nsurg
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Posts posted by nsurg
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I've done a fair amount of research in, and direct treatment of, closed head injury. Traumatic brain injury results from a change in velocity (acceleration) of the brain. There is very little that a "better" helmet can do to improve upon concussions and brain injury. We really aren't seeing an increase in concussions in the NFL, we are simply seeing and increase in awareness and litigation. If you like the current game of football you will have to get used to concussions. It's troubling to reconcile a desire to see the game stay the same vs a desire for better player safety. I suspect given litigation issues veiled in discussions using the word "safety" the NFL will yield in favor of the latter.
I'm disappointed that collie was not kept on with the colts, but I suspect there is also a trend towards labeling a player as injury prone without thinking much further.
Without much pure intelligence on the matter, I suspect that the depression and suicide rate among ex-NFL players has much more to do with fame->anonymity and wealthy->bankruptcy trends than it does with post-concussive dementia (many demented individuals are pleasantly ambivalent, sadly). I think it's the families that desire a free last payout that allow for litigation towards the dementia argument?
I've said all along that I believe collie is ok to play from a concussion standpoint, it's just a calculated risk and probably not a high one (I admit I'm not exactly in the loop on the severity of his concussions).
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I think Mcaffee is a pretty cool guy--he punts great, tackles surprisingly well (I'm sad that we even have to see him tackle), and has personality, but I think we may overemphasize the power of his leg. While his punt/drop-kick is fine, he never seems to kick the ball out of the endzone on kickoffs as often as a given kicker on an opposing team... and this seems to parallel fields goals a bit more accurately than does a punt.
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I'm glad you mentioned boxing. I've done a bit of research as to why the differences exist for the two sports as far as liability goes. The main difference is that in boxing, there is no central authority, and thus no league-wide official policy on the issue. The promoters never denied any findings as to the brain damage the sport could incur, so as studies proved the danger anecdotally described as becoming "punch drunk", there weren't counter-studies funded by promoters or boxing commissions to attempt to disprove them. No real denial or attempt to portray the sport as safer than it is. Fragmented as it is, boxing admitted to the risks, and in turn, boxing went from being a sport with an extremely high youth participation sport to being marginalized. The decline was evident even by the 1960's and 70's compared to its heyday- and even moreso today in the U.S. Most high schools and colleges used to have boxing teams, believe it or not. The sport became too expensive for many to carry as the risks became proven and liability insurance shot up. Now it's a club thing on most campuses, if it exists there at all. You won't find it in high schools.
That's what the NFL was trying to protect itself from in denying any link to long-term damage- they didn't want to risk lower participation rates and thus fewer fans like what happened to boxing. They were caught between a rock and a hard place- admit to the risk and face damaging their own youth marketing campaign, or deny the risks in the face of overwhelming evidence. The latter would mean the league would face an inevitable lawsuit from the players that their official stance lied to. There was no playing both sides of the fence forever, although the league did the balancing act well for as long as it could. The player's case is strong because of the denial factor in the face of all common sense, not the fact they got hurt on the job.
It's really the increased insurance costs and decreased youth participation the league is terrified of. And I don't say that with an ounce of hyperbole....they know that 99.9999% of every NFL player now will still keep playing even now that the risks are generally accepted and more well documented. It's the increased costs of admitting to that risk they don't want to face.
Thanks for the thoughtful comments on this... interesting.
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As a neurosurgeon, I don't believe it is either time for Collie to retire or go on IR this year... just felt compelled to reply to this topic.
I don't think anyone is worthy of blame or lawsuit for post-concussion players with dementia and psychological issues. It is a tragedy, yes, but this is worse in boxing which generates no such lawsuits to my knowledge (though I admit I don't follow anything about boxing to know). One might just as easily argue that the players should sue the NFL because they are all guaranteed to get advanced arthritic joints and literally walk very poorly earlier than the average US citizen, right? This country has the highest percentage of lawyers per capita and I think we have an attitude of blame without accepting personal responsibility for our actions. Players participated in the NFL willingly even back in the days when some would die after head injury. It's sad, but do we have to say "your drink is hot" on every cup of coffee and tell every player "football is dangerous and you could have long-term injuries"?? My vote is no, but that's just an opinion. Every sport has its dangers: http://www.theonion....s-drowns,29059/
As a last comment, based on the physiology of head injury I have very little faith that a "better" helmet is going to significantly reduce these issues. Changing the rules might help a bit, but it would require the entire game to be remodeled.
