NOTE: This column is a living document. I'll be updating as needed after team press conferences, imaging reports, Monday Night Football injuries, etc. Major changes to the content will be noted in red. I'll also be retweeting any key pieces of news and my own reaction and analysis, so make sure you're following @JeneBramel and checking my timeline on Twitter throughout the week.
INJURY ROUNDS
When asked to handicap a player's chances of suffering an injury in any given season, I always -- somewhat jokingly -- reply. "100%." I follow it up by reminding folks football is not only a collision sport, it's a traumatic sport.
Last week, Justin Hunter suffered a lacerated spleen and Miles Austin suffered a lacerated kidney. These are injuries you see regularly as trauma surgeons -- but they can also happen on the football field.
Last Thursday, Brandon Marshall became a trauma patient on the football field. If you don't like images or descriptions of traumatic medical care, scroll past this next section. Marshall will be fine in plenty of time for the 2015 season. If you're interested in the behind-the-scenes details on Marshall's past few days, read on.
brandon marshall | multiple rib fractures / hemothorax | out for season
You don't go to the hospital in the ambulance within 20 minutes of a football injury for observation. You go because there's concern for a critical injury. Sometimes it's not life-threatening. A dislocated hip or ankle needs surgical intervention to prevent limb complications, but it's not life threatening. In Marshall's case, the medical staff knew from the character of Marshall's pain, a careful exam and observation of his vital signs, and (likely) x-rays taken in the locker room that he needed emergent care.
We've seen players with collapsed lungs recover without invasive treatments and hospitalization before -- Tony Romo comes immediately to mind -- but like all injuries, there are degrees of severity. The term collapsed lung is a little misleading. There's a space between your lung and your chest wall (inside your rib cage) where there should be no air (or fluid). When that space fills with air or fluid, the lung cannot expand. It hasn't really "collapsed." If enough air or fluid enter that space, your lungs (and often heart) will not function well enough to keep you alive.
That's when trauma surgeons do very mean things to you in a hurry.
Marshall tweeted the picture to the right on Saturday night. It's an image of a chest tube, which the trauma team inserts directly through the chest into the space between the ribs and lung to drain air or fluid. In this case, even the color-blind among us can see what drained from Marshall's chest.
400 millileters of bloody fluid.
That amount of blood over 48 hours isn't as bad as it sounds. And the tube may have been placed primarily to relieve pressure from air that had leaked into the space when a broken rib punctured the lining from the outside.
But it goes to show how traumatic football can be.
Marshall will fully heal from this injury. His lung will heal and there's unlikely to be any affect on his conditioning or stamina in the long term. The rib fractures will heal, too. Expect him to be back to full strength well before OTAs next spring.
Now, onto your regularly scheduled orthopedic injuries of the week...
jamaal charles | high ankle sprain | day-to-day
I think Charles has a little Gumby in him. He was bent backwards over his lower body in the pile during a run early Sunday and seen yelling for the defenders to ease up on him. Often, such a mechanism and reaction means the cart is soon to follow and the player has a long term injury. Charles almost made it off the field before going to the ground and would later come back in the game.
It's hard to see just how much torque was put on Charles' foot and ankle on television replays, but the sea of bodies parted just enough to see how Charles might have gotten lucky here.
Charles' foot and ankle are being forcefully rotated outside here, which is the usual mechanism for a high ankle sprain. But you can see Charles has some room to get his foot out of that spot and the next 2-3 frames of video suggest he may have been able to do that.
Like many other players with a lower grade high ankle sprain, Charles was able to return to the game. Adrenaline and taping help to make that possible.
But the next 24-48 hours will determine Charles' Week 15 fate. If his ankle/leg swells and prohibits effective treatment in the next few days, Charles may be very limited this week and miss a game (or more). If not, there's a chance he can play this week and play effectively. And we've seen Charles play through similarly troublesome lower leg injuries over the past two seasons, so don't rule it out yet.
Expect Charles to be limited in practice this week and prepare for him to see fewer carries if he goes. We'll know more by mid-week. I'm going to be optimistic and label him day-to-day.
c.j. anderson | ankle sprain | day-to-day
Anderson hobbled off the field frequently on Sunday, but continued to come back on the field and play through his ankle injury. He was limping at times last week, too, so it's possible this week's injury is an aggravation of an already beat up leg.
I did not see a mechanism for a high ankle sprain on video, but the play on which the injury or aggravation occurred also did not show a typical low ankle sprain mechanism. If you watch the GIF closely, you can see a defensive lineman flatten out Anderson's foot and ankle as the lineman lands on it then roll the foot over a bit. Though it's not the typical ankle roll, the part of the ankle most stressed here is one of the ligament commonly sprained in a low ankle injury.
The same caveats apply to Anderson as Charles. His practice participation and Week 15 availability will depend on how his ankle looks on Monday and how quickly it responds to treatment.
It's safe to be optimistic on Anderson, but do what you can to have a hedge available if he's labeled a game time decision later this week.
percy harvin | ankle injury | out for the season?
I'm worried Harvin may have an Achilles injury. The video isn't conclusive, but I didn't see an obvious ankle injury mechanism. Mostly, I don't like the way Harvin flexed his left leg up into air after his final step of his route. It didn't look like a natural response to the location of the pass and a needed effort to catch the ball. The evasiveness in the locker room and quick rumors of a season-ending injury are also making my spidey senses tingle a bit here.
