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Tuesday, September 20, 2011
Status of Romo, Vick up in the air

By Stephania Bell



Oh yes, there were plenty of injuries in Week 2. Just ask the Kansas City Chiefs, who lost their third starter to an ACL tear. Running back (and top-5 fantasy pick) Jamaal Charles landed awkwardly near the end zone, grabbed his leg in pain and then was carted off the field. That told us all we needed to know about how serious the injury was.

There were plenty more, so here we go.

Tony Romo
Tony Romo led the Cowboys to victory Sunday despite suffering a punctured lung during the game.
Tony Romo, QB, Dallas Cowboys: The biggest injury story of Week 2 involves Romo, not only because of the unique nature of the injury but because of his ability to perform in the presence of significant pain. When Romo was injured in the first half Sunday, it initially was announced by the team that he had a broken rib and wouldn't return. But return he did, leading his team to an overtime victory against the San Francisco 49ers. Upon returning to Dallas and undergoing additional testing, including a CT scan, Romo's injury was further clarified as a single rib fracture (there was some question as to whether one or two ribs had been broken) along with a punctured lung.



Here is the official statement released Monday by the Cowboys, separated into sections, with some thoughts as to what it means.

Cowboys' official statement: Additional testing on the fractured rib of Tony Romo today revealed that he also has evidence of a pneumothorax -- a condition that is not unusual for an injury such as the one Romo sustained in the game in San Francisco.

Analysis: A pneumothorax essentially occurs when air enters the pleural cavity (the space between the chest wall and the lung). One of the mechanisms that can lead to a pneumothorax is blunt trauma, most often from a motor vehicle accident, assault (knife, gunshot) or rib fracture. The more air accumulating in the space between the lung and the chest wall, the more pressure there is against the lung. This pressure can eventually cause the lung (or a portion of it) to collapse. The obvious immediate complication is difficulty breathing, and in extremely serious cases, the condition can be life-threatening. In some cases, however, when the puncture is very tiny, the symptoms are much more subtle.



It is important to note that the "additional testing" Romo underwent back in Dallas involved a CT scan, a more sophisticated imaging technique than the initial X-ray taken at the stadium. A small pneumothorax might not be visible on X-ray but could show up on a CT scan. This underscores the importance of the physical evaluation of the athlete that is taking place at the stadium. If Romo showed evidence of serious complication from a pnuemothorax, such as extreme shortness of breath, a drop in blood pressure or confusion, he would not be allowed to return to competition.



Cowboys' official statement: Varying degrees of a pneumothorax can heal in differing time frames.

Analysis: A larger pneumothorax requires insertion of a tube into the chest to help evacuate the extra air. With a very small pneumothorax, there might be no treatment at all, just observation while the lung heals. As noted above, the time to heal varies based on the size of the pneumothorax and the individual's healing rate.

Cowboys' official statement: The Cowboys medical team will continue to monitor the situation and conduct additional tests as the week progresses.




Analysis: Repeat imaging is often performed to determine how the healing is progressing. Beyond the imaging, there is the issue of how Romo is feeling. Is the pain improving? Can he breathe, reach, twist and throw without significant pain? With a nondisplaced rib injury, the primary determining factor for return to play is typically pain. The presence of the pneumothorax suggests extra caution in this case. It should become clearer as the week progresses as to whether Romo has a chance to play Monday night.



Miles Austin, WR, and Felix Jones, RB, Dallas Cowboys: Romo is not the only member of Dallas' walking wounded. Of course, there's wide receiver Dez Bryant, who sat out Week 2 with a thigh contusion (the Cowboys are hopeful he will be available this week). Fellow wideout Austin suffered a setback to his hamstring, the same one he injured in the preseason. After turning in a three-touchdown performance against the 49ers, Austin aggravated the hamstring during the fourth quarter. According to ESPN's Ed Werder, Austin is not expected back until after the team's bye week (Week 5).

And then there's Jones. One might even refer to him as the oft-injured Jones (although Bryant likely eclipses that title). Jones displayed his own toughness though returning to the game after suffering a dislocated right shoulder. The injury was variably reported as a separated shoulder or a dislocated shoulder, but Werder confirmed the injury to be a dislocation, per sources. Dislocation means the humerus (arm bone) actually slipped out of the socket (on the shoulder blade or scapula). Jones was outfitted with a harness to support the shoulder and returned to play but is feeling plenty of postgame discomfort. It sounds as if the Cowboys expect to have him Monday night. He might be in a harness again and he might not be leaned on as much if he is limited. DeMarco Murray and Tashard Choice are there for this reason.

Vick
It took until just Week 2 for Michael Vick to leave a game with injury, this time a concussion.
Michael Vick, QB, Philadelphia Eagles: Every time Vick takes off out of the pocket, fantasy owners cringe just waiting for him to take the big hit that will inevitably sideline him. So how strange was it that the hit that knocked him out of the game happened while he was still in the pocket? And while it was a hard hit, it was made all the worse by Vick's front-facing helmet-to-helmet collision with his own teammate, offensive lineman Todd Herremans. In the postgame conference with reporters, coach Andy Reid indicated Vick had suffered a concussion, which is what kept him from returning to the game. Vick will be subject to the same return-to-play guidelines all players in the NFL now are mandated to follow, making a prediction on his availability impossible at this stage.

Arian Foster, RB, Houston Texans: Originally referred to as "fatigued" by coach Gary Kubiak, Foster acknowledged his left hamstring had tightened up on him at halftime Sunday and he opted to remove himself from the game. Disappointing as this was for fantasy owners, this setback does not sound serious. Foster might not have been his explosive self in the first half, but he didn't limp off the field, either. The tightness he felt served as perhaps a good warning signal that it was best not to push his luck in his first game back after suffering a setback in the preseason. This development does create a fantasy dilemma, however, as the Texans have indicated that Ben Tate now will be the lead back, at least in the short term. Kubiak indicated it would be a "process" to work Foster back to a full load, so fantasy owners might want to observe that process before trusting his health.

Quick Hits


• The New York Giants continue to rack up injuries, with their offense almost as nicked up as their defense. Wide receiver Mario Manningham, expected to perhaps see increased targets with teammate Hakeem Nicks questionable up until game time, exited early with a concussion. Nicks did suit up for the game and delivered a touchdown, plus he felt fine coming out of the game, undoubtedly a relief for the Giants. Finally, Domenik Hixon, seeing some time at wide receiver after missing all of 2010 with a torn ACL, made a spectacular catch in the end zone. However, the catch came at a price, as he walked off the field gingerly, headed straight for the locker room and did not do much afterward. According to ESPN New York, Hixon injured his right calf, the same leg that underwent the ACL repair. It sounds as if the injury was relatively minor, but keep an eye on Hixon's practice this week.

New England Patriots tight end Aaron Hernandez was seen limping after Sunday's game, and now we know why. Hernandez reportedly suffered a medial collateral ligament injury, but the degree of injury is unclear. Reports of how much time he will miss have varied, but plan on at least a couple of weeks without him.

• Add wide receiver Eddie Royal to the list of injured Denver Broncos. Royal suffered a groin injury Sunday, which the Denver Post reports will keep him out two to four weeks. Teammate Brandon Lloyd sat out last week with his own groin injury but had returned to limited practice late in the week, hinting at possible availability this week. As for running back Knowshon Moreno, we saw none of him and his injured hamstring last week, so we will have to wait and see whether he turns up in practice this time around. Right now, Willis McGahee is handling the load just fine.

We will continue to update these injuries and others as the week progresses.