- 3 minutes ago
Dr. Jeffrey R. Giuliani joins the show to provide some extra context on what Jayden Daniels may be dealing with after injuring his elbow again.
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00:00Dr. Jeff Giuliani is on the line.
00:03Dr. Giuliani is an orthopedic sports medicine expert,
00:08treats sports injuries, works with the Nats, works with D.C. United.
00:11Doctor, thank you for making time for us.
00:13How are you doing?
00:14Absolutely.
00:15Thanks for having me, guys.
00:16Doing great.
00:16How are you?
00:17We're good, man.
00:18We're good, man.
00:19We're trying to make some sense of everything going on with Jaden Daniels,
00:23and I know that you have not worked directly with him,
00:26so you're giving us kind of general information.
00:29But what do you see now that this elbow thing has become a reoccurrence?
00:37Yeah, I mean, exactly right.
00:39I don't know the finer details, but I watched like you all did
00:42and clearly had a similar mechanism, same dislocation injury like he had last season.
00:50And, you know, it's unfortunate, but good news is that it looked like the X-ray,
00:55there was no fracture, which is half the battle.
00:59So what we call this, we call it a simple elbow dislocation.
01:03It's a misnomer because it's still a soft tissue injury of the ligaments and capsules around the elbow,
01:08but it doesn't involve any of the bony anatomy.
01:11So what's going to happen is the MRI, which he, I believe, obtained yesterday is really going to tell the
01:20full story
01:20of what the return-to-play timeline.
01:24I don't think surgery is necessarily off of the table,
01:28and we can go through some of the things that may indicate surgery,
01:31but the MRI is really going to be telling.
01:34So what would recommend that he does surgery?
01:38Like what kind of damage has to be there to, say, get surgery,
01:42and what do they do when you do surgery to kind of stabilize it?
01:47Yeah, so, you know, we'll hope for the best that it is just a simple dislocation
01:52and it could potentially be the same sort of course of recovery that he had last year
01:58and there's a very good chance he gets back playing, you know, not too late in the season.
02:03But a couple things that we'd be looking for on an MRI that would push us to say
02:10that this elbow needs to be stabilized.
02:12And first and foremost is if the joint is not concentrically reduced, right,
02:18let's just call it like a ball and socket,
02:20and if the ball is not sitting perfectly concentric in that socket,
02:24that means something is interposed or something is blocking the joint from a full reduction.
02:30You'd have a good sense of that on the x-ray, but the MRI will show that in finer detail.
02:36Additionally, let's say the capsule or ligament is torn and a piece flips into the joint,
02:42similar scenario where there's a block to the reduction, that would force your hand.
02:48And then finally, if the elbow is just grossly unstable,
02:52and so what happens is elbow dislocates, his medical staff probably did a great job,
02:58got it back into place, and he's, you know, in a soft tissue splint right now to stabilize the elbow.
03:06When you come out, if the elbow is grossly unstable where if you try to range the elbow
03:10and it just wants to pop right back out again,
03:13the medical team's hands may be forced to do something to stabilize the elbow sooner rather than later.
03:19And what that entails is different in everybody,
03:22but suffice it to say it would be some combination of a ligament repair and or reconstruction,
03:30and that will all depend on the MRI.
03:34So in your opinion, you talked about like the levels of instability with the elbow.
03:42What do you think his options are going forward here?
03:45Obviously, there's a conversation around a brace.
03:47There's a conversation around surgery.
03:49Like, where do you think this goes from here?
03:52Because you can't just continue to operate where the threat of him popping his left elbow out of the socket
03:58could happen at any moment.
04:01Right.
04:02Well, you know, honestly, it's a little bit of a bizarre scenario.
04:05You know, NFL data shows these are mostly injuries we see in defensive players, you know,
04:11arm tackles and O-line where you can throw a brace on them, they can go back pretty quickly.
04:17Fortunately for Jaden, it's his non-throwing arm, and so he kind of falls in that same bucket.
04:24But, you know, assuming the MRI doesn't push their hand immediately to surgery,
04:30and we're talking non-operative, I think his options are still fairly good where, you know,
04:37you let the swelling go down, you do a little rehab with the training staff and get his motion back.
