Stephania Bell: Cornelius Brown

Matt Cassel undergoes appendectomy

December, 9, 2010
12/09/10
5:16
PM ET


This week's Thursday night matchup has the Tennessee Titans hosting the Indianapolis Colts.

For the Titans, wide receiver Kenny Britt is off the injury report and is expected to see his first game action since tearing his hamstring six weeks ago. While his recent practice activity and this "noninjury" status are good news, he is still not out of the woods. Hamstring strains, as we've seen many times this season, are very susceptible to aggravation. For that reason, especially given the severity of Britt's injury, it would not be surprising for Britt to see a light workload in his first game back. Fantasy owners who have better options may want to hold him for this week, but if he comes through unscathed, he could be very valuable the rest of the way.

For the Colts, the injury list remains as lengthy as ever. Already ruled out are Austin Collie, Joseph Addai and Mike Hart. None of those three being out is particularly surprising, but it does make those with a questionable status more critical. Donald Brown was on the injury report because of his ankle, but the injury appears to be minor. He practiced fully Tuesday and Wednesday and is expected to start. Tight end Jacob Tamme is listed as questionable with a knee ailment (note that early in the week it was called a hamstring). Tamme returned to limited practice Wednesday after sitting out early in the week. My sources seem to think he will play and that he may have been given additional rest because of the short week. Nonetheless, be sure to check game-time inactive reports. Wide receiver Reggie Wayne, also listed as questionable, practiced fully Tuesday and Wednesday and is expected to play, as he always does.



Here's who else you might be concerned about heading toward the Week 14 playoff rounds:

Quarterbacks

[+] EnlargeMatt Cassel
Tim Umphrey/Getty ImagesIt's very possible Matt Cassel could play just days after an appendectomy, but it would be very risky for fantasy owners.
Matt Cassel, Kansas City Chiefs: Cassel might be the most discussed injury concern in the past 24 hours as it was discovered that Cassel underwent a laparoscopic appendectomy on Wednesday morning. Essentially, he had his appendix removed using a more modern, less invasive approach that includes a scope or camera, as opposed to the old-fashioned "open" procedure which is a bigger cut and longer recovery.

The big question for fantasy owners, since the Chiefs have indicated Cassel's status is questionable and that there is really a 50 percent chance he plays, is will he indeed suit up against division rival the San Diego Chargers?

The answer: Maybe, but fantasy owners need to have insurance and probably should look elsewhere for a playoff-round quarterback.

To better outline the variables involved in determining whether Cassel could play this weekend, I spoke with Dr. Efren Rosas, Chief of Surgery at Kaiser Permanente in San Jose, Calif. Rosas has performed thousands of laparoscopic procedures and is an advocate of the less invasive approach, in part, because of the more rapid recovery for the patient. He was quick to say that not all laparoscopic procedures are identical, nor are all presentations of appendicitis, and several factors could influence whether Cassel could be available Sunday. It should be noted that Rosas has no specific knowledge regarding Cassel's care.

First comes the question of whether Cassel had a three-incision or single-incision surgery (in other words, how many surgical cuts are there on the abdomen). Three incisions are more standard, although one incision is gaining popularity in some places (such as Los Angeles), because there is only one surgical scar. With three cuts, each incision can be smaller, whereas with one cut, all of the surgical instruments have to pass through the same entry so the cut is larger. Following surgery, smaller incisions (typically one-quarter to one-half inch in size) mean less likelihood of developing a hernia (where abdominal contents push outward -- not pretty). That translates to less activity restriction after surgery with three incisions versus one.



Rosas, who treats patients of all ages, including competitive athletes, said, "I release all my patients, no matter what type of job or sport they have, to return at two weeks and if they're doing really well, they're clear within one." When asked if four days would be possible for an NFL quarterback, Rosas said that while it may not be likely, "If he's not too sore and can function effectively, I wouldn't completely rule it out." Rosas pointed out that from a medical standpoint, the tissue should heal within a few days, and that the biggest limitation, presuming no setbacks (such as infection) along the way, would be pain from where the surgical cuts were made. That pain may be amplified by the fact that a throwing athlete uses his oblique abdominal muscles, especially for distance and velocity, meaning long downfield throws might be tougher to make.

