain. At this point, Davi’s lower right rib injury seems to be the primary issue far more than the shoulder, which is at the very least a very positive sign for the right shoulder moving forward.

Dr. Rajpal Brar has a doctorate in physical therapy from Northern Arizona University, and runs his own sports medicine and performance business, 3CB Performance, in West LA and Valencia, CA. He also works at a hospital — giving him experience with patients in the immediate healthcare setting and neurological patients (post stroke, post brain injury) — and has been practicing for 1.5 years. Brar is additionally training at UCLA’s mindful awareness research center (MARC), and analyzes the Lakers from a medical perspective for Silver Screen and Roll and Laker Film Room.

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