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here is some constructive criticism for the op:
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Come on, folks, have some patience here... Recalling what his other 2 concussions looked like, this event is either minor or nonexistent. He's being protected and scrutinized, and it's a worthless preseason game. Additionally, major concussions are markedly different than minor. I don't think this event precludes him from playing football medically any more than his status just prior to this game, unless it is in fact more than a minor concussion.
While he is at risk of another future concussion more than another given player, and another concussion for him would have more relevance than a given player, he knows this and chooses to play, and he is cleared to play.
My feeling is that he will be back, and that's not a crazy decision for him to return, but we'll see how it plays out... our opinions don't matter!
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Just one more example of why this country is in need of tort reform.
Amen... but remember that the lawyers make the laws, so I guess it will never happen.
We are literally the world's fattest country with the most lawyers--lots of consumption and lots of blame?
Back to the article: The only change that will be made is that someday people will make football players sign waivers stating that football is dangerous. Is there any other country in the world that reminds people that their coffee is hot? Can't be many others if any.
Concussions will never go away even with stand-up linemen, new rules, and new helmets, we'll just have more paperwork and siphon more money into the pockets of those who manage our disputes.
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We've always been able to find "Good Hands" Wayne, Harrison, Gonzalez (Before he became the Offensive Version of Bob Sanders & went M.I.A.), Clark, Collie, Stokley etc.
"catchable" is a loose term, no doubt... in this sense, the "best hands" stats have a high degree of qb-wr association--it's not just a stat that reflects on the skill of a wr.
My guess is that, given the list of above stars and what we recall as their "good hands," we will go on to see some colts wrs fall to average catching percentage as luck gets up to speed, and will find out that garcon has flat out terrible hands as he goes to a new qb, even though rg3 should have decent accuracy. That being said, without seeing stats I do recall by my inaccurate memory that garcon dropped perhaps a bit less with painter throwing to him? So perhaps I just have no idea what I'm talking about...
if somebody is thorough we can dig up stats at the end of this year, might be a bit interesting.
wow, we need some real football to talk about.
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. He ran a 4.37 forty with 40V, 11'8" BJ,
while I must say I'm impressed, I don't think bj stats are appropriate to discuss in this forum...
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Did anyone expect the Denver receivers to say anything less than positive regarding Manning's throwing ability? Let's wait until the games are played.
, good point. John Elway would seem like an exciting, promising qb to them by way of comparison to tebow. -
I don't think it's possible to be surprised by Peyton. Did anyone doubt he was going to be able to throw?
Well, I doubted it. I feel like I've yapped on forever about his chances being poor of recovering arm strength (though I've tried to qualify my opinion by mentioning that it's really hard to get quality medical info out of the press).
When I've seen triceps weakness persist after a few months, I've never seen it recover completely. Who knows, I'll be delighted to be wrong on this point! I'm closer to Denver than Indy now, so I'd love to see him play. I suppose I'd wear my manning jersey (in blue).
I will have a lot of football to watch this fall!
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1.Colts
Gonna be fun to watch Luck his rookie season, everyone will be gunning for the new kid to get him before he gets good, and looks like this is gonna be Reggie's team till Luck takes command.
2.Broncos
How could you be a Colt fan and not want to see Manning. Plus look at who they play this year, Manning in his first season with a new team, back from 4 neck surgery's, fired from his team he made into a hall of fame career, playing the toughest schedule in the NFL. Thats just great football.
3.Giants
Come on man... They beat the Pats twice in the superbowl.
4.Whoever plays the Pats
nuff said
This.
And this:
5.whoever plays the eagles
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It's only been 6 months since the fusion. Recovery is supposed to take 12 to 18 months. They have to take a gamble, because he's not fully healed - nor should he be yet at this point. They have to rely on the doctors to project what he'll be doing by August and September.