Another variable would be the condition of the appendix at the time of surgery. A severely inflamed or ruptured appendix would result in significant abdominal inflammation, complicating the recovery. A minor case of appendicitis in a healthy younger male may mean less inflammation in the surrounding tissue and quicker healing time. Only the surgeon who was involved in Cassel's case has an appreciation for all of the factors in play and ultimately will make the decision as to Cassel's status when appropriate.

Pittsburgh Steelers quarterback Ben Roethlisberger underwent a laparoscopic appendectomy in 2006 and did not play in the first game of the season, a Thursday night game just days after surgery. Roethlisberger did start 10 days later in Week 2. It is worth noting, however, that Roethlisberger also was coming off a summer filled with injuries, having suffered facial fractures, a jaw fracture and a concussion in a motorcycle accident about three months earlier.



It would not be surprising if Cassel were to travel to San Diego with the team and ultimately be held back from starting. And although it appears unlikely, it's not completely inconceivable that he could play. Nonetheless, this is a fantasy situation to avoid for many reasons. This is a late game, so Cassel would likely be listed as questionable at best and even if he starts, may prove not quite up to finishing. It's best to wait a week and see how he's faring. The Chiefs may ultimately opt to do the same.

Ben Roethlisberger, Pittsburgh Steelers: Roethlisberger has a recently surgically repaired nose to go with his ailing right foot this week. Actually, the rest for his nose may have given his foot a little extra time off. Roethlisberger has been fitted with a protective shield that he will wear Sunday. Most importantly, there has been really no doubt about the fact he is expected to play.



Brett Favre, Minnesota Vikings: As of this writing, Favre has not yet tested his throwing. Thursday was to be the test date. Favre rested the arm early in the week to allow his sprained sternoclavicular (SC) joint some healing time. Tick tock ...

Running Backs

Ryan Torain, Washington Redskins: Torain was listed as a limited participant in Wednesday's practice although, according to The Washington Post, coach Mike Shanahan indicated that Torain did full work. Torain told the Post that he "feels great" and is eager to get back into the lineup. It looks as though he is on pace to rejoin his team on the field this week. Torain has essentially been out since Halloween after injuring his hamstring that day. He tried to return a couple of weeks later but aggravated the injury in warm-ups. Naturally, there will be some concern as to how Torain's hamstring will fare in his first game in over a month, and more concern over how the workload will be divided. Torain is likely to resume a lead role, but whether fantasy owners can count on that in his first outing is questionable.



Wide Receivers

[+] EnlargeHakeem Nicks
Chris Graythen/Getty ImagesHakeem Nicks has missed the past two games with a leg injury, so if he returned this week, it would be a week ahead of schedule.
Hakeem Nicks and Steve Smith, New York Giants: This tandem affects many fantasy rosters and everyone is eager to see what its status is for this week. Nicks was able to do about 60 percent of team drills Wednesday, according to Ralph Vacchiano of the New York Daily News. Nicks seemed confident that he would be playing; the medical staff gave him the official clearance Thursday, according to Mike Garafolo of the Newark Star-Ledger. Nicks practiced on a limited basis again Thursday, and if Friday goes well, looks as if he'll play. Teammate Smith has been practicing on a limited basis as well but also appears as if he'll return to game action this week. Smith has been nursing a partially torn pectoral muscle.

Vincent Jackson, Malcom Floyd and Legedu Naanee, San Diego Chargers: The Chargers face a critical game without some critical personnel. Then again, that won't be a new scenario for them as they've played musical chairs at the wide receiver position all season. Jackson is still recovering from his calf strain and while it still seems likely that he will not play this weekend, the San Diego Union-Tribune reported Jackson did practice on Thursday. Naanee, who had come back from a hamstring strain two weeks ago but suffered a setback, is unlikely to play. That leaves Floyd, who so far is doing well. Or at least well enough to not be on the injury radar right now. It appears that Floyd will play this week and likely have more opportunities.

Mike Williams and Ben Obomanu, Seattle Seahawks: Williams has an ankle sprain superimposed on his foot injury and it's not looking good for him as of now. Although the Tacoma News-Tribune reports Williams is out of his walking boot, he has not practiced and likely won't all week. While the Seahawks hold out some hope that Williams could feel well enough to play Sunday, even they don't sound overwhelmingly convinced. Obomanu suffered a deep laceration on his right hand that could make it difficult to catch balls. As a receiver, that does comprise a significant portion of the job description, meaning this injury may prevent him from being able to play. Obomanu will also have until Sunday to see how his hand is healing, but they could both be late-afternoon game-time decisions.



