Monday Injury Rounds: Week 3

Making rounds on this weekend's injuries, with updates on Tony Romo, Dez Bryant, Lamar Miller, Arian Foster, and others

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

More on a surprising and controversial bit of information about Dez Bryant's surgery in the followup section below, but we'll start this week's column with Tony Romo and why it can be so difficult to speculate on a recovery timetable before all the facts are in.

tony romo | clavicle FRACTURE | MONTH-TO-MONTH

Romo has a collarbone fracture, with multiple media members speculating a return in eight weeks.

While that sounds simple enough, it leaves out a lot of factors that may influence Romo's actual timetable to return. There are multiple approaches to a clavicle fracture depending on how severe the fracture is and whether the player and medical staff elect to fix the fracture surgically or not.

The most common scenarios include:

  • Minor fracture, no surgery >>> Await healing >>> Minimum six weeks, could be 8-10+ weeks
  • Minor fracture, surgery >>> Plate may stabilize injury sooner, but no guarantees >>> 6-8 weeks more likely than 8-10 weeks
  • Displaced fracture, surgery >>> Plate to stabilize injury, but recovery usually longer >>> 8-10 weeks more likely than 6-8 weeks

Recently, the trend seemed to be for surgeons to fixate the collarbone with a plate and screws in the hopes the injury would be stable enough to return 2-3 weeks earlier than if the bone was allowed to heal without surgery. The major outlier was Marques Colston, who returned within four weeks of his injury. But that's not always what's decided. Aaron Rodgers didn't have surgery last season and there was weekly drama about his status from four weeks after his injury until his return after seven weeks.

Romo will reportedly have more imaging on Monday to better define his injury. That means he's in the minor fracture category. A displaced fracture would be evident on x-ray, which he had immediately after leaving the field. The Cowboys and Romo will use the more detailed images to decide whether to pursue surgery. And that will better define his recovery timetable.

Whether Romo has surgery or not, don't expect to see him back in six weeks no matter what the Cowboys say. Teams are more cautious with their quarterbacks and will not risk a setback, even to the non-throwing shoulder. We're much more likely to see 8-10 weeks here.

drew brees | shoulder injury | week-to-week

530 PM: An early afternoon rumor about a potentially season-ending rotator cuff strain developed into what looks like competing reports about Brees' status this evening.

Ian Rapoport tweeted a sourced report suggesting the team knows of a shoulder condition likely to keep Brees out for multiple weeks. Shortly afterward, Ed Werder and Adam Schefter tweeted that a MRI did not show a serious injury and Brees' playing status would depend on his response to treatment. Though those reports sound markedly different at first read, they may be more similar than they look.

My interpretation of the two reports are that the MRI likely didn't show anything of high enough structural concern to necessitate immediate surgery for Brees. Note there's nothing in the Werder and Schefter tweets saying Brees has a chance to play this week even if he responds to treatment well. The detail that Brees had weakness in the shoulder -- which you could clearly see in a number of downfield passes yesterday -- and needs treatment is the key here. That doesn't sound like something likely to recover in just one week. Weakness could be related to pain, but may also be a sign of a nerve condition around the shoulder.

The Saints may not update Brees' condition, so we'll have to watch the practice reports closely this week...and possibly beyond.

eddie lacy | ankle sprain | day-to-day

Lacy's mechanism of injury was that of a low ankle sprain. If there's enough ligament damage, these injuries can be difficult to overcome quickly. Lacy tried to bear weight after having his ankle re-taped but was unable to do so comfortably and went back to the locker room for an x-ray. The injury was severe enough to keep Lacy from returning to the game. I'll update here with any new reports throughout the day today.

530 PM: Lacy's ankle injury is reported to be minor, but it's still too early to know how much he'll be able to practice this week. Consider him a game time decision until further notice.

lamar miller | ankle sprain | week-to-week

Miller suffered an ankle injury on a carry late in the third quarter. There is no clear view of the mechanism on the television broadcast, Miller left the locker room with only a slight limp, was allowed to talk to the media and said he considered going back into the game and wasn't scheduled for a Monday MRI. In a very similar situation last year -- Miller elected not to return in a close game and said his injury was minor -- he did not miss time. Miller's Wednesday practice participation will go a long way to confirming his status for Week 3.

tevin coleman | rib fracture | week-to-week

530 PM: Coleman had imaging studies today confirming a rib injury. Initial reports have him missing 1-2 weeks, but this will be a pain tolerance issue. Pain-killing injections and extra padding can help a player tolerate pain, but this is always a difficult injury for a running back to play through. It's not something that can be splinted or immobilized easily. If the injury involves cartilage damage, the recovery could be longer. We'll know more next week.

jay cutler | hamstring strain | week-to-week

530 PM: Other than confirming a hamstring strain, John Fox spent a good bit of his Monday press conference stonewalling the media on Cutler's status. Adam Schefter is now reporting Cutler will miss at least two weeks, which means Cutler has a mid-grade strain. Cutler isn't a mobile quarterback and could return before the usual 3-4+ week recovery timetable, but don't be surprised if he's still inactive in Week 5 or 6.


