Ask the Doctor is our new column, featuring an expert physician’s opinion on injuries affecting the NFL. Gustavo Ferrareto Pires is an orthopedist, specializing in sports surgery. An American football fan, he combined his two passions for writing: sports and medicine. You can follow him on Instagram at @gustavoferrareto
In last season’s NFC Championship Game, San Francisco 49ers quarterback Brock Purdy suffered a sprained right elbow on a throw with EDGE Haason Reddick (play video below). Unable to continue, Brock was forced to leave the match and saw his team lose the game from the sideline.
In the days after the game, it was announced that the QB had a torn ligament in his elbow, more specifically in the ulnar collateral ligament, and would undergo surgery, with the 2023 season possibly compromised. The surgery was performed in March, but the most recent reports show that, despite training, Brock should not start pre-season games. What is this injury that could jeopardize Mr Irrelevant’s 2022 draft season?
The medial collateral or ulnar collateral ligament (ULN) connects the humerus to the ulna and is an important component of the medial ligament complex of the elbow. With the head of the radius, they are the main stabilizers of the forces that act from outside to inside, or from lateral to medial, on the elbow (valgus stress, in orthopedic jargon). This ligament is divided into three parts, the anterior band (most important component), the posterior band and the transverse band or Cooper’s ligament.
Due to repeated valgus stresses that occur during the throwing movement, pitchers often have laxity of the LCU associated with cartilage damage in the radial head and lateral portion of the humerus. This is known as thrower’s elbow or thrower’s elbow, hitting both quarterbacks and other athletes who play overhead sports, baseball pitchers, volleyball players, javelin throwers, among others. Note that these athletes usually perform a backward rotation movement of the arm followed by a quick elbow extension.
Upon suffering the impact on the arm, Brock had his arm rotated to the extreme backwards, suffering a rupture of the LCU. Due to the high sports demand, surgical treatment was chosen and the quarterback underwent medial ligament reconstruction of the elbow. There are some types of surgery described, requiring the use of graft or metallic anchors, depending on the chosen technique. The athlete’s rehabilitation protocol involves:
short immobilization (five to seven days) after surgery until the fourth postoperative week: use of orthosis with passive mobilization of the elbow, but without maximum extension between four and six weeks postoperatively: beginning of strength exercises after four months postoperative period: start of throwing exercises, with progressive training time and throwing distance between nine and 12 months: free simulation of game intensity in training.
In general, reconstructive surgery usually has good results, restoring the elbow’s valgus stability and presurgical throwing strength.
So will the Niners QB return to pre-injury performance for sure? It’s not like that…
Like any surgery, ligament reconstruction of the ulnar collateral ligament presents risks inherent to the procedure itself, ulnar neuritis (inflammation or even dysfunction of the ulnar nerve) and infection are the main ones. If the postoperative rehabilitation protocol is not followed, there is a greater risk of rupture of the graft, requiring a new surgery (complete integration of the graft is said to take place between eight and nine months, which is why exercises at full intensity are usually allowed only after this period). In addition, athletes who already had cartilage injuries before surgery may evolve with maintenance or worsening of lateral elbow pain after reconstruction. If he develops persistent pain during recovery, the QB may need to work on some changes to his shooting mechanics.
See also
According to the news released by insiders, Brock Purdy has been training with some restrictions, showing good signs of recovery from the injury. Niners head coach Kyle Shanahan, however, said he thinks the player is unlikely to be on the field in preseason.
Rehabilitation seems to be going well, but we’ll still need patience to see Brock 100% healthy on the field.
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2023-08-15 13:22:35
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