Tight Ends

Antonio Gates, San Diego Chargers: Gates' condition hasn't changed much, but his status midweek has. Gates told the San Diego Union-Tribune "Antonio Gates will play," acknowledging the third-person reference. Maybe it's easier to deal with the pain by taking oneself out of one's body. He admits the pain is still excruciating but knows this is a must-win situation. Barring some unforeseen dramatic setback, Gates will gut it out again.

Todd Heap, Baltimore Ravens: Heap's own words belied his concern about his injured hamstring. Heap told the Baltimore Sun that he has rushed back in the past from a hamstring injury, "and that pretty much cost me the rest of the season." The Ravens play on Monday night and Heap has not practiced this week, both of which signal to fantasy owners that they should seek a replacement.

Other


• Minnesota Vikings wide receiver Percy Harvin did not practice Wednesday or Thursday as he continues to battle his latest migraine episode. Fantasy owners need to at least start being a bit concerned, as Harvin sat out Week 13 and has not returned to practice.



• Vikings running backs Adrian Peterson and Toby Gerhart were limited early in the week but, at this point, seem in no danger of sitting out. Proactive rest seems to be the rationale here.

• In addition to their wide receiver concerns, the New York Giants saw running back Ahmad Bradshaw on the injury report this week because of his wrist. Bradshaw did not practice Wednesday but returned to full practice Thursday and is expected to play Sunday.

[+] EnlargeBrandon Marshall
Ronald C. Modra/Sports Imagery/Getty ImagesBrandon Marshall has missed the past two games with a hamstring injury and he's scored just one touchdown all season.
Miami Dolphins wide receivers Brandon Marshall and Brian Hartline are both on the injury report this week. Marshall has resumed limited practice after sitting out another game in Week 13 and appears on track to play this Sunday. Hartline had surgery on his finger and was not in practice Wednesday. There has been some concern as to whether he would return at all this season. The Dolphins have not formally ruled him out but it appears he will miss Week 14, maybe longer. This might mean a lot of Davone Bess.

New Orleans Saints running back Pierre Thomas continues to practice fully this week and is expected to return to the playing field Sunday. Chris Ivory is probably in no danger of losing significant touches, but Thomas owners who have patiently held on to him may want to keep an eye on how he performs. He could have value in the home stretch.

Detroit Lions running back Jahvid Best (toes), and wide receivers Calvin Johnson (groin) and Nate Burleson (hamstring) all appear on the injury report this week but all are expected to play Sunday.

Jacksonville Jaguars wide receiver Mike Sims-Walker returned to limited practice Wednesday after missing Week 13 with his high ankle sprain. This is somewhat encouraging, but given that Sims-Walker reported his injury as a high ankle sprain, we need to see him successfully complete the week before getting too excited.



• The Tampa Bay Buccaneers version of Mike Williams is nursing a sore knee which could present a problem for Sunday. According to the St. Petersburg Times, coach Raheem Morris says Williams has been working through this "for a couple of weeks." The Buccaneers are hopeful that some rest during the week will allow him to play Sunday but he could be a game-time call.

Oakland Raiders tight end Zach Miller continues to be limited by his foot, which seriously impacted his pass-catching productivity. It's hard to hope for much based on the past few weeks and fantasy owners should be securing another option at least for early playoff rounds. The bad news for tight ends moves over to the Pittsburgh Steelers, where Heath Miller was on the receiving end of a scary hit last Sunday night that left him with a concussion. Miller did not practice Wednesday and is not expected to play this week. Fortunately in Atlanta, Tony Gonzalez's sprained ankle does not appear to be affecting his chances of playing Sunday. He told the Atlanta Journal-Constitution he would be fine, adding, "Especially at my age, I have to enjoy this." Gonzalez sees the playoffs coming and he's not going to miss out.



See you at Friday's injury chat (3-4:00 p.m.) and we'll have the latest injury updates affecting Week 14 in the Saturday morning blog!

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