Week 6 midweek practice reports

On Monday, I took a quick look at what injury news transpired over the weekend. Today I'll update that injury information and check in on a few other players who are trying to work their way back into the lineup.

Jake Delhomme, QB, Panthers: Delhomme will be undergoing that infamous procedure typically associated with baseball pitchers, Tommy John surgery, so named for the major league hurler who was the first to undergo the procedure. John ultimately returned to pitch successfully in the majors. Since that time, many others have successfully undergone ulnar collateral ligament reconstruction, as it is known medically, reflecting the actual surgical repair that is done. The ligament that reinforces the inner aspect of the elbow joint, the ulnar collateral ligament (UCL, and sometimes referred to as the MCL of the elbow), is often stressed with repeated throwing, and when it fails, the joint becomes painful and unstable. Surgeons typically use a tendon from the forearm to replace the damaged ligament and help restore stability to the joint.

Interestingly, when Delhomme first injured his elbow, he looked just like a pitcher who had suddenly experienced the sharp pain in the elbow associated with ligament failure. However, his injury was being referred to as a "strained elbow," and in the true sense of the word, "strain" is generally associated with a muscle injury (whereas "sprain" would have suggested a ligament injury). These two words are often interchanged, especially if there is no clear evidence as to what structure is causing the pain. Even in the case of a UCL injury, the ligament does not always appear disrupted on MRI imaging. In fact, the ligament can be only partially damaged but still be symptomatic enough to warrant surgery if it does not respond to conservative treatment. It appears that this was likely the case with Delhomme, as he was given the opportunity to rest the elbow and see if it would allow him to continue. After two weeks of rest, he still could not throw without pain, and the decision was made to have surgery.

The rehab process is long, and it usually takes about a year for an athlete to return to action. However, much like with athletes returning from ACL surgery for the knee, many throwers will say that it takes them two years to really feel like they're back to form. Working perhaps in Delhomme's favor is that the mechanics of the throwing motion for a quarterback are less stressful to the elbow than those associated with throwing a baseball. At this point, it is reasonable to expect Delhomme to be throwing by the time the 2008 training camp rolls around and should be able to return next season.

Trent Green, QB, Dolphins: According to the Palm Beach Post, coach Cam Cameron announced that Trent Green has suffered a Grade 3 concussion, the most severe form, and that he will be unavailable for this week's game against Cleveland. His status beyond Sunday remains unknown, and Green is expected to undergo further tests throughout the week. So what does Grade 3 mean? There are several versions of concussion classification. One of the most long-standing scales, the Cantu classification (named after neurologist Dr. Robert Cantu, who has been quite prominent in the ongoing discussion about concussion management in the NFL), describes a Grade 3 concussion as "severe," determined by a loss of consciousness of greater than five minutes or post-traumatic amnesia (memory loss) of greater than 24 hours. Another scale, known as the Colorado Guidelines, also describes a Grade 3 concussion as severe, but a loss of consciousness of any duration puts a player into this category.

Of late, the use of these scales to determine concussion severity has been called into question because it is impossible to truly assess severity until the player has recovered. Why? Because all brain injuries are unique. It cannot be known at the time of injury how long it will take for a player to fully recover.

Full recovery means no symptoms (such as light-headedness, dizziness, nausea or visual disturbances) and no evidence of cognitive deficits (measures of various aspects of brain performance). Furthermore, there has been significant evidence presented recently that suggests loss of consciousness is not necessarily a mark of severity of brain injury. Athletes who have suffered a concussion (now typically referred to as mild traumatic brain injury), as determined by the presence of symptoms such as those mentioned above, without sustaining a loss of consciousness, might have longer-lasting and more intense residual symptoms than athletes who have suffered a concussion with loss of consciousness. Therefore, it is only in retrospect that the true severity of a concussion can be known, and loss of consciousness does not appear to be the primary determining factor. The NFL is still grappling with how to translate this information into safe and consistent medical management for its players and training staff.

That said, the relevance for Trent Green is going to be how long it will take for him to return to "baseline" after this event. That is what the Dolphins' medical staff will be evaluating throughout this week and perhaps longer. The historical context of Green suffering a major concussive event just last year, now compounded by this recent injury, will no doubt factor into the decision of when, if ever, he returns to play.

Matt Leinart, QB, Cardinals: The Cardinals have placed Leinart on the injured reserve list because of the fractured left clavicle (broken collarbone) he sustained Sunday. This makes sense on several levels. First, it takes approximately six weeks for an injury like this to heal. That's if all goes well. The clavicle is a bone that often has difficulty healing, and when a bone fails to heal itself after a fracture, it is called a non-union. If this occurs, surgery might be required to help repair the bone. Remember Charles Rogers of the Detroit Lions? He broke his collarbone not once, but twice. Ultimately, he required surgery to repair it. Adrian Peterson, the electric rookie running back for the Vikings, broke his collarbone in college and missed most of his senior season. Remember everyone's concern about him at draft time? Was the collarbone truly healed? Would he require surgery? Ultimately, he did not need surgery, but the fact that the collarbone was such a concern indicates how serious this type of injury can be.

