Monday Morning MD: The most important draft medical info still to come

  Medical is the most important information a team can get at the NFL Scouting Combine. The Combine may be over but the pre-draft medical data won’t be complete for almost two months. Players coming off surgery or with active medical issues are asked to return to the medical rechecks in six weeks. Essentially this is the main group of players at risk to drop in the draft due to injury. The return visit allows all 32 teams to assess players’ recovery and improvement. Revisiting Indianapolis will be key for the former Notre Dame star linebacker and Butkus Award winner, Jaylon Smith. Unfortunately what was feared, has come true with revelation of a nerve issue at Combine. Although nerve recovery is quite finicky, the majority of improvement usually happens early. It is also important to get a second data point to see which way Smith’s knee is heading and how quickly. Remember the injury is still fresh and the timing of the second look at the rechecks essentially doubles his recovery time from injury/surgery. If the peroneal nerve has incrementally improved by then, that would be a good prognostic sign. If the foot drop remains unchanged in six weeks, that would portend a long and difficult road for recovery. Making progress is the key. Even without the nerve issue, it would be important to recheck Smith for his status after ACL and LCL surgery. Please note that it is absolutely inaccurate that Smith’s tweet could cost him millions. I never said such a ridiculous and presumptuous statement. No team or physician is going to base their medical opinion on my (or the player’s) tweets. All 32 teams will rely on their exam of the player. Let me be clear, Jaylon Smith self-revealing a video inadvertantly showing an AFO (ankle-foot orthosis) and indicating a peroneal nerve issue did NOT cost him anything. Teams were going to find out anyways. The injury will cost him millions, his post has nothing to do with it. Let’s stop ridiculing him for trying to make a good impression. Instead, Smith should be applauded for his great attitude. We are all rooting for him. I always find the herd mentality interesting. A week ago, no one worried about Smith’s knee and had him a consensus top-10 pick. Now many have his career over and compare him to Marcus Lattimore who never made it to play in the NFL. Sure both had serious knee injuries, but they tore different ligaments and cannot be directly compared. For weeks, media had the wrong ligament identified saying Smith had a multi-ligament injury that included his MCL when the video clearly showed LCL injury. At Combines, it was confirmed as an ACL and LCL tear. Media last week had his nerve as completely healthy. Now the pendulum has swung the other way. In a week’s time Jaylon Smith’s projections have gone from a top pick to never playing football again. Let’s give this kid a chance. Let’s wait for rechecks and all the medical info to come in. Let’s not shovel dirt on his NFL career yet. MMMD 1: Injury inevitable at Combine Unfortunately someone is injured every year at Combine. Cardale Jones pulled up lame during his second 40-yard dash and did not finish the workout. In 2014, fellow Buckeye Carlos Hyde suffered a similar injury during his Combine run. Offensive lineman Brandon Shell injured his quad during his 40-yard dash this year. Another common, but much worse, Combine injury is a pectoral tendon tear during the bench press, which needs surgical repair. Others have even torn the ACL in pre-draft workouts as well. Injuries are inevitable, even at the Combine. At least Jones’ appears to be minor and he still has a chance to participate in his Pro Day in two weeks. MMMD 2: Hands don’t grow It is no secret that players prep for the Combine like high school students study for the SAT exam. What is unusual is working on your hand size with massage therapy and stretching. Teams care about a quarterback’s hand size because it is thought to correlate with decreased fumbling and better grip in inclement weather. Brandon Allen’s hand measured at 8½ inches at the Senior Bowl and improved to 8 7/8 at the Combine measurement. It is impossible to “grow your hand”, but it is possible to make it measure larger. Hand size is recorded by spreading one’s fingers and measuring from the tip of the thumb to the tip of the pinkie finger. In reality it is more of a “pianist’s reach” than true hand size. Because this method essentially documents finger span, stretching could improve the measurable even though it is impossible to enlarge the size of your hand in a month. MMMD 3: Tony Romo proposed surgery Will he or won’t he? Plate or Mumford procedure? Those are the pending questions for the Dallas star QB. Here are the undisputed facts. Neither procedure is mandatory. Both are prophylactic in nature and attempt to decrease future clavicle fracture risk. The choice is one or the other (or none); both will not be needed. The purpose of the plate (and screws) is to strengthen and protect the collarbone. In the short term, this will help. The question is what happens in the long run and is there a stress riser at the end of the plate. The other procedure is to remove the end of the clavicle to decrease the transmission of force when tackled onto the left shoulder. The Cowboys medical staff is to be applauded for doing what it can to prevent a fourth clavicle fracture. The proposed surgeries do not indicate a failure of any current treatment. MMMD 4: Offseason is a time for optimism It is rare to have a negative injury update in the offseason. Not saying positive information is untrue or not warranted, just that when no regular injury reporting is required, voluntary reporting of bad news is harder to come by. I like seeing the good news parade: Jordy Nelson is ahead of schedule from ACL surgery, Luke Keuchly’s shoulder surgery went well, Jimmy Graham is doing great after patellar tendon repair, Terrell Suggs and teammate Steve Smith, Sr will be ready for 2016, and Chiefs edge rushers Justin Houston and Tamba Hali had successful knee scopes. I am not saying these reports are incorrect. Only noting that good news is easy to come by in the offseason. MMMD 5: Be wary when not hearing optimism The corollary to the above is to be careful of what you don’t hear. Antennas should go up when positive spin is not seen. The Steelers have been non-committal on a timeline for Le’Veon Bell’s return. Perhaps they are just being careful to not put pressure on their star running back; however, the worry is that his return might be delayed. MCL and PCL surgery is a more difficult recovery than from an ACL. I hope the reports of Larry Donnell being forced into early retirement for his neck are not true. However, offseason bad news is worth monitoring. MMMD 6: A rose by any other name… “What is in a name?” said William Shakespeare. Apparently J.J. Watt cares about the name as he asked people to stop calling his injury a sports hernia. Indeed the term sports hernia has progressed to athletic pubalgia and now the term core muscle injury is being used. The injury has not changed, but the scientific names for it have evolved. Sports hernia may not be the latest medical term used, but for the lay public, it is still acceptable. In this case, Watt prefers the old terms not be used for him. MMMD 7: ProFootballDoc scorecard In the offseason, medical evaluations are more sparse. There is one injury clarification. Indeed Thomas Davis does not need his forearm plate and screws removed prior to next season as some indicated. That updates the 2015 scorecard to 166-10 but does not change the 94.3% correct rate for the season. I am not sure if I should go to the effort to continue to keep weekly score for 2016. With a 2014 year at 92.6% and vetting each injury prediction in 2015, there may not be a point to keep track in 2016 but I will await your comments before I decide either way. In the meantime, I choose the Super Bowl as the start and end of an injury season. With Jaylon Smith indeed having a LCL (not MCL) injury and nerve issues (will only count it only once), that starts 2016 season at 1-0.    
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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