Dr. Surena Namdari on Manny Pacquiao's injury, surgery and rehab

SI.com spoke with Dr. Surena Namdari of the Rothman Institute about Manny Pacquiao and the general nature of rotator cuff injuries.

After the hyped clash between Floyd Mayweather and Manny Pacquiao failed to live up to “fight of the century” expectations on Saturday night, reports surfaced on Monday that Pacquiao fought through a torn rotator cuff in his right shoulder that will require surgery. SI.com spoke with Dr. SurenaNamdari of the Rothman Institute about the general nature of rotator cuff tears and Pacquiao’s specific injury.

SI.com: Let’s forget about professional athletes for a moment. How would a rotator cuff injury impact the daily life of an average person?

Dr. Namdari: It actually affects patients significantly. Rotator cuff injuries cause pain in very regular, daily activities, and patients with rotator cuff injuries most commonly complain of difficulty sleeping at night or excessive pain while moving around in bed. If people feel that pain during such regular activities like sleeping, you can imagine how difficult it would be to deal with that pain during high-level activities like boxing.

After the fight, Freddie Roach, his trainer, said Pacquiao sustained the injury in April. Do you suppose it is more likely Pacquiao was injured during a sparring session, or is this an injury that can develop over time?

Dr. Namdari: There are two kinds of rotator cuff tears: The type that occurs over time, which is called degeneration, and is most commonly found in older patients and in younger patients, tears are typically acute traumatic injuries, caused by lifting something heavy or experiencing an abnormal torque. I would suspect Pacquiao’s was some of a combination of both. For Manny Pacquiao, boxing for so many number of years, over time, the tendon may have experienced a gradual wear and tear. A lot of times in athletes it’s a combination of wear and tear and specific impact events.”

Mayweather vs Pacquiao: SI's Best Photos

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Floyd Mayweather won a unanimous decision over Manny Pacquiao to run his record to 48-0 on May 2. Here are SI's best pictures from the bout.

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Two of the judges scored the fight 116-112 for Mayweather, while the other judge scored it 118-110.

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Mayweather was successful in throwing his his jab to keep Pacquiao at bay.

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Pacquiao threw far fewer punches than he normally does in a fight, with Mayweather actually throwing more. (Text credit: AP)

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Pacquiao chased Mayweather around the ring most of the night, but was never able to land a sustained volume of punches. (AP)

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After the fight, it was disclosed that Pacquiao injured his right shoulder in training and that Nevada boxing commissioners denied his request to take an anti-inflammatory shot in his dressing room before the fight. (AP)

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By winning the welterweight bout, Mayweather cemented his legacy as the best of his generation. (AP)

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Pacquiao thought he had won the bout, largely on the basis of a few left hands that seemed to shake Mayweather. (AP)

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There were no knockdowns, and neither fighter seemed terribly hurt at any time. (AP)

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Mayweather fought confidently in the late rounds, winning the last two rounds on all three scorecards. (AP)

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The crowd of 16,507 cheered nearly every time Pacquiao threw a punch. (AP)

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Ringside punch stats showed Mayweather landing 148 punches of 435, while Pacquiao landed 81 of 429. (AP)

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In the corner, Mayweather's father kept yelling at his son to do more. But Mayweather was content to stick with what was working and not take a risk that could cost him the fight. (AP)

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Pacquiao landed probably the biggest punch in the fight in the fourth round — a left hand that sent Mayweather into the ropes — but he wasn't able to consistently land against the elusive champion. (AP)

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"He's a very awkward fighter, so I had to take my time and watch him close," Mayweather said. (AP)

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Pacquiao had vowed to take the fight to Mayweather and force him into a war. His camp thought Mayweather's 38-year-old legs weren't what they once were. (AP)

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"You're tough," Mayweather said to Pacquiao after the bout, hugging him in the ring. (AP)

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The fight unfolded before a glittering crowd of celebrities, high rollers and people who had enough money to pay for ringside seats going for $40,000 and up. (AP)

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In the final seconds of the fight Mayweather raised his right hand in victory and after the bell rang stood on the ropes, pounding his heart with his gloves. (AP)

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"I thought we pulled it out," Pacquiao trainer Freddie Roach said. "I asked my man to throw more combinations between rounds. I thought he fought flat-footed too many times." (AP)

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Mayweather says he'll fight one more time before calling it a career.

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Pacquiao was escorted into the ring by Jimmy Kimmel.

​Often with significant lower body injuries like a torn achilles or ACL, athletes’ awareness of their injuries seem to vary. Sometimes we’ll see someone in agony following an ACL tear. It’s also not uncommon for athletes to finish games—even multiple additional games—before realizing the magnitude of the injury. Can a rotator cuff injury be similar?

Dr. Namdari: People will generally notice the injury upon sustaining it. I definitely suspect his injury occurred during his training. Then, a person’s ability to overcome the pain depends on their discipline as well as their strength and conditioning in other areas of their body for which they can overcompensate for the injury.

In terms of overcoming the pain, how much of an impact did Pacquiao’s injury realistically have on the fight, in your opinion?

Dr. Namdari: If someone told me before the fight that Manny Pacquiao was experiencing a full thickness rotator cuff tear, I would tell you he’d have a really difficult time being able to land accurate punches with significant power. If he indeed asked for an injection prior to the fight, that would also tip me that he was experiencing significant symptoms of the rotator cuff tear as well.”

Pacquiao is expected to undergo surgery later this week. Los Angeles orthopedic surgeon Dr. Neal ElAttrache said the surgery usually requires nine to 12 months of recovery time. What can we expect from Pacquiao’s rehabilitation, especially with Mayweather reportedly being open to a rematch next year before he retires.

Dr. Namdari: For full thickness, which is a complete detachment of the tendon from the bone, that almost always requires surgery. The procedure is fairly routine and fairly simple: it only takes about an hour to an hour and a half by a trained surgeon with skilled hands. However, the recovery is not simple. The recovery time is at least 6 months before a rehabilitation process can occur and I would expect for someone at Manny Pacquiao’s age of 36, it would require up to 12 months for a full recovery to optimum strength and conditioning for elite athletic performance. That would definitely put a potential rematch in jeopardy.

Surena Namdari an orthopedic surgeon at The Rothman Institute. is an assistant professor of orthopedic surgery at Thomas Jefferson University. He specializes in the arthroscopic and open treatment of all conditions of the shoulder and elbow, including arthritis, tendon disorders, fractures and instability.