Tag: injury prognosis

Frank Ragnow injury analysis and outlook

Breaking down the medical prognosis and outlook for Lions C Frank Ragnow and his pectoral injury

A news bombshell dropped late Monday with the report of a Frank Ragnow pectoral injury suffered sometime during the Cardinals game on September 22, 2024. Ragnow played 100% of snaps without apparent issue, which made the news a surprise.

It was déjà vu for Lions fans as after game two of last year, CJ Gardner-Johnson surprise news dropped that he had torn his pec despite playing the entire game.

CJGJ ended up having surgery and missed 16 weeks. Fortunately, the pec injury and prognosis this year for Ragnow seems much more favorable.

Here’s what we know

Ragnow has a partial tear which means a grade 1 or 2 strain. The words tear and strain are synonymous medically, so the injury can also be called a pec strain.

While use of the word “tear” is terrifying albeit accurate, it isn’t a complete tear (grade 3) which would be a much bigger problem along the lines of CJGJ’s 16 week recovery.

Calling it week-to-week strongly suggests that surgery is not under consideration and the pec should heal well on its own.

Here’s what we don’t know

We don’t know the severity or location of the pec strain. Severity matters as it affects the healing time. A partial tear could technically be just a mild strain which might not be a big deal at all.

Location also matters, as complete tears of the pec almost always involve the tendon as opposed to the muscle body. Hopefully, Ragnow’s partial tear is not between the muscle-tendon junction and the tendon insertion point into the humerus, as those locations put him at risk for a complete tendon rupture.

OUTLOOK

A retrospective study (Sahota et al) done in 2020 of NFL players found 132 pec strains (grade 1 or 2) from 2000-2014. The average return-to-play for these players was 28 days. There was huge variability in return time but it gives a general idea of what to expect. Of note, ten of those players had surgery and missed significantly more time than those who did not have surgery. Ragnow presumably will not be having surgery.

Anecdotal data for non-surgical pec tears finds that Marcus Williams (2023) returned in four weeks and TJ Watt (2022) returned in nine weeks (the last week was a bye so he might have been ready at eight). TJ Watt reportedly did not tear the tendon.

As you can see, without knowledge of MRI results or other details, there is a wide range of when Ragnow might return.

I’m expecting him to miss the upcoming Monday night game vs the Seahawks, but a return after the bye for Week 6 vs the Cowboys is possible. Even with a longer recovery, he should be back in plenty of time for the stretch run and into the playoffs.

Lions Monday medical update for several players injured in Week 3 win

Lions Monday medical update for several players injured in Week 3 win, including Sam LaPorta, Alim McNeill, Derrick Barnes and more

There were some updates to Lions injuries on Monday including from Dan Campbell’s press conference. See my postgame article for my immediate thoughts with sideline videos.

I’m still here roasting away in Arizona so haven’t been able to watch the full game tape, but I’ve included some injury video here.

Marcus Davenport left elbow

This video shows his forearm getting chopped down while his elbow is in flexion. This mechanism could cause an elbow flexor muscle tear of the biceps or brachialis.

Unfortunately, Dan Campbell on Monday stated that “it looks like a season-ender”. Here is a detailed article by Jeff Risdon with options to fill Davenport’s role. 

Derrick Barnes right knee

The video looked like he took a shot directly to the right knee which can cause a hyperextension, bone bruise, and ligament sprains.

Campbell stated he’s “down for a significant amount of time” and alluded to a “ligament needing to scar in” and “once it heals, is he going to need surgery”. This strongly suggests a partial or complete knee ligament tear, possibly of the MCL based on the limited video.

While not great news, it does rule out worst-case scenarios like an ACL tear and gives hope he could be back this season.

Alim McNeill shoulder

He missed the 2nd half of the game, which was concerning. Good news was delivered Monday, though, as Campbell described the injury as “day to day”.

Sam LaPorta right low ankle sprain

Campbell described LaPorta as “day to day” which is consistent with a non-severe low ankle sprain. I’d expect him to get limited practices during the latter part of the week with a good chance of playing vs the Seahawks. The extra day before the next game on Monday night will serve him well.

Brian Branch concussion

Campbell stated he was “doing pretty good” on Monday. This suggests Branch is either asymptomatic or minimally symptomatic right now which increases the likelihood he’ll be ready next Monday.

Keep an eye on the initial injury report – a limited practice leans in; a no practice leans out.

 

Lions vs Cardinals Wednesday injury report medical breakdown

Lions vs Cardinals Wednesday injury report medical breakdown of the Detroit players dealing with injuries

Despite a rather long injury report, the Lions head into the desert in pretty good shape. Anzalone is likely going to be out and Glasgow is a question mark, but otherwise, the Lions’ starters should be intact.

