September 19, 2016 - Dr. David Chao
Monday Morning MD: Running back carnage
After a relatively healthy Week One, the law of averages has unfortunately caught up with the NFL. Among the many injuries this week, seven prominent running backs were injured. Fans and fantasy owners of Adrian Peterson, Arian Foster, Jonathan Stewart, Doug Martin, Thomas Rawls, Ameer Abdullah and Danny Woodhead are holding their collective breaths. Adrian Peterson is the headline injury as he could not put weight on his right leg when he was helped off the field and into the locker room. There were initial fears of ankle injury but further examination of video focused on his knee. His right knee appeared to be locked, a condition that could be caused by a bucket handle meniscus tear when knee cartilage flips and catches in an awkward position preventing full motion. I hope the early optimism is correct, but crutches and a locked knee brace is not the look of a player ready for next week. The big concern is the high association with ACL tear, although it is possible to not tear your ligament and suffer a locked knee. I wish I had a different angle on video as my worry is the step before the ankle is pinned. I hope his season and ACL are spared but even when a locked knee “calms down” and can straighten, that doesn’t mean the problem is solved. It would not surprise me to hear Peterson needs arthroscopic surgery at a minimum. Lets hope for a small meniscus tear and a quick return. Arian Foster was immediately ruled out with a groin injury. It is unclear if the injury is related to his hamstring issue, which he entered the game with. At the start of last season, Foster did suffer a groin injury that needed core muscle surgery. I hope his current injury is a pure groin muscle issue and not a sports hernia type injury like 2015. Jonathan Stewart and Doug Martin exited with hamstring injuries. There is no way to tell severity or if respective teams were being cautious by removing the two players. Their returns will be likely week to week. Thomas Rawls was coming off a high ankle type fracture and left with another lower leg injury. Coach Pete Carroll related Rawls got kicked and suffered a contusion which hopefully means he is back for next week. Ameeer Abdullah left with a foot injury after a nifty run with several hard cuts. The good news is, by video, there was no obvious injury mechanism on that final play. The bad news is one has to worry about potential fifth metatarsal stress fracture with all those hard cuts and no definitive misstep leading to his exit. X-rays were negative but that doesn’t preclude a stress fracture. Here is hoping it is not. Danny Woodhead injured his knee and did not return. As I indicated on twitter, I am purposefully refraining from comment or analysis here for professional reasons. I try to provide insider knowledge but can never give insider information. I hope this unlucky group of seven running backs can dodge serious injury and all be back to top form soon. MMMD 1: Quarterback AC joint injuries Jimmy Garoppolo and Josh McCown both appeared to suffer AC joint sprains. The Patriots QB did not return, but the Browns QB did. The difference is severity as well as injury to throwing versus non-throwing shoulder. The acromioclavicular (AC) joint sprain is also called a separated shoulder, but has nothing to do with the ball and socket joint. Still it can interfere with throwing mechanics and there are different grades of injury. It will be difficult but not impossible for Garoppolo to play on a short week here but the race is on to beat Tom Brady back to action in Week 4. McCown will undergo further evaluation on his left shoulder but the hope is he can continue to lead the Browns in RG3’s absence. After all, he did finish the game with the non-throwing shoulder injury. MMMD 2: DeMarcus Ware breaks forearm “Meet me at the quarterback” took on new meaning as Ware’s forearm met Von Miller’s knee. Ware is reported to have an ulna fracture. I expect surgery to be announced to allow for a quicker return measured in weeks without going on injured reserve. This appears to be a similar injury to the one Thomas Davis suffered in the NFC Championship Game where he had surgery and returned for the Super Bowl. My hope is to see Ware playing in a cast as early as in 3-5 weeks. MMDM 3: Buffalo injury worries continue The Bills have had bad injury luck already with Shaq Lawson and Reggie Ragland. They don’t need Sammy Watkins to miss time. Watkins had offseason foot surgery for a 5th metatarsal fracture and is reportedly dealing with foot pain. If the pain is from the bone, that is a bad sign. Jones fractures have a high rate of second surgery as happened with Dez Bryant, Julian Edelman and others recently. X-rays were reportedly negative but if symptoms continue, a bone scan or CT scan will likely be next. Here is hoping the pain is from the soft tissue and not related to the original bone injury. MMMD 4: Stiffer penalty for face masking I am not talking about an incidental tug or even instinctive grab; however, when a player is literally pulled to the ground by his face mask, that calls for a fine, ejection or even suspension. Brandon Marshall was brought down by his face mask to prevent him from scoring and injured his knee as a result. Fortunately it was a mild MCL, but it could have been much worse. In many ways, tackling by the face mask is just as or more dangerous than a horse collar tackle. MMMD 5: injury rundown There were the typical early season muscle injuries. Stewart, Martin and Braxton Miller were examples of hamstring strains. No matter how in shape players are, football shape is different and we usually see these injuries more frequently early on. Saints CB P.J. Williams was carted off on a spine board but appears to being doing better. He does not appear to have a cervical injury but rather concussion issues. Jaguars guard Kelvin Beachum also appears to have avoided serious neck injury after he too was carted off on a spine board. He was kept in San Diego overnight for observation after a concussion. Browns center Cam Erving was hospitalized for a bruised lung after being hit in the chest/ribs. He will likely miss at least a month. If he is placed on IR, then a choice would have to be made between him an RG3 as only one player per team can return from IR. Lions DE Ziggy Ansah ultimately left the game after an early leg whip from friendly fire. He was seen without a boot or crutches after the game so here is hoping for a quick return. Chargers safety Jaleel Addae was reported to have a clavicle fracture. Expect surgery and a 4-8 week return. Seahawks WR Doug Baldwin got the wind knocked out of him and injured his knee. He will have a MRI this morning. Vikings QB Sam Bradford’s hand was noticeably swollen but that doesn’t mean injury. The back of the hand swells easily and indeed Bradford finished the game without issue. No, the medical staff did not cut and drain his hematoma as some opined. MMMD 6: Concussion co-chair exoneration The co-chair of NFL Head, Neck and Spine Committee was cleared by a University of Washington panel of improperly influencing grants. A congressional subcommittee made headlines with accusations of impropriety singling out this doctor. I hope the exoneration makes similar headlines, but I doubt it will. Unfortunately, the original accusations will live forever at the top of any Google search but the clearing of his name will end up buried in the depths of the internet. Such is the world we live in today. MMMD 7: ProFootballDoc scorecard It was a busy week. Matt Jones did play with his AC joint injury as expected. Unfortunately, Keenan Allen did tear his ACL. Brian Cushing was confirmed with a MCL injury as was Brandon Marshall and T.J. Green. Russell Wilson was confirmed and played with a high ankle sprain. Demaryius Thomas played with his hip injury. Jimmy Garoppolo indeed has an AC sprain, not clavicle fracture. P.J. Williams and Kevin Beechum had concussions, not neck injury. Sam Bradford’s hand was not a big deal. Other analysis including Adrian Peterson is pending cross checking with MRI results. For the time being, the 28-1 record jumps to 39-1 at 97.5% .