Given that failure to heal from a broken collarbone is not unprecedented, Leinart's absence could have extended beyond six weeks anyway, potentially to the end of the regular season. Even if the fracture healed well, the injury was on Leinart's throwing side, and the clavicle plays a role in shoulder mechanics. After the time period required for normal bone healing, Leinart would have had to gradually work his way back to throwing, which could have translated to several additional weeks. Add to that the fact that Leinart was in a platoon with Kurt Warner and was not guaranteed to return to a starting position once he did recover. It made sense then for the Cardinals to put Leinart on IR and open up his roster spot. The Cardinals have already signed quarterback Tim Rattay as insurance for Warner, who has had his own share of injuries in the recent past and is no lock to make it through the remainder of the season himself.

Damon Huard, QB, Chiefs: The Chiefs got some good news related to their injured veteran quarterback. According to ESPN.com, coach Herm Edwards has announced that Huard's MRI showed no specific damage to his shoulder. Huard sustained a shoulder contusion (bruise) last Sunday, but according to Edwards, the quarterback has worked out two days this week. Huard has not yet thrown the ball, but he's expected to practice Wednesday and might attempt throwing at that time. With a contusion, Huard's activity will be dictated by how he feels. The Chiefs will have to make a decision as to whether to start backup Brodie Croyle or Huard, and we will monitor practice as the week goes on to see how Huard is faring.

Michael Pittman, RB, Buccaneers: The latest reports out of Tampa Bay indicate that Pittman sustained a serious high ankle sprain and is expected to miss 6-8 weeks. According to Roy Cummings of the Tampa Tribune, Buccaneers general manager Bruce Allen stated that tests on Pittman's ankle revealed no fractures. The Buccaneers are hopeful that Pittman can return this season and therefore have decided not to place him on injured reserve. Early reports suggested that Pittman suffered a fractured fibula (thin bone on the outer leg that forms the lateral part of the ankle joint), which is not uncommon in conjunction with a high ankle sprain. The absence of the fracture does not minimize the severity of the sprain; this is still a significant injury. It does mean, however, that Pittman might not need to have the leg immobilized for as long a period of time because he is not waiting on a broken bone to heal.

For now, Pittman likely will remain in a protective boot to minimize the weight he puts through the ankle joint itself. The ligaments will be allowed to scar down to heal, and then Pittman will gradually reintroduce weight-bearing activity. A big concern with high ankle sprains is chronic ankle instability and eventual arthritis that can develop in the joint as a result, if the injury does not heal properly. Consequently, the Buccaneers will take it slow with Pittman and bring him back in a measured manner.

Deion Branch, WR, Seahawks: Coach Mike Holmgren announced at his Monday news conference that the Seahawks expect Branch to miss two games with a midfoot sprain. The Seahawks have a bye following their next two games, so this timeframe would give Branch almost a full month to recover from his injury. Midfoot sprains can be difficult to recover quickly from, but at first glance, this seems to be a reasonable projection for Branch. Holmgren has always been forthcoming about the status of his injured players, so this appears to be a very realistic expectation, barring any setbacks along the way.

Antwaan Randle El, WR, Redskins: According to the Washington Post, Randle El, who suffered a hamstring injury in last Sunday's game, stated that he has a mild strain and that he "will be playing Sunday." Meanwhile, his teammate Santana Moss, who sat out last week's contest with a groin injury, was expected to return to light practice. Moss, who has battled nagging muscle strains in the past, appears to be taking precautions to avoid aggravating his condition. More to come on these two receivers after mid-week practices.

Updates: According to Texans coach Gary Kubiak, as quoted on the Texans' official site, there is "an excellent chance" wide receiver Jacoby Jones and running back Ahman Green will return in Week 6. The news is not quite as promising for Andre Johnson. Although Kubiak indicates that Johnson, the team's No. 1 receiver, is improving, he is not as optimistic about Johnson's imminent return.

Steve Korte of the Belleville News-Democrat is reporting that running back Steven Jackson (Rams) has already been ruled out for Week 6. This does not come as a huge surprise, as we have been projecting that his partial groin tear would likely sideline him for multiple weeks.

Bears wide receiver Bernard Berrian left last week's game with a toe injury in the third quarter. According to the Chicago Sun-Times, Berrian had an MRI on his right foot, which showed no major damage. I will watch to see how he fares in practice.

I will be monitoring practice and status reports throughout the week, so be sure to check back for more updates!