The Pat and Aaron Injury Report 12/29/22 with Dr. Morse

Aaron Jacobson: Pat and Aaron Show, 953 WDAN 620. Aaron Jacobson here. Pat Donovan out today. It is now time for the injury report. The Pat and Aaron Show injury report presented by Florida Orthopaedic Institute in partnership with Tampa General Hospital and time now to go to the friendly Kia D-A-E hotline where Dr. Adam Morse is joining us once again on the show. Good morning, Dr. Morse. Merry post-Christmas and happy upcoming New Year.

Dr. Adam Morse: Thank you. Merry Christmas and happy new to hear you as well.

Aaron: Let’s start locally with the Bucs and Leonard. Now, he posted on Twitter that he’s been dealing with a Lisfranc injury. He did that after their win against the Cardinals and then he deleted that from Twitter. How has he been playing effectively with that Lisfranc injury?

Dr. Morse: The Lisfranc injury is a sprain to the midfoot. It’s like an ankle sprain, but it’s about halfway down the foot between the tarsals of the large bones in the foot and the metatarsals along skinny bones. When those ligaments sprain, it’s just like having an ankle sprain. The ligaments are partially torn but not completely torn, and you just try to let them heal.

It takes about three months for them to completely heal. Just like in an ankle, you can have a real mild sprain that heals in a couple of weeks. You can have a real serious sprain that takes the full three months. Once he feels that he can perform on it, they’re going to let him go back and try.

Aaron: Is it something that if he performs on it, plays on it, tries, and it gets worse that he might require surgery in the offseason?

Dr. Morse: It’s possible, although it would have to probably get significantly worse to the point where he just couldn’t walk on it before they would rush in and talk about doing anything surgical.

Aaron: Now I want to go on to Baltimore, the Baltimore Ravens quarterback Lamar Jackson, obviously star quarterback Lamar Jackson, he has missed the last three games of the PCL strain. Now, I know you’re not in the locker room, you’re not with the organization, so you don’t know the inner workings of what’s happening with this injury. They’ve already clinched their playoff spot.

When you’re dealing with a PCL injury, would you have to guess it’s probably more precautionary if they keep him out, or is this something that could be a real issue for him for the playoffs?

Dr. Morse: They can be. Again, when you’re talking about a complete tear, it would be something that could keep him out for the playoffs. If it’s a strain, a lot of times a strain will completely heal, just like the foot in about three months is usually complete healing time, but they can brace him and get him back. The longer they can allow him to recover, the better a chance that he’s going to do better in the playoffs.

If they don’t need him to clinch the spot like you’re saying he’s already there, then they can certainly hold off and give him as much recovery time as possible, which will enhance his ability to play when they do need him.

Aaron: Especially when you’re dealing with Lamar Jackson, where he uses those legs frequently. Bucs Offense, our right tackle, Tristan Wirfs has been just fighting through his ankle injury. Came back to play against the Cardinals but reaggravated that injury, kind of like we were talking about with Leonard Fournette with the Lisfranc in the foot with the ankle. How difficult is that to try to test it out, especially with an offensive lineman and potentially making the injury worse?

Dr. Morse: They have two different types of ankle sprains. One is called a low ankle sprain, and the other one is a high ankle sprain. With a low ankle sprain braces work really well. Taping works really well, and then you can get him in practice and put him through his paces and see how he does. If he seems okay, then you let him play as long as he wants without really too much risk of doing much more damage. A high ankle sprain, the braces don’t work. The taping really doesn’t do much.

It’s a lot harder to recover from a high ankle sprain, which is actually a sprain of the ligaments that connect the two bones in the shin, as opposed to the low ankle sprain, which is the bones in the shin connecting to the bones in the foot.

Aaron: Now, is this a sign that maybe they brought him back too early?

Dr. Morse: Yes. Again, you can’t quantify the severity of an ankle sprain even by MRI scan and by exam. When the swelling calms down and he’s able to move on it, then they’re going to get him back as soon as he feels comfortable, and then they feel comfortable. Although I’m sure there’s tons of pressure for him to come back as early as possible despite being not quite 100% and then seeing if him at 80% or 90% is better than a backup at 100%.

Aaron: Dr. Morse I’ve been seeing Dr. Nydick over at the Florida Orthopaedic Institute because I’ve been dealing with– I broke my finger three weeks ago. My fingertip, the tip of my finger. I’ve been annoying him so much. He’s so great. You guys are all so nice. He’s so nice about it. I really have. I’ve been there two times now to get X-rays. I’m freaking out. Everything seems to be trending in the right direction. It’s a six-week injury.

When I take off my little finger splint, I’ve been keeping it straight. Can I start to bend it a little bit? Do you think I’ve recovered enough? Maybe after three weeks where I can start to bend my fingertip and try to try it out a little bit.

Dr. Morse: Again, without seeing the x-rays. That’s tricky because if it was a central slip like a mallet finger.

Aaron: It’s mallet finger. It’s mallet finger, doctor.

Dr. Morse: If you wait until that’s not completely healed and you start to bend it, it’s like taking two pieces of wood, putting some glue on it, and pushing them together, hold it for a minute, and then pulling them apart to see if it’s stuck yet. When it’s not, you keep doing that, eventually, the glue dries and you don’t get it stuck, and then you’re done. If you don’t wait for the full six weeks without bending it, then there’s a high chance that the tendon won’t stick back to the bone, and you’ll get a permanent deformity that needs surgery.

Aaron: It was a great answer. I don’t like it because I want to move my finger, but the way you painted that picture, I’m not moving it for another three weeks. Thank you, Dr. Morse. Real quick, before we let you go here, Tua Tagavailoa with the concussions, I know it’s a very strange thing we’re seeing with Tua, but at some point, when you’ve dealt with those many concussions, at what point does a doctor need to say, “Hey, it’s not worth it?”

Dr. Morse: That’s a really tricky question because, with some of the injuries I’ve seen from concussion and with the traumatic brain injury, long-term stuff that we see, it’s really questionable as to how safe repetitive head trauma is over years. In his case, there’s another concern, and that’s what we call second impact syndrome. If you get a concussion and you end up with some mild swelling in the brain and mild symptoms, if you get a repeat concussion within a couple of weeks, it can cause a rapid, progressive swelling in the brain, which can result in death.

Now, it’s rare, but when it happens, it’s devastating to the point where, how much are you willing to rest? When you’ve had a second concussion in the season that’s recorded and documented, it’s almost time to say, “Hey, look if it’s a significant concussion. We really need to give you an extended period of rest, not just a week.” Some people have a real mild concussion, and once they’re completely asymptomatic, it’s considered safe to go back.

Aaron: It’s so scary, all of it. We hope Tua recovers fully The Pat And Aaron Show injury report presented by Tampa General Hospital in partnership with Florida Orthopaedic institute, providing you access to one of the top orthopedic programs in the nation. I am a patient there as well, and if you’re dealing with an injury, you should go see them, schedule an appointment today at floridaortho.com. Dr. Morse, thank you so much and have a great new year.

Dr. Morse: Likewise. Thank you very much. Happy New Year.