04:43And with time and scar, the elbow, you know, probably would have enough stability to play with a brace,
04:50so a hinged elbow brace, which has bars or struts on each side of the elbow that give it side
04:56-to-side support and stability.
04:58But then more important, they build in what we call an extension block to that brace where he can't –
05:05it doesn't allow him to fully hyperextend his elbow, which is the, you know,
05:09the compromising position that can make this pop out again.
05:13So it would be a hinged elbow brace with an extension block.
05:16And, you know, that same data says this could be a four, as long as maybe an eight, ten-week
05:24recovery.
05:25I can't, you know, speculate, but it really could be decent news for him.
05:32So the braces, and I know a lot of guys hate wearing braces, whether on the knee or an elbow,
05:38when it's bulky.
05:39Is there anything developed like the brace that Pat Mahomes is wearing that says made from magnesium,
05:45which seems to be relatively light, not that bulky, but strong?
05:52Yeah, I mean, he played damn well with that brace, and it looks pretty good.
05:56So the magnesium is the composite of the metal that the bars, the struts are made of.
06:03And, you know, it's kind of like, suffice to say, it's like a titanium or something, a lightweight metal.
06:11And so it's good for Mahomes and that brace is because it's extremely lightweight, but it's extremely durable.
06:18There's a couple of options on the market that are, you know, low profile.
06:22And, you know, I think knee braces probably are less well-tolerated in a running athlete, contact athlete,
06:29than, say, an elbow brace, particularly if you're a lineman.
06:31But if this is his non-throwing arm, I don't know of any magnesium composite braces,
06:39and it may be out there for the elbow, but I think it's a little bit apples to oranges
06:44because the weight of the brace, the elbow brace, is so much smaller than the knee.
06:49And why athletes hate the knee brace is it tends to kind of slide down.
06:52I think they can get a really low-contour, well-fitting elbow brace, and it'd be okay.
06:59Talking with Dr. Jeff Giuliani here on the Rude Guest Hotline.
07:04Dr. Giuliani is an orthopedic surgeon specializing in orthopedic sports medicine.
07:10Doc, I want to circle back to something you mentioned there, that, you know,
07:14a potential good news or a good timeline could be like four to six weeks.
07:19Is that kind of what you're thinking?
07:22Now, granted, you're a little removed from the situation,
07:24but, like, you don't see this as something he could be back in two weeks wearing a brace.
07:31You know, as you know, it seems NFL anything can happen, and I'm only speculating,
07:36but if we go off of data and literature of what their average return to play is,
07:41would be to manage this non-operatively in a primary setting.
07:45You're looking at, and the range is broad, but as soon as four weeks, sometimes ten weeks.
07:50We see what happens if you go back a little bit too soon, like last season.
07:55And this is also a different scenario because it's a recurrent instability event.
08:00So if the MRI shows that the soft tissue damage is more extensive than it was last year,
08:06that may shift the timeline to the right.
08:08But, you know, if we want to play best-case scenario,
08:12there is a potential he's back with a good brace in several weeks or slightly more.
08:21Man, interesting.
08:24Doc, I don't know if you saw this, but Kurt Warner, Hall of Fame quarterback,
08:28said yesterday on ESPN or NFL Network or somewhere that he played through this injury,
08:33and he was able to put a brace on and play through it.
08:36And a lot of people kind of took that as, like, Kurt Warner was calling Jayden a win.
08:40I don't think that was the case.
08:41That's not what he was doing.
08:42Kurt came out today, though, and just posted,
08:46by the way, it's also true that because I played with this brace,
08:50now I can't straighten my arm, do yoga, or lift his wife.
08:54That's what his wife was saying.
08:55Yeah.
08:56So, like, what are – say they don't do surgery.
09:00Seriously, say they don't do surgery.
09:02They put the brace on him.
09:04Jayden's in his third year.
09:06He's 24, 25 years old.
09:08Like, what are the long-term possible impacts of this?
09:13Yeah, I mean, there's life in the NFL and then life after football.
09:17And if you're referring to the latter, it's, you know,
09:21it's an injury that every time the elbow dislocates,
09:24there's probably some component of, you know, cartilage shear
09:28or, you know, extensive soft tissue injury.
09:32And if we're trying to protect him from extension,
09:36a lot of times patients can lose a little bit of terminal extension.
