Inside the Injury Report: Week 9

A look into the developing injury situations of the week, including detailed speculation on Tony Romo and Gio Bernard

thursday night expectations

jimmy graham | shoulder | questionable

Graham again put in a full week of limited practice. I don't believe he was fully himself last week, but he was moving better and looked to be comfortable extending his arms to make plays on his targets. He still actively avoiding taking a direct hit to his shoulder, however. Injury recovery concerns aside, the most important development was that Drew Brees looked to Graham early in his progressions. Brees wasn't doing so in Week 7, whether due to trust or game plan. Graham's continued recovery and Brees' increased trust is a great sign for Graham's usage despite a likely continued lower than normal snap count.

Fantasy expectation: Graham's floor is still lower than usual, but the ceiling is there. Use him as you normally would.

khiry robinson | forearm | questionable

Robinson is listed questionable but did not practice all week with a forearm injury that's clearly more than a "boo-boo." There aren't a whole lot of potential injuries in the area -- it's either a soft tissue contusion, a bone bruise or a fracture. We've not heard about surgery and I haven't seen any reports about casting or splinting. It's also possible the Saints are using the term "forearm" when the injury is nearer the wrist or the elbow. Regardless, with this injury stretching to ten days, it's possible Robinson has an injury with the potential to keep him out four weeks or longer. Hopefully, it's the short week working against Robinson and he'll be back to practice and play next week.

Fantasy expectation: I don't expect Robinson active tonight. If he is, it may be in an emergency capacity only. Without practicing, Robinson won't have been included in the game plan. The Saints will be leaning heavily on Mark Ingram II again.

deangelo williams | ankle | probable

Williams will play tonight. He's had over four weeks to recover from a high ankle sprain and should be at near full strength. Limited early week practices and a full Wednesday workout are a good sign he's feeling minimal discomfort and his conditioning is good. However, with Jonathan Stewart healthy and there are game scripts against New Orleans which could greatly decrease the number of Carolina rush attempts.

Fantasy expectation: I don't see Williams getting more than ten touches tonight. With a limited ceiling and a low floor, he's a flex play only tonight -- even in a week with six teams on bye.

Onto the mid-week injury updates (which won't include Doug Martin, who I think is out for an extended time with an under-reported ankle injury, and Darren Sproles, who is fully practicing and should be back this week) and some very detailed speculation on Tony Romo and Giovani Bernard.

tony romo | back | dnp

Romo has had two back surgeries in the past two years and there were multiple reports of his struggles with soreness, loss of strength, and loss of flexibility through the preseason. But the injury he suffered on Monday night is different.

Dr. David Chao tweeted on Tuesday about his concerns Romo may have suffered a fracture to a part of his vertebrae:

The type of hit Romo suffered -- a direct hit to the back -- and the use of CT rather than MRI both argue strongly in favor of a bony injury. Although Romo was overheard to say the hit happened "right in the spot," there's no indication the injury is related to his April 2013 facet cyst surgery (my speculation on that here) or late 2014 discectomy. 

Further, a good friend of mine is a neurosurgeon and he reached out to me on Thursday morning with the very same concern. We had a discussion about the likelihood of a transverse process fracture and the chance Romo would be able to play through such an injury.

I try to keep the medical jargon out of these blurbs as much as possible, but a quick anatomy discussion is important here. Although we're talking about a fractured bone in the spinal column, this particular injury is not the same as a broken neck or broken back where the spinal column itself is unstable and further injury could mean paralysis.

This bone is away from the vertebral column itself. As with any fracture, it's a painful injury, especially because many of the muscles running alongside the spinal column insert onto these processes. Muscle spasm and inflammation around the nerve roots coming out the spine add to the pain involved. These type of injuries are troublesome in the same way most rib injuries are -- there will be pain with any rotational movement of flexion/extension of the trunk.

Earlier in the week, Romo told reporters if it was an issue of pain tolerance he'd play. Mostly, that's the case here. But this won't be an easy injury to pad and inject. Padding will limit the risk of another direct hit causing more damage to the area. But Romo was wearing lower back protection during the game and suffered the injury anyway. And padding will do nothing to improve the pain felt when twisting to avoid a pass rusher, getting fallen on by a defensive linemen or each time he rotates around his trunk to thit'row a pass.

What about a gameday injection? I'm told by my neurosurgeon friend Toradol isn't a great option if the injury is a bony fracture. It can limit healing and increase the risk of bleeding around the injury. The medical staff may choose to use Toradol, especially if inflammation and muscle spasm seem to be the primary limiting factors on Sunday morning.

More likely, an anesthetic injection would be the treatment of choice. But there are issues with that, too. First, to ensure effective treatment for this particular injury, it's best to give this injection with x-ray guidance. And it's the type of x-ray guidance not available in an NFL locker room. So, the injection would have to be given off site and wouldn't be repeatable at halftime. It's a medication that could wear off as the game progressed as well.

So, although, Romo has played within seven days of a fractured rib and collapsed lung, suffered through multiple drives after last year's aggravated disc herniation, and returned to play within an hour of last week's hit, this is going to be very tough for him to play through this week. If he does, in-game aggravations and his general effectiveness are in question.

If Romo doesn't have a bony injury -- i.e. the x-rays showed a suspicion of a fracture the CT scan ruled out -- and is dealing with a soft tissue contusion, muscle spasm, another disc herniation, etc., the chances he'll be able to play effectively may be marginally higher.