We should learn more later today.
FOLLOW-UP APPOINTMENTS
andre ellington | sports hernia / hip pointer / peroneal strain | out for season
Ugh. Sometimes, you have to cry "Uncle" and call it a season.
Ellington has been surprisingly effective through a foot injury which may need surgery this offseason. The hip pointer was a major concern last week. But news broke late in the week Ellington was also playing through a sports hernia and visiting Dr. William Meyers, who is to sports hernia surgery what Dr. Robert Anderson is to Lisfranc and Jones fracture surgery.
On Monday morning, multiple sources report Ellington will need surgery to repair his sports hernia -- which is more specfiically a tear in one of the abdominal or pelvic muscles and not a true hernia -- and will go on injured reserve.
The quick hook to IR is a little surprising. Dr. Meyers quotes recovery periods between three and eight weeks on his website. Most often, we hear 4-6 weeks after surgery. Some players have returned within four weeks. With the Cardinals likely to make the playoffs and still playing in four weeks (and possibly beyond), it's a sign Ellington has a muscle injury in a more difficult area and/or the tendon issue in his foot remains a concern.
Ellington's effectiveness and willingness to play through injuries this season was impressive. He'll now get the rest and rehab time he needs to return to full strength in 2015. I'll be watching for news on whether Ellington needs surgery for the peroneal tendon injury in the coming weeks.
JULIUS THOMAS | ANKLE SPRAIN | DAY-TO-DAY
rashad jennings | ankle sprain | day-to-day
torrey smith | knee contusion | day-to-day
There's a little bit of everything in this M.A.S.H unit of players who were active, but not really active, on Sunday.
We see situations like that of Julius Thomas every year. Sometimes they're easy to see in hindsight. Other times, the reasons why a player with a reportedly minor injury misses multiple weeks of action remain a mystery. We've seen players with severe low ankle sprains miss close to a month in the past. Often they later have surgery. But it's hard to trust the reports suggesting Thomas' injury was not a high ankle sprain in hindsight. I've been relying on those reports (and practice participation and press conference notes) from the start as the video wasn't conclusive. So I have nothing new here. But this much is clear -- until Thomas is back to full practices, it's impossible to expect him to play meaningful snaps.
I'm surprised Jennings was active yesterday. He barely practiced and was then expected to be used in pass protection only. That suggests the Giants see him as an expendable commodity, willing to risk an aggravation that would put him out multiple weeks to protect Eli Manning in a game with no playoff implications. It also means Jennings will try to play through the injury in future weeks. With luck, his ankle is no worse today than it was last week and he'll be more effective in Week 15.
Smith's knee swelling (and reports of heavy wrap in pregame) likely means the mechanism of banging his knee on the turf last week was the cause of his injury and he's dealing with a contusion somewhere around the knee joint. Smith will get more treatment this week. Practice participation will determine his availability.
reggie wayne | knee / elbow / tricep | day-to-day
Wayne is clearly not himself. Reports that Wayne's post-ACL surgery leg was testing at over 100% of its previous strength were borne out in the season's first weeks. But there are obvious issues with his acceleration and separation from defenders. He's not closing quickly on passes and there are visible timing issues between him and Andrew Luck. Add in some hesitance -- or an inability -- to extend his arms and use his hands to catch passes in the past two weeks, too.
Chuck Pagano told reporters after Sunday's game Wayne was dealing with knee pain and continuing to struggle with an elbow injury which cost him multiple weeks recently. He also reported Wayne had a torn triceps, though didn't specifically say whether that's the "elbow" injury itself. If Wayne has a torn tricep tendon at the elbow, I'm not certain why he's been cleared to play. Such an injury would make it impossible for him to extend his arm at the elbow. That's, obviously, critically important to catch passes. Even a muscle tear in the middle of the upper arm would seriously limit Wayne's ability to do his job.
Don't be surprised if Wayne has to shut it down, and possibly go on injured reserve, if his condition doesn't improve soon.
zach mettenberger | aggravated ac sprain | out for season
This was the risk in allowing a quarterback to play through a low grade AC sprain behind a so-so pass blocking offensive line. Mettenberger fell directly onto the shoulder, likely aggravating his injury to a higher grade. At another position, that may not have been a major setback. A higher grade AC injury affects the integrity of that joint, however, and there's some debate over which Grade 2-3 AC injuries need surgery in players who rely on an overhead throwing motion. Two recent comps include Mark Sanchez and Sam Bradford, both of whom tried to rehab their mid-high grade AC sprains for weeks, only to later choose surgery. Mettenberger has a good chance to make a full recovery, but he's not likely to return until 2015.
Ladarius Green suffered a concussion. Kendall Wright broke a bone in his hand late last week in practice and was unable to play. I'll also have an eye on the progress of Roddy White in Monday night's game.
AROUND THE TRAINING TABLE
Lavonte David has a concussion and will need to clear the return to play protocol to return this week. There were reports Gerald McCoy dislocated his kneecap. I've never seen a player cleared to return after reduction of a knee dislocation. I'm interested to see more accurate details on this one. Louis Delmas tore an ACL and is out for the season.
I'll be updating this feature throughout the day. Footballguys Insiders will get a full update with additional fantasy perspectives on Wednesday, with analysis of the week's game-time decisions early Sunday morning. Follow me on Twitter @JeneBramel for breaking injury news and analysis throughout the week.
