Week 2 Injury Review- Chargers

Breaking down the latest injuries following the Week 2 loss to the Los Angeles Chargers.

Different week, same result. Another loss to the Chargers sends the Buffalo Bills to 0-2 on the season and more questions remain. Fortunately, the Bills began to look like a real NFL team in the 2nd half, holding the Chargers to just 3 points while scoring 14. Regrettably, the hole they dug in the first half down 28-6 was just too much to overcome. In addition to the poor outcome, several players found their way to the injury report with varying degrees of injury. Today’s post will assess the injuries sustained in the game and what this means going forward.

First point I would like to address before the injuries is the sudden retirement of CB Vontae Davis. As everyone by now knows, Davis “retired” at halftime and left the stadium, leaving the Bills a man down and questioning his motives. He has since stated that he felt he could no longer play up to his standard and knew when it was time to be done. He has his reasons for doing that and well, it’s his decision. Personally, this is not something I would do nor do I believe it is the right decision to make in the middle of a game. However, he made his decision, he’s sticking to it, and I believe that the coaching staff, the team, and fans all want players who want to play for this team to be there 100%. I wish Vontae the best in his retirement and the Bills can move forward without him.

First injury up is CB Phillip Gaines who suffered a dislocated elbow late in the 1st quarter. He suffered the dislocation during a tackle and came up having difficulty moving his right arm. He was observed requiring support to the forearm area walking off to the medical tent to have further assessment. Upon video review, he dislocated his elbow when he attempted to tackle RB Melvin Gordon. Quick anatomy review, the elbow is made up of 3 bones: the ulna, radius, and humerus. The ulna is the bony portion of the elbow that articulates with the humerus and fits rather snugly in against the humerus acting as a hinge joint. The radius is a lesser bone of the elbow but provides forearm support and motion to the wrist during rotation.

As he began wrapping the ankles up, his elbow hit the ground while Gordon continued to run forward, creating a rotational force which caused the ulna to dislodge either posteriorly or medially from the humerus and appeared to stay dislocated. This was why the training staff needed to support the area with his inability to bend the elbow. At some point later, they were able to successfully reduce the elbow and wrap it for protection and swelling management. The picture below describes the types of elbow dislocations including the posterior and medial dislocations mentioned above.

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Credit: www.orthopaedicsone.com

While this does sound rather gruesome, it is probably one of the best joints to dislocate for quick recovery as once the joint is reduced, it can regain normal function due to the makeup of the joint being as stable as it is compared to a shoulder or ankle which has much more mobility. There is no word yet on whether there was other damage that occurred but Gaines return to the lineup seems relatively hopeful. These types of injuries require 1-3 weeks to rest and recover along with rehab to increase motion and maintain swelling. He may be ready/forced to play against the Vikings unless the Bills make roster moves to address the depth with the loss of CB Vontae Davis. It does help that CB Taron Johnson should be back next week in order to fill the gaps.

Next up is RB Taiwan Jones who suffered a very hard hit to his forehead on a play whistled dead in the end zone off of a muffed punt midway through the 3rd quarter. During the recovery, Jones lost his helmet and while attempting to keep the play alive, got struck by a Chargers defender, drawing what looked to be a gash on his head, dropping him to the ground. When he got up, there was visible blood on his head wrap and he appeared to be in pain. He was taken back to the locker room for a concussion evaluation which later reports indicated that he did not suffer a concussion. Reports also mentioned that he had a CT scan of the head to assess for skull fractures. Thankfully, it appears that he only suffered a rather large gash on his head which required stitches to close up. Depending on how the wound is healing, it may be possible that he can play next week but more likely he would miss no more than a week so that he may let the skin fully heal. Brutal injury, but positive outcome.

Finally, RB LeSean McCoy suffered what was initially reported left broken ribs late in the 3rd quarter due to C Ryan Groy falling on top of McCoy after he had been tackled. The veteran back appeared to leave the game and return only to leave again later and ruled questionable with a rib injury. Reports came out that he suffered broken cartilage in the ribs which can be more difficult to manage than a single broken rib. The chest is made up of ribs that act as a cage around the vital organs such as heart and lungs and provide structural support for the abdominal wall and upper extremities. Connecting these ribs together is cartilage, a firm but pliable tissue that allows the rib cage to move with breathing motions and adapt to movement. This is the same type of cartilage that makes up your ears and nose. In the picture below, the blue tissue is the rib cartilage that McCoy fractured on the left side near the lower portion that connect the false ribs to the sternum.

