True story: Nearly 10 years ago, I flunked my first college biology class. 

It was a weed-out class at the University of Alabama, held in an auditorium filled with more than 450 students. In other words, a course that separates students from becoming a surgeon, or, well, a sportswriter. 

So here we are, a decade later, and I can admit I’m still entirely unqualified to talk about human anatomy. 

But now is a chance at redemption! 

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Memphis was stunned this week by the news that star point guard Ja Morant is done for the season with a labrum tear in his right shoulder. The city is on edge wanting to know what it will mean for the biggest star to ever take the floor for the Grizzlies. 

In an effort to find an answer to the nervous questions, I called in an expert, Dr. Christopher Brusalis, to give me a lesson. 

This guy is sharp. Don’t just take my word. 

“I’m an orthopedic surgeon at Hospital for Special Surgery (HSS) in New York City, New York, which is World Report’s No. 1 orthopedic hospital in the country,” Brusalis said. “I am a part of the sports medicine institute, which collectively takes care of many of the professional sports teams in New York, including the New York Knicks, Brooklyn Nets, New York Mets and New York Rangers. 

“My specific area of sports medicine that I focus on is the shoulder and shoulder surgery. I went to Yale for college, then the University of Pennsylvania for medical school. I did my training at HSS, after one year of fellowship in Chicago, where I was the assistant team physician for the Chicago Bulls and Chicago White Sox. 

“I also did advanced training in shoulder surgery where I traveled the country doing a traveling fellowship, as well as to Nice, France, where I studied shoulder surgery under a French surgeon there.”

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Seriously, there may be no one more qualified to talk about shoulder injuries and surgery than Brusalis. 

“I spend every day thinking about shoulders,” he said. 

We talked for 30 minutes Thursday night, discussing all sorts of questions from the procedure to recovery. He explained everything to me as if I were 5 years old. 

But we should also note: Brusalis does not know the specifics of Morant’s injury, and he was speaking generally about the injury as it relates to elite athletes. 

So let’s start with a labrum. What the heck is that?

“I think it’s important to start with the anatomy,” Brusalis said. “I think the best analogy to use to help people understand what a shoulder is, is to consider the shoulder like a golf ball sitting on a golf tee. That analogy equates to the ball and socket joint of the shoulder.

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“Even though a golf ball and tee might have a slightly different orientation, the concept is that for a shoulder to have stability, the ball needs to stay on the socket while the arm is moving in space. 

“So, as someone moves their arm around, the ball is moving ever so slightly, but it still has to stay on the tee. How does that happen? There are a number of things that allow the ball to stay on the tee and not fall off. 

“The concept of the ball staying on the tee is stability. The concept of the ball falling off is instability. How do you keep it stable? Well, surrounding the perimeter of the socket, or the tee in this analogy, is the labrum. 

“The labrum is a soft tissue structure that acts basically like a fence for the socket and keeps the ball contained within the socket.

“Most commonly in young male athletes, if they move their arm or their arm gets moved for them in a very traumatic, unusual way, it can create such a force that it actually causes the ball to dislocate or fall off the tee.”

Morant’s injury, however, was considered a subluxation, which is only a partial dislocation. So what’s the difference?

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He explained, in this simplified analogy, that the golf ball did not fall completely off the tee, but it came so close to falling off that it injured the surrounding structure, the labrum. 

“You may hear a lot in sports medicine about something called a labral tear,” Brusalis said. “But I think a key distinction for readers is that the labrum, that fence-like structure, typically does not tear. Typically, it detaches from the socket. 

“So when we are talking about a labral tear we are talking about the labrum getting detached from the socket, and typically getting stretched a little bit.

“The problem with that is when it happens your body reacts with a lot of pain and discomfort because there is a lot of inflammation in the shoulder. But that goes away with time. The real issue is that after it happens, when the labrum gets detached from the socket and stretched, you are at increased risk of the shoulder dislocating again.”

Got it? Good. 

Over the past week, I’ve done a lot of reading about players who suffered similar injuries. One thing I noted was that Clippers star Paul George has bandied about how his shoulders actually felt stronger than they did prior to the surgery. 

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So I asked if that was a possibility. Could Morant’s shoulder actually be stronger after the procedure?

“I think it’s a little bit of an overstatement to say it is stronger than it was ever before, if someone has never had this injury,” Brusalis said. “I guess there are two categories: People that have had recurrent subluxations, where the labrum has gotten stretched and stretched, and people that experience this as a one-time incident. 

“If this is just a first-time dislocation, I don’t think the shoulder is necessarily stronger than it was before (after surgery).”

It was at this point that I started to wonder what it looks like when surgeons attempt to make this fix. Is it plastic? Is it metal? 

“So, basically, there are these little threaded sutures that get put into the socket and wrapped around the labrum to reattach it down to the socket,” Brusalis said. 

“A patient’s dominant arm is a little bit more challenging, just because their activity level with that arm is higher, so the stress they are placing on that arm is greater.”

Dr. Christopher Brusalis
Orthopedic surgeon

He makes it sound easy. It’s not. 

In fact, Brusalis went on to explain that this is a bit of game of cat-and-mouse. 

