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Sports surgeon Dr. Michael Alaia on JD5's 2nd elbow dislocation: "My worry is that if this doesn't get stabilized, this might be more of a recurring type injury.. Bracing has been shown to help unstable injuries.. Sometimes surgery is indicated."...Listen to the full interview
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00:00Coming up in 30 minutes at 5 o'clock in Audio Vault, all on Jaden Daniels' reactions from
00:07around the country over the last 48 hours. We'll play some clips from some of the primary
00:13football analysts in America, and we'll get into what they're thinking about Daniels,
00:17see what we agree with and disagree with. As we welcome you back on Grant and Danny,
00:22though, we wanted to get some details, some insight on what's going on with that elbow.
00:26We're going to welcome onto the show a Dr. Michael Alea, sports orthopedic surgeon at NYU,
00:33is on the Rude Guest Hotline, Rude, the most reliable heating and air conditioning products
00:36in the DMV. Thank you for the time, doctor. It's Grant Paulson at Danny Ruye on the fan.
00:41How are you? Doing great. How are you doing today? Very well. Very well. So I guess let's just start
00:47with when you see that someone has had two very similar elbow dislocations on, from a football
00:55standpoint, what is a pretty innocuous kind of planting of the arm play, your thoughts are what?
01:04Well, I guess the first thing that runs through my head is when someone has the same injury
01:09on a joint that's been treated without surgery, my worry is that if this doesn't get stabilized,
01:18perhaps it might continue to happen, almost like shoulder dislocations, right? If the shoulder
01:24pops out once, sometimes you rehabilitate it. And if it pops out again, two, three times,
01:29then you find a way to potentially make this operative so that you stabilize the shoulder,
01:34let the athlete go and compete. So I think my biggest fear is that this might be more of a
01:39recurring type injury at this point, if it's not addressed in a different way, shape or form.
01:44But again, that's, that's really not my decision to make, you know, the physicians that are treating
01:51this athlete are world-class professional physicians that know the ins and outs of this
01:57to a T. So, you know, obviously they're going to do what's best for the patient, what's best for the
02:02athlete. And they make those decisions together. But, you know, anytime you see a recurring injury,
02:07you get a little bit nervous. So you mentioned separated shoulder. I had a teammate who separated
02:14his shoulder, diving into third base forever ago. And then it was to the point where if he just kind
02:19of leaned the wrong way against the wall, the thing would pop out. I mean, I'm being hyperbolic,
02:23but it was literally, it was this recurring thing. And finally it was, you got to get something done
02:26to stabilize this deal. And, you know, as a 20 year old kid, that was a hard decision, but this
02:31is a
02:31professional. I guess my point is, can you imagine resistance to that? Or what are those conversations
02:37like now at this point? And do you think that was on the table with the first injury?
02:42You know, I think that many elbow dislocations without significant injuries to the ligaments
02:48or to the bones or to the cartilage are treated non-surgically. There have been many, many athletes
02:53that have had elbow dislocations and they're out for a few weeks and they have a full uneventful
02:58recovery and they never have a dislocation again. And that usually is the norm. It would be very rare
03:05to subject an athlete to a season ending surgical procedure to reconstruct ligaments when the great
03:13majority of the time, the athlete's going to be fine without anything done. But again, like when
03:17they start happening more than once, that's when the worries start getting in your head. Okay, maybe,
03:22maybe we need to do something. But again, you know, they have to look at the MRI. They have to
03:25see if
03:26there are any structural damage, see what the ligaments look like. Are there significant tears? Are there
03:30injuries like loose bodies or cartilage damage floating around the joint, any fractures, etc.? So
03:35lots of things will go into play. And then again, the, as you were alluding to the, the conversations
03:41between the player and the physicians and the training staff and the agents, I mean, they're
03:47detailed conversations. They're going to run through every possible outcome here. They're going to go
03:52through the gamut of treatment options. And at the end of the day, the player really makes the decision
03:56as to what they would like to do or what not to do. But, you know, as long as the
04:00player is educated
04:01about risks and benefits of proceeding either non-surgically or surgically, that's when good
04:05medical care is delivered.
04:07Sports Orthopedic Surgeon NYU, Michael Alea is with us here on Grant and Danny. So when you say
04:14that it needs to be stabilized, can that be with a brace or are you talking about surgery?
04:22Yeah, either one is certainly possible. I mean, bracing definitely has been shown to help elbow
04:27injuries, particularly unstable elbows. There have been players that play in braces quite often if
04:33they have evidence of elbow instability. Sometimes surgery is indicated on athletes or even on you
04:39and me. I mean, if we have the same recurring injury over and over, sometimes surgery is indicated
04:43for the average person as well. It all depends on the symptoms and what the quality of life is and
04:49what the expectations about the stress that are going to be put through that joint are going to
04:53be.
04:54What protections, if any, or precautions could have been taken to prevent that second injury?