FOLLOW-UP APPOINTMENTS

Randall Cobb was limited by his shoulder sprain but appeared to finish yesterday's game without a setback. Expect him to be limited in practice as the Packers prevent him from taking contact that would aggravate his sprain again this week. Alshon Jeffery didn't have his usual explosiveness and lift but showed he was healthy enough to separate off the line and when breaking off routes. He should be even healthier in Week 2 and is less at risk of an aggravation with each passing practice.

dez bryant | metatarsal fracture | month-to-month

Before Romo's clavicle fracture, the big Sunday news was a early morning report that Bryant's surgery to fix a broken fifth metatarsal included a bone graft and concerns for a longer recovery timetable. There's quite a bit going on in that sentence. And every media member seemed to have a different take on what it actually meant for Bryant's recovery.

First, the bone graft. Orthobiologic treatments -- bone grafts, platelet rich plasma treatments, etc -- are gaining favor among orthopedic surgeons to improve healing times. One of the reasons fifth metatarsal fractures can be so troublesome is the relatively poor blood supply to the bone. Bone graft treatments during surgery may accelerate healing by boosting the number of growth factors to the injured site. Bone grafts are arguably now standard of care when a screw needs to be revised or a previously broken fifth metatarsal is reinjured. But it's odd to see a bone graft done with the initial repair. So, either Bryant has had a stress reaction in this bone before or the surgeon elected to do the bone graft in the hopes of ensuring smooth healing.

But the bone graft will take time to heal in. That's where the report of a lengthened timetable from 6-8 weeks to now 8-10 weeks comes in. Bryant may not be allowed to do weight bearing rehab as soon as he would have without the bone graft. There's some debate among orthopedic sources interviewed by national media members -- some say 6-8 weeks is still possible. And the Cowboys clearly believe that to be the case. There's more to their decision to keep Bryant off the injured reserve / return list than wanting to keep him in the facility and engaged around practice.

I argued last week to expect 8-10 weeks of recovery time. That's based on a study published by the leading surgeon in the field. So, not much has changed for me in that regard. But the bone graft means the team won't have a good sense of Bryant's status for at least a month. I'll continue to watch for additional developments here.

ARIAN FOSTER | CORE ABDOMINAL SURGERY / GROIN STRAIN | WEEK-TO-WEEK

There was lots of positive buzz on Foster last week, including a swell of reports he could return to play this week. We're now right in the middle of the 6-8 week recovery timetable that made sense for Foster's combination of injuries and he was able to get through two consecutive limited practices last week. I felt two weeks of reconditioning time was critical for Foster given his history of soft tissue injury and the usual risk of an aggravation in the first 7-10 days after return to practice. If Foster is fully practicing by the end of the week, he may be immediately ready to assume a full workload. Expect Foster to be the most discussed injury situation of the week.

todd gurley | acl recovery | day-to-day

Foster's situation is likely to be the most discussed of the week, but the status of Gurley will be a close second. The Rams have steadfastly stuck to a plan to recondition Gurley to full contact. But you could almost hear Jeff Fisher hold himself back from saying Gurley was ready to play in Week 2 in multiple press conferences last week. Expect Gurley to have another full week of contact this week and be active in Week 3.

andre ellington | pcl sprain | week-to-week

There's a slim chance Ellington could return to play this week. But PCL sprains are tricky. Even minor injuries can take multiple weeks to get right. Players may feel the knee joint is stiff or loose longer than originally anticipated. Ellington's practice participation will be your guide here. If he's feeling good enough to work early in the week, he'll have a chance to condition in time to play in Week 3. Realistically, Ellington probably won't be ready to return until Week 4.

victor cruz | calf strain | week-to-week

We didn't need confirmation Cruz's calf strain was a mid grade injury. He's been out for over a month. But Cruz told reporters last week he had blood in the belly of the calf muscle and couldn't return to practice until he'd fully recovered. There's no chance Cruz will be able to recondition in time to play this Thursday night, but expect to hear that Week 4 is a possibility. Don't buy into that timetable until we see Cruz practice this week. He'll need at least two weeks to recondition before getting back to game action. And the Giants may not rush him back to practice while working to game plan on a short week.


AROUND THE TRAINING TABLE

There were quite a few injuries that didn't quite make the cut for an extended treatment above, but will have my attention on Monday and throughout the week. Carlos Hyde was evaluated for a head injury and dizziness and held out for precautionary reasons. The Niners denied he had a concussion after the game, but the symptoms fit. Don't be surprised if Hyde works through a return to play protocol this week. Jordan Cameron left yesterday's game with a groin strain. He briefly tried to return and could not. Expect to hear that the Dolphins will send Cameron for a MRI on Monday. Jay Cutler left with a hamstring strain and didn't return. Tevin Coleman was carted off with an injury later reported to be a rib condition. See above for more on Coleman and Cutler. Julius Thomas, Breshad Perriman, and Delanie Walker are all expected to continue to increase practice participation this week. Thomas and Perriman are doubtful for Week 3, but Walker has a chance to return.

Luke Kuechly is advancing slowly through the return to play protocol after a Week 1 concussion. There hasn't been any report of recurrent symptoms, but concern will grow if Kuechly isn't cleared for at least a limited practice by Wednesday. There is serious concern that Kiko Alonso may have re-torn his left ACL and he'll have a MRI on Monday. The Eagles also lost Mychal Kendricks to a hamstring strain. More imaging is likely for Kendricks, too.

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.