See my postgame report for videos and initial impressions of injuries coming out of the Bucs game.

DETROIT LIONS

Amon-Ra St. Brown FP quad, WR

Excellent news for Amon-Ra after hobbling at least three times during the game. Video showed a definite left thigh contusion and a possible left leg groin or thigh strain.

The contusion is no concern, and with an FP, that means any possible muscle strain is very mild at worst. He’ll play with no limitations.

Graham Glasgow NP knee, OG

This was a surprise as I didn’t see any signs of a knee injury on initial watch. He was down briefly after his left arm collided with Jameson Williams but that apparently is not an issue.

A positive sign is he played 100% of snaps so hopefully this means the knee injury is mild.

Alex Anzalone NP concussion, LB

The NP suggests he is still symptomatic after taking a helmet blow from Derrick Barnes. With only three days until the game, he likely won’t have enough time to pass through the 5-stage concussion protocol.

Terrion Arnold NP illness, CB

The finger is not listed which likely means no fracture, complex dislocation, or tendon/ligament rupture.

Video suggested a left index finger injury with a dislocation being a possibility. He will play likely with a splint or buddy tape of the 2nd and 3rd fingers until it heals. Tackling and interceptions will be more challenging.

The “illness” usually is not a a concern although there are exceptions like with Christian Mahogany’s mono.

Ennis Rakestraw NP hamstring, CB

Rakestraw hurt his hamstring in pregame warm-ups. The severity is unknown but we’ll have a good idea by the end of the week depending on if he goes on IR or not.

Marcus Davenport FP groin, DE

Davenport had 3x NP last week and a doubtful designation. The FP means he will play on Sunday barring any setback.

Kerby Joseph LP back, S

Good to see Joseph’s hamstring from last week is not listed. The back is new but the LP suggests it’s mild. Joseph played the full game last Sunday with no signs of injury. I’d expect him to play on Sunday.

Isaiah Williams LP abdomen, WR

Williams was out with an ab last week and it’s a good sign he’s up to an LP now. With all the WR’s healthy ahead of him along with Tim Patrick’s emergence, there’s no rush here.

Ifeatu Melifonwu NP ankle, S

Hurt likely during the 2nd preseason game, his ankle is acting very chronic.

Notables Unlisted

Penei Sewell‘s ankle which may have been a high-ankle sprain is unlisted which is very good news. He had missed two practices last week.

Jameson Williams was hit on the head by Graham Glasgow’s arm after the 4th quarter interception and has avoided a concussion diagnosis. Also, his suspected mild left high ankle sprain from last week is off the report.

Derrick Barnes who was involved in the Alex Anzalone concussion has avoided his own concussion diagnosis.

David Montgomery was seen briefly not bearing weight on his right foot but did return to the game.

Frank Ragnow logs his 3rd straight week of being unlisted. His chronic toe has made frequent appearances over the years.

ARIZONA CARDINALS

Dante Stills LP shoulder, DT
Will Hernandez FP ankle, G
Xavier Weaver FP oblique, WR

Notables Unlisted

Jonah Williams starting RT on IR
Darius Robinson DE 1st round rookie on IR
Zay Jones WR suspended
BJ Ojulari DE on IR
Elijah Jones CB 3rd round rookie on IR

Lions vs. Buccaneers postgame medical report

Lions vs. Buccaneers postgame medical report updates on Amon-Ra St. Brown, Alex Anzalone, Terrion Arnold and more

Despite some pain on the scoreboard, this was an overall healthy game for the Lions. No long-term injuries are anticipated.

Amon-Ra St. Brown left leg

Let’s walk through the three main videos of his injuries.

1q 00:17 – Saint’s left leg gets pulled on the tackle which could have caused a thigh strain or groin muscle strain.

 

3q 3:53 – The direct blow to the left thigh here likely caused a simple contusion and charley horse. It’s also possible the impact aggravated the previous injury.

 

4q 00:30 – His left leg gets pulled again on this tackle, possibly aggravating the initial injury. There’s a small chance of a mild MCL sprain.

We’ll see if Amon-Ra shows up on the Wednesday injury report. My guess is he’ll be listed with a groin or thigh due to a muscle strain. This wouldn’t be a long-term issue but could cause a missed game. Last year, Amon-Ra missed one game with an oblique muscle strain.

Dan Campbell, in the postgame press conference, didn’t think it was anything “long-term”.

Terrion Arnold 1q 7:00 left index finger

After the play is over, Arnold is seen looking at his left index (2nd) finger. Dislocations are common in the NFL and there’s a good chance of that here.

