Injury Analysis: In Street Clothes...

In Street Clothes...
By Jim Russo
RotoWire Injury Expert


Now that the calendar has shifted to 2009, injuries will start to have even more of a significant impact on teams around the NBA. Earlier it was the All Star Game that was in question for some players but soon we will start to talk about playoff implications and questionable returns.

Mickael Pietrus

One such player is Orlando guard Mickael Pietrus. Pietrus missed ten games in December after a right thumb injury November 29th. The injury was a torn ulnar collateral ligament in his thumb, a serious injury depending in the severity of the tear. Grade three, or complete tears usually have to be corrected with surgery, which would force him to miss three or four months at least. The ligament is located on the inside of the thumb in the webbing that connects the thumb to the second finger, and prevents movement of the thumb away from the rest of the hand.

Like I said, surgery there that would put his season in jeopardy so I guess Pietrus and the team were willing to give it a shot. That may all change now as a recent MRI revealed a fracture in the wrist as well. Apparently an X-ray didn't show the injury but the MRI did, which is normal when diagnosing these tricky injuries. The problem is that it may seriously affect his return to the club. If the two injuries are related, there is less chance the ligament will heal on its own, and surgery may be indicated. It's a little early to tell what the plan will be, but we should have more information in the next week or so, and a better idea of the new rotation for the Magic's back court. Right now I'm not very optimistic.

Steve Nash

Steve Nash is battling back spasms that seem to be related to an underlying issue in his lower back. He reported to the media that he has a slipped vertebrae in his lower back that causes his back to knot up and become painful. It doesn't happen often and Nash declared that he's likely to play tonight after missing a game and a half earlier this week. This is just speculation but the slippage is probably a condition common in basketball players called spondylolisthesis, where one of the vertebrae slides a little too far forward from the one beneath it. It causes the symptoms mentioned earlier and can be an acute issue from a bad fall or twisting injury, but usually happens over time. The problem is that it can progress and bad cases often have to be repaired with surgery. Obviously we're getting way ahead of ourselves at this point…from what Nash has said, the team has a good handle on it and treatment is eliminating most of the symptoms. I don't think now is the time to get too worried about this, but keep an eye on him regardless. Like I said this is an injury that can worsen.

Caron Butler

Another player battling an ankle sprain shouldn't surprise anyone at this point. Caron Butler twisted his left ankle during a Christmas night game versus the Thunder and has missed the team's last three contests. Once again we hear that an MRI didn't reveal any significant injuries, and he is questionable for tonight's match up with the Celtics, but how many times have we heard that before, only to wait another week or longer for a player to return? Butler has been putting up great numbers this year and a ton of minutes as the focal point of the Gilbert Arenas-less offense, but you just never know. One of the things we look for when examining these injuries is trends across the league, and usually the trend with this injury is a two week absence, minimum. For Butler owners, you will have to wait and see and hope for the best. At the same time, prepare yourselves is this thing lingers.

More Updates:

Now a few knees to update. It looked like Zach Randolph was originally dealing with a left knee sprain after injuring it last Monday in a game versus the Raptors. After a layoff it was still bothering him with activity so he had an MRI last weekend to assess the joint and now the diagnosis is a bruise. Apparently there wasn't any ligament or cartilage damage in there so on the surface it appears much less serious. Then we learned he would miss at least the next one to two weeks with the injury. I'm not trying to trivialize a knee contusion, especially to a basketball player who needs to run and jump 30-plus minutes a night to be effective. They are extremely painful and if located in a bad spot, like right on the patella, or immediately below it, they can be very limiting. For now he will treat it with all the usual anti-inflammatory medication and necessary rehab to get that tenderness out of there and maintain his strength. He should be riding a bike or working in a pool, gradually progressing to the treadmill and then the court. When you start to hear reports of him practicing, even in a limited role, then you can start to plan his return. Until then, you may need some patience.

Patience is a word that Carlos Boozer fans and owners out there may have forgotten by now. After missing 21 games with what was originally termed a strained quad tendon in his left knee, and three MRI's, Boozer will undergo arthroscopic surgery on the knee in early January. It's unclear at this point what doctors are looking for, and that may be just the point. They might not know either so there is more to come from him, but definitely not on the court any time soon.

Teammate Paul Millsap's knee injury was made a little clearer recently when we learned he sprained the PCL, or posterior cruciate ligament, in his left knee when he went down December 23rd. The PCL is located inside the knee joint and crosses paths with the ACL, preventing backwards movement of the tibia when the femur is fixed in place, as opposed to the ACL which prevents forward movement of the tibia. Injuries to the PCL however are usually less serious because it is much bigger and stronger and doesn't produce as much stabilization as the ACL. Sometimes players may even play with a complete tear of the PCL, while that would never be possible with a torn ACL. For now the plan is for Millsap to be out at least a week, but he may have some lingering pain and swelling so that is definitely not set in concrete.

As for Tracy McGrady and his troublesome knee…anyone who thought this ordeal was over when he returned to the lineup before the holidays was dreaming. Now he's on the fence again and apparently will not play in back to back games for a while. All I can say at this point is good luck with that one.

To close, we have a few muscle injuries that are noteworthy. Pistons Richard Hamilton aggravated a strained left groin December 26th and has missed three games since. An MRI revealed a slight tear, but this is one that will be watched very closely. Rip had a bad tear in there back in '01-02 that caused him to miss almost eight weeks. The Pistons obviously don't want to repeat that performance. Reports indicate that he may be able to return sometime during their upcoming four game road trip out to the west coast, but I think caution will win out here. If he does come back on that trip, expect it to be towards the end. Hamilton's teammate Rasheed Wallace left their New Years Eve matchup with the Nets with a sore left foot and did not return. There should be more to come on that in the next few days.

And finally we have Brandon Roy's troublesome hamstring. Portland's leading scorer missed the team's win over the Celtics last Tuesday night with a strained right hamstring and is questionable for tonight's home contest versus Chris Paul and the Hornets. It doesn't look like a serious injury and it should be classified day to day, but as we have seen all year, you just never know. And like I said earlier, injuries that happen over the next few weeks can realistically affect player's availability for the rest of the season. The last thing Portland wants to do is risk a long term thing with a guy who was has quickly become one of the most exciting players in the league.

Jim Russo is a certified athletic trainer with a Master's Degree in Exercise Physiology.

Article first appeared on 1/2/08