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Tuesday, November 23, 2010
Updated: November 27, 1:17 PM ET
Week 12 Tuesday injury update


San Diego Chargers quarterback Philip Rivers continues to show that he can get the job done no matter who steps in to take his handoffs or catch his passes. In front of millions on "Monday Night Football," Rivers delivered a star performance with running back Ryan Mathews, wide receiver Legedu Naanee and tight end Antonio Gates all watching from the sidelines. Mike Tolbert handled the bulk of the running game (and likely will again in Week 12) and fresh-off-the-injury-report Malcom Floyd did his part to contribute to the passing game with a couple of catches and a score (although according to Kevin Acee of the San Diego Union-Tribune, Floyd tweaked his hamstring again, so stay tuned).

Patrick Crayton
Patrick Crayton's left wrist was injured as he scored this touchdown.

But the Chargers couldn't get through the game without suffering yet another loss of a key player. Wide receiver Patrick Crayton landed awkwardly in the end zone while finishing off an impressive catch-and-run touchdown. He came up holding his forearm bent 90 degrees, and didn't let any of his teammates touch that left hand for congratulatory high-fives. Often when a person instinctively cradles his arm that way, it suggests a serious wrist or forearm injury. ESPN's Adam Schefter is reporting that Crayton suffered a dislocated wrist and is undergoing further testing Tuesday to determine the course of action. Since the wrist joint consists of two forearm bones (radius and ulna) interfacing with eight small wrist (carpal) bones, which in turn interface with the bones of the hand, there are many possible injury presentations. In other words, rather than speculate as to the specifics, we will wait to see what the Chargers reveal after Crayton's follow-up tests. Suffice it to say, this is not exactly good news. One might say that the timing of Vincent Jackson's return, scheduled for this week, couldn't be better. Something tells me Rivers will adjust just fine.

But how will Eli Manning adjust to the loss of another star wide receiver in the span of a week? The New York Giants, who recently saw Steve Smith go down with a partially torn pectoral muscle, have now lost Hakeem Nicks to a case of compartment syndrome in his right leg. Compartment syndrome is typically something that develops over time (chronic) but it can be brought on suddenly (acute), as was the case with Nicks, by trauma. Nicks reportedly was hit in the leg at some point during Sunday's game, according to ESPN New York, but was able to play into the fourth quarter. When Nicks arrived at the team facility on Monday, coach Tom Coughlin said the medical staff felt the need to "take immediate action." Nicks then went to the hospital and underwent a fasciotomy, a procedure whereby tissue is released surgically to alleviate pressure on blood vessels and nerves in the area.

Nicks
Hakeem Nicks has scored the sixth-most fantasy points among wide receivers in ESPN standard leagues.

The lower leg is divided into regional compartments, each of which contains muscles, blood vessels and nerves, and the compartments are separated by connective tissue called fascia. Each compartment functions like a container of sorts. In the presence of swelling, the contents within each compartment are subject to increased pressure, which can constrict the blood vessels and nerves and prevent normal function (picture a blood pressure cuff squeezing around the leg and cutting off circulation). The individual can feel pain and tingling as a result of the compromise to the nerves and blood vessels. More importantly, if the blood supply to muscle is compromised for any length of time, the muscle tissue will die, hence the emergency nature of the procedure. Relieving pressure on the compartment by cutting the fascia is the immediate treatment. The next steps are waiting for the wound to heal, then gradually restoring the motion and strength in the lower leg.

The Giants have indicated that Nicks will miss the next three weeks following his fasciotomy. Time to recover from such a procedure can vary from several weeks to a couple of months, depending on the extent of the procedure, how well the wound heals, and whether there are any complications along the way. It should be noted that most acute compartment syndromes are associated with significant trauma, such as fractures or crush injuries. Sometimes in sports, however, there can be a direct blow that results in a hematoma (collection of blood), which in turn creates significant localized swelling and pressure. This may be the origin of Nicks' injury. Assuming no prior history of compartment issues for Nicks, the three-week timetable would seem reasonable, assuming no setbacks. During the first week, Nicks will do very little, but as he is able to increase his activity, we should get a better idea of whether he will meet the projected timetable.

