McCarron’s Buffaloed Clavicle

Detailing the confusion behind why A.J. McCarron was initially diagnosed with a fracture but found to have later not have one.

It’s been several frustrating days for both the Buffalo Bills and QB A.J. McCarron. First, McCarron has a less than stellar performance against the Cleveland Browns which alone appeared to place his job in question. Then to add injury to insult, he suffered a shoulder injury that was initially reported as a hairline fracture in his clavicle. The original timetable for McCarron would have been 4-6 weeks, leaving him possibly without a job by the time he was healthy. However, McCarron sought out a second opinion and was recently reexamined to find that he did not suffer any breaks in his collarbone and that he has essentially a shoulder contusion. Today’s post will identify what the clavicle is, it’s function, and possibly why there was so much confusion regarding the original injury.

clavicle.jpg
Credit: humanbodyanatomy.co

The clavicle is a bone in the chest region that acts as a strut as part of a framework that makes up the shoulder girdle. It connects the scapula or shoulder blade via the acromion to the sternum or breastbone and allows the scapula to move freely on the back for proper arm movement. During motion, it rotates up and out of the way so that the shoulder can move without restriction. The clavicle also protects nerves and blood vessels that pass through to the shoulder to the arm. Finally, the clavicle also acts as an attachment point for several muscles in the chest and neck region including the pectoralis major, the sternocleidomastoid, deltoid, and trapezius muscles.

It is usually injured during a fall on an outstretched arm or shoulder or a direct blow as the clavicle is compressed between the sternum and shoulder on impact. The injury appears to be a direct blow to McCarron’s shoulder according to video. The clavicle is the most common bone to break in the body and we have seen NFL quarterbacks that have suffered this injury at the hands of a hungry defensive end. Based on the mechanism of injury described above, these types of injuries occur as the quarterback is driven onto the shoulder during a tackle. We have seen this befall QB Tony Romo and QB Aaron Rodgers in previous seasons. The mechanism for injury appeared to be similar for McCarron when he had the entirety of DE Myles Garrett come down on him. Interestingly, McCarron was able to finish the series despite appearing to fall onto his right shoulder, which is his throwing arm.

It was revealed after the game that McCarron allegedly suffered a hairline fracture by Buffalo News writer Vic Carruci. While this initial injury prognosis was grim, it did not deter McCarron as he sought out a second opinion. As he is fighting for a roster spot and starting job, he needed to be absolutely sure he was unable to play. Fortunately, he was found that he did not suffer a fracture and that he would be able to return to practice very soon. The big question is, why the change?

After doing some reading and asking some questions to other medical providers who deal with imaging far more often than I do in my line of work, I found some possibilities. There was thought that if he found another doctor to evaluate, they could give the green light to play despite a small fracture. It was also possible that the imaging could have been misread. As the saying goes, a picture is worth a thousand words, imaging can be interpreted differently by various medical professionals, especially when there is possibly swelling in the area which could occlude a proper view. It is worth noting that the clavicle is one of the last bones in the human body to fully ossify, or harden. This does not usually occur until ages 21-25. As McCarron is only 27, it is possible that someone saw a fused growth plate and mistook that for a fracture or the results were inconclusive but the source that reported the injury may have took inconclusive as close enough and ran with it.

Thankfully, X-rays are not the only imaging that we have to diagnose fractures. We have CT scans, MRI’s, bone scans, etc. at our disposal to help identify exactly what we cannot see. As described to me, the method for determining imaging need is known as ALARA: As low as reasonably achievable. This means that whatever they are looking for, they will use the cheapest, most efficient means possible to get the results, but move up in diagnostic imaging in order to find the problem if inconclusive. In certain cases, there may be limited options available as CT and X-ray’s use radiation and MRI’s use magnetics to view the structures inside the body. There may be contraindications that would prevent a patient from getting one type of image but be appropriate for another.

As to what method the second opinion used to identify that he did not have a fracture will probably not be revealed. However, now knowing this, McCarron will only miss several days of practice. This comes down to the injury being reclassified as a contusion. I have detailed contusions in previous articles and it is really up to McCarron when he is ready. From the original injury, my best guess is missing a week at most as he will push to get back to practicing but his major limitation will be pain. Unfortunately, with pain, it can affect function. So we may see some less zip on his throw or less reps as he works his way back into practice. After Friday’s game, he may be relegated to backup but he will still compete until he is told otherwise.

This is certainly a blow to McCarron’s starting chances but this does allow him to fight for a roster spot instead of finding a job elsewhere. He does provide a veteran presence that each team looks to have especially with younger players on the roster. I do not foresee McCarron having any long term issues following this injury.

Continue to follow for the latest updates and news coming out of One Bills Drive. Special thanks go out to @GAPeachpolymer, @Frosini_thomas, and @FischerWilliamsPhoto for their specific knowledge on imaging for injuries, I could not have completed this article without you! Follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, http://www.bangedupbills.com and on reddit at u/BangedUpBills. As always, thank you for reading and GO BILLS!!

Author: Dr. Trimble

My name is Dr. Kyle Trimble and I am, first and foremost, a Buffalo Bills fan!! When I am not cheering on the Buffalo Bills, I am a Physical Therapist. To give a background on myself; I was born and raised in Erie, PA, moved to Buffalo in 2006 to begin my studies at D'Youville College towards becoming a Physical Therapist at which time I became a devoted Buffalo Bills fan.  I graduated in 2013 with my Doctorate in Physical Therapy and moved home for several years. Moving back to the Buffalo area in 2016, I have gained extensive experience in outpatient orthopedics, skilled nursing, acute care hospital, and home care. Having obtained a significant wealth of knowledge that continues to grow, along with a undying fandom of the Bills, puts me in the unique position to educate my fellow fans about our great team. 
I am currently an injury spotter working with Dr. David Chao, Orthopedic Surgeon @ProFootballDoc based out of San Diego. In this role, I provide real time updates regarding injuries during the game. I hope you enjoy what I publish and I welcome any comments or questions you may have.
Disclaimer: My opinions are my own.  Any thoughts I have on the injuries is based on media reports, my knowledge of the injury, and speculation based on the information currently available.


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