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Credit: acuteinnovations.com

Unfortunately for McCoy, rib cartilage breaks are more difficult to manage as this tissue helps attach the ribs together and to the sternum or breastbone. So instead of one isolated rib, the pain can be all over the injured area, leading to greater deficits. As with most other tissues in the body, the cartilage will heal and pain will be reduced. Rib cartilage takes between 3-4 months to heal completely as it does not have a good blood supply which means it’s slower to heal. McCoy does not have this type of time frame to work with considering the NFL season. However, with proper bracing and pain management, he can play through this injury. However, all upcoming defenses are now aware of this and may try to target that area to knock him out of games quicker. He may benefit from a week off to get more rest so that he can play with greater effectiveness in future games.

Overall, the Bills did not suffer a lot of injuries, but the ones that did occur were rather moderate. All 3 players could come back to play next week if need be, but may benefit from at least 1 week’s rest in order to heal more effectively. As always, it comes down to whether the training staff, ownership, and the player have to agree that they are able to play.

Continue to check back for the latest updates and news coming out of One Bills Drive. Continue to watch for the latest injury news on Twitter @BangedUpBills, on Facebook at Banged Up Bills, on Reddit at u/BangedUpBills, and on http://www.bangedupbills. As always, thank you for reading and GO BILLS!!

Week 2 Bills Injury Preview- Chargers

Read the latest injuries prior to the home opener against the LA Chargers!

Football is back in Orchard Park for another season which means today is the home opener with the Bills looking to regroup after a performance against Baltimore that led Bills fans questioning many things. Last week’s game left much to be desired in terms of quality and being at home where the Bills went 6-2 last year should change things. Today’s article will review the injuries going into the game and how this will impact personnel decisions.

Roster moves made since last article include the releasing of DT Adolphus Washington and WR Jeremy Kerley for DE Nate Orchard and DT Robert Thomas respectively. These moves are surprising as both players released are veterans and have demonstrated an ability to play their respective sides of the ball. Washington throughout his career has been fairly healthy and has been available. Kerley was by far the most experienced receiver on the field and demonstrated the ability to be consistent considering the question marks at QB. These moves were made to improve depth especially with the loss of DE Shaq Lawson and improve the rotational depth at DT. The Bills move forward with new depth in the front 4 established with hopes to better control the scoreboard.

Those already ruled out for the game include DE Shaq Lawson (hamstring) and CB Taron Johnson (shoulder). Both injuries occurred last week with Lawson in the 4th quarter and Johnson in the 2nd. Lawson has a garden variety right hamstring strain that is best to let rest as to further not injure it. Johnson appeared to have a right shoulder stinger and may not be ready for contact, similar to what QB AJ McCarron suffered during the preseason. There’s always the possibility there is something else going on such as an AC joint sprain, but he was moving it freely walking off the field and did not require any support to the shoulder indicating instability. Both could be available next week based on their recovery.

Those questionable are WR Ray-Ray McCloud (knee). The rookie wideout missed the season opener with a left knee injury suffered in the final preseason game against the Bears on a punt return. Video was limited and appeared that he suffered some type of minor sprain based on the hit to the outside of the knee. As it has been 2 weeks and change, he may be healthy enough to suit up today. With the loss of WR Jeremy Kerley, the tea leaves point to him playing, though he has the final say on if he feels he’s ready.

Other injuries to consider include DT Kyle Williams (knee) and DE Trent Murphy (groin). Both have avoided the injury report with exception of Williams who requires veteran rest days. Williams, the heart and soul of the front 4, appears to be nearly full health after the right knee sprain in the preseason and doesn’t appear to be worth mentioning moving forward. Murphy played last week on a snap count and was set to increase his reps as a result but will be forced into greater service with the absence of Lawson. He will still be limited only due to not being in game shape.

Overall, the Bills are still healthy, major injury to key players remain limited, and as a fan, I’m expecting a better Bills team to show up today. I’m looking forward to sitting back and watching a much more competitive game with what I hope will be a more favorable outcome today.

Continue to follow for the latest updates and injury news coming out of One Bills Drive. Follow me on Twitter @BangedUpBills, on Facebook at Banged Up Bills, on Reddit at u/BangedUpBills, and online at http://www.bangedupbills.com. As always, thank you for reading and GO BILLS!!

Week 1 Bills Injury Review- Ravens

Breaking down the latest injuries following the loss to the Baltimore Ravens.