Plenty of other teams continue to adjust to injury situations and this week some have only a few days to do so. With the Thanksgiving holiday, there will be three NFL games Thursday. The Detroit Lions host the New England Patriots for the early game. Then the New Orleans Saints visit the Dallas Cowboys followed by the New York Jets welcoming the Cincinnati Bengals. Given the short week for those teams, their initial practice injury reports were issued Monday (usually they do not come out until Wednesday). For key fantasy players in Thanksgiving Day games, here's what we know about their early-week activity.

Detroit Lions: The Lions had only a walk-through Monday but still provided practice report "estimates." Among those who would not have practiced were running back Jahvid Best, quarterback Matthew Stafford, tight end Tony Scheffler and kicker Jason Hanson.

Jahvid Best
Even if Jahvid Best plays on Thanksgiving, remember that he hasn't had a double-digit fantasy game in ESPN standard leagues since Week 2.

Fantasy owners are probably most concerned about Best and rightfully so. Best has been limited to some degree by his toe injuries since early in the season. He reportedly suffered a setback Sunday and was seen getting one of his toes re-taped during the game. Ultimately, the toe situation was problematic enough to keep him from returning to the field. While he may continue to have some good days, the condition is going to persist and be a risk factor until he has lengthy time off.

The Lions' dire situation at running back has been compounded by the loss of Kevin Smith to injured reserve. Smith, who had just started to emerge following his ACL reconstruction of last year, is now recovering from thumb surgery. Nonetheless, it's hard to imagine Best being even close to ready for a full game Thursday when his pattern has been one of not practicing until late in the week. And as we saw last week, that schedule still was not enough to allow him to perform on Sunday. Dave Birkett of the Detroit Free Press reports that Best was in practice Tuesday, yet he still expects Maurice Morris to be the No.1 back this week.

As far as the other injured Lions, no one really expects to see Stafford anytime soon, if at all, this season, so his absence comes as no surprise. Scheffler injured his ribs in the second quarter of Sunday's game, according to the Detroit News, and is anything but certain to play. Hanson is recovering from an MCL sprain and his status for Thursday is still up in the air.

New England Patriots:The Patriots also conducted only a walk-through Monday but reported several players as limited, including quarterback Tom Brady and running back Fred Taylor. Brady, who is still listed on the report because of his foot along with his shoulder, will continue to play as anticipated. Based on his recent performances, it's hard to see the foot as a limitation. As far as Taylor, he returned to limited practice with his team a couple of weeks ago and is awaiting the green light to see playing time. Taylor seems to be as in the dark about when that will be as anyone else. The Patriots' running game appears to be in good hands so the team may elect to guard Taylor's use, even once he has been activated for game day.

Reggie Bush
Reggie Bush nearly returned to action in Week 11 before becoming a late scratch, but he might finally be able to play for the first time since Week 2.

New Orleans Saints: Despite the encouraging sight of Reggie Bush in team practice last week, he was deemed not quite ready for prime time and was held out of Sunday's game. Maybe not such a bad idea given that the team's next game is coming just four days later. Bush was listed as a full participant in the Saints' Monday walk-through practice report and is expected to play Thursday, barring a setback. Of course, the team expressed optimism that he would play last Sunday and he didn't, but keep in mind that Bush was only a limited participant in practice throughout the week. According to the New Orleans Times-Picayune, that's exactly what it came down to for the coaching staff, which did not want Bush's first full test to come in a game. Coach Sean Payton told the Picayune, "[Bush's] pregame workout was good. And yet I just felt like what I didn't want to do was err on the side of bringing him, just because you're wanting to bring him up."

It will be interesting to see how the Saints utilize him in his return outing. But with Bush champing at the bit to return, and the Saints feeling as if they're getting him back in good shape, he could provide a spark to the offense. Meanwhile, Pierre Thomas is not looking as if he'll play Thursday. There are conflicting reports about the exact nature of his ankle injury but the Picayune reports that Payton maintains Thomas' injury is a sprain. Either way, it appears that his return will not come before December.

Tight end Jeremy Shockey sat out Week 11 because of a rib injury and has been a limited participant in practice so far this week. Whether he will play on Thursday or not is not yet determined.

