December 05, 2016 - Dr. David Chao
Monday Morning MD: Earl Thomas season over
Three weeks ago two stars collided when Earl Thomas tackled Rob Gronkowski in one of the most talked about hits of the year. Now both headline players are done for the year. Gronk was placed on IR on Friday (details in Item #1 below). Thomas, a leader of the Seahawks “legion of boom”, will soon follow suit after his lower leg injury last night. This time the collision was between star teammates, when Kam Chancellor’s leg inadvertently “karate chopped” Thomas’ tibia bone. He tried to stand on it momentarily but couldn’t, yet refused to be carted off the playing field. Pete Carroll indicated a “cracked tibia” and mentioned six weeks in his timeline, but Chancellor said it was a fibula but season ending. By video, the truth is somewhere in between: a season ending nightstick tibia fracture (with fibula intact). The tibia is the much larger weight bearing bone in the lower leg. The fibula is the smaller bone. The recovery for an isolated fibula fracture is non-surgical and approximately six weeks (see Thomas Rawls). The healing for an isolated tibia fracture is about six months and usually means rodding surgery. Because the fibula was intact, the lower leg did not need an immediate fracture splint, yet it is still a serious injury. Unfortunately, I don’t see a scenario where Thomas could return this season, even if the Seahawks make it to the Super Bowl two months away. Fortunately, he has an excellent chance at full recovery for the 2017 season. Famously, UFC fighter Anderson Silva and NBA star Paul George fractured both tibia and fibula and both made full returns. Other recent NFL players to come back after tibia fracture include Khiry Robinson and James Develin. Thomas tweeted about possible retirement immediately after the injury. I would never blame a player who makes the decision to hang up his cleats, but the best safety in the league will be back next year, if he chooses to do so. MMMD 1: Gronk career not over With his eighth surgery consisting of a low back procedure, some are saying Rob Gronkowski may be done or on serious decline. No question a third disc surgery is concerning, but all were not at the same level (one L4-5 and now a second at L5-S1). Three at one level would beg the need for lumbar fusion, which would end an NFL player’s career. This does not seem to be the case. The Patriots and Gronk/family are rightfully taking the cautious course. Gronk could return to play at 6-8 weeks post discectomy in time for the conference championship game or Super Bowl, but would not be at 100% until at least 3-4 months. Just like J.J. Watt could come back now after his second surgery on his same disc; however, the Texans are being cautious and looking at the long-term picture. One can argue any player starts to decline as he approaches the age of 30, but I do not see this as a career ending deal for the 27 year-old superstar. Yes, Gronk will need to be careful and perform lifelong back stabilization exercises and he does risk back pain and degenerative changes long term; however, it would be premature to say his career is over or in decline. MMMD 2: Hockey injury descriptions? Julio Jones was described by his head coach as having a “lower body injury”. Normally such descriptions are reserved for the NHL, where a team indication of upper or lower body injury are all that is routinely given. Although the NFL reports are far from complete, at least it requires a body part and is far superior to the NHL. With the NFL getting rid of “probable” designations, I hope this is not a sign of moving towards even less information. MMMD 3: Sideline tent During last week’s Monday night game, there was much intrigue over the Packers structure behind the bench. Cameras followed Aaron Rodgers entering the mysterious canopy causing fans to wonder. This is simply a medical tent for potential evaluation and treatment. Rodgers entered for privacy to drop his pants to get a hamstring pressure pad wrap. Several colleges have even bigger versions. I personally wanted to have one when I was a NFL team doctor. Ironically now, I would rather teams not have them as I would rather see what is going on. Often it saves a trip to the locker room or provides a place to quickly relieve one’s self without running inside. MMMD 4: Vikings get head coach back Mike Zimmer had emergency eye surgery and missed his team’s game. This third procedure for a detached retina was likely more than a simple laser and may be his last chance to regain all of his vision. Opthomologists have quoted to me a 25% chance of permanent visual impairment