I think the clock started ticking in april or whatever, when his nerve was first injured. I think it's optimism that he has much improvement to go, and I think it's concerning that he has not released quality footage of throwing by now... I'd love to be wrong, and I hope I am.
This was a related post I'm too lazy to retype...
I think Irsay knew manning would be hot on the free agent market, and was sure enough he wouldn't play well again. I think manning knows the first part of this, and hopes that the second can be overcome. The money made it easier but wasn't the deciding factor, perhaps?
We'll see.
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Well reasoned and thought out.
However, if PM is not yet NFL-ready, wouldn't his new team, during their due diligence, find out when he worked out for them prior to finalizing a contract?
Once that got out to the news, the PR slap will reverse course.
Agreed. Everyone will see he is is not now nfl ready, but teams and doctors will disagree on his prognosis. A bidding war could begin and one of those teams that banks on terms like "upside" will give a contract with heavy incentive. The colts see their whole team as a project right now, and i think pm and irsay both feel that way. Irsay also had more of a financial gamble with the proposed contract than a new team would with a fresh contract, and pm and irsay probably didn't see any point in an insulting contract restructure with a building team and a hot new qb with a potential for a power struggle. Manning will work his tail off and try to play. I predict he will see the field, but I just can't figure if he will play on a high level again. I sure hope he does. My guess is both pm and irsay agreed on this outcome after laying their cards out, and they are both sad about it. Didn't that clip from irsay's car at the airport look like the awkward moments after a mutual dating breakup?
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I think people need to read between the lines a bit. It occurred to me that, assuming that irsay and manning are both telling the truth, there is a major piece missing from what was discussed in the press conference, and the proof of this may be that both sides are still at peace at face value for the discussion:
Peyton is simply not at nfl form at this time.
Peyton thinks he can recover, irsay (and probably those advising him such as the team neurosgeon feuer) thinks he cannot.
Feuer has the power to sway this... when I lived in indy I remember feuer once mentioning how he nixed drafting a very promising tight end due to cervical issues from the mri done at the combine. He was right by the way.
I believe that irsay really would keep manning... he said he would keep him if he can play. I believe the "not about money" comment, as they gave him this killer contract even after he had 2 surgeries. Manning clearly wants to play football for the colts. So the only conclusion I can reach is that irsay sadly doesn't think he can get the full peyton back.
I would bet money they both respectfully disagree on peyton returning, so agreed to not voice medical concerns so peyton could at least have the fair opportunity to have teams court him. Irsay is probably taking a huge PR slap in the face by not publicly explaining his health concerns for Manning, but respects manning this much that irsay allows himself to look like the bad guy by not burning manning. I'll bet they agreed to this conclusion and irsay simply promised to keep mum on the health concerns.
Sure the march 8 money forced an early conclusion to this problem, but unless somebody is lying here what else makes sense?
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well, I think he could throw ok but just had some pain, that 2nd surgery up in chicago disrupted things and it was just a minor procedure to see if they could take a bit of the pressure off of the nerve roots (FAIL), and so it goes and you are absolutley correct,,,, his abilty to throw got even worse.
I think these statements are not consistent with everything I've ever read about this situation.
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What if ? (manning would have opted to NOT have surgery last march and just endured the discomort for another season) WOW, the whole landscape and infrastructure of the current Colts would be completely different. I can't even imagine how that decision weighs on Peyton right now. I'm sure he is still numb and indifferent about it all. I do feel for Peyton.
He had no option to avoid surgery if his goal was to ever play again. His arm never would have had any chance to recover. You are probably right about numb, though... in his right middle 2 fingers.
There's not much that could have been avoided here imo, just terrible luck. I don't know why there wasn't a contract restructuring, probably pride.
Sad series of events and conclusion. Looks like we'll be dominating the high draft picks for the next few years.
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So, "The best back and neck guy in the country" said
If you haven't noticed by now, every surgeon you will ever meet is the best in the country.
