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.
INJURY ROUNDS
There are three major skill position injuries of note this week. None of them were impressive on television replay and, with luck, none of them will result in any missed time.
C.J. spiller | leg
The Bills originally reported Spiller's third quarter injury as a knee injury. Adam Schefter called it a thigh injury this morning. Spiller said the injury likely occurred in the first half when he was landed on by multiple Jets after a run. He doesn't believe the injury will keep him out of this week's game. Taken together, those reports suggest Spiller has a quad contusion in his lower thigh. His availability for Week 4 will depend on how much bleeding and inflammation occurs in the first 24-48 hours, but Spiller's Monday comments are very optimistic. He may not practice much, but there's a strong chance he'll be able to play this week.
Andre johnson | leg
Andre Johnson's injury didn't look impressive on replay, but the knee of linebacker Josh Bynes hit him in a bad spot on his shin. It's an area with a small area of muscle overlying the shin bone that's prone to significant bruising. Johnson tried to play through the injury, but the muscle in that area is critical for flexing the foot and the bone bears 90% of the weight of the leg and he was unable to play effectively. X-rays showed no obvious fractures, but he'll have an MRI today. With luck, there will be only minor soft tissue damage and no evidence of significant bleeding or bone bruising. If that's the case, he could play this week with treatment. Though not a high risk, the worst case scenario is the development of increased pressures in the leg (compartment syndrome) from swelling and bleeding that would necessitate surgical treatment. That cost Hakeem Nicks multiple weeks in 2010 after a similar injury.
430 ET: This afternoon, Gary Kubiak called the injury a "shin bruise" and thinks Johnson will be day to day. We've seen Kubiak minimize injuries before, but that's an optimistic first report.
Vincent Jackson | ribs
Like Spiller and Johnson, Jackson didn't have an eye-popping mechanism of injury. But the Tampa Bay medical staff ended his afternoon quickly and he's reportedly undergoing multiple tests today to better define his rib injury. We've seen bruised and collapsed lungs, rib fractures and dislocations of the chest wall and collarbone in recent years, so lots of potential diagnoses are on the table. I think we would have heard if there was serious concerns and Adam Schefter is reporting that he's day to day, but I'll withhold thoughts on a timetable for his return until we hear more information from the team.
jermichael finley | concussion
Finley was very unsteady on his feet after his concussion yesterday, but that doesn't necessarily mean his injury is severe. The next few days of symptoms will be informative. He'll have to progress through the return to play protocol to be cleared for contact. I can't find any record of Finley suffering a previous concussion since his days in the NFL, which should allow him to progress through the algorithm in the minimum five days if his recovery goes well. The Packers have a bye in Week 4. If Finley isn't cleared for practice by early next week, it will be a sign that his absence could be prolonged.
Miles Austin | hamstring
Austin has proven that he cannot make it through a season without a hamstring strain. He took precautions this preseason to prevent another injury this year, but here we are again. The Cowboys are calling the injury minor, but there are no minor hamstring strains in Austin's world. As they've been in the past, expect the Dallas medical staff to be very cautious with Austin. At minimum, he'll be a game-time decision this week and it won't be surprising if this turns into a multi-week injury.
FOLLOW-UP APPOINTMENTS
The most interesting news of the week comes in the followup section of the column. Late last week and Sunday morning brought interesting news on Danny Amendola, Rob Gronkowski and Reggie Bush and -- not unexpectedly -- the injuries to Ray Rice and Vernon Davis were more limiting than originally reported by the team and media.
DANNY AMENDOLA | GROIN
Amendola's injury was better defined for us this weekend. Last week, there was discussion among specialists involved in Amendola's care whether or not he had torn hip adductors or a sports hernia and whether or not he'd need surgery. There's lots of possible anatomical overlap in that sentence, but that's for another discussion. Amendola elected not to undergo surgery and the consensus opinion reportedly was that his injury was not one of the many core muscle injuries that define a sports hernia. Yesterday, Albert Breer reported that Amendola's groin tear is off the bone and couldn't be made worse.
That's enough information to narrow the diagnosis down, as Yahoo!'s Les Carpenter did yesterday afternoon, to a torn adductor tendon. That's a fairly common injury in athletes who must change direction quickly and under stress and, in isolation, is not considered a sports hernia lesion. It's also a tendon that may not need to be reattached -- due to redundancy in the muscles that perform the same function -- for a player to return to play effectively.
Carpenter notes this in his article and states that the normal recovery time for this particular tear is two to six weeks and that Amendola could return in 3-4 weeks if his rehab continues to progress.
But it may not be that simple. And, as always, it's optimistic.
A 2009 study reported on 19 NFL athletes who suffered this injury between 1992 and 2004. Five players had surgery and none returned within 10 weeks. 14 players did not undergo surgery. The average time to return to play for those players was six weeks. So, you can see why Amendola -- who has tried to push the limits of recovery with elbow and chest injuries in the past -- would choose to rehab without surgery. However, there are only two skill position players in the series (one wide receiver and one running back) in that group. Both took eight weeks to return. And sample size issues confound the data, with the range of return without surgery being 3-12 weeks.
