The Pat and Aaron Injury Report 9/22/22 with Dr. Sellman

Pat: The Pat and Aaron Show Injury Report presented by our good friends, the Florida Orthopaedic Institute, in partnership with Tampa General Hospital, and joining us once again today, we love having him on, Dr. Jeff Sellman. Dr. Sellman, thanks for coming on today.

Aaron: He’s an X-factor.

Dr. Sellman: Hey, thanks for having me, P and A, how are you guys?

Pat: We’re doing great. We’ve got a lot of injuries to get to. I know a lot of people want to deal with their fantasy lineups. They want to get them in order, and a lot of concerns just for players for the Buccaneers that are going to be out. I want to start in San Francisco with the 49ers, Dr. Sellman. All the conversation going into the season, was Trey Lance ready to step up for that starting job? Jimmy Garoppolo was almost out of town. They were going to trade him.

He wasn’t even practicing during training camp. Now he’s their starting quarterback, but Trey Lance, just a real tough go with the ankle injury. He had surgery, he’s going to miss the entire season. Dr. Sellman, I’ve heard multiple reports. I heard that he actually broke the ankle in a couple different spots. What do these ankle injuries look like? How difficult are they to treat and get back to normal?

Dr. Sellman: Oh man, you’re absolutely right. First of all, this is an unfortunate event for him, but probably not for Garoppolo. I’ve seen different reports too on the number of fractures, but I think more important, to be honest with you, is the number of ligaments that have been injured that then would create this instability that, unfortunately, he is probably suffering from due to having to go through surgery. He sounds like he not only did some ligaments in between the two big bones, the fibula and the tibia, but it sounds like he broke the fibula or sure. The tibia likely was not broken from what I could tell, but more than likely the fibula itself.

What you would expect is not only this period, unfortunately, where he has to undergo surgery to put some screws, rods, and other things in there to make it stable, but then also a period of re-strengthening, which because of the ankle itself and where it’s located on our body, it will take sometimes longer than a year to get back.

Pat: I’m very curious when you say you’ve seen different reports on exactly how many bones were fractured. Is that the case of people playing telephone, if you will, and just the story changes as it gets down the line, or is that the type of thing where different people are actually looking at the same images and just seeing different things? Is that possible? Because I’ve heard that sometimes with different doctors, you might see different things and have different opinions on that injury.

Dr. Sellman: 100%. There’s a lot of us sitting on the sideline going to look at how the ankle went and then presume the way the forces of the twist and the way the ankle pointed downward to then presume which bones are actually broken. Then, of course, we try to get all the good dirt and information about what was actually performed that then would suggest what actually was injured during the actual injury itself.

Pat: Dr. Jeff Sellman joining us right now, Florida Orthopaedic Institute in partnership with Tampa General Hospital. I want to talk about Jameis Winston here for a second because the Bucs just took on the Saints, big win for the Bucs. Jameis was pressing late in that game, as we’ve seen him do before, but we heard before the game that– I believe Jay Glazer was the one who reported it, that Jameis Winston was actually playing with four fractures in his back. Now, a normal person like myself, Dr. Sellman, I hear any fractures anywhere and you’re playing on like you’re the superhero. What does this actually look like? How hard is it to actually go out there and play on Sunday with four fractures in the back?

Dr. Sellman: The good news is that for Jameis, his back is actually connected to his toe. He’s going to be pretty good that way.

[laughter]

Pat: But with the fractures, what do those look like? Playing with that, what would that feel like? What type of pain would that be?

Dr. Sellman: It’s going to be a lot of tight type of pain because if you guys know the spine itself, where you actually touch on your back and you can see those bones come out, that would be the presumed location of where he actually has some small fractures, which would not do as much damage as if the big part of the vertebral body, which then protects the spinal cord itself. What is likely going to happen is that he’ll be really stiff, really sore to touch, and also when he twists. That’s why he uses that brace to try to protect it to prevent those continued hits and probably not have any numbness and tingling that some of us would.

Pat: I want to ask you about something, doctor, that’s actually just come out in the last 25 minutes or so. According to the Dallas Cowboys or people at Dallas Cowboys practice, apparently, 10 days after his surgery on his right thumb, which was fractured, Dak Prescott is back on the practice field, gripping and throwing a training ball. It’s trying to build him towards returning pretty quickly as early as week four or week five. I’m not sure how much you know about the surgery he had on his thumb, but just hearing a fractured thumb and being able to be on the practice field 10 days after that, throwing and gripping a training ball, how unique is that?

