Monday Morning MD: Injury decisions not made in a vacuum

How long before a grade 2 MCL sprain to return to play? The answer depends on many circumstances and the medical status is not the only factor in the decision. Obviously the sport, position, type of player, associated injury, time of season and many other factors come into play. At this point of the year, a team’s record and playoff position factors into return to play. If the Dolphins were out of the playoff race, surely there would not be talk of Ryan Tannehill returning with an ACL/MCL sprain. Adrian Peterson accelerated his meniscus repair rehab to try to bolster the Vikings fading division chances. The Packers rested Aaron Rodgers during the week but they roll the dice on his calf and hamstring come game time to chase down the Lions. Sammy Watkins continues to suit up with a reported broken foot with the Bills still having a small glimmer of post-season hope. Now that the Bengals are officially out of the playoffs, will A.J. Green still push to return from his hamstring injury? The eliminated Chargers likely will continue to play it safe with Melvin Gordon even though he is only three yards shy of a 1000-yard season. On the other hand, the Patriots in control of a first round bye, can give Danny Ammendola all the time he needs on his presumed high ankle sprain. The division leading Falcons also take it slow on Julio Jones’ toe sprain. Of course there are always the old school guys like Matt Forte. His Jets are long eliminated, yet he continues to play through a documented meniscus tear which will likely require surgery at season end. The bottom line is that decisions on return from injury are never made in a vacuum. This time of year, the team’s standing usually factors into a player’s and team’s mindset and risk tolerance. MMMD 1: Double good news for Packers Green Bay continued its resurrection winning their fourth straight game and Aaron Rodgers came through without aggravating the recent calf or previous hamstring injury in the bitter cold of Chicago. His strong arm took over, often throwing off the back foot. Rodgers looked better than he did with his December 2014 calf strain that lingered into the playoffs. He actually ran on some plays, something he refused to do with a similar injury two years ago. Hope his calf can hold up. MMMD 2: Doubt the Dolphins can get their QB back Miami got initial good news of ACL and MCL sprain on Ryan Tannehill but a sprain is a tear. Grade 3 sprains are complete tears. The hope is for lower grade sprains meaning partial tears. Tannehill is reported to be in a cast with a slight ACL tear. He was seen using a crutch and walking with his left knee immobilized. Unfortunately, this is not the look of someone who will make it back before the end of the regular season. I hope Tannehill can return. The Dolphins have said no surgery is needed now, but there still may remain the possibility of a procedure after the season. Only on rare occasions does a partial ACL ultimately not need surgery. MMMD 3: Quick meniscus repair return Kudos to Adrian Peterson and the Vikings medical staff for a fast three-month return after his meniscus was sutured. He played with a knee brace and was not particularly effective (6 carries for 22 yards) but neither was his team. This is not a knock on Peterson. It is very hard to miss three months of football, practice for three days and play well. Hopefully he can help salvage the minimal Vikings playoff chances and stay healthy. MMMD 4: Finger dislocation a regular occurrence Derek Carr and Matthew Stafford have much discussed finger dislocations since they happened on their throwing hands. Both played reasonably well despite the injury. When fingers are dislocated, by definition, ligaments are torn. Fortunately they heal and scar in without surgery in most cases. Finger dislocations happen routinely. Michael Crabtree and Chris Hogan appeared to dislocate fingers recently and finished their games with key receptions. Often players reduce their own finger dislocations or have teammates help out with the reduction without coming off the field. In my NFL experience, there is probably a finger dislocation every game that we don’t hear about. When it happens to a quarterback, then comes all the attention. MMMD 5: Ravens with only DOUBTFUL players to play We covered the ACTIVE rates of QUESTIONABLE players previously. DOUBTFUL players are essentially always inactive. The only three exceptions this season were all from the Ravens: Terrell Suggs, Steve Smith, Sr. and Alex Lewis. If your favorite player is listed as DOUBTFUL, count on him to be out, unless he plays for Baltimore. MMMD 6: Injury rundown Fortunately Week 15 seems to be one of the better injury weeks, but there will be the typical late injury announcements to follow. Janoris Jennkins exited after a teammate’s knee to his back. It was announced there was worry for organ injury, which based on location would be either lung or liver. Hope he is OK. Will Gholston dislocated his right elbow, but his season is not necessarily over. He is likely to return if the Buccaneers make the playoffs and could play in Week 17 in a brace. Stephon Tuitt left the game early with a knee injury. By video, there is some worry for a meniscus tear. Darius Slay left with a hamstring injury and will obtain a MRI. Lamar Miller hopes to be fine after a late game ankle injury. Austin Hooper is hoping for the best but fearing the worst on his knee injury. Matt Forte saw limited action but played with a MRI documented meniscus tear that is likely to need an offseason scope. Bryce Petty suffered a chest bruise but should be fine going forward. Melvin Gordon is likely to return from hip/knee injury but not until completely healthy. A.J. Green’s hamstring is nearly healthy but his team’s playoff chances are done. Julio Jones initial turf toe diagnosis is now called a toe sprain. He missed his second game but should be back next week. Danny Ammendola was seen in a boot still, likely meaning his high ankle sprain is still several weeks away, but he should return for the Patriots first playoff game. MMMD 7: ProFootballDoc scorecard Here is a quick review of some of this week’s calls. Matt Stafford played with a modified glove and minimal obvious effects from a finger sprain. Jared Cook is OK after a hard fall to ground and played this week despite possible lung contusion. Duron Harmon was not injured but momentarily short of breath. Jimmy Smith left with a high ankle and may be out for a few weeks. Haloti Ngata was not seriously injured and returned after a thigh contusion. Janoris Jenkins took a knee to the back. Will Gholston did dislocate his right elbow. This slightly improves the 174-10 (94.6%) record to 181-10 (94.8%)
Dr. David Chao
Two decades of NFL team physician experience including two Super Bowls and two Pro Bowls. Providing unique perspective to injuries and the NFL sideline/locker room. Successful orthopedic surgery and sports medicine practice in Southern California.

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