Jaylon Smith: A Dark Prediction?

Be glad to get this behind us.

FuzzyLumpkins said:

"Complete palsy" includes several types of nerve injury ie severed nerves or where the outer nerve is damaged. Given the outer nerve was intact he had axonotmesis and not the more severe type 3+ injuries which you're including.

What does the literature say about axonotmesis because the literature I read had a much better prognosis that 1 out of 3?

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Im not at all an expert on the subject but I have access to most of the journals on pubmed and know how to read the literature.

I agree he most likely had axonotmesis since his doc said he had nerve "stretch" not severing. However, to my understanding, axonotmesis rarely has FULL recocery in general and nerve location is important for prognosis. I dont see any literature specifically for peronal nerve injury that specifies the grade lesion so i think it is unknown. The point Dr. Chao is making is that neuropraxia typically has rapid improvement with a high probability of full recovery. The fact that it has taken, what 15 months, signals that this is axonotmesis which rarely had complete motor recovery.

waldoputty said:

I found the study: http://orthodoc.aaos.org/immerman/LE Nerve Trauma - Immerman HJD Bull 2014.pdf
The big question is really what spontaneous recovery means.

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That is a nice broad review but actually isnt the paper i was referring to.

https://link.springer.com/article/10.1007/s00167-015-3676-7

Spontaneous recovery is recovery without intervention. Recovery with a tendon transfer is basically allowing regular people to walk its not something that would let jaylon play football so you have to keeo that in mind. These success rates are for a much lower bar than he needs. Also all small studies for interventions will be biased for positive results which could influence the high rate of success.

waldoputty said:

I have a couple questions about your post.
It has been reported that Jaylon has already been able to lift his foot.
Does that not already put him in FNC-3?
The additional information is that he is quickly improving - quoting a test that improved by 5X in one week.
I presume that is an EMG that is improving by 5X a week (but we dont know the starting point) - but does that not actually suggest he is heading to a good or complete recovery (FNC-4 to 5)?

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I heard he could just move toes. If he can lift his entire foot against gravity yes he is frc3. I have no idea what those emg's show we are going off of Stephen jones' interpretations. I think it is optimistic news. I still suspect the odds of COMPLETE recovery are quite low. But he may be able to still be an exception athlete with 4/5 strength and no brace. Not needing the brace is not the same as having COMPLETE recovery.

hra8700 said:

Im not at all an expert on the subject but I have access to most of the journals on pubmed and know how to read the literature.

I agree he most likely had axonotmesis since his doc said he had nerve "stretch" not severing. However, to my understanding, axonotmesis rarely has FULL recocery in general and nerve location is important for prognosis. I dont see any literature specifically for peronal nerve injury that specifies the grade lesion so i think it is unknown. The point Dr. Chao is making is that neuropraxia typically has rapid improvement with a high probability of full recovery. The fact that it has taken, what 15 months, signals that this is axonotmesis which rarely had complete motor recovery.

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@waldoputty posted some stats for type 2 injuries in this thread and it was better than good. Like 93%.

hra8700 said:

Im not at all an expert on the subject but I have access to most of the journals on pubmed and know how to read the literature.

I agree he most likely had axonotmesis since his doc said he had nerve "stretch" not severing. However, to my understanding, axonotmesis rarely has FULL recocery in general and nerve location is important for prognosis. I dont see any literature specifically for peronal nerve injury that specifies the grade lesion so i think it is unknown. The point Dr. Chao is making is that neuropraxia typically has rapid improvement with a high probability of full recovery. The fact that it has taken, what 15 months, signals that this is axonotmesis which rarely had complete motor recovery.

That is a nice broad review but actually isnt the paper i was referring to.

https://link.springer.com/article/10.1007/s00167-015-3676-7

Spontaneous recovery is recovery without intervention. Recovery with a tendon transfer is basically allowing regular people to walk its not something that would let jaylon play football so you have to keeo that in mind. These success rates are for a much lower bar than he needs. Also all small studies for interventions will be biased for positive results which could influence the high rate of success.

I heard he could just move toes. If he can lift his entire foot against gravity yes he is frc3. I have no idea what those emg's show we are going off of Stephen jones' interpretations. I think it is optimistic news. I still suspect the odds of COMPLETE recovery are quite low. But he may be able to still be an exception athlete with 4/5 strength and no brace. Not needing the brace is not the same as having COMPLETE recovery.

