This article is part of our Injury Analysis series.
Week 2 was a busy week for NFL medical teams as numerous injuries occurred across the league. The day started with Carson Palmer and Doug Martin already sidelined and it wasn't long before Robert Griffin III, Jamaal Charles, AJ Green, DeSean Jackson, and Knowshon Moreno joined them.
Robert Griffin III
RG3's injury was the most noteworthy and will easily have the most impact of all those that occurred. Griffin suffered a dislocation of his left ankle while scrambling to avoid a would-be tackler. As he ran, he forced his ankle inward in an atypical direction known as eversion. Most "normal" ankle injuries occur when the ankle is forced in the opposite direction, spraining the ligaments on the outside portion of the joint. This is largely due to the physical makeup of the ankle. The position of the bones and strength of the medial (inside) ligaments make eversion a much more limited range of motion. Try it. Move your ankle and toes inward toward the midline of your body. Inversion is easy, right? Now attempt to move your ankle outward in eversion. It's much more difficult and your foot doesn't move nearly as much.
Part of the reason for this is the strong deltoid ligament located on the inside of the foot. The deltoid ligament is arranged in a triangular shape that increases and fortifies the area. The ligament is so strong that the bone here often breaks away in an avulsion fracture before the ligament will fail. This type of injury is relatively rare but has occurred in recent years, most notably to Cowboys running back DeMarco Murray during his rookie season.
However Griffin's injury went one step further. Instead of the ligaments simply tearing or pulling away a small piece of bone, one of the bones of the ankle actually displaced from under the two lower leg bones. In Griffin's case it was the talus bone shifting outside of the tibia and fibula. Whenever a dislocation occurs there is ligament and soft tissue damage and a bone fracture is common. However further tests Monday revealed the bone did not break and Griffin will likely avoid surgery.
A timeline has not been established but he will need multiple weeks to recover. The focus of his recovery and rehab program will be on the damaged ligaments and insuring the ankle is stable. Additional focus should be applied to insure full range of motion at the ankle is restored. A limitation here could easily have a cascade effect on the knee, a joint Griffin has previously injured. Kirk Cousins remains a must-add and will likely be the starter for at least the first half of the season.
Knowshon Moreno
Moreno's injury was also a dislocation when his elbow was forced out of alignment during the team's loss to the Bills. The elbow is comprised of three bones, the humerus (upper arm bone) and the radius and ulna (the two lower arm bones). In an elbow dislocation, the humerus is driven out of alignment and away from the other two bones. The severity of the injury is dependent on the degree of damage to the neighboring soft tissue structures like muscle and ligaments as well as any associated damage to the bone and neighboring blood vessels and nerves. Moreno is still awaiting the results of further tests to identify if the damage resulted in a fracture. Fracture or not, Moreno will miss at least the next four weeks. If a break were uncovered, the timeline would shift closer to the six or eight week mark. Lamar Miller becomes the feature back in Miami, assuming his ankle sprain is minor. Former Dolphin Daniel Thomas has resigned with the team to provide additional depth.
AJ Green
The Bengals receiver limped off the field with what is being described as a turf toe. As previously discussed during the preseason in regards to LeSean McCoy, turf toe occurs when the big toe is forced into hyperextension, spraining a joint known as the metatarsophalangeal (MTP) joint. Like a dislocation, the severity is dependent on the associated damage. Most often the damage is isolated to the ligament and joint capsule, but may sometimes involve the sesmoid bones of the big toe. The sesmoid bones are located at the base of the big toe and help with weight-bearing and toe motion. Occasionally these bones will break or their involved tendon is damaged following hyperextension of the MTP joint.
Fortunately Green's injury appears to minor with little to no sesmoid involvement. However even the mildest case of turf toe can be very painful, specifically when trying to push off the foot. The injury limits the affected individual's mobility and ability to make sharp cuts, a major issue for a receiver. Even if Green is able to play, expect this to limit his productivity for the foreseeable future.
DeSean Jackson
Washington's new starting quarterback may not have one of his top options available when the team takes the field in Week 3. Jackson suffered an acromioclavicular (AC) sprain in the win over Jacksonville. The AC joint is located when the collarbone connects to the shoulder blade at a bony proves known as the acromion. The joint acts a strut for the shoulder and allows for the arm to be raised overhead. Two ligaments, the acromioclavicular (AC) and coracoclavicular (CC) ligaments, stabilize the area but are susceptible to injury when the tip of the acromion is forced downward, generally following a direct blow or hard fall.
