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Monday Injury Rounds: Week 3

Jene Bramel's Monday Injury Rounds: Week 3
By Jene Bramel, September 15, 2014

Monday Injury Rounds: Week 3
Photo: Imagn Images

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.

Week 2 was the NFL equivalent of a Billy Mays infomercial. If you thought there were a lot of injuries after Week 1, "Just wait, there's more!!" Unfortunately, for fans and fantasy owners, I won't be able to offer an attractive "Act Now!" deal at the end of this week's column.

Unlike last week, the primary diagnosis for those players injured on Sunday is known. The precise location and severity won't be known until these players have further imaging studies and specialist visits. So, although there are timetables being floated for many players on Sunday night, realize that nothing will be locked in until the imaging results are known and the severity of injury has been determined.

INJURY ROUNDS

 

robert griffin iii | dislocated ankle | month-to-month

Griffin dislocated his left ankle yesterday. His lower leg bones moved to the inside [see screenshot], laterally dislocating the ankle joint. That likely means a complete tear of his deltoid ligament, the major stabilizer of the inside of the ankle joint. A dislocation of this type almost always involves a fracture around the ankle joint. The early word from the Washington locker room, however, is hopeful. which may hint that x-rays immediately after the injury did not show any obvious fractures.

This is critical. If there are any broken bones in the ankle joint, Griffin would likely be done for the season with a likely 12-16+ week recovery period. If only ligaments are damaged, it's possible Griffin could return in 6-8 weeks. While it's reassuring Griffin was taking media questions on crutches and not immediately taken for surgery, there's no guarantee he did not suffer a fracture. The definitive word on that will come after a Monday MRI.

Regardless of how much additional damage the MRI may show, the hopeful 4-5 week estimate pushed by a source to ProFootballTalk late Sunday afternoon is optimistic.

If Griffin only has ligament damage, Washington is still in a tough spot. They've already used their injured reserve - recall spot on Barry Cofield. If Washington isn't certain Griffin can return within 6-8 weeks, he may be put on season-ending injured reserve anyway. Jay Gruden may have hinted as much in a post-game media interview, in which he expressed remorse that Griffin's season had ended. Though Gruden quickly backtracked, the concern is clearly on the team's mind.

Whether Griffin eventually returns in 2014 or not, it's unlikely he'll ever be the same player he was in 2012. Ankle joints dislocated in this way are unlikely to return to their pre-injury form. Griffin was already struggling to regain the explosiveness and change of direction he had before his LCL sprain and later ACL/LCL tear. Now, with another catastophic joint injury to the opposite leg, a full return to form will be that much more difficult.

1200 ET: Breaking news on Griffin's injury from Will Carroll.

There's been no confirmation on this from Washington, but it fits with some of the later reports from Sunday. Specifically, it was odd for Griffin not to be taken for more testing immediately to rule out fracture and need for surgery. The suggestion that Griffin could return in just 4-5 weeks, as I wrote above, didn't seem possible for a dislocated ankle.

Here's what Will is getting at with his report.

Griffin's ankle joint may not be affected by this injury at all. What may have occurred is a subtalar dislocation. The talus is a bone that makes up the bottom part of the ankle joint, with the two lower leg bones making the top half of the joint. A subtalar dislocation, then, occurs below the ankle joint.

And that could make a huge difference here. If the ankle joint wasn't disrupted, there won't be any major ligament damage around the ankle. And the bigger bones around the joint space wouldn't be broken. The ligaments disrupted in a subtalar dislocation are smaller and aren't as key to the stabilization of the lower leg. Further, it's much less likely (just 44% compared to 90%+) that Griffin would have any broken bones associated with this injury.

Add it up and the 4-6 week timetable is much more likely than it seemed 18 hours ago. For now. that's all that should be taken from this discussion. Griffin will still need additional imaging -- err, scratch that, news on that is in, too.

Evidence clearly mounting that Griffin's injury isn't nearly as bad as feared and his expected recovery may be shorter than anyone believed. However, despite the short term good news, the long term effects of this injury can still be problematic. There's an increased risk of arthritis with these dislocations, though that's not an immediately concerning issue.

As always, more as it comes in...

