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NFL Injuries

Breaking down the Ryan Shazier injury in layman terms-Dr. Morse

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© Aaron Doster-USA TODAY Sports

Pittsburgh Steelers Ryan Shazier was involved in a scary traumatic injury in Monday night football‘s game versus the Cincinnati Bengals. He went for a tackle and apparently suffered an axial load injury, as it appeared he lead with his head. This resulted in instant pain in the mid-part of his back, where he fell to the ground and immediately grabbed the middle part of the thoracic spine with his left hand while rolling over, in almost a limp fashion. The video is very scary as you can imagine. Unfortunately, at the time it appears that Shazier was unable to move his lower extremities, which, after evaluation by the Steelers medical staff, resulted in him being taken emergently off the field by stretcher. He was immediately sent by ambulance to likely the nearest trauma center for full evaluation. 

As more information has continued to come out, Steelers GM Kevin Colbert said the running diagnosis for Shazier was spinal cord contusion, and that he will not require surgery. It is possible that Colbert misstated, and meant to say that he had spinal cord concussion, at this point we don’t really know. My suspicion is that he underwent a series of tests, including x-rays, CT and likely an MRI of his head, cervical spine, thoracic spine and lumbar spine. At this time it is being reported that he has been able to move his lower extremities (how much is unclear), which is fantastic news.

I will preface this article with saying the fact that I am not a neurosurgeon, but instead a sports medicine fellowship-trained family medicine physician, so I will try to explain this injury in the easiest way that I can. Spinal cord injuries are a major cause of disability that can have devastating neurological outcomes. Let’s talk about both spinal cord contusion and spinal cord concussion, as it is important to distinguish between the two.

So what is a spinal cord contusion? This injury occurs secondary to crushing of the spinal cord with part of the surrounding tissue often being spared. This often results in a significant amount of bleeding and swelling from local blood vessels, which in turn leads to bruising of the specific injured area(s) of the spinal cord. This bruising and swelling can lead to disruption of the nerve signals that are being transmitted through the spinal cord. The severity of the spinal cord contusion is determined by a variety of factors, including imaging (usually MRI), the status of the remaining nerve fibers, and whether or not the “signals” that are being transmitted through these nerves are still able to do their job.

This type of injury can occur as a result of a traumatic event (motor vehicle accident), but also result from a sports related injury, like the one that Shazier experienced. The most common location for this contusion is in the cervical region, as thoracic and lumbar injuries occur less often. The thoracolumbar junction is a transition zone between the relatively rigid thoracic spine, and the relatively flexible lumbar region, making this area a high risk for injury. While we know Shazier grabbed the middle of his back, likely in the T12 region, we do not know the exact location of his injury, whether it is one or multiple locations.

Some of the symptoms that may be accompanied by this spinal cord contusion include the following: paralysis, loss of bowel and bladder function, muscle spasticity, difficulty breathing, difficulty with heart rate and blood pressure, and difficulties with memory. Obviously each and every one of the symptoms is very scary! 

There are other reports claiming that this is being diagnosed as a spinal cord concussion, also known as cervical cord neurapraxia (CCN). Most cases of CCN occur on the football field, secondary to high-speed collisions and open-field tackling. CCN involves a transient injury to the spinal cord causing a brief disturbance of sensation/ability to move. The most common symptoms include numbness and tingling of the hands or feet, as well as weakness and even sometimes complete paralysis, often briefly. This paralysis can range from a single limb, to all four limbs, depending on the severity and location of the injury. The episode typically last less than 24 hours, and some resolve even in a few seconds. CCN occurs in 7 out of every 10,000 football players, and while this does not sound very common, considering the amount of football players there are in United States this injury likely occurs more often than we imagine. 

This injury can get quite complicated, including the parameters of return to play – that is if the patient is lucky enough to return to full function. Evaluation of spinal canal width, which can be measured by MRI can play an important role in determining whether or not the athlete will be able to return to play. All of these decisions are typically done by the medical team, often guided by a neurosurgeon. Please click here to learn more about spinal cord concussions.

Let’s briefly compare the two. To keep it simple, a spinal cord contusion means that there was actual bleeding in the spinal cord, which can be seen on MRI. Spinal cord concussion on the other hand typically does not leave any MRI-detectable bleeding or damage. Therefore, a spinal cord concussion would be a better diagnosis for Shazier than a spinal cord contusion. 

So what’s next? Shazier will likely continue to go undergo a myriad of tests to evaluate how much swelling and damage he has to his spine, and how this correlates to his symptoms. Shazier has a long ways to go before he can consider stepping onto a football field again. At this point, as fans, we should be happy that he is alive, and not fully paralyzed. My hope is that he will be able to walk again, and I wish him the best of luck in his recovery.