04:59This is the part that I keep going back to, Doctor, is that that wasn't what's coming. I mean,
05:03you look at Jackson Dart getting sandwiched between two 300-pound guys and the quarterback
05:07position. Guys are going to get hit and thrown around, etc. That was a trip. I did that two weeks
05:13ago,
05:13you know, and it's like my elbow didn't fly out of socket as it was. If it was that minor
05:18a thing
05:18that could lead to this injury, couldn't there have been some precautions taken or am I off
05:22base there?
05:23No, I don't think so. I mean, I think that this was just a freak occurrence again. And,
05:28you know, it's hard to put precautions on a professional athlete. All right. You know,
05:33they have to be, they've got to meet usually three criteria for return to play. And no matter
05:38what kind of athlete we're treating, whether it's a collegiate athlete, high school athlete,
05:42professional athlete, they have to have painless range of motion. They have to be no senses of
05:46objective instability, right? So the athlete has to feel that the elbow or the shoulder or the knee
05:50is completely stable and they have to have full strength. If they meet those criteria,
05:55then theoretically they are eligible to play. And, you know, these are freak occurrences. I honestly,
06:02when you talk about a hinge joint, like the elbow coming down like that with rotation force,
06:06there's really not much you can do to prevent that from happening, whether it be bracing or,
06:11or, okay, wear this or don't do this. I mean, this could happen to anybody at any time.
06:16So, you know, to answer your question, no, I don't think it was preventable.
06:19So even if he was wearing a brace this weekend, like my, I keep coming back to,
06:23everyone keeps acting like the brace is some magic bullet. Like he's going to put a brace on,
06:27he'll be back in a few weeks, and then he's very unlikely to tear it, or excuse me,
06:31to dislocate it again because the brace will prevent it. We even saw him take a really hard hit
06:36against the Vikings in the one game he came back for. He landed right on his elbow.
06:40He left with an injury, but it didn't dislocate. Theoretically, the brace worked.
06:44But my point is, if everyone's acting like the brace is such a catch-me-all,
06:47then why wasn't he wearing it yesterday?
06:50Because it's not, and the brace is not necessary, nor is it indicated a lot of times.
06:57I mean, when you see people that tear their ACL, sometimes they will come back to sports
07:02and wear a brace, whether it be through skiing, your everyday athlete, and they can still tear
07:07their ACL through the brace. The brace only protects against movement in certain planes.
07:12You know, when you fall and land on an outstretched hand, like Jaden did, there are loads that are
07:18being transmitted to that joint with rotation, with axial load. You cannot prevent those movements
07:26simply by wearing a brace. It is impossible. The brace can help certain side-to-side motions,
07:32but when you come down and land like that with torsion, load directly onto the extremity,
07:38there's nothing that a brace can really do to prevent that.
07:41So then, I don't want to put words in your mouth, but let me ask this, because your point is,
07:47the brace is not the catch-me-all, but also it's possible that he doesn't have the surgery.
07:54And you said at the start of the conversation, you know, once you have it happen twice,
07:58then you're at risk, or you have some fear that maybe it could reoccur. What is to prevent him
08:03from wearing a brace and having this happen in a month?
08:08I don't know. You know, I think it's a very good question. And these are the discussions that are
08:13going to be happening behind closed doors that we're not privy to. You know, the physicians who
08:19are, again, world-class at what they do, the trainers, world-class. They have these discussions with
08:25the athlete. And at the end of the day, the athlete makes the decision in terms of how they want
08:29to
08:29proceed. There are certain times where people won't get cleared or they will get cleared and
08:34surgery is recommended or not recommended. But again, at the end of the day, these are decisions
08:38that are made behind closed doors as a team. What would rehab look like after a surgical procedure?
08:46So surgical procedures, you know, it's going to look, it's going to be months. All right. So,
08:51I mean, think about Tommy John surgery, right? So Tommy John surgery for professional baseball players
08:56for rotation, for torque, that's usually about a year long recovery because these pitchers are
09:01going to torque through that ligament constantly, all the time with every pitch they throw, they're
09:05going to be stressing that ligament. It might be a little bit less. I mean, I haven't done one of
09:09these cases in as long as I can remember. So for me, I don't treat that much elbow instability
09:15anymore. I treat mostly knee instability, shoulder instability. But when you talk about reconstructing
09:20ligaments in the elbow, you would imagine it's going to be about six months to one year for
09:24full return if the patient has to go undergo a surgery for ligament reconstruction in that elbow.
09:31One year for full return, non-throwing arm, I guess, wouldn't be a factor. So if he were to wait
09:38until after the season and do that in February, there's no real path for him being on the field
09:44for training camp in the summer, it doesn't sound like.
09:48We don't know. I mean, again, non-throwing arm, and that ligament is not going to be used for any
09:56kind of throwing mechanism. Again, the recovery is probably about six months to a year for return
10:00to contact sports. And we don't make any guarantees when it comes to return to training camp. And
10:06again, we don't know where things are going to wind up when the MRI comes out and these physicians
10:12ultimately make their decisions.