AC injuries are graded on a different scale that most other sprains or strains. Instead of a three or four-point system, AC sprains are classified on six-point scale. A Grade 1 sprain is the least severe and involves overstretching and microtearing of the two aforementioned ligaments. A Grade 2 sprain indicates a torn AC ligament while a Grade 3 denotes a rupture of both ligaments. The final three grades are considered severe and involve varying degrees of muscle damage and collarbone displacement.
Fortunately for Washington, Jackson's injury appears to be a Grade 1 sprain. The receiver said the pain had subsided by the end of the game and he is optimistic about his chances to play against for former team the Eagles. Consider him day-to-day.
Carson Palmer
The shoulder injury that forced Palmer from the lineup is actually a nerve issue. Palmer said the nerve is asleep and the root of his soreness. While an official diagnosis hasn't been provided, it sounds like the injury is a neuropathy. Neuropathies can involve direct nerve damage or damage that reduces or prevents the transmission of signals from the spinal cord and brain.
If this is indeed what Palmer is managing, determining when he will ready to play is extremely difficult. Nerve tissue takes a considerable amount of time to heal and the Cardinals admitted he wasn't even close to playing on Sunday. Palmer owners should be quick to add Drew Stanton, if they haven't already, as he appears primed to be the man behind center for at least another week or two.
Jamaal Charles
The Chiefs running back suffered what Coach Andy Reid described as having "the component of a high ankle sprain." Charles injured his left ankle early in the team's loss to Denver and was unable to return. The classification of the injury as a high ankle sprain is disappointing as it means Charles is more likely to miss time with the ailment. High ankle sprains vary from what most people think of as an ankle sprain. In your typical ankle sprain, the ligaments on the outside or lateral portion of the ankle are overstretched and damaged. However in a "high-ankle sprain", or syndesmotic sprain", the damage is located at the distal tibiofemoral joint. Here the distal ends of the lower legs bones, the tibia and fibula, form what is referred to as the ankle mortise. Multiple thick and strong ligaments, including the interosseous ligament and the anterior and posterior tibiofibular ligaments, stabilize the junction. However this positioning leaves them vulnerable to injury when the ankle is twisted while being forced upward. When these ligaments are sprained or in come cases completely torn, it is classified as a high-ankle sprain. Treatment for these sprains is similar to that of a normal ankle sprain but high-ankle sprains often require additional time to heal. Like Griffin, extra precautions will be needed to insure the ramifications of the ankle do not have a cascade effect on his previously injured knee.
The Chiefs have yet to rule out Charles but rushing him back would be unwise. There's plenty of examples of players playing through the injury but failing to be productive, including last year when Buffalo's CJ Spiller just wasn't the same following an early season high ankle sprain. Knile Davis would see the bulk of the carries if Charles were unable to play. Davis looked impressive over the weekend finishing Sunday's game with 22 carries for 79 yards with two touchdowns and six catches on nine targets for 26 yards.
Turf Burns
Mark Ingram: Ingram, one of the early season surprises, will miss roughly a month with a broken hand injury. The involved bone was not disclosed though surgery doesn't appear to be necessary. Pierre Thomas will likely benefit the most, though rookie Khiry Robinson could be an interesting addition.
Doug Martin: A left knee injury kept Martin in street clothes on Sunday though it appears to be improving. However the Buccaneers take the field on Thursday, limiting the amount of time he has to test the joint and work through any lingering issues. Keep a close on the situation and expect this to be a game-time decision.
Ryan Mathews: After an impressive 2013 season, Mathews has once again succumbed to the injury bug. A sprained MCL is expected to sideline the running back for at least four weeks. The MCL is capable of healing without surgical intervention but still needs time to repair itself. Look for Donald Brown to see an increase in responsibilities and Danny Woodhead to continue to see looks out of passing sets.
Tavon Austin: Austin also suffered a MCL sprain on Sunday but his injury is believed to be less severe than Mathews' injury. The St. Louis receiver will miss at least two weeks with one of those weeks coming during the Rams' Week 4 bye.