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It's nice that your well informed pessimism is grounded in the reality that there isn't enough public data for a firm conclusion. Could you elaborate on why you're not optimistic on his ability to regain arm strength? It certainly seems very possible that he'll never regain strength, I'm just curious what you're picking up on that leads you to believe this is likely?
I hope it doesn't come off as "well informed pessimism"... I'm just trying to be honest. It drives me nuts how much press this gets with pseudo-medical jargon and anecdotal information, so that's my motivation to post.
Read posts I've made before to answer the questions in more detail (I think it's possible to search posts by a given user?). In short, his nerve was originally injured in spring of 2011 (I think April or May?). I realize he's had several surgeries, but that's when the injury began. With no personal ego stroking intended (this is a very humbling field, IMO), probably 80% of my practice is spine surgery. I don't believe I've ever seen a significant amount of weakness 10 months after an injury that later went on to improve to "normal". Most weakness from a cervical nerve compression either begins improving very soon (obvious with a few weeks) if it is "destined" to get back to normal. Whatever pace is established generally continues for 8-12 weeks and then tapers off to a plateau. I do believe maximal improvement is probably not reached until 12-18 months, but I also think that 80-90% of that improvement is pretty much established by 3 months. Yes, these numbers are opinion, and they are estimations that are mine only.
Surgery is what it is, but I've always felt that my daily challenge is determining who can be helped with surgery, what the exact goals are, what the chances are of achieving those goals, and what the risks and alternatives are. I think pretty hard about this stuff, because if I were in this situation as a patient that's exactly what I'd want to know about.
Peyton is getting a raw deal here, but think about how many regular people in life lose their $30k jobs because they can't go back to work at a labor-intensive job, and on top of that now have substantial medical bills even if they are lucky enough to have insurance. And those people don't often have a viable backup plan.
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the SI article says that he had this "procedure" in Chicago with his original surgeon, so that would be Rick fessler. I would bet the bank it wasn't an epidural. fessler doesn't do those.
The si report is extremely vague and probably does represent a hippa violation by some tech aware of the case, I doubt it was an intentional leak by a major party involved.
I cannot glean any useful medical info out of the article other than the implication that manning has a pretty challenging neck. word among some peers is that he has substantial right sided cervical degenerative disease which may be the result of football and his style of play, but this is unsubstantiated and still vague, giving no useful prognosis in and of itself.
again I think the only thing that will matter is his arm strength... I do not think it is likely that it is dangerous for him to play, I just don't have high hopes that his arm power will be adequate.
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My understanding is nerves of the peripheral nervous system can grow up to 2mm per day if small, and up to 5 mm per day for large ones. This does not take into account roadblocks/plateau's etc...
Conventional wisdom is 1mm/day or about 1 inch/month. This really has very little clinical relevance for compression of a nerve, it may apply more to a nerve transection with attempted direct repair where one anticipates the start of noticable clinical recovery.
For nerve compression there is no rule, but it is so exceptionally common that any astute surgeon (who actually bothers to follow patients postop) will have a general understanding. I have somewhat summarized typical nerve regeneration patterns in previous posts.
I think we're all arguing a moot point. My sad prediction is that manning will be on the roster for some team next season but will probably never play again at a high level/arm strength which may equate to simply not playing again. I absolutely could be wrong, and I'd love to be wrong.
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It's just a very intelligent, very educated way of saying "dunno".
, you nailed it! Though not always intelligent, but certainly wordy, no?We should sticky this comment, ban all future speculative posts (I'm sincere, not sarcastic here) and then wait a year for more information. This is going to get much worse now that nobody has actual football games to watch for 6 months.
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...It was injured in April, but wasn't it relieved until after the fusion? So that was what? Six months ago?
It's very hard to glean any medical details from the press... I've pretty much tried to piece things together by reading articles from espn and what is linked on the board, putting more weight on detailed articles.
