Cowboys second-round draft pick Jaylon Smith working out

FuzzyLumpkins said:

There were no reports that it was torn that I saw. The doctor that did the surgery said it was elongated, not stretched, and the exterior of the nerve was intact.

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FuzzyLumpkins said:

Palsy is just another word for paralysis. For a quick and easy diagnosis you go by whether or not the patient can feel anything. If they cannot then the success rate is poor. Reports are that Smith could not feel his foot. That means the Cowboys are stupid right? Maybe.

Thing is that all palsies are not created equal. First caveat to remember is that when a nerve is palsied all of the interior of the nerve dies from the point of injury to the outer region aka the distal region. So in this case all of the synapses from Smith's knee to his foot died. He couldn't feel anything. There was much despairing.

If you cut the nerve it's a palsy and without surgical intervention the nerve has no route to grow the synapses along. The prognosis is extremely poor.

If you stretch the nerve and damage the exterior then it impacts the bloodflow to the area. There are several complications that can arise from this. The cells that feed the neurons can atrophy and die. There is no bloodflow to allow lymphocytes (re: white blood cells), to the interior to transport out the dead cells. This leads to scar tissue and if there is too much scarring it will block the passage leading to a partial or blocked recovery.

If the exterior of the nerve is intact and blood flow is preserved then the nerve should regrow. The issue is reconnecting to the axonal exchanges with the muscle. There is a lot of theory about this process and I couldn't find anything definitive. Then again the research stuff you can find for free on the interwebs is typically a few years old at best. I cannot tell you what the current state of medicine is. I am not a doctor.

The thing is that 40% success rate from the study above conflated all three of these nerve injuries. A partial palsy is type 1 and has a very good success rate. I listed in order types 4, 3, and 2 here. That 40% is balanced by a less than 5% success rate with type 4s.

Now the thing is when we drafted him he was nearly 5 months post op. There are special MRI called MRNs that look at nerves so we at the very least could see whether or not scar tissue had been forming and the rate or regeneration. It is unlikely that the axonal junctions had been happening. Now that has likely changed.

The point being is that it appears that Smith had a type 2 injury. I can understand why the Cowboys would be relatively bullish on a complete recovery. I won't guess at a prognosis. If I do certain people harass me to no end. The above however is how I would inform my guess.

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FuzzyLumpkins said:

Palsy is just another word for paralysis. For a quick and easy diagnosis you go by whether or not the patient can feel anything. If they cannot then the success rate is poor. Reports are that Smith could not feel his foot. That means the Cowboys are stupid right? Maybe.

Thing is that all palsies are not created equal. First caveat to remember is that when a nerve is palsied all of the interior of the nerve dies from the point of injury to the outer region aka the distal region. So in this case all of the synapses from Smith's knee to his foot died. He couldn't feel anything. There was much despairing.

If you cut the nerve it's a palsy and without surgical intervention the nerve has no route to grow the synapses along. The prognosis is extremely poor.

If you stretch the nerve and damage the exterior then it impacts the bloodflow to the area. There are several complications that can arise from this. The cells that feed the neurons can atrophy and die. There is no bloodflow to allow lymphocytes (re: white blood cells), to the interior to transport out the dead cells. This leads to scar tissue and if there is too much scarring it will block the passage leading to a partial or blocked recovery.

If the exterior of the nerve is intact and blood flow is preserved then the nerve should regrow. The issue is reconnecting to the axonal exchanges with the muscle. There is a lot of theory about this process and I couldn't find anything definitive. Then again the research stuff you can find for free on the interwebs is typically a few years old at best. I cannot tell you what the current state of medicine is. I am not a doctor.

The thing is that 40% success rate from the study above conflated all three of these nerve injuries. A partial palsy is type 1 and has a very good success rate. I listed in order types 4, 3, and 2 here. That 40% is balanced by a less than 5% success rate with type 4s.

Now the thing is when we drafted him he was nearly 5 months post op. There are special MRI called MRNs that look at nerves so we at the very least could see whether or not scar tissue had been forming and the rate or regeneration. It is unlikely that the axonal junctions had been happening. Now that has likely changed.

The point being is that it appears that Smith had a type 2 injury. I can understand why the Cowboys would be relatively bullish on a complete recovery. I won't guess at a prognosis. If I do certain people harass me to no end. The above however is how I would inform my guess.

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Bizwah said:

Wow! Very nice post. Lots of research on your part. I think the fact that the Cowboys have him working on bands bodes well. It's interesting that they have MRI machines that can track the growth of nerves.

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hra8700 said:

To my understanding smith had a complete palsy meaning he lost all ability to use the muscles the nerve connects to. Based off the most recent review of all previous reports in the medical literature, there is less than a 40% chance that he will recover enough function to be able to lift his foot up against gravity (that doesnt mean he will have normal strength, jist enough to lift against gravity).

In other words, not at all promising that he will recover enough to play at a high level.

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Titleist said:

I would find it shocking if this is indeed true. I don't care if it's Joe Montana, spending a high 2nd round pick on a player who has <40% chance of lifting his foot again is absolutely insane.

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FuzzyLumpkins said:

It's 40% if you consider type 2-4 nerve injuries which all result in palsy. Type 4 has a virtual 0% success rate without surgical intervention. I'm not sure of the other two success rate or what the proportions of incidents are but that is a very generalized prognosis whereas we know that Smith has a type 2.

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hra8700 said:

To my understanding smith had a complete palsy meaning he lost all ability to use the muscles the nerve connects to. Based off the most recent review of all previous reports in the medical literature, there is less than a 40% chance that he will recover enough function to be able to lift his foot up against gravity (that doesnt mean he will have normal strength, jist enough to lift against gravity).

In other words, not at all promising that he will recover enough to play at a high level.

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AbeBeta said:

Bravo Wikipedia Dr.!

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FuzzyLumpkins said:

More like various medical journals, speaking with a neurologist, and webMD. I never claimed to be a doctor.

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Little Jr said:

I'm not a Dr but I live with it every day for the past 10 months and will for the rest of my life. I've talked to multiple drs about this condition and best odds I was given a 50/50 chance that's would get my moment back. If not I'll wear a brace for the rest of my life to keep my foot up or they'll fuse my foot to my ankle. Then my foot would be in the position that it is when we stand up in place.

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AbeBeta said:

So internet Dr.

Are you qualified to evaluate evidence from a medical journal?

Reading don't mean anything

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AbeBeta said:

You are not an elite athlete

So obviously, no comparison

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Little Jr said:

I'm not a Dr but I live with it every day for the past 10 months and will for the rest of my life. I've talked to multiple drs about this condition and best odds I was given a 50/50 chance that I would get my movement back. If not I'll wear a brace for the rest of my life to keep my foot up or they'll fuse my foot to my ankle. Then my foot would be in the position that it is when we stand up in place.

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FuzzyLumpkins said:

What degree of injury did you have. What shape was the nerve in? Crushed, stretched, severed, intact?

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