 

jamaal charles | ankle sprain | day-to-day

Charles left the game after one of his own offensive linemen rolled up on his left leg midway through the first quarter and did not return. According to Ian Rapoport last night, Charles will have an MRI Monday to assess the severity of what's been diagnosed as an ankle sprain.

The injury mechanism is hard to see on video replay. But three things are notable from the television broadcast angles.

First, Charles may have gotten lucky. As the lineman starts to roll into him, his right foot is planted in the ground in a way in which a Lisfranc injury often occurs if it's driven into the turf at that angle. But Charles limps off clearly favoring his left foot and ankle.

Second, although it's not clear what happens underneath the lineman's body at the moment of injury, Charles' foot looks like it much more likely turned away from his body than rolled inward. If that's what happened, a high ankle sprain is more likely than a low ankle sprain. 

Finally, Charles limped off not wanting to put weight on the inside of his foot. That's not a clear indication of any particular injury, but it's not a common type of limp for a low ankle sprain.

That's video speculation of course. No part of Charles' sideline exam was shown on television and the MRI result isn't known. I'll have more here as soon as it's released today.

110 ET: Andy Reed confirmed the diagnosis of a high ankle sprain this afternoon. As yet, there are no specifics on the grade or a prospective timetable for his return.

Reed would later tell reporters Charles' injury doesn't "look to be a real severe one." That implies a lower grade injury, but doesn't offer much in the way of a recovery timetable. That will depend on Charles' pain tolerance and the stability of the joint as it heals. 

a.j. green | toe sprain | day-to-day

Green left Sunday's game after planting his foot to set up a block in the open field. He limped off and couldn't return. As is usually the case with a Bengals' injury, there's a mess of confusing tweets and reports about Green's injury, mostly from the ProFootballTalk account.

Here are a few relevant points in Sunday's timeline:

Here's what I think we can take from that run of tweets. No drum roll necessary, because it's very, very little.

If the reporting above is accurate, Green has a ligament sprain somewhere in his foot other than the capsule around the big toe. That doesn't narrow it down much and it doesn't provide enough information to guess at a reliable timetable. Don't jump to any conclusions on the PFT tweet. The source may not be medical and almost certainly has no direct knowledge of the location of the ligament sprain either.

Until we hear something more definitive, don't flip out about the Lisfranc connection. Is it possible? Yes. Lisfranc injuries can be difficult to diagnose. But the report of an aggravation and no report of Green leaving the locker room in a boot and on crutches are reassuring. It's also a serious stretch to think that a Lisfranc injury was misdiagnosed as turf toe at any point. The exam findings for a Lisfranc injury can be deceiving. That's not the case with turf toe. There's pain and swelling at one specific joint. It's a joint that's near the Lisfranc joint, but the two wouldn't be confused.

Cross your fingers for more information from the Bengals today. But don't expect any.

Still, I doubt Green will practice this week and I don't believe we'll see him in Week 3. He's already aggravated an injury that significantly limited his practice time and cost him almost the entire game on Sunday. The Bengals have a bye in Week 4. Hopefully, that's the worst case scenario. If we do hear the words midfoot, plantar plate, Dr. Robert Anderson, specialist, Charlotte or North Carolina this week, then all bets are off.

 

ryan mathews | knee sprain | week-to-week

It's believed Mathews has a sprained MCL. Some sources are reporting a 2-4 week timetable for his return. That's an estimate in every sense of the word. Sideline and locker room exams are usually reliable. It's rare that a player is later determined to have a more severe injury as Sam Bradford was this preseason. However, it's impossible to know the grade of Mathews' sprain without an MRI. Mathews will have that additional imaging tomorrow.

2-4 weeks may prove an accurate estimate, but Mathews' return will ultimately depend on two things. First, the Chargers' medical staff will want to see no looseness in his knee joint. Second, Mathews' will have to be confident his knee does not feel loose when he cuts at speed. Recovery may take just 1-2 weeks, but it may stretch into 4-6 weeks. Mathews has never been a quick healer, so I'd tentatively expect him to be out closer to 3-4 weeks than 1-2 weeks. 

1230 ET: An update on Mathews' status from Ian Rapoport:

As I note in my tweet, the low end estimate of four weeks suggests at least a mid grade sprain for Mathews. Expect an extended absence here.