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1. FO has specifically said he can lift his foot and his toes. So we are at frc3.
2. Stephen and Jerry were very specific about a test being 5X better week to week. The only test I could think of would be EMG. If EMG is improving that quickly, it would seem to indicate fast improvement when he is already at frc3. However, I dont know how much nerve conduction is needed for him to be able to lift his foot. Any thoughts?
3. I think a MD here as well as a couple PhDs I know have said that 100% nerve conduction recovery is simply not needed for full functional recovery.
4. If you pull up the paper I listed, it refers to another paper that mentions recovery for stretched nerve at over 90%. I dont think it broke out which recovery level.
5. Even if he can walk without the brace, not having full strength may require use of some type of protection/brace for his foot/ankle. Last thing we need is another horrific injury. That was one thing the PhDs stressed was "even if he is almost the same, do you want to risk it".
6. This Chao fellow has been extremely negative in a way that does not seem to match the data for the type of injury involved.

waldoputty said:

1. FO has specifically said he can lift his foot and his toes. So we are at frc3.
2. Stephen and Jerry were very specific about a test being 5X better week to week. The only test I could think of would be EMG. If EMG is improving that quickly, it would seem to indicate fast improvement when he is already at frc3.
3. I think a MD here as well as a couple PhDs I know have said that 100% nerve conduction recovery is simply not needed for full functional recovery.
4. If you pull up the paper I listed, it refers to another paper that mentions recovery for stretched nerve at over 90%. I dont think it broke out which recovery level.
5. Even if he can walk without the brace, not having full strength may require use of some type of protection/brace for his foot/ankle. Last thing we need is another horrific injury. That was one thing the PhDs stressed was "even if he is almost the same, do you want to risk it".
6. This Chao fellow has been extremely negative in a way that does not seem to match the data for the type of injury involved.

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1. Guess so
3.. Functional recovery in the literature is mostly talking about 50 year olds who want to be able to walk. If you have 4/5 strength you can walk without a brace easily. I'm not sure jaylon smith can be an all pro linebacker with 4/5 eversion at the ankle, but perhaps, who knows? That's the big question since it is too rare to really know.
4. I looked at the original paper it was referencing. It is a completely different scenario. That paper includes ALL types of common peroneal nerve injuries, most of which are non-traumatic and due to compression. Those are very easily correctable with neurolysis. The exact degree of injury was not specified and included incomplete and complete palsies. Type of injury was assessed clinically (which btw the sunderland scheme seems to have fairly limited clinical utility) and success was defined as 3/5 strength. So, by that definition, jaylon smith i already a successful case.
6. He has been very negative but he is an expert in this field and I've seen another orthopedist and a neurologist on twitter all concur with his viewpoints. Everything I have read from the literature also supports his view. The reasons for optimism are a. none of us including him know the full story, so the fact that there is optimism in the organization supports that there are things about this case that are different than standard b. this is pretty rare so we don't really know what he can do even if he doesn't fully recover

Spagnola 5/5/17

Of course, you have heard the optimism over his improved drop-foot condition being spewed from Jerry and Stephen Jones, along with Garrett. His peroneal nerve damaged when he tore his ACL and MCL in the 2016 Fiesta Bowl vs. Ohio State is coming to life. His last few EMGs (electromyogram) have shown the nerve getting better and better and better.

While Smith still wears the brace to counter the drop-foot problem, he has been out here during the offseason workouts, doing what all the other guys have been doing. Running. Cutting. Stopping and starting. And he’s in envious shape.

http://www.dallascowboys.com/news/2...hese-two-not-so-new-guys-become-unforgettable

As a doctor myself albeit in clinical psychology, not medicine, I see it as a red flag when a doctor attempts (without solicitation) to draw medical conclusions on diagnosis and prognosis without personally evaluating the patient. In this case, it is fairly obvious that Dr. Chao is using Jaylon Smith's medical condition to promote himself as an expert on nerve regeneration and recovery and has based his opinion solely on media reports and interviews with Jerry and Stephen Jones. In other words, his prognosis on Jaylon Smith is 100% pure speculation. It is also unethical since he has distorted the media reports upon which he has based his opinion in order to create a contrarian position designed to gain attention for himself.

After reading the aforementioned article detailing his long history of inappropriate and illegal behavior both as a doctor and as an individual, it is not surprising that he is employing these tactics to repair his poor reputation.