Well, that didn’t go very well. The Bills laid an egg with a very lopsided 47-3 loss to the Baltimore Ravens. Nothing seemed to click Sunday with mistake after mistake piled on until changes had to be made which stopped the bleeding but the damage was already done. This was one of the more painful losses the Bills have sustained during my time as a fan mostly because while I expect that the team may regress, it should not to be that effect. However, since this is a sports injury website, I will leave the game analysis to my good friends at Cover 1 and The Rockpile Report. Check them out if you haven’t already; absolutely fantastic content for the Buffalo Bills!

Today’s post will review the injuries sustained in Sunday’s blowout loss and what this means going forward. First up is CB Taron Johnson who suffered a right shoulder injury during a textbook tackle midway through the 2nd quarter. He was able to walk off and not require any additional assistance in supporting his arm but he was eventually ruled out. Looking at video, it appeared as though he suffered a stinger, basically a hard hit. This is supported by the fact that he did not have extra support walking off the field and he was rolling his shoulder out freely exiting the field. Considering the game was out of hand, he is a rookie, and there was no benefit to him playing, he was most likely ruled out. Had he suffered any real damage, it would have been revealed by now. I expect him to practice in full and play next week.

DE Shaq Lawson suffered a right hamstring injury attempting to chase down QB Joe Flacco on the first play of the 4th quarter. Reviewing video, it appeared as though when he attempted to tackle Flacco, he slipped and fell to the ground. Once he got up, it appeared as though he tried to resume running and possibly suffered his injury. As I reviewed in my hamstring article, there are varying grades of severity. I believe that Lawson suffered a Grade 1 hamstring strain which could cause him to miss 1-2 weeks. It is possible that he could play next week but his availability during practice will dictate the severity and availability.

Other injuries that the Bills are still dealing with include LB Julian Stanford and WR Ray-Ray McCloud. Stanford appears to be still doing with a broken nose and may be available next week now that he has more time to heal. As for McCloud, he is still dealing with what appeared to be a left knee injury suffered in the 4th preseason game. I really don’t have any idea what he is still out with. I suspect a sprain based on the possible hit he suffered during the punt return. Until more information is released, I can only speculate.

Those that were able to play after coming off injury include DE Trent Murphy, who was on a snap count and DT Kyle Williams. Murphy appeared in 35% of defensive snaps and 21% of special teams with no apparent re-aggravation of his groin injury. While his stats were not eye-popping which included 0.5 sack and 1 assisted tackle, it demonstrated that he was finally healthy and McDermott noted that he would increase his workload for next week.

Williams looked very efficient and did not appear to be favoring his right leg. He was able to play in 56% of defensive snaps and 21% of special teams which was in line with the other DT’s on the line. He will continue to require rest days but should return to full healthy and continue his effective play through his final year.

There may be other names that pop up on the injury report but overall the Bills continue to stay healthy. I believe this was the difference between making the playoffs and missing last season. While playoffs may not be expected this season especially after Sunday’s performance, I still believe that they will stay competitive in future games.

Continue to check back for the latest updates and Bills injury news. Follow on Twitter @BangedUpBills, on Facebook at Banged Up Bills, on Reddit at u/BangedUpBills, and www.bangedupbills.com. As always, thank you for reading and GO BILLS!!

NFL Injury Series- Meniscus Tear

Read up on what the meniscus is, how it is injured, indications for surgery, and recovery times.

Today on Banged Up Bills, we will detail the ever common meniscus tear. This post will identify what the meniscus is, it’s function, and the severity of a tear which could affect whether a player misses weeks or the season. This is an injury that we have seen in past seasons and will continue to see.

Last season, we saw TE Charles Clay and WR Kelvin Benjamin both tear their meniscus during different points of the season with varying availability following the injury. Clay missed 3 games while Benjamin missed 2. Clay required surgery to fix his issue immediately while Benjamin was able to tough it out the rest of the season with eventual surgery. There are many reasons why there are differences in meniscus tear management despite the same outcomes.

To understand proper management of the meniscus after injury, the structure must be understood. The meniscus is two concave structures that are c-shaped and lie over the tibia in each knee. The meniscus is comprised of a medial and lateral meniscus and act as shock absorbers during activity. These meniscus also help deepen the joint so that the femur can articulate with the tibia, providing stability. During meniscus tears, a rotational force is applied to the area while the knee is bent and causes a shearing motion, causing a portion of the meniscus to tear.