10:14So I guess this is so hard to pin down, obviously, because we're not in the rooms doing examinations,
10:19and I wouldn't know what to do if I was. But in terms of the variance of what this could
10:24be in
10:24terms of severity, could you go into that? Is it a, it looked gruesome on television, but that's
10:29because I'm squeamish. Like, from your perspective, what are kind of the wide ranges here of the,
10:34hey, this is, he could be back next week with a brace, or this is, even without surgery,
10:38a five-month thing? Just give me kind of the range here. Yeah, and it can range anywhere from
10:44a few weeks to months. And again, it depends on what is found and what the overall goals of
10:50treatment are. So when you think about elbow dislocations or any joint dislocation, whether
10:55it be ankle, shoulder, knee, typically what happens are the soft tissues are involved. And by soft
11:02tissues, we mean ligaments, all right? So ligaments help keep joints together. They connect,
11:08from one bone to another bone to impart stability on whatever joint that might be. And whenever
11:14joints pop out of place, ligaments are always stretched out. At the very least, you got to
11:19figure something is stretched out. And it might be torn, okay? And the MRIs will kind of help you
11:27figure out where exactly it's torn. And then you have to start thinking about other structures inside
11:32the elbow, like tendons. Tendons connect muscle to bone, and that allows people to move unencumbered.
11:40It allows you to have strength and mobility. So lots of tendons attach around the elbow.
11:45And then you've got bony structures, right? You want to see if there's any fractures. Sometimes if
11:49you dislocate a joint, you can knock a piece of bone off, or you can have a fracture through one
11:52of the
11:53bones. And then finally, cartilage. Cartilage is the lining of our joints. That allows us to move
11:58freely. It's almost like ice rubbing up against ice. And it allows our joints to glide very smoothly.
12:03So you can imagine a patient with arthritis, their bones are rubbing up against each other because
12:08their cartilage is gone, because the rubber on the car tire is all worn away, and now they're driving
12:12on their hubcaps. So cartilage can also be a problem inside the elbow or the shoulder or the knee or
12:18the ankle. So lots of things are going to be looked at on these scans. And again, the overall picture,
12:26the overall forest instead of the trees, will be looked at by everybody in the room.
12:31I mean, there's no way for you not having looked at the imaging or put your hands on him to
12:36obviously
12:37predict what happens in this situation. But I guess I'd ask if he's back in a month wearing a brace,
12:43I mean, are you like watching that as a doctor? If that's your client and someone you've got back
12:49on the field, are you nervous for him? Or is it if he's cleared, if he's out there, he's just
12:54like
12:54anybody else, basically?
12:56If he's out for me, if he's out there, he's just like anybody else. Because again, you've got to have
13:02complete confidence, right? And if he's going back to play, in my opinion, those people have complete
13:08confidence. Everybody in the room has got complete confidence. And I'm in no position to judge,
13:14obviously, because I'm not treating the patient. I'm not the patient himself. So, you know, we as
13:20physicians, you know, ethically, we don't look at the way other patients are being treated and say,
13:25oh, we should have done that or we should have done that. That's, you know, playing that part is
13:31never a good look. I treat patients all the time that go back to surgery and they can have another
13:37tear or another injury. And it's not a sign that a mistake was made. It's just a sign that, hey,
13:42this was just the way this was going to play out. You know, at the end of the day, medicine
13:46is
13:47half about education, the other half about execution. And doctors get it right nearly all the time.
13:55Doctor, really appreciate your time and insight. Very informative stuff. Thank you so much.
14:00Cheers, guys.
14:01You got it. There is a orthopedic surgeon who deals with players who have injuries and does
14:08some of these operations with good information. I want to talk about the timeline, though, that he
14:12just referenced to a surgery where you're talking about six to 12 months. If you just split the
14:18difference and go nine months, if he has the procedure in January, that takes you to the start
14:23of next season. No training camp, no preseason, no summer, no spring. So if you wait, that's why I keep
14:30saying, I don't think he would have the procedure in January or February. It's now or it probably
14:35isn't happening. Yeah, if you do a procedure now-ish, if you don't, you just don't at all.
14:39Exactly. Right. Everyone keeps saying, just get to the offseason and have the surgery as if he's
14:43going to be ready for training camp. But there's that six-month window where it's like you're not,
14:47did you even recover, bro, if you weren't quote-unquote ahead of schedule?
14:50Sure. Which puts the expectation there.
14:52It's just a big ask. I know.
14:54For no setbacks, no issues. We do this with Tommy John, like, oh, he'll just be back in 12 months.
14:59And then you're Cade Cavalli and it's two years without pitching. And you're Josiah Gray
15:03and it's three baseball seasons. What do you guys make of that news? That six to 12 months
15:08on the recovery, just taking the mean amount would mean he'd have to have the surgery basically
15:15a week or two after the season ended. And then you're scratching and clawing every step
15:20of the way just to be ready for training camp with no setbacks. 800-636-1067. How would
15:26or should that affect what they do? GND on the...
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