Dallas Cowboys: It's interesting that there has been so much chatter about the recent X-rays taken of Tony Romo's left clavicle fracture, as if there were some hope of a full recovery. Most bones require six weeks for fracture healing, with actual remodeling of bone continuing well beyond that point. Add to that the fact that the clavicle is notoriously slow to heal, and four weeks -- which is how much time has passed since Romo's injury -- would not likely be enough to demonstrate full bone repair. It's certainly possible that the clavicle showed some progression in healing and that's often why X-rays are taken at an interim stage, to assess how the bone is shaping up. The bottom line is if anyone was expecting Romo to return to the lineup sooner than the original minimum six-week projection, it's not going to happen. Eight to 10 weeks has been the more reasonable healing timetable estimate all along, but it is not guaranteed, and the team may decide it is not worth risk of reinjury to have him appear again this season.

Of more immediate concern, running back Felix Jones is still dealing with a hip ailment and spent Tuesday working with the rehab staff, according to The Dallas Morning News. Jones, who injured his hip Sunday yet returned to the game, did not practice Monday but said he was "doing better," according to the Fort-Worth Star-Telegram. We'll see how the team designates him for Thursday's game, but resting early in a short week may give him the best chance to play on Thanksgiving.

Cincinnati Bengals: Running back Cedric Benson came into Week 11 with a foot injury but it did not appear to hamper him during the game. At one point, Benson was forced out with an eye injury but he was able to return. He should be available Thursday.

New York Jets: Wide receiver Jerricho Cotchery had a groin strain that kept him sidelined in Week 11. ESPN New York's Rich Cimini reports that Cotchery is doing light positional drills Tuesday but is still "iffy" for Thursday's game. As we've seen in the past, groin injuries are not only difficult to overcome, they are easy to aggravate. It would not be surprising if Cotchery is out again this week.

Here's who else we're talking about heading into the rest of the Week 12 contests:

Miami Dolphins quarterback Chad Henne, who injured his knee in Week 10, practiced Monday after serving as the emergency quarterback last Thursday. While the Dolphins have not yielded any information as to the specifics of the injury, the fact that Henne is participating in some level of practice is encouraging, but we'll have to see how the team designates him later in the week. Tyler Thigpen may still be at the helm.

• The Tennessee Titans had a bizarre weekend but we'll stick to the injuries. Vince Young has now been placed on injured reserve as he is expected to undergo thumb surgery to repair a torn flexor tendon. Kerry Collins is still recovering from a calf strain, which was initially projected to keep him out for several weeks, and is not expected to be ready for this Sunday. Thus, Rusty Smith is likely to start at quarterback in Week 12 after stepping in last week when Young was injured. The Titans have signed Chris Simms as insurance.

Portis
Clinton Portis had a short-lived return to the Redskins' lineup after missing five games with a groin injury.

• Running back Ryan Torain of the Washington Redskins sat out Sunday with his hamstring injury, with Clinton Portis getting the start. Portis didn't last long though, aggravating his groin injury after just five plays. Considering that Portis had not been cleared to play Monday night, it's hard to imagine that he was suddenly 100 percent healthy. That said, as an athlete is recovering from a muscle strain, the only way to truly test his health once he's fully practicing is to put him in a game situation. No one ever wants or expects a setback to come so quickly, but that is the nature of this type of injury. Portis underwent a subsequent MRI and the results, according to Jason Reid of The Washington Post, "revealed nothing new. Just swelling." Unfortunately, just swelling is enough to indicate there is still some inflammatory response taking place around that healing tissue, making it less likely we will see Portis in Week 12. Meanwhile, the Redskins lost running back Chad Simpson to a foot injury and have added running back James Davis to their active roster. With Torain still recovering from his hamstring injury, it appears Keiland Williams will be the starting back for the Redskins.

Indianapolis Colts wide receiver Austin Collie left the Week 11 game early for what the Colts called "precautionary reasons." Collie, who was returning to play two weeks after suffering a concussion, took some big hits in last week's game. He is not expected to play in Week 12. Running back Joseph Addai is still considered day to day, as he has been essentially since the injury occurred. In other words, fantasy owners can't plan for a scheduled return.

Carolina Panthers quarterback Jimmy Clausen says he expects to be available in Week 12. Both he and running back Jonathan Stewart will need to receive medical clearance to return to practice, and their status will not be known until later this week.

We will continue to update these injuries and others as the week progresses. Due to the Thanksgiving holiday, there will be no chats on Friday. But check back for the latest injury updates affecting Week 12 in the Saturday morning blog! Happy and healthy Thanksgiving everyone!