There's also some concern in the literature about just how much strength a player loses without that particular muscle. The authors of the study quoting better outcomes without surgery acknowledge that their outcome measures didn't include biometric testing and are dependent on return to play only. I think it's notable that prominent sports hernia surgeon, Dr. William Meyers, published a study that deemed surgeries that included a full release of that tendon a success if a player had returned to play within six months.
Can Amendola return in 3-4 weeks? Sure. But it isn't necessarily likely and there's no guarantee that he'll be in full form when he returns. And my spidey senses worry when one specialist consulted felt Amendola did have a sports hernia lesion. That makes me wonder if there is a small tear in one of the nearby core muscles.
I admire Amendola's guts and optimism. I wonder whether he'll be able to outwit and outwork his own body.
rob gronkowski | arm
Patriots fans saw reason for optimism -- as did I -- in Friday's practice participation report, which listed Gronkowski questionable and, theoretically, gave him a chance to play this weekend. But Ian Rapoport brought everyone back to earth yesterday with his report that Gronkowski's return is being delayed because his arm isn't in playing shape yet.
Frankly, I'm not certain what that means.
It's hard to believe that the Patriots would move Gronkowski to the active roster if they knew he was more than four weeks from being in playing shape. But the implication is that Gronkowski isn't yet ready for contact. It's been four full months since the plate was replaced in Gronkowski's arm. Orthopedic literature suggests that it can take as long as 18-21 months before an arm with surgical hardware is no longer at increased risk of re-fracture. The risk is low after a much shorter period of time, however, and most players are cleared to play within 6-12 weeks.
I think there's a good chance that Gronkowski is very near 100% and the Rapoport's tweet was meant only to inform readers that the more recent surgery is (maybe unexpectedly in the minds of many) not the more pressing concern. But I can't dismiss the possibility that there are lingering concerns about the surgical plate and still healing bone standing up to contact. Essentially, we are where we were -- expectantly watching Gronkowski's day-to-day practice participation.
Reggie Bush | knee
Bush lobbied hard to play yesterday, but had enough residual swelling in his knee that the team decided not to risk an aggravation of his current injury or a compensatory injury elsewhere. It still seems most likely that Bush has a contusion around his knee based on the limited information the team has released and the mechanism of injury on replay, but the added caution could be evidence that there's more going on here. Bush had a torn meniscus in the same knee during the 2008 season and missed time after arthroscopic surgery. He then had a microfracture procedure on that knee the following offseason. File that piece of news away if Bush's practice participation suggests the team has a higher concern than they've made public.
Larry Fitzgerald | hamstring
Fitzgerald had five catches yesterday but wasn't targeted more often than he was in Week 2 on a per pass route basis. While he was clearly not able to get to top speed, he finished the game and was more effective on his routes than last week. There's a chance he may increase his practice participation and be near 100% in Week 4. He will still be at high risk of an aggravation until his muscle fully heals.
Ray Rice | hip flexor strain
Rice missed this week's game and arguably was never close to playing. It's still a little bizarre that the Ravens decided not to pursue an MRI for a multi-week injury, but Rice is still within the time frame of a low grade hip flexor strain. If he doesn't practice or play this week, it's time to wonder if the injury could be a higher grade issue.
Vernon Davis | hamstring
Davis didn't practice at all last week and his "We shall see." comment when asked about last week's availability wasn't as optimistic as it sounded. With the Niners playing on the road on Thursday night, Davis could struggle to get ready for this week's game. If he's not practicing tomorrow, his absence could stretch through Week 4.
Daryl Richardson | foot
There continue to be no specifics released on Richardson's foot injury. There have been reports that he's had his toe and/or foot wrapped. Shortly before yesterday's game, local beat writers speculated on Twitter that he may not be able to do much after a lighter week of practice than what was on the injury report. Then Richardson left the game after two snaps when his foot was stepped on. That's concerning for a nagging turf toe or similar issue that could linger for more than one additional week. Jeff Fisher isn't likely to release much information, so we're left to continue to watch the injury report closely.
Le'Veon Bell | midfoot sprain
Bell practiced fully last week and is close to returning. I've maintained that most running backs need 2-4 weeks of strenuous rehab and practice before returning. It's looking more promising, but there's no guarantee we see Bell this week with the Steelers looking at a Week 5 bye.
IN THE TRAINING ROOM
There are a handful of other skill position injuries to monitor [Chris Ivory - hamstring, Jordan Reed - quad, James Starks - knee, Eddie Lacy - concussion recovery] but the defensive side of the ball was hard hit by long term injuries this week. Cameron Wake could miss 2-4 weeks with an MCL sprain and was lucky it wasn't more than that given the mechanism of injury on replay. ... Patrick Willis may struggle to get ready for Thursday night with a groin injury that looked to be more than a minor, low grade issue. ... Mario Williams couldn't finish yesterday's game with an ankle sprain. ... Henry Melton is out for the season with an ACL tear. ... Charles Tillman added a groin injury to his knee trouble and was unable to finish last night's game. ... The Cardinals lost both Sam Acho (ankle fracture) and Lorenzo Alexander (Lisfranc surgery) for the season.
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.