if this surgery doesn’t go well. Position, stress, airplane restrictions and temporary visual impairment are common. It has been reported that if Zimmer can now fly to Jacksonville for the next game and has resumed coaching duties. Even with the good news, there is no question he will be limited this week in terms of watching film and installing the game plan. Zimmer and the Vikings should be smart and do whatever it takes to restore his vision as a priority. MMMD 5: Medical marijuana in NFL? Seantrel Henderson was suspended for marijuana use that he claimed was used to treat his known Crohn’s disease. The 10 game suspension was confirmed despite the medical reason for usage. Although recreational and medical marijuana are becoming increasingly legal in various states, it is still strictly prohibited in the NFL. Currently there are no medical use exemptions. If players want this to change, it needs to be a topic for the next collective bargaining agreement (CBA). Don’t be surprised if that happens. MMMD 6: Injury rundown Let’s start with positive medical news. Eric Berry beat cancer just over a year ago and now his pick-6 and pick-2 literally won the game for his Chiefs. Aaron Rodgers was limited but survived without re-aggravating his hamstring, which is tough given the cold weather and poor footing with the snow. If the Packers can continue a playoff push, this injury should be behind Rodgers if they make it to the post-season. Derek Carr didn’t have any issues with his finger dislocation. He did not use a glove or buddy tape the pinky and lead the Raiders to a decisive comeback win. Dennis Pitta had a career threatening injury when he dislocated his hip the second time. It took surgery and two years but he is finally back, as he had nine catches for 90 yards and two TDs, his first since the injury. Clay Matthews and Justin Houston both played through AC joint sprains on Sunday. Michael Bennett returned to play four and half weeks after his knee scope. The worst injury of the day belongs to WR Cecil Shorts. By video, he suffered a multi-ligament knee injury which likely involves his ACL and MCL. The Patriots likely will loose Danny Amendola for some time with a right high ankle sprain, but the hope is to be 100% for the playoffs. Jason Pierre-Paul by video has a groin strain, which was confirmed. Sammy Watkins played through his Jones fracture, which has still not completely healed. The Bills targeted him nine times but he only had three catches for 28 yards. At some point, one has to shut him down and have surgery again to get right for next season. A.J. Green seems to be improving and on course for a late season return from a grade 2 hamstring injury. Doug Martin limped off with an injury to the left side where the injury was obscured by a pile of bodies, but hoping/expecting that it is minor. Trevor Siemian did not practice with his left foot injury and missed the start but I think he has a good chance for this week. Charles Johnson injured his left hamstring and may miss some time. An abdominal injury is trouble for any kicker and the Steelers replaced Chris Boswell with Randy Bullock temporarily. MMMD 7: ProFootballDoc scorecard There were three mistakes this week. They were not bad ones and I could argue that I was at least partially correct but I will take my lumps. There may have been more to Gronk’s injury than the innocuous Jets fall but he is done for the year with a disc injury. Despite the fact the Jordan Reed should return soon from his grade 3 AC sprain, he did miss this week. The Danny Trevathan injury turned out to be an ACL tear. Jay Cutler’s season is over with labral tear surgery. Ryan Kalil is suffering the same fate. A.J. Green has a multi-week proximal hamstring strain. Daryl Williams has a left high ankle sprain. Steeler’s kicker Chris Boswell abdomen did keep him out. Derek Carr played well despite last week’s finger dislocation. Sammy Watkins does still have a fracture in his foot. Dont’a Hightower avoided serious injury from a chop block as his feet were not planted. Andrew Whitworth suffered a mild MCL sprain and later returned. Luke Stocker appears to have a left high ankle sprain. Bucs WR Adam Humphries left due to a concussion. JPP had a groin strain confirmed. Michael Crabtree avoided serious injury. Charles Johnson exited with a left hamstring injury. Justin Houston played through his apparent mild AC joint sprain. Michael Bennett took longer than the original 2-3 week return as expected. Danny Amendola was confirmed with a high ankle sprain. These new additions to the scorecard lower the previous 145-6 (96.0%) record to 161-9 (94.7%).