Arnold finished the game with a splint that used the 3rd finger as a buddy for support. Most dislocations heal within 3-6 weeks and for a CB, can be played through with protection like in this game.

Alex Anzalone 3q 00:47 concussion

Anzalone took a brutal direct blow to his right jaw from Derrick Barnes’ helmet and was officially diagnosed with a concussion.

There were no signs of fencing or loss of consciousness on video, which is good news and hopefully means a milder concussion.

Despite the concussion, there is still a pretty good chance he could play this Sunday. Watch the Wednesday report – a “limited practice” leans towards playing while a “no practice” leans not.

Jameson Williams 4q 7:44

After the interception, Jamo took a mild hit to the side of the head from Graham Glasgow’s arm. Nothing on video looked concerning and he finished the game without problems. If no concussion symptoms are reported in the next two days, he should be in the clear.

David Montgomery 4q 4:14

The video was totally obscured but he came up briefly putting no weight on the right foot/ankle. He left the game but returned later in the drive which is reassuring.

Ennis Rakestraw pregame hamstring

Dan Campbell’s postgame press conference revealed that Rakestraw pulled his hamstring in warmups which is why he was inactive. No word on severity.

NOTABLE

The three questionable players entering the game – Penei Sewell (ankle), Jameson Williams (left ankle), and Kerby Joseph (hamstring) – played the whole game and didn’t appear to suffer any aggravations.

Lions injury breakdown: Christian Mahogany outlook after mono

Lions rookie offensive lineman Christian Mahogany is sidelined after getting mono. What is his medical and football outlook?

Christian Mahogany, the Lions 6th-round-pick who mysteriously missed all of training camp and preseason, has confirmed that mononucleosis (mono) was the culprit.

 

Mono is typically caused by the Epstein-Barr virus and studies have shown that over 90% of humans have contracted it at some point in their life. Most people likely contracted it as a child and developed some immunity, which would help prevent a more severe case later in life.

If an athlete is diagnosed with mono, the main concern is enlargement of the spleen (splenomegaly), which is found in about 50% of patients. The splenomegaly can lead to splenic rupture, which is rare but life-threatening. Avoiding contact sports and even heavy lifting for three to four weeks is thus recommended as usually the spleen returns to normal in that time.

In rare cases, the splenomegaly can persist beyond four weeks, which would necessitate a longer absence. Mahogany likely has had ultrasounds of his spleen to check for this issue. Presumably since he has resumed strength training, any significant splenomegaly has resolved.

OUTLOOK

There are unlikely to be any long-term issues for Mahogany due to mono. About 10% of individuals report persistent fatigue for months but this usually resolves over time. Some may experience lingering sore joints and that could affect performance.

Mahogany has been on the NFI (non-football injury) list since the start of camp and is remaining on NFI into the season. This means he is ineligible to play or even practice the first 4 weeks of the season. The earliest he is eligible to play is October 13 vs the Cowboys, after the bye.

Physically, there is a good chance he could play by the Cowboys game as that will have given him about six to eight weeks of training and conditioning. But since he is a rookie who has missed a significant amount of practice, it’s his mental game that might delay his return. Hopefully, we can see him take on a limited backup role at OG sometime in October.

Lions injury breakdown: Antoine Green concussion video analysis and outlook

Lions injury breakdown: Antoine Green concussion video analysis and outlook for the wide receiver

With the recent revelation by Brad Holmes that Antoine Green was trending towards winning the X-receiver spot (detailed in the article by Jeff Risdon), let’s review the video of the injury that sidelined this Lions 2023 7th-round pick.

Green suffered a concussion in the 1st preseason game as seen below.

In the video, you can see Green get knocked forcefully down by a Giants defender. Watch his head whiplash when his fall is interrupted by Sione Vaki’s leg. It’s interesting to note that Green’s head never actually hits the ground.

Whiplash can create surprisingly extreme acceleration/deceleration forces due to the physics of the action. For example, the eponymous whip can reach speeds that break the sound barrier of 760 miles per hour. Anyone who has been snapped by a wet towel in a locker room can painfully attest to this effect.

Concussions can be caused by the brain impacting the inside of the skull. The sudden movements of a whiplash can cause this brain impact without the head actually hitting anything. While certainly possible that the initial hit by the Giants player caused the concussion, the whiplash very well may have been the actual cause.

Not only can whiplash cause concussions, but those same extreme forces can injure any part of the neck. Injuries to muscles and ligaments of the neck are likely. Much more seriously, injuries to the spine, nerves, or large blood vessels supplying the brain are possible, albeit unlikely.