Jesse A Morse, MD is a fellowship-trained sports medicine doctor practicing in Miami, Florida. He specializes in Regenerative medicine, musculoskeletal ultrasound, fractures and, non-surgical orthopedics. Dr. Morse treats professional athletes regularly and understands their mindset and how to get them back on the field. Born and raised in Worcester, Massachusetts, Dr. Morse grew up watching the Larry Bird led Boston Celtics, the Wade Boggs and Pedro Martinez led Boston Red Sox, and then the Tom Brady led Patriots win multiple championships. Dr. Morse has served on the medical staff of multiple professional teams, including the Philadelphia Phillies, Toronto Blue Jays, and the Miami Marlins. In his spare time, Dr. Morse loves exercising, sports cars, and playing fantasy sports/DFS.

NFL Injuries

NFL Week 8 Injury Review

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As week eight comes to a close, unfortunately we saw several big-name players again go down with injury. The San Francisco 49ers continue to be ravaged by injury, as they likely lost both George Kittle and Jimmy Garoppolo for the remainder of the season. Kittle fractured a bone in his foot, and Garoppolo re-injured his high ankle sprain. Add in Tevin Coleman, who was recently activated off IR due to a knee injury, re-injured the same knee and is awaiting additional imaging.

On Thursday night football Teddy Bridgewater suffered a potentially serious neck injury, but thankfully got lucky and no significant injury was done. He should play in week nine. In that same game, unfortunately Falcons elite wide receiver Calvin Ridley suffered a midfoot sprain which would likely keep them out a couple of weeks.
Week nine should finally see the return of elite running back Christian McCaffrey. Fellow running backs Miles Sanders, Nick Chubb, Joe Mixon, Mark Ingram and Aaron Jones are all likely to miss at least one more week with their respective injuries.
The Packers play on Thursday night, and Aaron Jones’ calf injury likely has not had enough time to heal to allow him to play on Thursday.
We found out that Jacksonville Jaguars’ quarterback Gardner Minshew has been playing with multiple fractures and a ligament injury in his throwing thumb. Whether or not he needs surgery, he is likely to miss the next 2+ weeks.
Jets quarterback Sam Darnold re-injured his throwing shoulder, as he was dealing with an AC sprain and is questionable to play in week nine. Jamison Crowder is still dealing with a groin injury and has missed the past several weeks. Breshad Perriman also failed to play in week eight secondary to not clearing the concussion protocol yet.
The Colts saw Michael Pittman return after suffering that crazy injury where he had to undergo emergency surgery on his calf. Parris Campbell should not be too far behind him. Unfortunately T.Y. Hilton suffered a groin strain and is likely to miss at least a week, maybe a couple. Rookie running back Jonathan Taylor, who has disappointed so far, at least based on expectations, suffered an ankle injury and his week nine status is in question.
The Rams Darrell Henderson Jr. re-injured his thigh, but appears to be able to play after the bye. Cooper Kupp, fresh off of a monster game, appears to have injured his wrist. Expect additional imaging to rule out possible fracture.
The Seattle Seahawks backfield was really banged up going into week eight, as Chris Carson, dealing with a midfoot sprain, and Carlos Hyde, dealing with a hamstring strain both missed the game. Travis Homer, who is dealing with a bone bruise in his knee, and DeeJay Dallas both saw carries.
The Steelers Diontae Johnson seems to be injured more than he has been healthy. He injured his hamstring early in the game, but still managed to run the most routes on the day, but only managed to catch one pass on the day.
The Lions Kenny Golladay suffered a hip injury, that looks like it may keep them out a couple weeks, and he is a possible temporary IR candidate.
The Tennessee Titans Adam Humphries sustained a scary back and neck injury, but thankfully managed to avoid any life-changing injuries other than a concussion after being carried off on a stretcher.
Surprisingly the Eagles activated Dallas Goedert, less than a month after sustaining a non-displaced fracture in his ankle, only one week before their bye week. He was not very effective in his first game back. Jalen Reagor, also activated, flashed his potential and reeled in a touchdown. Miles Sanders should return after their bye, possibly Alshon Jeffery too.
The majority of these injuries were covered in this injury review video: https://youtu.be/nCl4eS3lh0Q
Top Recent Videos: Jimmy G (Dr Morse): https://youtu.be/iNSRre6r-So Jimmy G (surgeon take): https://youtu.be/jenxfNnMoXU George Kittle (surgeon take): https://youtu.be/4OSOCGdLssM George Kittle: https://youtu.be/M8oEGsMfcl4 Kenny Golladay: https://youtu.be/dbOnzinDz54 Jonathan Taylor: https://youtu.be/RfLqHeqjjjk Darrell Henderson Jr.: https://youtu.be/CoBf9hOL7U8 Cooper Kupp: https://youtu.be/GmhWoqjdaIo T.Y. Hilton: https://youtu.be/Zoi3aX8GQko Trent Brown: https://youtu.be/bs8KXfRmXtA Tevin Coleman: https://youtu.be/xy8TMbk24dI Adam Humphries: https://youtu.be/C9xfje_pnNA Diontae Johnson: https://youtu.be/tv7EBloVsfU Tua Tagovailoa: https://youtu.be/C0m6yvw5Tw8 Saquon Barkley update: https://youtu.be/-hTXuA4mv8w Allen Lazard: https://youtu.be/Iwaku9w_jHQ Calvin Ridley: https://youtu.be/-klAQFP69HE Gardner Minshew: https://youtu.be/f3WKeFT9Vw0

