Jerry Hughes’s Wrist Is A Big Problem

The sting of the overtime playoff loss to the Texans was still very fresh in everyone’s mind when a seemingly innocuous tweet from DE Jerry Hughes was released. Below is the tweet which shows his passion & love for his team. All well and fine, we love you too Jerry! But 5 words within that statement got the Bills put on notice by the league & raised questions about the Bills injury reporting this season.

We will be back 2020 season!!???????? pic.twitter.com/TClGV47QoQ

— Jerry hughes Jr (@Iam_jerryhughes) January 7, 2020

“Torn ligaments in my wrist”

Normally that statement wouldn’t be an issue because NFL players get injured. It’s a fact. But Hughes never appeared on the injury report this season with a wrist injury. This is where the league doesn’t like that news. Below is the first few paragraphs of the NFL injury report policy.

The Personnel (Injury) Report Policy has been a cornerstone of public confidence in the NFL for many decades. The credibility of the NFL, teams, owners and team personnel requires full compliance with and uniform enforcement of the policy.

The intent is to provide full and complete information on player availability. It is NFL policy that information for dissemination to the public on all injured players be reported in a satisfactory manner by clubs to the league office, the opposing team, local and national media, and broadcast partners each game week of the regular season and postseason (including for the two Super Bowl teams between the Championship Games and Super Bowl).

The information must be credible, accurate, timely, and specific within the guidelines of the policy, which is of paramount importance in maintaining the integrity of the game.

A violation of the policy may result in Commissioner discipline, which may include a fine on the involved club, fines or suspensions of involved individuals, as well as the possible forfeiture of draft choices by the involved club.

This weekly injury report is the cornerstone of what I do, commenting on Bills’ injuries. Fortunately, this injury was something I was aware of, but unaware of the severity of the injury as most teams won’t come out and give details.

I had first noted that Jerry injured his right wrist sometime in the preseason, likely occurring during the Bills vs Panthers preseason game. Hughes played 14 snaps in that game and was his usual self during the first few series he was in. Having reviewed that film several times, there didn’t appear to be any smoking gun with regards to injury either indicating that the injury was not realized until later or that it did not occur during the game.

Hughes was able to play in all 16 games & the postseason, only suffering an ankle injury at the beginning of camp & a groin injury during Week 12 which limited him that week in practice in addition to the wrist. He also had several veteran rest days, which isn’t uncommon for a player his age. Looking back at pictures from this season, it’s observed that he has a brace or tape for support every time he plays.

As you can see in all those pictures throughout the 2019 season, he has a wrist brace on during each game, indicating that this was a lingering injury.

The next question is, what ligaments did he tear? Based on the lack of obvious injury & previously unknown severity, it’s hard to identify what he exactly did. We obviously know he didn’t suffer any fractures or dislocations as those would have either been season altering or season-ending.

I can also say confidently he did not injure any ligaments in his thumb as supported by the picture above, specifically the one with him during practice. You can see that he has tape supporting the area but the thumb moves freely, indicating that the interphalangeal joint, metacarpal joint, and carpometacarpal joint are intact. Otherwise, a thumb spica splint would have been noticeable & higher up the thumb.

Evaluating the anatomy of the wrist, the carpals and distal ends of the radius & ulna make up the wrist as you can see in the picture below. There are multiple ligaments in the wrist that you can view on your own if you wish. Clinically significant ones include the scapholunate ligament, the lunotriquetral ligament, & the triangular fibrocartilage complex (TFCC), among others.

The ligaments listed above are the most common wrist ligament tears from what I could find in literature, but there are certainly others. To generalize the mechanism of injury for these injuries, it typically happens when there is a fall or sudden force that places the wrist into extension and then into radial or ulnar deviation along with possible forearm pronation or supination. The presentation includes swelling, pain, weakness with range of motion, possible clicking/grinding, point tenderness, and difficulty with specific wrist movements. According to literature, if these injuries are suspected, the patient is to be placed in some type of bracing since there is instability noted.

As mentioned above, without a specific mechanism of injury or further details, hard to say what he did. Most of the time when these injuries occur, surgery is indicated to restore stability in the area. There are always reasons for non-operative treatment, but either outcomes are poor or ineffective. The only one that can be treated after the initial injury is the scapholunate injury in where surgery can be performed within 18 months of injury & splinting may be effective with incomplete tears.

It’s possible he injured the scapholunate ligament either falling on the hand or getting his hand caught up in a blocker, getting it twisted around to the ulnar side. But this is merely a guess.