As a resident of San Diego, I can make an educated guess why Dean Spanos used to employ Dr. Chao. Spanos has a reputation for being very cheap so I think it likely that Dr. Chao had given Spanos a huge discount to be the team's head physician. Unfortunately, it is well known in the San Diego area that all Spanos cares about is money and he was never going to allow the Chargers to remain in San Diego. All I can say is we are very fortunate to have Jerry Jones as the owner of our beloved Cowboys. He would never hire an unethical doctor nor allow the team to leave the Dallas area.

hra8700 said:

1. Guess so
3.. Functional recovery in the literature is mostly talking about 50 year olds who want to be able to walk. If you have 4/5 strength you can walk without a brace easily. I'm not sure jaylon smith can be an all pro linebacker with 4/5 eversion at the ankle, but perhaps, who knows? That's the big question since it is too rare to really know.
4. I looked at the original paper it was referencing. It is a completely different scenario. That paper
includes ALL types of common peroneal nerve injuries, most of which are non-traumatic and due to compression. Those are very easily correctable with neurolysis. The exact degree of injury was not specified and included incomplete and complete palsies. Type of injury was assessed clinically (which btw the sunderland scheme seems to have fairly limited clinical utility) and success was defined as 3/5 strength. So, by that definition, jaylon smith i already a successful case.
6. He has been very negative but he is an expert in this field and I've seen another orthopedist and a neurologist on twitter all concur with his viewpoints. Everything I have read from the literature also supports his view. The reasons for optimism are a. none of us including him know the full story, so the fact that there is optimism in the organization supports that there are things about this case that are different than standard b. this is pretty rare so we don't really know what he can do even if he doesn't fully recover

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@Doc50 was explaining how much of the muscles were used for different motions. frankly i dont remember any of the details.
correct me if i am wrong, eversion is used for cutting only.
i presume he would still have his speed because his pushoff should be the same?
i see what you are saying - these studies do not necessarily test for return of all-pro capabilities.
well at this point, we can take heart in the 5x improvement per week in his EMGs (per speedkilz88 quoting the flagship) as well as his ability to lift his foot already.
given the way stephen, jerry and mcclay are talking, i have to guess that the dr. cooper is giving them a pretty rosy prognosis recently.

waldoputty said:

@Doc50 was explaining how much of the muscles were used for different motions. frankly i dont remember any of the details.
correct me if i am wrong, eversion is used for cutting only.
i presume he would still have his speed because his pushoff should be the same?
i see what you are saying - these studies do not necessarily test for return of all-pro capabilities.
well at this point, we can take heart in the 5x improvement per week in his EMGs (per speedkilz88 quoting the flagship) as well as his ability to lift his foot already.
given the way stephen, jerry and mcclay are talking, i have to guess that the dr. cooper is giving them a pretty rosy prognosis recently.

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Yep, I'm optimistic, a couple months ago with still no movement I had basically lost hope, big difference since then!

Yeah the tibialis anterior isn't that important, but presumably it is important to stabilize the leg in the process of pushing off and you need to rapidly dorsiflex the foot to be able to have strides in rapid succession when running. The degree to which you need complete strength to be a pro athlete I have no idea. When it happened I was surprised how important dr chao says it is in sports, but he knows much much better than I do.

hra8700 said:

Yep, I'm optimistic, a couple months ago with still no movement I had basically lost hope, big difference since then!

Yeah the tibialis anterior isn't that important, but presumably it is important to stabilize the leg in the process of pushing off and you need to rapidly dorsiflex the foot to be able to have strides in rapid succession when running. The degree to which you need complete strength to be a pro athlete I have no idea. When it happened I was surprised how important dr chao says it is in sports, but he knows much much better than I do.

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well may be doc50 will chime in on the muscles again...

As a mathmetician, I would have to consider these percentages rather arbitrary. What is meant by 100%, for example. Does he mean he can function at the exact same level and capacity as he could prior to the injury of is it 100% of what would be considered normal for the average person?

When they say less than 100%, say 93%, how does that differ from 94% and how does his 93% compare to some other player's 100%

Since every single player has unique skill sets, experiences and even body srructure, how relevant are these percentages. After the season starts, how many players remain 100% fit?

What if a 90% Jaylon is better than 100% of any other linebacker in this league?

How he plays is your test. And you'll get some reports from the player.

Idgit said:

Everything I've heard on the topic had Smith's recovery rate at or ahead of schedule the entire time. And we heard early on that the recovery rate was supposed to be ~inch/month. Neither of those is consistent with what 'ProFootballDoc' is reporting here.