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NFL Injuries

Podcast: NFL Week 8

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QB/TE:

 

RB:

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NFL Injuries

NFL Injury Review-Week 7

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Heading into week seven of the 2020 NFL season there were a ton of injuries to keep track of.

Thursday nights game saw a couple injuries that bear monitoring. The New York Giants Devonta Freeman suffered an ankle injury of unknown severity, possibly a high-ankle sprain. Eagles DeSean Jackson suffered a significant ankle injury similar to teammate Dallas Goedert, likely a combination of non-displaced ankle fracture as well as high ankle sprain, and should likely miss at least six weeks. However there is some good news, and that Jalen Reagor is expected to be activated off IR and should play in week eight.
Several of the consensus top 20 running backs were injured in some capacity, and Miles Sanders, Mark Ingram, Joe Mixon and Aaron Jones were all added to that list over the past week.Aaron Jones suffered a calf injury late in the week and was inactive for Sunday’s game.

In the early games Dak Prescott’s replacement, current Dallas Cowboys quarterback Andy Dalton suffered a head injury secondary to a dirty hit that knocked him out of the game. He was diagnosed with a concussion.

Denver Broncos quarterback Drew Lock appeared to have suffered a knee injury, however this was only a minor concern and he didn’t miss any time.
Broncos running back Phillip Lindsay sustained a concussion.
The San Francisco 49ers ran all over the New England Patriots, but 49ers got even more injured in the process. Losing Deebo Samuel to a hamstring strain for a couple weeks, as well as fill in running back Jeff Wilson Jr., shortly after scoring his third touchdown of the day, suffered a high-ankle sprain, and is likely going to short term IR. On the opposite side of the ball Patriots’ wide receivers Julian Edelman and N’Keal Harry both struggled, Edelman with a knee injury, and Harry appear to have sustained a concussion.
The most significant injury of the day belonged to Odell Beckham Jr., who unfortunately suffered a season-ending torn ACL after trying to track down an opposing defender who just intercepted a pass.
Jaguars wide receiver Dede Westbrook appears to also have sustained a torn ACL. The Jets finally got to active stud rookie Denzel Mims after suffering double-hamstring strains early in camp, but were without Jamison Crowder due to a groin injury and then Breshad Perriman sustained a concussion.
The Steelers Diontae Johnson, who has struggled with injuries, was targeted 15 times, scoring two touchdowns but unfortunately suffered what appears to be a minor ankle injury.
The Chargers Virgil Green in the middle of catching a touchdown pass suffered an ankle injury and possible fracture.
The Sunday night game between the Arizona Cardinals and the Seattle Seahawks was a shootout. Unfortunately many of the running backs in this game sustained injuries. Kenyan Drake suffered a high-ankle sprain and is likely out at least 3 to 4 weeks, and will go to temporary IR. It’s Chase Edmonds time.
Three of the four Seattle Seahawks running backs sustained injuries. Stud Chris Carson sustained a mild midfoot sprain, commonly described as a LisFranc, that should keep them out at least two weeks, possibly longer. His back up Carlos Hyde sustained a hamstring injury, and third string running back Travis Homer sustained a knee injury. Both Hyde and Homer are questionable for week eight.
In the Monday night game, the Los Angeles Rams were without tight end Tyler Higbee who is dealing with a hand injury. Running back Darrell Henderson was also dealing with a thigh injury, but played well and Robert Woods a groin injury but managed to play. Bears stud wide receiver Allen Robinson was being evaluated for a concussion at the end of the game.
Here is a video injury review:
Several individual videos of players injuries are listed below as well:
Until next week!

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