After uncorking your mind from all that anatomy jargon, we go back to why Hughes & the Bills may be in trouble. The injury never appeared on the injury report during the season. Below are the indications of why an injury would automatically be reported.

Some injuries are automatically reportable because they result in the player’s unavailability or limited availability to the club. These include any injury that:
(a) causes the player to miss a game;
(b) prevents the player from finishing a game;
(c) causes the player to miss a practice (Did Not Participate);
(d) limits the player’s participation in practice (Limited Participation); or
(e) prevents the player from finishing a practice (Limited Participation).
Other injuries may be reportable because of their effect upon the player’s performance despite his continuing availability to the club.

The club must continue to list the player on its weekly Practice Reports
until the player’s injury no longer affects the player’s performance.

Below is what makes up the practice report & define full, limited, and DNP.

The Practice Report’s player participation categories are defined as follows:
Did Not Participate: means zero percent of a player’s normal repetitions.
Limited Participation: means less than 100 percent of a player’s normal repetitions.
Full Participation: means 100 percent of a player’s normal repetitions. In general,
this category should be used for players who missed or could not complete the prior
game due to injury, but have returned to participate fully in practice the following week.
It should also be used for a player who (i) sustained an injury in the prior game that
affects his performance, but was able to finish the game, and (ii) participates fully in
practice the following week, as in the example on page 2 (injured quarterback).

I think he suffered the injury in the preseason, had it addressed with the brace & likely rehab. He probably had it evaluated and determined that he could practice/play through it & get surgery later. He did not play in the Lions or Vikings preseason games but was able to play Week 1, giving him just over 3 weeks to give the wrist some time to recover.

Furthermore, this happened in the preseason where injury reporting is not as strict & by the time it got to the regular season, he was healthy enough to play. Did the injury impact his performance? Hard to say. His stats over the years show a bell curve, indicating that his best years are behind him & that he wasn’t far off from last season, though a slight drop was noted. Why were his stats down?

Possible reasons include: he may have been double-teamed more, Hughes is no longer as effective as a defensive end, scheme fit; overall, not my place to say.

Finally, what qualifies as a torn ligament? By definition, a sprain is a ligament tear with the grades varying in severity. Hughes may have suffered partially torn ligaments; never fully healing due to the rough nature of the NFL, & they require surgery. He may have fully torn some ligaments & there’s instability noted. Hughes may have also exaggerated or been misinformed about what he was saying in his post.

We always find out later that guys were playing with injuries the team did not divulge or have to publically report on. We also find out that what appeared to be a minor injury, turned out to be more significant. I think this is one of those cases. We knew that there was some type of injury, we didn’t know what exactly happened & the severity.

Do I think the Bills get fined? It’s possible, considering the Raiders had injury reporting violations last year & the Lions had issues this year with Matt Stafford resulting in a fine. The Steelers also got hit with a fine this year following Ben Roethlisberger & the management of his elbow injury. So this isn’t a rule that doesn’t get enforced.

I think the only difference from the above-mentioned fines & what the Bills did was how far removed from the injury the players were. All the other fines were responses to acute injuries. Hughes didn’t appear on the injury report for a rest day until late September.

Wednesday injury report: pic.twitter.com/VjdNUQRhsc

— Buffalo Bills PR (@BuffaloBillsPR) September 25, 2019

The only way the Bills are in violation of this rule is due to the statements below.

The supplemental entry “Not Injury Related” applies to situations in which a player is withheld from his normal repetitions for reasons other than injury. Examples include: resting veteran players, team discipline, jury duty, illness in family, personal matter, etc. In these cases, the club must explain specifically – on its own participation release issued to the media – why the player missed or was limited in practice. Use of this category is prohibited if the player in question has an injury that is otherwise reportable under the policy. An injured player cannot be listed as a “resting veteran.”

The Practice Report is expected to provide clubs and the public an accurate description of a player’s injury status and his level of participation during the practice week. All players who have reportable injuries must be listed on the Practice Report, even if the player takes all the reps in practice, and even if the team is certain that he will play in the upcoming game. This is especially true of key players and those players whose injuries have been the subject of local or national media coverage.

Looking at this as a whole & how I interpret the rules, I don’t think the Bills were in violation. Hughes is a key player, but when the injury was & how it was managed I believe make this different. Full disclosure, I am a Bills fan, but looking at it from when I put my medical hat on confirms my thought process. The Bills & the NFL know far more than I will & ever should know and the decision will be handed down. I hope I am right, but we shall wait & see.

Top Photo Credit:

Twitter.com/Iam_JerryHughes