Should also note he's quoting Chao pretty heavily here, and Chao had nothing to do with Jaylon's procedure or recovery.

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Yes, was just about to post...Dr. Chao who is not Jaylon's doctor...but Dr. Cooper who is Jaylon's Doctor....I will go by what Dr. Cooper says.

And Chao, if pronounced Chow...is a dog and a dog food...which is what his opinion is worth to me....no disrespect to dogs or dog foods.....

plasticman said:

As a mathmetician, I would have to consider these percentages rather arbitrary. What is meant by 100%, for example. Does he mean he can function at the exact same level and capacity as he could prior to the injury of is it 100% of what would be considered normal for the average person?

When they say less than 100%, say 93%, how does that differ from 94% and how does his 93% compare to some other player's 100%

Since every single player has unique skill sets, experiences and even body srructure, how relevant are these percentages. After the season starts, how many players remain 100% fit?

What if a 90% Jaylon is better than 100% of any other linebacker in this league?

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Woodson on ESPN yesterday said, that Jaylon at 80% from what he did in college, and would have been a top 5 pick, is far better than most LB's at 100%
And the other 2 guys did not disagree at all, they didn't even flinch at that statement.

I'll just say that I do believe that the Cowboys went thru their doctors and medical experts to get their opinion on Jaylon before drafting him instead of hoping this would work out. From there, you're going to get doctors that tend to think it will work and those doctors that think it won't. One thing to keep in mind is that you can get doctors who act like they are an expert in the field and have no experience whatsoever. And usually you can find these doctors on Twitter because it's a good way to make a name for yourself.




YR

As a businessman I have dealt with many people who have never experienced this kind of injury. I don't think it's fair for me to put it into percentages but there are definitely possibilities that he does fully recover, as well as the possibilities that he doesn't fully recover. One way or another, we will find out whether he can get back to his former self before his career is over

dagreat1_87 said:

well that guy is a party pooper....but at this point it doesn't matter what anyone says. we'll find out soon enough if he can play or not

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I think each case is differnt.. Back in 2012 I suffered a significant burn on my lower right leg...the nerves in my leg were damaged leaving me with no feeling at all in half my leg....you could stab it with a knife and I would not feel anything. Last summer I was laying on the bed and out of nowhere full feeling returned and it is normal now...truth is they dont know cor sure...

jazzcat22 said:

Yes, was just about to post...Dr. Chao who is not Jaylon's doctor...but Dr. Cooper who is Jaylon's Doctor....I will go by what Dr. Cooper says.

And Chao, if pronounced Chow...is a dog and a dog food...which is what his opinion is worth to me....no disrespect to dogs or dog foods.....

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i would trust dr. cooper more also but his info is filter through the jones.
lets do not go there with the names please. i am asian also and i really dont appreciate it.

Doomsday101 said:

I do not criticize his qualifications, I tend to listen to the doctor who is actually treating a person over those who are looking at the situation from the outside.

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Fair enough. I have no problems with your perspective.

plasticman said:

As a mathmetician, I would have to consider these percentages rather arbitrary. What is meant by 100%, for example. Does he mean he can function at the exact same level and capacity as he could prior to the injury of is it 100% of what would be considered normal for the average person?

When they say less than 100%, say 93%, how does that differ from 94% and how does his 93% compare to some other player's 100%

Since every single player has unique skill sets, experiences and even body srructure, how relevant are these percentages. After the season starts, how many players remain 100% fit?

What if a 90% Jaylon is better than 100% of any other linebacker in this league?

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i thin the 93% is a statistics of those reaching a certain level of recovery.

separately we are discussing the level of recovery.
jaylon can lift his foot (technically cure of foot drop) but still not have full strength in his muscles.
i think hra8700 agrees with the level of recovery is 3 (out of 5) if we trust the jones' word that jaylon can now lift his foot.
the question is can he get back to full strength (5).

this is one thing we can take heart in is that jaylon is way pass the point of black magic.
the black magic part is the nerve making some level of connection.
it has done that and the nerve signal conduction (measured by EMG) is (at least was last week) was increasing at a rate of 5X per week.
we dont know the starting point was, but at least he was already able to wiggle toes and lift foot.
the cowboys already seemed really up beat about the chance for full recovery, and dr. cooper would have all the EMG nerve conduction data.
unless the cowboys are bluffing, i would say his chance is pretty darn good.
and also what do the cowboys do if he is at 4.67985?
the researchers i know said to me - do you want to take a chance - wear some type of protection/brace.