For Clemson fans, the news brought the second sigh of relief of the day. Shortly after Chandler Catanzaro mad a 43-yard field goal as time expired to cap a comeback win over Wake Forest, coach Dabo Swinney told reporters that Sammy Watkins has a sprain of his AC joint and that he might play against N.C. State.

Midway through the third quarter, the freshman wide receiver was injured on a kickoff return. The team’s medical staff examined Watkins shoulder and ribs on the sidelines before taking him to the locker room.

Tigers fans already anxious with their team down by 14 points to the Demon Deacons were seen on television noticeably worried as they watched the Heisman candidate walk off the field. Patrick Sapp reported on the radio broadcast that Watkins’ x-rays were negative. Gene Sapakoff tweeted, “Re: Sammy Watkins: Clemson has an X-ray machine at Death Valley but not an MRI machine. Expect an update soon..” He soon announced by Twitter, “Sammy Watkins update: ‘Upper body injury’ and will not return. Doesn’t sound good.”

Notice the vertical separation (orange arrow) between the tip of the acromion and end of the clavicle in this more serious AC separation.
If these reports are true, the injury, diagnosis, and treatment are fairly straightforward. The acromioclavicular joint, or AC joint, is the small joint on top of the shoulder between the tip of the shoulder blade (acromion) and the end of the collarbone (clavicle). It’s the joint typically injured in a shoulder separation. These injuries typically occur when a player lands directly on his shoulder or is hit directly on his shoulder by another player.

Television cameras showed the medical staff examining Watkins’ shoulder. Usually with AC separations, a doctor can make the diagnosis by physical exam. If the injury is severe and there is vertical separation between the bones at this joint, one can see a bony prominence there. If there isn’t a noticeable bump but the athlete has pain when the doctor presses directly at this joint, or when he positions the player’s arm across his body, he likely diagnoses a mild AC separation.

X-rays are appropriate for these injuries to help make the diagnosis and determine its severity but also to rule out other injuries, such as clavicle fractures. Sapakoff is correct that Death Valley, like most stadiums, have x-ray capability for exactly this type of situation. The x-rays being negative suggests that this is a mild AC separation, where the ligaments stabilizing the joint are sprained instead of ruptured. The lack of vertical separation on x-ray suggests that the ligaments are not torn.

Coach Swinney noted that Watkins won’t need an MRI. Again, if the x-rays showed no displacement vertically between the end of the clavicle and the acromion, it is likely that most of the ligaments stabilizing the joint are intact. An MRI wouldn’t change the treatment plan. And while Death Valley might not have an MRI machine, it wouldn’t have been feasible to perform one anyway. The 30 minutes lying in the magnet plus time on either side taking off and putting on the pads and uniform would have taken too long to return even if the stadium did have one.

The problem with AC separations, even mild ones, is that they hurt. Often the pain at that joint makes lifting and using the arm painful. And it can be difficult to predict how long it will be until that pain subsides. Clemson athletic trainers and possibly physical therapists will work diligently to decrease his pain with ice, electrical stimulation, and ultrasound, and work to restore his muscle strength. As his pain decreases and strength improves, they will allow him to try to practice. They might try to pad that area for upcoming games, although if the injury hasn’t fully healed, a direct blow there can still cause a good deal of pain.

The team will wait and see if this process will take 3 or 4 days or 3 or 4 weeks. I’m guessing by these reports that his recovery should be a quick one, but I would not be surprised if Swinney and the medical staff hold him out next week at N.C. State for precautionary reasons if he isn’t 100%. But the news that the Tiger star should return soon should relieve Clemson fans dreaming of a BCS berth.

Note: A modified version of this post appears in my sports medicine column in the November 14, 2011 issue of The Post and Courier.