Both surgeries he had done were very common and straightforward. I would be shocked if the decompression in april (perhaps it was may?) was anything less than excellent. I think nerve decompression started then. My feeling, and that of surgeons I have spoken with (who are simply forming opinions as well, without direct knowledge), is that he had enough joint decompressed with the surgery that his spine was a bit unstable, leading to pain. The trick of a non-fusion surgery is to remove enough joint that the nerve has space, but not so much that the joint fails.... it's judgement on the surgeon's part and thus could theoretically fail on both objectives (though rarely). The nerve didn't recover, so he had fusion to create additional space for the nerve and stabilize the presumed hypermobile joint.
It really doesn't matter when nerve decompression "started" though. If he wasn't fully decompressed until august, that's still not good news--means the nerve was actively compressed for months, which also portends a poor prognosis. Conversely, if it was perfectly decompressed in the april (may?) surgery, he hasn't apparently shown improvement over 10 months which is depressing.
I assume he's throwing "poorly" as I've stated (I have no idea) simply because he has every reason in the world to show off for the media if he's anything approaching good, right? But yes, it's an assumption, and I don't know.
Medicine, even at its finest, is about opinions, science, and experience. There is not a single cut and paste article which gives us an answer. Irsay said in his interview that no qb in the history of football has ever had a similar injury, which means weakness of the dominant arm triceps due to a c7 nerve compression on that side.
I don't think he's done improving, but it is a reasonable assumption that most of his improvement has already occurred and may be possible the nerve will improve no further. He still has some portions of the nerve working, which we may assume knowing that he can throw at all, so perhaps the muscle fascicles that are innervated currently can hypertrophy further and become "good enough". But how much can that occur? Nobody can grow new muscle fibers, they simply enlarge or atrophy, so some will be gone for good.
Again, my opinion. I'd love to be wrong, but as I've stated all along the good news should have come in January when he was "fused" and allowed to be vigorous with his neck. To not have power at this time is discouraging.
Some of you may also note that about half the neurosurgeons in the country, if not more, will happily state that they are an expert/innovator/authority on any given field given the opportunity to do so in the press. Good for elective referrals, they might hope. Read between the lines and look for bias.
My personal motivation in this is just to give some info--I guess it drives me nuts to read misinformation, anecdotal results of random people, and blathering doctors seeking to get their names in the national press. I'd love to see him play. I'd prefer to remain somewhat anonymous because I simply don't care to have an internet presence about this... sorry for my username, but I chose it years ago on the old board and transitioned over, thought it was subtle then and something simple to remember.
This could be worse, we could be drooling over jamarcus russell at the number one pick years ago, right?
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Nerve regeneration is variable, and the length of the nerve has some relevance. The C7 nerve to the triceps is a relatively short distance, so typically recovery of substantial strength, if it occurs at all, is seen within the first few months. Anecdotal results from a given person do not apply. Manning's nerve was injured in April, approximately 10 months ago, by what I have read in the press. I have not seen patients go 10 months after this problem with poor improvement that later improved. I'm not happy to say this regarding manning.
, good point. John Elway would seem like an exciting, promising qb to them by way of comparison to tebow.
Ahmad Bradshaw visiting Colts/Colts now in 'heavy negotiations' with Bradshaw again. (merge)
in Colts Football
Posted
Perhaps because of this they should look for the highest pay? Seriously, most NFL players should take as much as they can get, because only a precious few get significant endorsements. Figure high tax rate, subtract agent's fee, subtract loans for house and usually a family member's loan as well, subtract even just a few bad decisions (by a 20 year old), subtract potential losses to scam investors, subtract a car commensurate with one's perceived status, and that's not much saved. Multiply by 3 years on the average career, and you still have very little saved.
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Next, they're young, poor, and have no skill set and no useful knees, what should they do next? I feel a little bad for the non-superstar NFL athlete. We as the fans will always have the next round of fresh players to enjoy watching, but they're pretty much all done.
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They nearly all go broke, so they sincerely should take their highest paycheck times the safest long-term career. It's the second part of that equation that is so difficult to predict...
http://www.npr.org/blogs/monkeysee/2012/10/02/162162226/espns-broke-looks-at-the-many-ways-athletes-lose-their-money
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But at least your paragraph makes me start thinking about meat... mmmmm.Â