 

mark ingram | hand injury | week-to-week

Adam Schefter reports Ingram suffered a hand injury in yesterday's game and is expected to be out "about a month." Schefter has now also reported the injury to be a broken hand. It's a more difficult injury for a running back to recover from unfortunately, giving the demands of handling the ball, catching passes and blocking. Ingram will be cleared to return when his splint allows him to handle the duties of his position.

knowshon moreno | elbow dislocation | week-to-week

Moreno dislocated his elbow on Sunday. There are already reports he'll miss 4-6 weeks. While a reasonable return to play estimate, it presumes Moreno has no fractures around his elbow joint. We were given a similar expectation on Tyler Eifert last week, only to later see the Benglals put him on injured reserve - recall. We'll have more certainty on Moreno's prognosis after his Monday MRI.

 

desean jackson | AC sprain | day-to-day

Jackson fell onto his shoulder trying to pull in a deep ball from Kirk Cousins shortly after Griffin left the game. X-rays did not show a clavicle fracture and, presumably, also did not show a high grade AC joint injury. Jackson told reporters he was day-to-day after the game, though he did acknowledge this injury was a little more severe than a similar injury he had during his time in Philadelphia. 

Jackson will undoubtedly have more soreness over the next 48 hours. If his shoulder responds well to treatment, he may be able to play with special padding and an injection next week. Expect him to be limited during midweek practices and try to increase his participation later in the week.

 

vernon davis | ankle | day-to-day

Davis had both legs rolled up on during a tackle Sunday night. He reached down for his left shin and ankle on the sideline. There wasn't a visible mechanism of injury on the lone television ankle shown. I'll have more later today if the Niners update Davis' situation.

 

vontaze burfict | stinger | week-to-week

Burfict was checked at least once for concussion symptoms on Sunday. The first time, he was cleared to return to the game. That was, frankly, shocking. There already seemed to be some uncertainty about Burfict's availability after a Week 1 concussion. Though he practiced fully on Friday, it's not clear when he saw the independent neurologist to pass the final hurdle for game play. There were hints on Twitter Burfict wouldn't be cleared until warmups on Sunday. Given his late 2013 concussion and that uncertainty, Burfict's locker room evaluation must have been very reassuring.

Then, Burfict took a knee to the earflap of his helmet in the third quarter and reached for his ear and head. The Bengals would shortly rule Burfict out with a stinger, taking his helmet. That may be accurate. But there's three potential holes in the story. First, players don't reach for their ear and head after suffering a stinger. Second, it's not common to take the helmet of a player you've ruled out with a stinger. Third, Burfict was not in the locker room during media interviews. Players under observation for concussions are watched closely outside the locker room until cleared to go home. 

Hopefully, Burfict only has a stinger. If he does have a second concussion in two weeks (and third since late last season), there's very little chance we'll see him cleared until after the Week 4 bye. And it puts him on a concerning track for the future as well.

FOLLOW-UP APPOINTMENTS

 

carson palmer | brachial plexus injury | week-to-week

Mike Jurecki, who's been invaluable with injury tidbits for Cardinals' players this season, tweeted a key piece of information about Palmer's injury on Sunday morning. According to Jurecki's Twitter feed, "Last week [Palmer] should've got down or ran out of bounds when he was trying to gain a few extra yards."

That led me to this play [see GIF on right] during the second quarter of last Monday night's game against the Chargers. Palmer lowers his shoulder into Eric Weddle at the end of the play. As he's taken to the ground, you can see his right arm being pulled away from his body. That's a classic mechanism for a stretching injury to a group of nerves (brachial plexus) that run from the neck though the armpit and branch out through the shoulder and arm.

As I wrote on Sunday morning, nerve injuries that persist for over 72 hours are rarely cleared to play. And nerve injuries that last seven days often don't improve for 3-4 weeks due to the time it takes nerve tissue to heal. Carson Palmer told reporters after the game he wasn't close to playing. Even more telling, Palmer said:

Palmer's condition may improve quickly this week and allow him to play. But I wouldn't count on it. This isn't something that can be accelerated. More likely than not, Palmer won't be ready to return until after the Arizona Week 4 bye.

 

alshon jeffery | hamstring strain | day-to-day

Jeffery was clearly less than full strength and progressively more limited in Sunday night's game in San Francisco. There was little explosion off the line, no lift on balls thrown above his shoulders and it took multiple steps for him to slow down and accelerate on his double routes. It's a testament to his toughness and pain tolerance that he was able to make it through four quarters and play as well as he did.

