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Holmes, Jennings lead Week 4 injuries

Week 4 is in the books! There weren't as many new additions of key fantasy players to the injury report this week as last but nonetheless, the accumulation of names continues. Several players who sustained injuries early in the season were on the field this week and while some managed to survive the week relatively unscathed, others were less fortunate. Here's an early look heading into Week 5.

Wide Receivers

Santonio Holmes, New York Jets (foot): Holmes went down in a heap late in Sunday's game and it wasn't immediately apparent which body part he had injured. When the New York Daily News reported Holmes later emerged from the stadium in a golf cart, wearing a walking boot, it became clear that the problem was with his left lower leg. X-rays of his left foot were reported to be negative, but the results of an MRI taken Monday morning were not made public. Even if the MRI confirms no fracture, the most vulnerable structures in the foot are the many ligaments that connect all the bones to one another. Football fans have become savvy to the term "Lisfranc" as representing a serious foot injury and are understandably concerned that this is what Holmes may be facing. While there is certainly a chance that this is the case, it's worth noting that there are multiple injury possibilities when it comes to the foot. There are even multiple variations of Lisfranc-type injuries. If it was easy to definitively diagnose and treat, there wouldn't be a need for the opinion of a specialist.

ESPN New York reported Holmes' MRI was being "shipped to different places," according to coach Rex Ryan. At least one of those reported to be consulting on Holmes' case is Dr. Robert Anderson in Charlotte, N.C., a noted foot and ankle surgeon and team physician for the Carolina Panthers. (Anderson has treated many NFL athletes and has performed surgery on Houston Texans quarterback Matt Schaub, New York Giants wide receiver Hakeem Nicks and Baltimore Ravens linebacker Terrell Suggs, to name a few.) There is still no word as to the specifics of the injury and while the Jets have only said Holmes is out "indefinitely," there is clearly concern that this will be a multiple-week or even, depending on the degree of damage, a potentially season-threatening injury.

Greg Jennings, Green Bay Packers (groin): Jennings has been dealing with a groin injury since Week 1 and it has already cost him one complete game and part of another. Is it time to sit out and let the groin fully heal? That appears to be under consideration after Jennings aggravated the injury Sunday in the second quarter and did not return. According to the Green Bay Press-Gazette, after Jennings' setback coach Mike McCarthy said, "I would think we are back where we were a couple weeks ago." McCarthy acknowledged the possibility of keeping Jennings out to allow him more time to get past the injury, saying it is "definitely an option." Injuries to groin muscles are problematic for receivers and running backs because of the role those muscles play in core stability. It's not solely lateral movement that is impacted. Plain, old straight-ahead power running is impaired as well and if Jennings can't run normally, his presence on the field isn't necessarily beneficial. It looks as if he's likely to miss Week 5, but there will be more clarity late in the week.

Quarterbacks

Jake Locker, Tennessee Titans (shoulder): Locker appeared in the Tuesday column after Week 1 when he injured his left (non-throwing) shoulder while attempting to make a tackle after throwing an interception. Locker showed rapid improvement and was back on the field in Week 2 after practicing every day that week. On Sunday, Locker again injured his left shoulder, this time on a sack in the first quarter. He looked to be in significant pain and was tended to on the field by the medical staff. Locker did not return to the game but reappeared later on the sideline with his left arm in a sling. The injury appears to be more serious this time and there already are expectations that Locker will miss this week at the very least.

According to news reports, Locker underwent an MRI on Monday that revealed no major structural damage. Coach Mike Munchak described both the injury and the imaging test as very similar to the first time. "The MRI was very similar," Munchak said. "It popped out, and they popped it back in. He's real sore right now, so they're just waiting a couple of days to get a full examination." In other words, they are letting some of the pain and inflammation settle down in order to be able to better evaluate Locker's shoulder before offering further prognostication.

Locker likely will remain in a sling for a brief period to support the shoulder and will gradually begin the process of restoring range of motion and strengthening. Although his pain improved rapidly last time, it may not be as quick to do so again. A primary concern with repeat dislocations is that even in the absence of significant soft tissue damage on MRI, some of the structures responsible for supporting the shoulder are compromised, making it progressively easier to re-injure. In addition to further stretching and tearing of ligaments and joint capsule, there can be damage to the bone (humerus) itself, which can be traumatized as it moves out of position.

The shoulder is a joint that allows extreme mobility in many directions (as compared, for instance, to the hip). This is what permits us the range to both throw overhead and reach behind our backs. If that mobility becomes even greater through injury, it is virtually impossible for the muscles around the shoulder to compensate adequately to keep it in place. Add in pain and inflammation and the shoulder muscles become less efficient as well. In cases of repeat dislocations in high-level athletes, surgery is often warranted to stabilize the shoulder.

Locker can always have a chat with one of his AFC South counterparts about what it's like to not only deal with this injury as a quarterback but what the recovery is like post-surgery, should that become part of the equation. Texans quarterback Matt Schaub suffered a left shoulder dislocation in 2007. He too injured his shoulder twice in the same year; the second incident was in Week 12 and Schaub did not return for the remainder of the season. He underwent surgery in the offseason to stabilize the shoulder and was ready to go by the start of the 2008 season.

Running Backs

Ben Tate, Houston Texans (toe): The Houston Chronicle reported Monday that Tate missed the Texans' walkthrough because of a sore toe. He was undergoing X-rays, according to head coach Gary Kubiak, who indicated they would know more Thursday.

And we're keeping an eye on

Fred Jackson (knee), and C.J. Spiller (shoulder), RB, Buffalo Bills: Both backs managed to suit up in Week 4 and neither seems to have suffered a setback. Both are expected to practice again this week, although it remains to be seen how much. As of now, it appears both are in line to play in Week 5.

Ahmad Bradshaw, RB, New York Giants (neck): Bradshaw missed Week 3 after being diagnosed with a bulging disc in his neck. By the middle of last week, Bradshaw was guaranteeing his return and he did indeed get back on the field. More important, Bradshaw said afterward that his neck felt fine. He looks to be in good shape heading into Week 5.

Matt Forte, RB, Chicago Bears (ankle): Forte returned to action Monday night but gave everyone a scare when he left the game after appearing to aggravate his ankle on the first play. He exited briefly but returned for a total of 13 carries on the night. Another week should help continue to move his recovery forward.

Pierre Garcon, WR, Washington Redskins (foot): Garcon had not played since Week 1 after suffering an unspecified foot injury in that game but he returned to action Sunday. The Redskins had indicated before the game that Garcon would be limited if he did participate, and he was. He's not fully recovered from the injury, nor did we expect him to be, but he is also reportedly no worse.

Hakeem Nicks, WR, New York Giants (knee/foot): Nicks' swollen knee was the reason for the late downgrade last week, or at least it was the knee in combination with his recovering foot. Nicks has only been practicing once a week in an effort to protect his foot, and that day is usually Thursday. In other words, there may not be any real clues as to whether Nicks has turned a corner with his injuries until then.

Rashard Mendenhall, RB, Pittsburgh Steelers (knee): Mendenhall, coming off of ACL reconstruction, has been steadily working his way back into increased practice activity this fall. He ramped up the contact in advance of Week 3 but with the Week 4 bye, the Steelers gave him a little more time to progress. He is expected to make his season debut this Sunday and the Steelers could use him. That said, he is not likely to get a full workload out of the gate, but if he performs well, we could see his usage increase as we have with Jamaal Charles and Adrian Peterson.