09:39And what that means is if, say, his other elbow hyperextends five degrees,
09:45his injured elbow may get to perfectly straight
09:50or maybe a couple degrees short of full extension.
09:52So, you know, long-term is loss of full extension by a handful of degrees,
09:58and it's variable.
09:59And then, you know, elbow arthritis later in life where we all seem to kind of
10:04have some aches and pains of our joints.
10:06But this may be a little bit quicker in him.
10:09I think the immediate effects for football, given that it's his non-throwing arm,
10:13I think, you know, it's in his favor.
10:16I think if he has surgery or not, playing football,
10:20he's going to have some of those issues later on in life.
10:23I had basically one surgery in football, and I deal with stuff,
10:27but none of it is nothing major that stops me from doing anything.
10:31So.
10:33Doc, can I ask you a question?
10:34Talking with Dr. Jeff Giuliani here, who is an orthopedic surgeon specializing in sports,
10:39works with the Nats, works with D.C. United, the Washington Spirit.
10:43I don't, like, for medical people, they always are able to separate kind of the emotion
10:51from the medical side of things.
10:53Well, you know, there is a scientific robotic answer to, like, okay,
10:57well, you've got to get the elbow back in the socket, blah, blah, blah.
11:00When you watch this one, you watch this one from Dallas,
11:04and you watch the injury against Seattle last year, it is gruesome.
11:09It is like, hold your stomach, oh, my God, is he okay?
11:13And is there a potential, when you watch that, that it could be worse?
11:19Like, when you watch that, you're almost wondering, like, oh, my God,
11:22could this dude's bone pop out of the skin?
11:26Like, how close is it to that?
11:31You're exactly right.
11:32I mean, honestly, I've been doing this for 20-plus years.
11:36I turn my head away from the live footage of injuries during games.
11:41I have no problem fixing it, but watching it is gruesome.
11:44And, you know, ankle dislocations, just like elbow dislocations,
11:48where there's not a lot of soft tissue around that joint,
11:51and then the bones are fairly prominent to begin with,
11:54when that forearm bone pops out behind the arm bone like Jaden's did,
12:00it just looks grossly deformed, and it's not pleasant to anybody's eye,
12:05to include the layperson's eye.
12:07So it looks awful, but you'd be surprised sometimes if it goes straight to the back.
12:15And I don't know what his original MRI looked like last year,
12:18but I was reading something of the effect that, like,
12:19the collateral ligaments didn't look too bad.
12:22It may have popped out in the same exact direction,
12:25and therefore the soft tissue damage isn't much different than the first time.
12:29Vice versa, it could be that there is complete tearing of the collateral ligaments
12:34and the capsule, and it's much worse than we thought.
12:37So really shooting in the dark without the MRI, but your point's well taken.
12:42I think it's hard to watch, but it doesn't always mean what the prognosis is going to be.
12:48You mentioned ankle dislocation.
12:51That happened with the guy Scatterboo last year from the Giants.
12:55He's back this year running as crazy as he was before.
12:58You know, what's the major difference from, like, an off-arm of a quarterback
13:03and an ankle of a running back who needs all that?
13:09I think it's huge.
13:10I think that, to your point, it's his non-throwing arm, which is, you know, very fortunate.
13:16We don't see these often in quarterbacks, number one.
13:19Number two, you don't often see recurrent dislocations, but in football anything can happen.
13:24In the ankle, I think the ramifications of just a really stiff, sore ankle
13:31is probably more of a problem than the elbow,
13:35and it probably necessitates, you know, oral anti-inflammatories,
13:39maybe injections to get through the season,
13:41and it can be what I feel probably more of a concerning issue.
13:48Hey, Doc, while we got you, I wanted to ask you about a couple other quarterback injuries.
13:54Caleb Williams had quite the meltdown on the sideline before it was revealed he has a mild hamstring injury.
14:01What did you think of Caleb's reaction?
14:04Like, maybe he was just in a lot of pain?
14:06I don't know.
14:07I'm not trying to – I guess I am kind of making fun of him.
14:10But what did you think of Caleb's injury and kind of what we found later?
14:16Yeah, I mean, I think you're allowed to make fun of him.
14:18I'm not sure I can.
14:19I think that, you know, on face value, the way he went down, his reaction on the sideline,
14:27and just reading what I read, I saw the review highlights.
