Smark Out Moment

Welcome to another edition of Smark Out Moment WRESTLING DOCTOR'S NOTES where we discuss medical issues that are either being reported in the wrestling world or generally afflict wrestlers. As always, please note my disclaimer at the bottom of the post.

This is my first "Spotlight" post where I focus on a given wrestler's specific injury. In this case I will be talking about the shoulder injury suffered by AJ Styles in the 2020 Royal Rumble.

What Happened?

During the 2020 Royal Rumble match AJ took a spear from Edge. AJ bumped like a beast as he often does, flipping over backwards. Looking carefully at the footage AJ appear to land directly onto the front of his left shoulder with a lot of his body weight above it.

Still shot of AJ landing awkwardly on his shoulder. Video clip courtesy of PWInsider.

AJ then pretty much stayed in the corner for a short while. An audible appeared to have been called with a referee talking to Edge. AJ was then eliminated from the Rumble shortly afterward.

What Is The Diagnosis?

At this time the working diagnosis is a "shoulder separation." People toss around various terms for injuries that are not always accurate, but most of the time a "shoulder separation" refers to an injury to the acromioclavicular (AC) joint.

When we think of the shoulder joint we are actually thinking of a the glenohumeral joint, the connection between the glenoid fossa of our scapula (shoulder blade) and the humerus of our upper arm. There is actually a second joint in this area that connects the clavicle (collarbone) to the scapula which is the AC joint. If you press on the front of your shoulder it's a bony prominence that juts out a bit in the front.

The two major articulations of the shoulder. Image courtesy of arthritis-health.com.

An AC joint separation is a relatively common injury due to the superficial location of the joint. There are six subtypes of AC joint separation that - in general - are of increasing severity. Type I injury is a sprain of the AC joint ligament that holds the joint together. Keep in mind that a sprain is a partial tear of a ligament, just not bad enough for a ligament to lose its integrity. Type II and Type III injuries are where the AC ligament is fully torn with the Type III also involving another ligament (the coracoclavicular ligament if you're curious). Types IV through VI involve not only ligamentous tears, but also varying degrees of dislocation of the clavicle.

Rockwood Classification of AC injury, details above. Image courtesy of radiopedia.org.

What Is The Prognosis?

It depends. Type I injuries are fairly minor with athletes able to return to some form of activity within a few days and full activity in 6 weeks (as a general rule, it takes about 6 weeks for a ligament to heal, assuming it is kept immobile). Type II injuries require a full 4-6 weeks of rest before a return to activity and a more gradual return after that is advised. Type III injuries do not usually require surgery and have a similar, but longer time frame for recovery. Types IV-VI require surgical intervention for fixation.

AJ Styles nurses his shoulder on the floor after being taken out of the rumble. Image courtesy of WhatCulture.com.

At this time it is being reported that AJ is undergoing "testing." The initial workup of this injury would be a radiograph ("x-ray") of the shoulder with the patient standing with arms hanging down normally and then while holding weights. If the AC joint is injured, the joint space will widen to varying degrees while the patient holds a weight. From a simple radiograph we would know if it was a more minor injury (Type I or II) versus a more severe grade. If there was suspicion that the injury was worse, they would consider getting an MRI to directly visualize any torn ligaments.

Having suffered this injury myself and seeing a lot of patients who have had it, I'm worried that this is on the more severe side of the spectrum. AJ seemed to be in a lot of pain and the rapid nature with which they got him out of there makes me also think the prognosis is guarded. Type I injuries hurt, but most athletes tend to shrug it off and keep going for a bit before realizing something is wrong.

In Conclusion

We'll know more in the next day or so, this is overall not a challenging diagnosis to make. If AJ's injury is more mild he'll probably take 2-4 weeks off, do some lighter ring work for a while after that, and then be ready for WrestleMania. If - on the other hand - it's worse than that, I would not anticipate AJ to have a match at WrestleMania.

There is one good thing that came out of this though. Nobody can complain about Edge's spear looking weak anymore, right?

Disclaimer: These articles are general discussions about medical topics/diagnoses. As we are not personally interacting with wrestlers and do not have intimate knowledge of their maladies, we cannot comment specifically on their medical courses unless information has been previously freely reported. These articles reference wrestlers as examples based on what is either reported by them or their companies, but what is said beyond that is only speculation based on the general course of a given diagnosis. Any information here should not be used for self-diagnosis. If you are experiencing medical issues yourself, I advise you to see a licensed physician for a full evaluation.