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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
I'll be watching closely for news on Jamaal Charles (stinger), Reggie Bush (aggravated ankle), Ryan Tannehill (ankle), Delanie Walker (concussion), Allen Hurns (concussion), and Dexter McCluster (knee) today and throughout the week.
There were two critical offensive skill position injuries on Sunday. One, Carson Palmer, is a known entity already. The second is a concern with Brandon Marshall. More on that below.
carson palmer | torn acl | out for season
The ink had barely dried on Palmer's contract extension when he stepped up in the pocket to avoid a sack and (very likely) ruptured the ACL graft in his left knee. Palmer will have an MRI today to define the tear and look for any other injuries (MCL, meniscus, etc.).
There isn't much to debate with Palmer. He'll almost certainly need revision ACL surgery. While Palmer's prognosis is positive and the results of these revision surgeries have been good, the percentage of full recovery is lower and risk of another ACL injury higher than if this was his first ACL tear. The presence of a MCL or meniscus tear may make things tougher on Palmer, too. A straightforward 6-8 month recovery period would put Palmer on track to practice at some point in camp. OTAs are likely out, however.
a quick aside on diagnosing injuries on the sideline
Good friend and Footballguys staffer Cian Fahey asked a question on Sunday about diagnosing ACL injuries on the sideline, specifically wondering why there seems to be certainty before an MRI on whether a player has a torn ACL or not.
@JeneBramel, if they haven't had the MRI yet, how can they have ruled out the ACL? They can't, right? https://t.co/auCP5zG6o5
— Cian O'Fathaigh (@Cianaf) November 10, 2014
Though athletes get multiple imaging studies as a matter of routine, there's usually a fair amount of certainty about the type of injury a player has on the sideline. You can often easily diagnose a collarbone fracture before an x-ray. You can usually feel a big defect in a large muscle like a hamstring or quad or calf immediately after the injury. Tendon tears also have obvious exam signs. And manual examination of the knee usually shows an identifiable looseness on the side of a ligament tear.
Orthopedic injuries are about anatomy and physics. A combination of seeing the injury happen, listening to the athlete describe the injury, and a skilled examination will give an athletic trainer or physician enough clues to correctly predict an injury. The imaging studies are helpful in defining the exact nature of injury and its grade. They help surgeons game plan for procedures and help direct rehab goals. But it's rare to be surprised by the basic injury diagnosis itself.
Here's are two great instructional videos showing methods of examining the knee for an ACL injury.
In the first video, you'll see a trainer exam a patient with an ACL tear on one side and an intact ACL on the other. It's subtle and some of the exam is based on feel, but you can see the difference with a torn ACL. After you've done a few of these, it's an easy exam to get right -- especially before the knee swells and becomes too painful to examine well.
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This next video shows a pre-operative examination with a relaxed patient and a variety of manual exams for an ACL tear. All of these can be performed on the sideline. Again, experienced hands working on an athlete before pain and swelling limit an exam often can tell immediately whether an MRI will be positive.
Not every exam is clear. Sam Bradford's second ACL tear earlier this season was preceded by mixed messages in the media. I suspect the St. Louis team physicians were more suspicious than what was told to the media. But there will be times where an ACL diagnosis isn't fully known until the MRI.
I could put up similar videos on MCL sprains, tendon tears, AC sprains, and fractures of any number of bones. Imaging studies are very helpful, but there's no substitute for a skilled physical exam.
brandon marshall | ankle injury | week-to-week
I think Marshall's injury will be minimized this week. There was no reason to make much of it during the television broadcast of Sunday night's blowout. And the local media wanted Marshall's take on the state of the Bears more than any other angle, especially after Marshall told them he'd be sore but play next week.
However, as I noted on Twitter last night, the video suggests otherwise.
That's not the mechanism of a low ankle sprain. Without the benefit of an exam, it's impossible to say for certain, but a high ankle sprain, deltoid ligament sprain (think Vernon Davis last month) or a bone bruise are all on the list of potential diagnoses. I'd lay odds on the high ankle sprain as the most likely diagnosis, but that's my speculation only.
Regardless, all three injuries are painful and will look worse on Monday than they did Sunday night. I would be shocked if Marshall wasn't scheduled for an MRI on Monday. And it's unlikely he'll practice much, if at all, this week. We've seen Marshall work through ankle injuries on the field earlier in the season. But prepare to hear about game time decision-making and limited usage for at least this week.
400 ET: As expected, there wasn't much said about Marshall in Marc Trestman's press conference today. Trestman would only say there was optimism from the trainers when Marshall was evaluated today. If that's the case and no MRI was necessary, there's an excellent chance Marshall will be practicing and effective this week. We'll know more after Wednesday's first workout of the week.
ronnie hillman | foot | day-to-day
There have been no specifics on Hillman's injury reported yet. During yesterday's telecast, it was called both a foot and ankle injury. Hillman had already been dealing with a shoulder problem. I'll go through the video more closely before Wednesday's injury report feature, but Hillman was able to play a few snaps here and there after the injury was announced.
I'll leave the day-to-day expectation up until we get more information. With Montee Ball soon to return and C.J. Anderson impressing on Sunday, Hillman's role may be marginalized even without a serious injury.
430 ET Mike Klis reported this afternoon Hillman's injury is a midfoot sprain, which John Fox would later confirm in his press conference. Klis said the injury is to Hillman's right foot, Fox said left foot. Klis felt Hillman's injury occurred on a pass play in the first half but my video review suggests it likely happened on this play.
Unfortunately, there's not enough here to make a strong educated guess on the mechanism or likely location of injury. Whenever you hear "midfoot sprain," however, it's a Lisfranc injury which immediately comes to mind. But that's not the only potential area in the midfoot that can be sprained. Though it's dangerous to read too much into early timetables, it's at least reassuring Fox told reporters "day-to-day", Klis says "at least two weeks" and there have been no reports about Hillman in a boot and on crutches. And I've yet to hear Hillman connected to specialist visit with Dr. Robert Anderson.
We've seen Adrian Peterson and Jamaal Charles and Andre Ellington suffer midfoot sprains and play effectively shortly afterwards. Le'Veon Bell and Demarco Murray took six weeks to recover from theirs. Maurice Jones-Drew and Darren McFadden had Lisfranc injuries that weren't reported as such until much later. That's the long way of saying it's too early to say much specifically about Hillman. I'll be watching carefully for more clues in the coming days and weeks.