The Lions waived Green just four days after the injury, which was surprising because players can usually return to practice within a few days following a concussion. In his press conference after Green’s release, Dan Campbell alluded to concerning “scans” as referenced in this article by Billy Riccette.

“Scans” is a vague term but suggests something abnormal showed up on CT or MRI. A concussion will rarely show anything concerning on these imaging tests, so an abnormal finding could mean a more serious concussion with complications or a significant injury involving the neck area.

Losing Antoine Green may turn out to be the most impactful injury of this preseason, as he was on his way to earning an important role in the WR room. Hopefully, Green can heal from his injury and fulfill the promise he showed in training camp.

Lions injury breakdown: Dan Skipper makes the 53-man roster with high ankle sprain

Lions injury breakdown: Dan Skipper makes the 53-man roster with high ankle sprain. What is his injury outlook?

Dan Skipper, the NFL’s “most eligible” offensive lineman, has made the initial 53-man roster. He was not one of the 2 players (Moseley, Martin) placed on the “designated-to-return” injured reserve list. Note that rosters are subject to change and he could be placed on I.R. at any time. Skipper is currently recovering from an injury suffered during the Lions 2nd preseason game.

MEDICAL HISTORY

August 17, 2024: Skipper appears to sprain both high ankles on the same play during the Lions 2nd preseason game vs the Chiefs.

Skipper got rolled up on, thus trapping both ankles in external rotation, which is the mechanism of a high ankle sprain. He finished the drive but was limping toward the end of the drive. He never returned to the game, although this may have been precautionary with it being a preseason game.

The ankle sprain is likely of mild severity based on the following:
-Video evidence did not show a severe deformity.
-Continued to play in the game.
-Dan Campbell after the game stated it was a “minor” ankle

SUSPECTED DIAGNOSIS

High ankle sprain – left, right, or both. Mild severity.

PROGNOSIS

-A mild high ankle can sideline a player for 2-4 weeks.
-For comparison, 2 offensive linemen for the Lions last year had similar injuries.

-Taylor Decker was hurt in week 1, finished the game, but missed the next 2 games.

-Jonah Jackson was hurt in Week 5, finished the game, but missed the next 3 games.

OUTLOOK

Expect Skipper to be available within the first 2 weeks of the season. With the season opener being 3 weeks from the date of injury, there is a decent chance Skipper will be ready for game 1. As always, return to play depends on many factors, including the severity of the injury, ability to play through the injury, player importance to the team, and game importance. No long-term issues are expected.

James Houston makes the 53-man roster after severe ankle surgery

James Houston makes the Lions 53-man roster after severe ankle surgery. What’s the medical outlook for Houston?

James Houston, who missed almost all of last year with a severe ankle injury and fibula fracture, has currently made the 53-man roster. As always, the roster is subject to change. By making the roster, it gives hope that we will once again see the pass-rushing demon that terrorized the NFL with 8 sacks in only 7 games his rookie year.

MEDICAL HISTORY

September 17, 2023: Suspected severe right high ankle sprain with associated fibula fracture. Required surgery which may have involved plate & screws for fibula, and tightrope procedure for high ankle. Missed 4 months before returning for the final game of the season vs the 49ers.

 

August 2024:

-Wore a right knee brace during 1st preseason game. Reported after the game to have a bone bruise. Uncertain if the knee brace was related to the bone bruise. This brace was not present in last season’s finale vs the 49ers.

-Did not play in the 2nd preseason game.

-Played in the 3rd preseason game without the right knee brace.

PROGNOSIS

The severe right high ankle injury and fibula fracture is healed but remains a long-term concern. Like most injuries, there can be residual effects and the body may never return back to the previous level. Given the importance of ankle flexibility and strength to his style of pass rush, even a mild impairment could dramatically impact his efficacy.

The mechanism of his injury suggests that it will be easier for Houston to perform an outside rush from the right end position compared to the left end position. This is because an outside rush from the left end puts an external rotation force on his ankle which was the mechanism of his injury as seen in this video.

 

During the preseason, I found it notable that he mostly played at left end. He did register a sack from the left end position in the 3rd preseason game but this was on an inside rush.

The bone bruise may affect him in the short-term but is of minimal long-term concern as he was healthy enough to play in the 3rd preseason game without a knee brace.

OUTLOOK

We have yet to see James Houston display the spectacular pass rushing ability he showed before the injury. It’s still too early to make judgments though especially with a recent bone bruise that likely slowed him down during the preseason.

On August 12, Dan Campbell said that they were ending the experiment of playing Houston at SAM LB and would just focus on him as a pass rushing DE. Hopefully, this focus helps him return to the electrifying pass rusher we saw during his rookie year.