It was also a major risk. Players are at very high risk of aggravating muscle strains within 7-10 days of their original injury. I think it's likely that Jeffery will have reset his rehab clock to where it was last Monday. Hopefully, Jeffery won't have aggravated his strain to a higher grade injury. 

Prepare for Jeffery to practice very little, if at all, this week and for him to again be a game time decision for Week 3. We know now that Jeffery can and may play though this injury without practice, however. Watch his practice participation closely.

 

jordan cameron | ac sprain | week-to-week

Cameron didn't practice all week and was held out of Sunday's game. The Browns didn't provide any specific information about the injury last week, though Cameron said his MRI was negative. I think it's fair to assume the MRI did not show any complete ligament tears or fractures around the AC joint. I've been told by two orthopedic surgeons that it would be unlikely for Cameron to seriously aggravate his sprain. But it's clear that the most recent aggravation was too limiting for Cameron to play last week.

The Browns have a bye in Week 4. I could make convincing argument the bye makes it both more likely that Cameron will sit in Week 3 and more likely he'll play. We'll know more later this week. I doubt Cameron practices much early in the week, but he could get ready to play with just a late week practice if necessary.

 

andre ellington | foot strain | day-to-day

Ellington saw another 16 touches on Sunday (after 18 on Monday night) and showed good, though not full, acceleration. If he can get through Week 3 without a setback, he'll have two additional weeks to allow his tendon strain to heal. Whatever risk there was in playing through his injury seems to be paying off nicely so far.

 

doug martin | knee | day-to-day

Martin was something of a surprise inactive today after Lovie Smith told reporters he was optimistic Martin would play. That proved to be gamesmanship, as word broke late Sunday morning that Martin would be inactive. And given this Rick Stroud tweet shortly after inactives were released, it would appear the decision to rest Martin was being considered before pregame warmups.

If Stroud's sources are accurate, Martin will play Thursday night barring a setback in practice.

 

brandon marshall | ankle sprain | day-to-day

Marshall didn't have much difficulty moving in a straight line on Sunday night. And he didn't need a healthy ankle to be productive in the red zone. There didn't appear to be any aggravations of his ankle injury. Hopefully, he'll practice more this week than last and continue to improve in future weeks.

 

toby gerhart | ankle sprain | day-to-day

Gerhart played a similar percentage of snaps in Week 2 after increasing his practice participation throughout the week. There were indications he wasn't fully healthy, including a tendency to round off his cuts off both feet and a relative decrease in his acceleration. There were no reports of an aggravation. Monitor his practice participation this week.

 

maurice jones-drew | hand injury | week-to-week

The precise nature of Jones-Drew's hand injury is unclear. One local beat writer reported the injury was a broken bone, but Jones-Drew denied it and wasn't wearing a splint in the locker room last week. It's also odd that a procedure on a broken bone wouldn't be performed until Wednesday. If the injury is a broken bone, Jones-Drew's availability will depend on the size of any protective splint and how well he can grip the football. Those hurdles are likely the same if the procedure addressed something other than a broken bone. I'll have more in Wednesday's column.

AROUND THE TRAINING TABLE

Eric Decker aggravated a preseason hamstring strain and will need to be monitored closely this week. Tavon Austin suffered a right knee injury and will have an MRI on Monday. Allen Hurns left Sunday's game with an ankle injury and left the locker room on crutches. Lamar Miller was held out of yesterday's game, reportedly as a precaution after Moreno's injury with the Dolphins down multiple scores, with an ankle injury.

On the defensive side of the ball, Gerald McCoy reportedly broke his hand, Charles Tillman may have again torn his right triceps, Jon Beason may have significantly aggravated his toe/foot injury, Eric Berry left with an ankle injury, Mason Foster was unable to return after a shoulder injury, and D.J. Swearinger Sr left with a hyperextended elbow.

100 ET: Marcedes Lewis will miss 6-8 weeks with a high ankle sprain.

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.

Photos provided by Imagn Images
Tags Injuries Tavon Austin Kirk Cousins A.J. Green DeSean Jackson Gerald McCoy Eric Weddle

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