14:30It was – I thought his hamstring tendon origin had torn, and, you know,
14:36in a running athlete, that's usually surgical.
14:38We fix those.
14:39So I thought he was definitely going to have surgery and probably out for most of the season.
14:43I don't know what the final diagnosis was in terms of – it was a hamstring strain is what I
14:49understand.
14:50They do come in various grades of one through three being more severe.
14:55But I was a little bit shocked to hear what the injury was in relation to the amount of pain
15:03he was in.
15:05Yeah.
15:05Yeah, I know, and I saw him go down.
15:07I thought nobody touched me.
15:09He just went down.
15:10I was like, it could be Achilles, you know.
15:11But it was – he wasn't really stopping, so I kind of went away from that.
15:15But I didn't expect it to be just the hamstring.
15:18Yeah.
15:19And a two-week hamstring strain.
15:21Doc, what about Jackson Dart last night?
15:25Well, I don't want to admit this on the telecast.
15:27I'm from New Jersey, so I was watching, and it was sad.
15:32We seem like Giants can't catch a break.
15:34But, you know, I like kind of predicting or saying what I think it is until they get the MRI.
15:42And, again, you're completely off base, going off experience without an MRI.
15:47But the way – I think Troy Aikman nailed it exactly right.
15:50I think he's lucky his leg wasn't planted when he got hit because that would have been, I think, devastating.
15:58The fact that it was kind of, you know, degrees of freedom in midair, yes, he still tore and or
16:05high-grade strained his ligaments.
16:07And the way he walked afterwards – now, everybody needs to know, even with an ACL tear, you can walk
16:13afterwards but be a full, surgical ACL tear.
16:16But the way he walked came back out, I think if he completely blew out his MCL, a lot of
16:23times the knee just wants to buckle, and it's painful.
16:26And I was surprised how well he was walking.
16:29So, you know, again, given the response from the training staff and Harbaugh and what they were saying how I
16:36think he's going to be okay
16:37and the reports of it being only an MCL, I think the – you know, what would be ideal is
16:44if it's like a grade 2 out of 3 or grade 3 MCL
16:48and the ACL is either mildly strained or fine, that's a huge win for him because I was concerned about
16:54an ACL-MCL injury.
16:56Yeah.
16:57Yeah.
16:57The report last night, one report was that Dart was trying so hard to get back in the game, they
17:02had to confiscate his uniform, which is just hysterical.
17:05But also, Doctor, you've seen guys who tear it and they are these psychos in a sense.
17:13They could give you a reaction and make you think it's less serious than it really is.
17:18The other people, you get it and you get there.
17:21Yeah.
17:22Like Caleb.
17:23And you know Jackson has that mindset.
17:25Yeah.
17:26Hey, Doctor, thank you very much for the time, man.
17:28Really appreciate you joining us and giving us such good information.
17:33Yeah, my pleasure.
17:33Thanks for having me.
17:35All right, take care.
17:35All right, that is Dr. Jeff Giuliani, orthopedic surgeon at Inova, specializes in sports medicine.
17:43It's tough listening to the doc and him kind of being like, yeah, you know, I think there's a good
17:47chance this is only four to six weeks
17:48and he comes back with a brace and, like, that's kind of the best case, it sounds like.
17:52Like, now, obviously things can change and this is a fluid situation.
17:56Yeah.
17:56But, I mean, four games gets you through the bye.
17:59You're talking week eight against Philly at home.
18:02Like I said, if it, depending on how it popped off, if it just went out right back, that could
18:07be quicker.
18:07I also, I know how tough Jaden is.
18:10Yeah.
18:10And I know where his pain threshold is.
18:12I mean, he showed that to you as a rookie playing through the broken ribs.
18:15I can barely, like, walk to the mailbox when I broke my ribs.
18:18Um, Jaden's desire to play at some point needs to be balanced with, like, long-term stability of his career.
18:30Like, this cannot keep happening.
18:32And maybe if the brace is all that's required, that's all that's required.
18:36But that sounds like the brace being the magic fix sounds optimistic to me.
18:42I think, yeah, you want to, but you need, a person to come back after injury has to have that
18:50drive.
18:51If you don't have that drive, you're not coming back.
18:53100%.
18:54So.
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