During the regular season, it will be interesting see if Houston plays more on the right or the left side and how it affects his productivity.

Lions injury breakdown: Emmanuel Moseley torn pec outlook, possible return from I.R.

Lions injury breakdown: cornerback Emmanuel Moseley and his torn pec outlook, possible return from I.R. timeline

With the news that Emmanuel Moseley has taken one of the two “designated-to-return” IR slots at the 53-man cutdown, here is an analysis of what to expect from the 28-year-old cornerback after his 3rd major injury in three years. By being placed on the “designated-to-return” list, he must sit out at least the first four games of the season.

Medical history

August 5, 2024: Torn pectoral

October 8, 2023: Torn right ACL

October 9, 2022: Torn left ACL

Making an educated guess at a return date is complicated by the wide variety of pec tear types, as well as the possibility of a partial tear that may not require surgery. A full tear with surgery is typically about a 4-month recovery.

For comparison, C.J. Gardner-Johnson was able to return in 16 weeks last year.


If Moseley follows the same timeline, he would be back for Thanksgiving, which would give him 6 games in the regular season plus the playoffs.

There’s a chance he could be back earlier than 16 weeks, as evidenced by these cases:

-J.J. Watt in 2019 had surgery and returned in 9 weeks, but he may have come back earlier than recommended because it was the playoffs.

-T.J. Watt in 2022 did not have surgery and returned in 8 weeks.

-Marcus Williams in 2023 did not have surgery and returned in 4 weeks.

Outlook

Keep an eye out for reports of whether Moseley had surgery or not. If he had surgery, then we should hope to hear him start practicing in early November, with a return starting around Thanksgiving. If he did not have surgery, then a much sooner return is likely.

Once Moseley returns, I would not expect the pec injury to affect his play because of his position at defensive back. It is not an upper-body, strength-dominant position like with a lineman. With how common it is for cornerbacks to be sidelined with injury, as well as the need for multiple cornerbacks to be active for a game, Moseley has a very good chance to be an impactful player for the Lions later this season.

Lions injury breakdown: DJ Reader quad tendon tear and what his activation off PUP list signifies

Breaking down the medical outlook for Lions DJ Reader now that he’s been activated from his torn quad tendon ahead of Week 1

DJ Reader, who has yet to practice this preseason, was removed from the PUP (physically unable to perform) list today which allows him to start the individual drills that Dan Campbell forecasted last week. The Lions did have the option of keeping him on the PUP list into the regular season which would have made him ineligible to play the first 4 games of the season.

Keeping Reader on PUP would have freed up a roster spot at the 53-man cutdown this coming Tuesday. By removing him from PUP now, it suggests the Lions feel Reader’s rehab is going well enough to start ramping up to play in a game. He is available to play as early as Week 1, but there there are a few reasons why this should not be the expectation.

RELEVANT MEDICAL HISTORY

-June 2024: Knee scope, which is often a sign of cartilage damage. This likely affected his rehab.

-December 16, 2023: Tore right quad tendon requiring surgery. This is typically about a 9 month recovery so the start of this season was always in question.

-2022: Knee injury, missed 6 games.

-2020: Tore left quad tendon in game 5. Returned for the start of next season.

QUAD TENDON PROGNOSIS

A quad tendon tear carries durability concerns even after fully healed. Here are some recent case reports of quad tendon tears:

-Anthony Walker 2022: injured in game 3, returned 1st game next season, played 12 games before a knee injury ended his season.

-Gerald McCoy 2020: injured in preseason, returned 1st game next season but hurt opposite knee in that 1st game and never played again.

-Mike McGlinchey 2021: injured in game 8, returned 1st game next season, played all 17 games.

-Dontari Poe 2019: injured in game 11, returned 1st game next season, played 7 games before being released and never played again.

-Beau Allen: injured in 2020, never played again.

A retrospective study in 2004 of NFL players found 14 quad tendon tears over the previous 10 years. Only 50% returned to play in the NFL and the average games played for those who returned was 40.

OUTLOOK

I would not expect DJ Reader to be ready for Week 1, but today’s removal from the PUP list implies he likely will be ready by Week 5. Last year, the Lions had a similar situation with Emmanuel Moseley, who was also coming off a long-term injury (ACL), also had a knee scope during rehab, and also was removed from the PUP list late in preseason (August 23). Moseley did not end up playing in a game until Week 5.

Durability this season and beyond is a concern due to the bilateral quad tendon tears, possible knee cartilage damage, and age (30), so the Lions might be wise to load-manage him either through snap counts or games off if they hope to have him healthy into the playoffs.