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Credit: physio-pedia.com

There are various types of tears which include but are not limited to: complete or partial, horizontal or vertical, longitudinal or transverse. Acute tears are more likely to present as longitudinal/bucket handle and radial tears most likely seen in football players. Symptoms of a meniscal tear typically consist of pain, tenderness, and swelling, locking or clicking during knee movement, and initially difficulty in placing weight through the knee. Meniscal tears are typically seen in conjunction with MCL sprains/tears and ACL tears due to the rotational forces through the knee during impact.

Overall, these types of injuries can slow up a player but not entirely derail their season. Several tests to identify meniscal tears include Apley’s, McMurray’s, joint line tenderness, and Thessaly’s test all assist in identifying whether a meniscal tear is present. However, these tests are not always reliable or specific which means they may identify pain and restrictions but will not be able to identify type or severity of tear. These tests replicate the mechanism that would cause the meniscal tear. This typically warrants further imaging such as MRI to identify specific lesions which will determine the appropriate interventions.

Once a tear has been identified, the type of tear can affect healing rates: longitudinal tears heal better than radial; simple tears heal better than complex; traumatic and acute tears heal better than degenerative. Based on location and length of tear will determine proper management. The meniscus has several “zones of vascularity” which include: red-red zone, red-white zone, and white-white zone. The red-red zone has the highest blood supply and lie on the outermost portion of the meniscus. The red-white zone is the area that connects the red-red and white-white zone and contains some blood supply. The white-white zone has a poor blood supply and demonstrate the poorest area for healing. If the tear is small, conservative management or a meniscectomy may be performed to remove to remove the offending piece. If the tear is larger, then a suture repair of the meniscus is warranted and an extended rehab is required.

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Credit: physio-pedia.com

Regardless of whether surgery is required, rehab typically consists of restoring range of motion, controlling swelling/pain, and restoring strength to the knee. Once the immediate objectives are met, then further increasing strength and return to play activities are initiated to ensure that the athlete can play at their full abilities. In the event of WR Kelvin Benjamin, he was able to play through his minor tear due to effective rehab and an understanding of the type of tear which most likely allowed him to rest, recover, and eventually return to full participation knowing the tear was stable enough to play through. In the event of TE Charles Clay, his tear may have been blocking motion and been more severe, warranting surgery to remove the offending piece before rehab could begin.

In the option that surgery is performed during the season, recovery times for a meniscectomy can last anywhere from 2-6 weeks or even longer based on the severity of the tear and corresponding damage. In the event of a major tear, surgery is indicated and recovery time can last for up to 3 months which could end a season for most players depending on the time in the season it was torn. The preferred method years ago used to be cut out the offending piece. However, surgeons later found out that each time they cut a piece out, it accelerated arthritic changes in the knee which reduced healing and the ability for players to return to full health for a prolonged career. They have also found recently that surgeries do no better than rehab alone when compared to long term results in the normal population. However, surgery is still recommended when a return to sport is necessary and will quicken the recovery in dealing with the NFL.

Meniscal injuries are still concerning but can still allow a player to play through the injury despite requiring further interventions in the future. If a player sustains a meniscus injury, they will miss some time but can return to play later in the season with favorable results after testing and a positive response to rehab. Despite returning to play, there are still instances where players will not be 100% and their production will noticeably decrease. Overall, a concerning but not season ending injury.

Continue to check back regarding further updates and injuries throughout the season. Follow on Twitter @BangedUpBills, Facebook at Banged Up Bills, on Reddit at u/BangedUpBills and http://www.bangedupbills.com. As always, thank you for reading and GO BILLS!

Preseason Injury Review- Bengals

Read up on the latest injuries following the loss to the Bengals and how these affect the Bills come the regular season.

Despite Sunday being Kid’s Day and Buffalo finally got to thank Cincinnati QB Andy Dalton for the miraculous TD to open the playoff door after a long wait, the Bills managed to stumble through an ugly loss to the Bengals. The 26-13 score led to more questions than answers especially at the QB and OL positions. Thankfully, the Bills managed to avoid serious injury and live to fight another day. Today’s post will review the few injury concerns coming out of the Bengals game and what this means going forward for the Bears game and regular season.

Amazingly, the only reported injury coming out of Sunday was LB Julian Stanford (nose). The only injury that a nose can sustain is a broken nose. This is evident from the reports that he is week-to-week and there are no further reports indicating surgery or any other facial injuries. The word is still out on whether he will make the roster but a broken nose should not cause any concern.

