Monday Morning MD: Ultimately things make sense

Dez Bryant’s injury was called a “hairline fracture” by his head coach. With his team saying their star wide receiver was day to day, that just didn’t make medical sense. Were the Cowboys that desperate that they would jeopardize a playmaker’s health? Was Dallas just sending out false information to make the opposition do extra homework in game planning? The truth seems to be neither, but rather that Bryant seems to have a bone bruise rather than a fracture. This new diagnosis indeed jives with how the team has been handling the injury. The first thing that seemed weird is that the team didn’t release Bryant’s MRI results. Fans feared that they were hiding something. Then it came out that there was no Monday MRI. This led me and others to think the injury wasn’t significant enough to warrant an MRI. The truth was the Cowboys were initially just protecting their star player, as Dez missed his MRI appointment while going temporarily AWOL. The next unusual thing was that Jason Garrett broke the news of a “hairline fracture” to the 49ers media rather than his hometown beat reporters. Now it seems clear that it wasn’t an intentional slight but simply being forthcoming with the next media opportunity after the Wednesday MRI results. When the injury was confirmed to be in the lateral tibial plateau, medically that meant a minimum 4-6 week absence. However, the Cowboys continued to insist it was a day-to-day injury. A hairline fracture implies injury to the cortex (hard outer surface) and indicates damage to the structural integrity of the bone. Playing on it would risk displacing the fracture and needing surgery. Now it all makes sense. A bone bruise can be described as microscopic fracture of the trabecular (soft inner) bone. This is not structural and one can see how Garrett could have unintentionally mistermed it a “hairline fracture”. Indeed the team is not putting Bryant at risk with its “pain tolerance only” stance expecting return in 1-3 weeks. A bone bruise was always a worry and made sense combined with the MCL sprain based on video. I have always said that teams aren’t stupid. If a decision made on the inside looks silly to the outside, that just means we don’t have all the facts. The Bryant/Cowboys situation is another example of how there is usually a logical explanation for everything. MMMD 1: Another major NaVorro Bowman injury By video, the star 49ers linebacker unfortunately suffered a left Achilles rupture.cty9ysrumaax_wc The team ruled him out immediately with a lower leg injury. Media has confirmed worry of Achilles tear. I hope my film analysis to be wrong but this was a classic change of direction, non-contact, eccentric load type mechanism. Bowman missed the entire next season after his 2014 combined ACL and MCL tear needed surgery. Now he will miss all of this season with surgery again. The only good news is he medically should be on track for Week 1 2017 and chances are good to be 100%. The injury is on the same side but there is no definite linkage of the two. MMMD 2: Concussions for Cam and Carson Cam Newton needed to keep his head on a swivel but a momentary relaxation lead to a goal line concussion. Carson Palmer’s head slammed to the turf before entering the concussion protocol. The Panthers play next Monday, while the Cardinals are scheduled for this Thursday night. Newton has twice as long to recover before the next game. Although concussions are unpredictable, Palmer seems very unlikely to play while recent data would have Newton 50/50 on getting cleared. Safety of Thursday games comes into play again. Adding a bye week and pairing up midweek games with the bye would eliminate this problem. With the Packers and Eagles having their bye this past week they likely would welcome a second bye in the late season. MMMDS 3: Broncos win with another rookie QB Trevor Siemian has now been confirmed with an AC joint sprain (separated shoulder). By video, it was never a clavicle fracture as some feared. Siemian could have returned to play but instead was confirmed as the emergency QB. Likely the Broncos decided a healthy rookie Paxton Lynch was a better option than an injured QB. Siemian’s injury is very similar to that of Jimmy Garoppolo except it is on the non-throwing shoulder and thus should be available next week. If Siemian doesn’t start/play next week, it will mean a coaching decision regarding limited practice and a QB not being 100% rather than an inability to play through the injury. MMMD 4: Rookie quarterbacks fairing well This year seems like a Seinfeld episode with a “George Costanza opposite” season for signal callers. The Broncos, Eagles, Patriots & Cowboys all have first time starters at QB and are a combined 13-2 so far. Meanwhile, established Pro Bowl QBs Drew Brees, Cam Newton, Philip Rivers and Carson Palmer are a combined 4-12. In a quarterback league, it is certainly a “bizzaro world” to see rookies with all this success and star players struggling. MMMD 5: Harbinger of a London based team The Jaguars played overseas for the fourth straight year but that is not what signals to me the growing likelihood of a British team. To me the significance is that both clubs voluntarily choose to fly to London on Thursday. The days of the early travel and week-long stays in England seem to be over. This signals the growing feasibility of travel. In fact, the Colts do not even follow London with a bye, which had been the league norm. These subtle but important changes are paving the way for a global NFL. MMMD 6: Injury rundown As feared, Sammy Watkins does seem to have a bone issue with surgery with a larger screw and bone graft coming. He was placed on injured reserve and will not return. This is not uncommon for Jones fractures, but when healed, he will be 100% again for 2017. J.J. Watt had a second discectomy surgery on the same L5-S1 level. There was no fusion and thus no fear of career implications. Eric Decker has a partial rotator cuff tear. The extent of the tear and his response to rehab will determine whether he needs surgery. Russell Wilson lead his team to victory and the good news is with the bye, he should be 95% healthy by his next game with the MCL and high ankle essentially behind him. Tony Romo is likely to practice fully and is getting close to a return. With Dak Prescott performing well, it gives the Cowboys luxury to wait until after the Week 7 bye. Lee Smith suffered a gruesome ankle fracture yet still limped off the field under his own power.ctygyiousaafwzw The Raiders TE will likely need surgery and is done for the year. Kevin White appeared to have an third quarter mild high ankle sprain but there was only one limited view. Darelle Revis left with a hamstring strain and his return is uncertain. Chris Johnson was announced on TV as his left knee giving out, but by video to me he had a groin strain, which was confirmed. Dewayne Washington was announced as an ankle, which may be good news as there was initial worry for turf toe or Lisfranc injury. Eric Ebron, Brandon Bolden and DeForest Buckner were rolled up upon in similar fashion. All three may have the combo MCL and/or high-ankle sprain with recovery based on severity. Dont’a Hightower played with partially torn meniscus. He seems to be trying to finish the season but a scope may be in his future. Gerald McCoy left with a calf injury. This may be something that lingers for the Buccaneers. Tyler Lockett is reported to be playing through a PCL sprain. Kudos for toughness but the worst is likely behind him and he is unlikely to need surgery for what seems to be a mild sprain. Tyron Smith of the Cowboys has a bulging disc, which usually does not need surgery but return to play depends on symptoms. Randall Telfer had a Browns friendly fire high ankle sprain. The Steelers suffered a host of injuries including Marcus Gilbert with a likely mild high ankle sprain. MMMD 7: ProFootballDoc Scorecard Russell Wilson played through injury. Sammy Watkins did indeed have a bigger issue. Brian Cushing played at three weeks, sooner than the six week projection as expected. Josh Doctson’s Achilles tendonitis is lingering. Charles Tapper is now on IR with pars defect. Dez Bryant does have a MCL with bone bruise. Jay Cutler missed while Jacoby Brissett played. NaVorro Bowman does seem to have an Achilles rupture. Trevor Siemian has an AC sprain and was available to play. Chris Johnson has a groin strain, not knee. Martellus Bennett’s injury was mild. Dez/Scandrick/Tyron Smith all were inactive as expected. The previous 48-2 record is now 61-2 (96.8%).
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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