Jerry Jones said Romo was day-to-day on Wednesday. That's understating what's going on, but not entirely inaccurate. We'll know more as the week progresses.

gio bernard | hip/shoulder | DNP

It's always fun to try to decipher what's really happening with an injury in Cincinnati.

On Monday, I wrote that I didn't see a clear mechanism for a hip pointer or a non-contact hip flexor strain and quoted Ian Rapoport's tweet which hinted at minimal concern.

But I'm not surprised things have changed in the past 48-72 hours. First, on Monday night, Bengals' radio color man Dave Lapham told a radio host he saw Bernard moving through the locker room looking like an old man earlier in the day. Then, news reports began to trickle out Bernard did suffer a hip pointer. And after practice Wednesday, this from Richard Skinner in the locker room:

First, let's address the clavicle comment. Bernard is very unlikely to have a clavicle injury. It's nearly certain this is the same shoulder injury he suffered two weeks ago and it's likely to be a low grade AC sprain. He played effectively through it at the end of the game two weeks ago and last week. While it's painful, it's probably a small issue.

The hip pointer is the larger concern. First, it's not really a hip issue. Take your hand and put it on top of your waist above your leg. That's rounded area of bone that lives just under your skin? That's where a hip pointer lives. Like the front of your shin, there's very little tissue there preventing a bruise to and around the bone. Like a shin contusion, it's especially likely to bleed around the injury and swell and put pressure around the surrounding nerves. Hip pointers can be difficult to treat and settle down.

Skinner's comment about the impending Week 10 Thursday night game -- against divisional rival Cleveland -- may be a key factor here. I don't think we'll see Bernard practice on Thursday. That makes Friday key. If Bernard is limited, there's a chance he plays this week. If not, I think they'll hold him out in the hopes he'll recover enough to play in Week 10.

For now, I don't see an prolonged absence. But this is Cincinnati. The sands may change quickly and without warning.

a.j. green | toe | limited

Green passed the first hurdle to return to play this week by practicing with the team on Wednesday rather than just conditioning on a side field. Thursday is key. If he feels well enough to practice again today, his chances of playing Sunday rise exponentially. An optimistic locker room interview -- from Green himself, not Marvin Lewis -- would also go a long way to a positive expectation.

Regardless of Green's Week 9 status, his toe condition will not fully heal this season and will be prone to aggravation. Without knowing specifically what the injury is, it's very difficult to slot him on the Andre Ellington (who looks likely to stay effective despite an injury prone to aggravation) and Jon Beason (who could not play through his). With luck, the new orthotic he's playing with this week will be enough to support him through the pain.

robert griffin iii | ankle | full

On Monday, I felt if Griffin was seeing first team reps on Wednesday or Thursday, it was a strong indication Washington had built the weekly game plan with him in mind. Not only was he taking some first team reps, Griffin fully practiced and reports broke he'd start this week. Video of him moving with the ball in shorts last week isn't too inspiring, though. He still has a hitch in his gait and a brace on his ankle and knee and he wasn't moving fluidly. I'm not sure how effective he'll be and his movements may put him at risk for a soft tissue strain. We'll see how effective he is this week, but I think it'll be a while before he's fully comfortable moving in and out of the pocket.

ronnie hillman | shoulder | limited

arian foster | knee | dnp

justin forsett | ankle | dnp

There may be nothing to these situations, but all warrant close monitoring on Thursday and Friday.

Hillman landed funny in practice according to John Fox, but there's been nothing else of note on him yet. That's probably a good sign -- it's likely a national media member would have picked up whispers of a collarbone injury, a worrisome AC sprain, dislocation, etc. -- but we'll know more after the rest of the week's practice unfolds.

Multiple local media members believe Foster's missed practice was his usual Wednesday day off. But any injury listing for Foster is a concern. I'd feel better if he was listed as "not injury related."

Forsett's absence is believed to be mostly maintenance related as well. But the distribution of touches in Baltimore has been fickle at times this year. Any tweak and missed practice time could affect game planning and Sunday production here.

jordan cameron | concussion | dnp

ESPN Cleveland's Tony Grossi is speculating the Browns are planning to be without Cameron for multiple weeks. I raised that possibility on Twitter Sunday and in the Monday injury column here, but I don't know that a missed Wednesday practice is an absolute indication Cameron will be out for a long period of time. The history of concussions and multiple missed games in previous years is a red flag, however, so Grossi's speculation may well prove accurate.

rashad jennings | knee | [dnp]

ryan mathews | knee | dnp

Jennings plays on Monday night and the Giants didn't have an official Wednesday practice. Although back conditioning now, Jennings is no lock to be available this week. In fact, it seems likely he'll rest until next week. Should he play, I don't believe he'll see close to his pre-injury usage.

I think Mathews follows the same pattern. Condition for a week, then play. He's not far along the conditioning pathway at all yet, so he's arguably still more than one week away if he's unable to do something by the end of this week.

reggie wayne | shoulder | no practice yet

I'll have more on Wayne on Twitter and in the Sunday AM column. Consider him a game-time decision at best right now.

Follow on Twitter @JeneBramel for breaking injury news, updates and analysis. Check back Sunday morning for my expectations on all of this week's game-time injury decisions.