So Will Big Ben Answer The Bell Against The Broncos? Ask The 'AC'

By Dr. Dave Hnida
(CBS4) -So can Big Ben answer the bell against the Broncos? Or will an injured throwing shoulder force him to  keep the bench warm for his team mates?

After a Friday practice, he continues to be officially listed as "questionable," or day-to-day, but Ben Roethlisberger did take to the field today to make some throws. And that suggests doctor's orders will be full steam ahead come game day.

The quarterback is reported to have a "shoulder sprain." But an MRI makes the diagnosis a little more precise. It's actually an acromioclavicular sprain, a mouthful of a joint which is usually referred to as an "AC sprain," or even more simply--- a separated shoulder.

So what's an "AC"?

If you look at the x-ray, you can see where the shoulder (acromion) attaches to the collarbone, or clavicle. Hence the term acromioclavicular. The joint is not as stable as the true shoulder joint, which is a ball and socket. This one is simply a couple of straight bones held together by some ligaments. Think of two pencils being held together end to end by some rubber bands.

If you fall on the shoulder, or the arm gets forced upwards, or something pushes the bones apart, that's a separation. On the x-ray, you can see that the collarbone has been pushed away from the shoulder—that space shouldn't be so wide.

A Grade I sprain means the ligaments have stretched.
A Grade II means they've been stretched and a few fibers torn.
A Grade III means a complete tear of the ligaments.

It's believed Roethlisberger has somewhere between a II and a II.
And you can play with a I or II.
A III, you are done.

One major study of QBs showed the average time lost with a Grade I was 7.3 days
A major point here: There's a big difference between a shoulder separation and dislocation. A dislocation means the arm bone has been pulled out of the socket. A separation means simply that---a separation of a different joint. If he had a dislocation, he would be cooked.

Think about it—Roethlisberger left the game and then came back in. No sling when he left the field or the stadium. He threw passes when he re-entered the game (albeit short ones). His final pass was to a receiver 23 yards away—and he threw it over the guy's head. So his arm works.

The key will be pain.

If he can be comfortable, he can throw. And sure, most passes will probably be short—they may be sidearm (since overhead motion really hurts an injured AC)—but he still may be able to unleash the big one---or more.

You typically inject the shoulder with cortisone to get the pain and inflammation down. A little novocaine type numbing medicine (Lidocaine or Marcaine) into the AC will make it hurt less and work better. Taping the shoulder in a special way will also make the joint more stable.

And you know he got a week's worth of therapy, ultrasound, etc. under his belt.
Then throw in the year 2008. That's the year Roethlisberger suffered a Grade I AC sprain and continued to play. In fact his last pass of the season traveled 48 yards in the air.

Now sure, he could make it worse by throwing, but his biggest worry is landing on it, as in a sack. Now that's a risk, and could turn a I to a III, and spell surgery.
It all boils down to the fact that it's never good to have a bad AC----but it doesn't mean you can rest on your heels. And you know the Broncos know that.

The final prognosis: Roethlisberger plays.

But even without his AC or other Pittsburgh injuries, Broncos win Sunday.

And you can take that to the MRI machine.

Dr. Dave Hnida is CBS4's Medical Editor. He blogs about the latest studies and trends in the health world. Read his latest blog entries, check out his bio or follow him on Twitter @drdavehnida