As the 4th preseason game will showcase most of the players that will not make the roster along with the several few that will, there are several starters that are still in question for the regular season. First up is RB LeSean McCoy (groin). The veteran starter has seen limited action this preseason and has been slowed by a groin injury sustained recently. As he is still able to participate in limited fashion in practice, I do not believe this is is anything that will linger into the season and he is more limited due to his veteran status and avoiding injury.

Another veteran dealing with a lingering injury is DE Trent Murphy (groin). He has been unable to participate with a nagging groin injury sustained early in the preseason. There is no possible reason that he would suit up in the final game but considering he has nearly 2 weeks until the preseason opener, there is reason to believe that he will be ready for the game against the Ravens. He originally sustained the injury at the very beginning of August, was able to return to full participation with practice a week after the injury and then re-injured it shortly after. He has been able to participate with individual drills and able to dress for games indicating that he is nearly ready to play given that it has nearly been a month. However, an additional 2 weeks will only benefit Murphy so that he can hopefully revert back to 2016 form prior to his ACL tear.

DT Kyle Williams (knee) is still out due to the sprained right knee he suffered in the win over the Browns. While it will be a long shot for him to return for the season opener, it is possible that he could participate in the home opener against the Chargers based on what he is able to do in practice. It has been reported that he is participating in light reps during individual drills and has been regularly seen without any bracing with the exception of a compression stocking. This indicates that the knee is stable and healing properly. Participating in individual drills also leads me to believe that he has no pain at rest and most likely full range of motion in the knee. Rehab is most likely progressing at an acceptable pace and I do not believe it is out of the question to see him in pads in 2 weeks with additional time allowing him to get game ready.

WR Brandon Reilly (rib) has been battling for a roster spot despite breaking a rib during the first preseason game against the Panthers. Injuries such as these require extra padding but otherwise the ability to withstand pain when hit. A broken rib has no long term implications besides whether Reilly has a job come September 9th.

Others dealing with injury include OT Dion Dawkins (hip), DB Kelcie McCray (hamstring), and QB AJ McCarron (shoulder). It is unknown what Dawkins specifically did to his hip, but it may just be a contusion considering he has still been able to participate in practice. He is another player the Bills would prefer to keep healthy in order to get to the regular season. McCray is battling a hamstring injury that appears to be a Grade 1 as he has not been ruled out for several weeks as some of his teammates have with other injuries. However, as all muscle strains are, rest and time must be primary factors for healing so as to avoid making this a chronic issue. Finally, McCarron was videoed tossing footballs around practice today indicating that he is feeling better and able to release the ball without compensation according to video. He got roughed up while in the pocket against the Browns but otherwise may be settling in for the backup role when the Bills travel to Baltimore. None of these injuries appear to be long term and should not hinder performance come the regular season.

As this post was very light, this just means that the Bills continue to avoid major injury and focus on becoming better football players. There are many positional battles that still need to be sorted out, but it is fortunate that these battles are between starters and second team, not 3rd stringers and street free agents due to injury. While the Bills will not avoid injury entirely this year, preseason’s such as this allow the Bills to build depth they’ve sorely lacked in previous years.

Continue to follow for the latest updates and news coming out of the Bills preseason. Follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, on the web at www.bangedupbills.com, and on reddit at u/BangedUpBills. As always, thank you for reading and GO BILLS!!

NFL Injury Series- Achilles Tear

Analyzing the Achilles’ tear, causes, rehab, and return to play rates in the NFL.

Training camp is in full swing and the Buffalo Bills continue to stay healthy despite significant injuries elsewhere in the league. One injury that the Bills have avoided for some time is the Achilles tear which is the topic of today’s article on Banged Up Bills NFL Injury series.

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Credit: http://www.medi.de

The Achilles tendon is a thick tendon that connects the gastrocnemius and soleus muscle to the calcaneus which is the heel bone. The gastrocnemius muscle or calf muscle allows the foot to point down or plantar flex which is required for the leg to push off during walking and running. It also assists in flexing the lower leg at the knee joint along with the hamstrings. The gastrocnemius and soleus help drive the body forward in walking and running and are especially in maximum use during sprinting.

Like other tendons, the Achilles tendon can become injured which can develop into a tendonitis. This occurs when pain/inflammation affects the insertion point of the muscle and it becomes painful with activity. This can eventually lead to microtears occurring in the tissue during injury and the tendon heals improperly. Normal tendon and muscle striations are linear in nature allowing for maximum contraction of the muscle. In the event of tendonitis, the tissue heals improperly and instead of consistent striations, there is a disorganized mess of muscle fibers that does not allow the muscle to contract as efficiently which can lead to further pain and inflammation with continued overuse.