“The reason why the shoulder is on this precarious balance is because you want it to be stable, where it won’t dislocate, and you want it to have the maximum range of motion that the shoulder allows,” he said. “It is the most unique joint in the body. 

“Another ball and socket is the hip, but you can’t move your hip the same way you move your shoulder, and that’s because of all that range of motion. That’s why as a surgeon you want to be very careful to restore the native anatomy but not make it so tight that they don’t regain the range of motion they need to do all their activities, particularly athletes.”

The Grizzlies announced Thursday that Morant had successful surgery, starting a five- to six-month recovery process.

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‘Successful’ is the word almost always used after a procedure like this. So, after the procedure is an athlete out of the woods?

“I think there a couple of challenges,” Brusalis said. “One is the initial phase of recovery requires a period where you let the labrum heal back down. That means a period of inactivity. The sutures hold the labrum to the socket, but over the next six to 10 weeks there’s a biologic process that allows the labrum to heal to the socket. Again, it becomes one structure, not necessarily reliant on the suturing. That takes patience. 

“For athletes who are in season, there is often the temptation to want to get someone back as quickly as possible instead of rehabilitation according to the goals of returning to specific performance. 

“That’s always a balance. You have to make sure everyone is on the same page about being patient and allowing that biologic healing to happen before you fully start the rehabilitation. 

“The main goal is getting that full range of motion back. Typically, patients are held in a sling, the number of weeks varies from surgeon to surgeon. It’s two-to-six weeks, maybe with an average of about four weeks.

“If you put anyone in a sling for four weeks, afterward their shoulder is going to feel stiff. If you add surgery to that, there is stiffness there. The main focus is trying to restore the range of motion they had prior to the injury.”

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All the times that Morant has dashed to the basket and scooped in a tough-angled layup flashed through my mind. The fact that he shoots jumpers with that shoulder came to mind.

“A patient’s dominant arm is a little bit more challenging,” Brusalis said, “just because their activity level with that arm is higher, so the stress they are placing on that arm is greater.”

And, yes, Morant takes hard falls very often.

His father, Tee Morant, said Tuesday in Dallas that he believed Morant may have been playing through the injury for several games. 

They wasted no time getting the surgery done. 

Of all the things Dr. Brusalis said Tuesday, this certainly stood out:

“Again, not talking about one person specifically, but in general, the success rate of recovering from these injuries is very high. 

“There are two things I would tell you. One is there isn’t a wide spectrum of injuries related to shoulder instability. When a shoulder dislocates or subluxates, we have discussed that the labrum can get detached from the socket or the glenoid. That happens, essentially, every time a shoulder dislocates. 

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“In addition, there are other injuries that can potentially happen. For example, the surface of the socket is covered in cartilage. It’s a protective surface, think of it as the lining of a car tire. When it dislocates, that cartilage layer could get injured. So there are additional potential injuries that could happen when a shoulder dislocates. 

“The prognosis and success of surgery is in part dependent on the number of other concomitant injuries that happen.

“One more key principle that is important when you are understanding shoulder injuries: In general, for young, high-demand individuals, we counsel patients that we are increasingly aggressive about treating these injuries with surgery. What we understand is that with each successive dislocation or subluxation event, there is greater collateral damage that can be done to the shoulder.

“As we discussed, there are other structures to the shoulder. Each time it dislocates, those other structures can be injured more severely. You want to have surgery so you can lower the chance that the shoulder dislocates, and therefore, lower the risk of concomitant injuries.”

So it’s not necessarily about pain, which makes plenty of sense.

Morant, in a sling, seemed to be perfectly happy in the locker room following the victory over the Phoenix Suns last week, just one day before he underwent an MRI. He didn’t appear to be in excruciating pain. 

But, before anyone freaks out, let’s get to the good news. 

No, Brusalis hasn’t seen Morant’s MRI. But he knows that the likelihood a basketball player will return to the same form as before, such as Paul George, is very high. 

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“In general, if someone just has a subluxation event, where they have an injury to the labrum — where it separates from the socket, and not some other injury —it’s probably the most common event. Most surgeons would quote a success rate of 85% to 90%. 

“That is very good. What we mean by success is that the shoulder does not re-dislocate. 

“There are other types of surgeries in the shoulder and other areas of sports medicine where it is hard to get patients fully back to where they were. But, in general, for patients who have this surgery, following it they can expect to get back to very close to the level, if not the same level, that they were performing at before the procedure.”

I may not be the doctor I once thought that I was going to become. But I’m decent with numbers. 

Given the success history of shoulder procedures, it seems like Morant has a good chance to fulfill the hopes of Memphis prior to the setback, no matter how aggressive he plays. 

“There’s that 10% to 15% chance of recurrence following that type surgery as a general ballpark number,” Brusalis said. “The surgery is done in very high-level athletes. We are talking rugby players, football players; people who put as much, if not more, stress on their shoulders than basketball players. 

“The surgery is supposed to return him as close to possible to his prior condition. If I’m a sports fan and someone gave that number, that’s an encouraging sign to me. You should be encouraged by that number. Across all orthopedics, that’s a very good number.”