Dr. Sellman: It’s the beauty of surgery, honestly, not very unique when it comes to the thumb. Remember Jerry Goff last year, but he gets the fractured thumb I believe in the bone just away from the wrist itself and it’s not part of the joint space. He had some plates that actually makes it more stable when he has those plates in there than if he did not, and he did not have the fracture. The fracture, although not healed, he can actually start moving that thumb around and definitely get some range of motion in throwing the little training wheels around.

Pat: One of the many reasons why we love you, Dr. Sellman, is you can deviate away from some of our original questions. Patches did it, I’m going to do it as well, because I know throwing you a curve ball, you knock them out of the park. Speaking of curve ball, Shane McClanahan was dealing with a shoulder impingement recently. He had to go on the IL, we got him back, but in his first start back, he had to be taken out in the fifth inning due to a neck issue. Could that shoulder injury, that impingement in the shoulder, could that have potentially been tied or led to that neck injury?

Dr. Sellman: Just like the hip and the lower back, the shoulder and the neck are intimately related. A lot of the muscles that could also lead to impingement are not only integrated by the shoulder or have nerve endings in the neck itself, but also have muscles running to both. Depending on what kind of relative rest that happened while he was in the recovery program may have set him up to have a neck injury as well.

Pat: I’m not only going to throw you another curve ball, I’m going to ask you a very selfish question because this is actually about me. Although I suspect it may be about some of our listeners as well because we are in Florida and we’re all aging here, a lot of us anyways.

Dr. Sellman: [chuckles] Not me.

Pat: Congratulations.

Dr. Sellman: Thank you.

Pat: This pops up from time to time and it seems to bother me for a couple days and then go away. I get this pain sometimes at the very top of my leg and it’s on the front of the leg almost in that, I guess, pelvis area. It feels like it’s the top of the leg where maybe the joint is going into the hip or something. I’m not exactly sure, but again, it’s on the front of the leg, it’s not really the side or the back, although sometimes I get it in conjunction with some back pain around there. Do you think that’s a hip issue, or is it something where you can’t really tell just by me asking you dumb questions on the phone?

Dr. Sellman: [laughs] First of all, no question is a dumb question, you know that for sure. I love being a deviant on this show and deviate from everything. It is certainly more than likely for us related to a little bit of wear and tear on the musculature in front of hip creating that. Of course, all that anatomy down there for us guys, we’ve got to be careful with those parts as well.

Pat: Yes. That is definitely the truth. Before we let you go–

Dr. Sellman: Those are important jewels.

[laughter]

Pat: The crown jewels. Before we let you go here, I want to ask you about Akiem Hicks from the Buccaneers ruled out after his foot injury. He’s going to miss about a month, it seems like. He was taken on a double team. What does his foot injury– How much could this impact him? Four weeks, is that pretty generous as far as getting him back? He’s a guy who’s dealt with injuries before.

Dr. Sellman: You said it all right there. Man, he just suffered so many different injuries on his lower extremity, his ankles, his groin, hamstrings. I think that might be a little bit generous for him to come back. It sounds like the planter fascia was partially torn or if not a little bit completely torn on one part of it in his left foot. That’s going to be very painful and tight when and if he’s able to come back rather quickly. For us, man, you can have plantar fascia pain that lasts for years and it’s just very annoying. For an acute injury like this, 10 weeks is very reasonable, so 4 weeks might be a little bit generous.

Pat: This is why we always send you all and we have Dr. Sellman on the air with us, and we send you to our friends at Tampa General Hospital and Florida Orthopaedic Institute because of the knowledge that guys like Dr. Sellman have, but also the comfort. We feel comfortable when we talk with Dr. Sellman. That’s exactly what he’ll do if you go check him out. Florida Orthopaedic Institute in partnership with Tampa General Hospital. Dr. Sellman, thanks for coming on again this week.

Dr. Sellman: Thanks for having me guys, so much.

Aaron: Thanks, Doc.

Pat: The Pat and Aaron Show injury Report presented by Tampa General Hospital, in partnership with Florida Orthopaedic Institute. They provide you access to some of the top orthopedic programs in the nation. If you need, schedule an appointment today at floridaortho.com.

Aaron: Have you noticed we are beyond a first-name basis now? He’s just like, “What’s up, Pand A?”

Pat: Yes, we’re P and A.

Aaron: P and A.

Pat: That’s my comfort zone. That’s where I like to be.

Aaron: What’s the only thing better than P and A?

Pat: Chris Mathis.