Risk factors seen in football players which could increase the incidence of an Achilles tendon rupture include: excessive body weight, heavy weightlifting, use of anabolic steroids, long term use of corticosteroids, immobilization of the ankle/foot, of the male sex, and muscle weakness/imbalance. While some of these risk factors are preventable, others are not and this is where doctors have to use best judgement when performing interventions for both short term and long term implications following injury.

With improper rest or not performing preventative exercises such as stretching or regular strengthening, an Achilles can eventually tear with either chronic overuse or suddenly. Unfortunately, most traumatic Achilles rupture warning signs can be asymptomatic and do not usually present with problems until after the major injury occurs. This means that because you have Achilles tendinitis, does not mean you will have rupture. However, because you do not have symptoms, does not mean you won’t have further injury.

In the event of a tear, most athletes are jumping, sprinting, or cutting with such great force that the tendon ruptured suddenly. The muscle is stretched past its limits suddenly or asked to do more than it is capable of after periods of inactivity. Even in conditioned athletes, this can still occur as the athlete is continuously pushing themselves to their limits. When rupture occurs, it is likened to a shotgun blast and loss of function and pain is immediate. This is an injury that even the strongest, most determined athletes cannot work through. The ability to push off the foot simply is not there. Here is an excellent clip of an Achilles tendon rupturing in real time.

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Credit: http://www.sportsinjuryclinic.com

In the event that there is a suspected Achilles tear, a Thompson test would be performed. This is where an athlete would lie on their stomach with their foot hanging off a table and the calf would be squeezed. If the foot moves, the Achilles is intact. If there is no movement, then this confirms the tear. Imaging may be done to assess severity but if the Thompson test is positive, then it is a tear. Tests such as this are typically accurate, similar to the anterior drawer test with ACL injuries.

Once the Achilles tear is confirmed, surgery is usually recommended immediately as tendon ruptures tend to retract back to the origin or attachment point of the muscle which means the longer surgery waits, the more difficult it will be to reattach the tendon. Rehab typically takes 6  months to a year to fully recover. Once the procedure is performed, the patient is placed in a boot that encourages the foot to point down to place slack on the tendon so that it can heal properly. If the foot were to be flat, that would place stress on the healing tendon with the foot in neutral and there would be a lesser chance of it healing properly.

Once the foot/ankle is immobilized with progressive weight bearing as instructed until 8 weeks to allow the tendon to fully heal back to the attachment point that is the bone. Light strengthening begins after 8 weeks with active stretching to the surgically repaired area occurring after 12 weeks. Progressive strengthening up to 6 months occurs with focus to avoid high forces on the tendon to reduce re-rupture. Similar to the ACL of the knee, full return to sports takes 9-12 months due to the demands of the structure.

Fortunately, re-rupture rates are exceptionally low in the repaired Achilles. While it is a long recovery, re-rupture rates following a repair are between 3.5%4.5% which indicate the overall long term success of the intervention. Non-surgical methods are available but are not recommended unless the person is a poor surgical candidate. While the re-rupture rates are fairly low, return to play rates are much poorer in comparison. Roughly 30% of athletes who sustain an Achilles tendon rupture and repair are never able to return to the NFL. Those that do typically suffer a decrease in performance up to 50% according to research. Those that do have a surgical repair have about a 6% chance to tear the contralateral or opposite Achilles.

Interestingly, the last confirmed Achilles tear that the Buffalo Bills had suffered dates all the way back to 2005 when LB Takeo Spikes tore his in the early in the season. There may have been more recent ones but pro-football-reference.com only goes back to 2009 with injury reports for the Bills and I was unable to find any Achilles tears after 2009. I pray that this is one streak that we don’t end for some time.

This is another nasty injury that occurs far too often in the NFL. Regrettably, it is a sad reality and there can only be so much done to prevent these injuries. So far, only two have been reported, CB Jason Verett of the LA Chargers and Patriots OL Isaiah Wynn. However, this will not be the last one by any stretch as it is still early in preseason and unfortunately many more injuries will occur.

This wraps up another article in the NFL injury series. As the preseason progresses, continue to watch for more Bills camp updates, injury articles, and any other breaking news coming out of One Bills Drive. Follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, and on reddit at u/BangedUpBills. As always, thank you for reading and GO BILLS!!

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.

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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!!