General Medical Info on Jaylon Smith Nerve Regeneration

[roughneck266]

We're all going to be Doctors Zoners!

Neurosurgeons even! I gotta go buy a new car, and house, and trophy wife....

 

[waldoputty]

Found what a fellow zoner ( @Eskimo ) wrote - he is clearly medical.
- He said the 1 inch/month is a best case rate - can explain the time it is taking.
- He also explain different degrees of damage - note that he is using "type" the way we used "degree" and he used "degree" as a subcase of "type".
- He basically said there is a gamble between the good case (2nd degree) and a mixed case (3rd degree) and medical technology cannot differentiate between the two.

Have fun!

Here is what he wrote back in May:
There is some confusion about the degree of the nerve injury or whether the nerve was injured at all. There are 3 types and 5 degrees of nerve injury, roughly. The 3 types are neurapraxia (1st degree) which involves thinning of the outer insulation of the nerve, axonotmesis (2nd to 4th degree) which involves disruption of the inner wiring or axons of the nerves but leaves the outer nerve sheath physically intact and neurotmesis (5th degree) in which the nerve is transected.

Now Smith clearly has the 2nd type of injury, axonotmesis. This basically means the axons distal to the point of injury degenerated completely. However, we don't know how much of the inner architecture (endoneurium, perineurium and epineurium) were affected. If the inner architecture of the nerve is fully intact (2nd degree) he may get close to a complete recovery and on a reasonable timeframe. If there is 3rd degree injury there will be some loss of inner architecture, there will be scar tissue and the ability of the nerves to re-grown and find their way back to the muscles will be impaired to some degree and his recovery will be partial and probably take longer than the 1 inch per month figure which is usually a best case scenario anyways. If there is 4th degree injury that means much of the inner architecture has been disrupted, there will be a lot of scarring and nerve re-growth will be markedly restricted. Such patients will often have a later revision surgery to try and aid in recovery.

I think Smith likely has some 2nd and 3rd degree injury based on descriptions of surgical findings. How much is 2nd vs. 3rd degree isn't something you can figure out with current medical tests. If the Cowboys doctor thought it was probably more 2nd degree than 3rd degree than his thoughts on the subject could have influenced the Jones' decision as no one would know better than him as he visualized the nerve and how much deformation there was.

 

[waldoputty]

Neurosurgeons even! I gotta go buy a new car, and house, and trophy wife....

sorry, i think an orthopedic surgeon did the job.
i think that is less $

so new car, yes
new house, not in California
trophy wife, sorry

 

[waldoputty]

More info from @Eskimo in May in the same thread.
He basically said:
1. Hard to do any EMG until the nerve got to the muscle - sounds like the nerve is done growing.
2. Dr. Cooper guessed it is a 2nd degree injury (good outcome) based on visual inspection.
His comments seem to be pretty close.

His post:
Nerve regrowth is difficult to follow clinically because there is no output to study on EMG until the nerve reaches its organ (the muscle). What you do see when it first arrives is very small scrambled up waves (small polyphasic waves also called nascent potentials) on the screen.

What you can see clinically before the nerve reaches its end target is Tinel's sign. If you tap at the end of the nerve where active growth is occurring you cause a funny tingling sensation. You can follow this along to see how the nerve is growing.

In terms of the comments from the surgeon what he is getting at is the outer nerve sheath was not significantly deformed. He is then inferring it is much more likely that the inner architecture of the nerve may not have been disrupted too badly. That is the key to good recovery. If the endoneurium is intact (the smallest nerve sheaths) then the axons have a supportive environment to grow in and will find their way back to the correct spot fairly quickly for a short segment injury. However, if the endoneurium was significantly damaged then the amount of recovery will be less and the recovery will take longer.

I think it is an educated guess based on the doctor's reports that he has a predominant 2nd degree injury (intact endoneurium) as there are no reliable tests that will sort this out for you. Based on how aggressively they drafted him they must believe his chances of recovery are very good. It is one of those things where only time will tell. His leg power will be very good regardless of how the nerve recovers because all the main propulsive muscles are intact. The key issue will be ankle stability. They can try taping him up so much that little ankle movement occurs although that may be at the expense of his agility.

 

[roughneck266]

sorry, i think an orthopedic surgeon did the job.
i think that is less $

so new car, yes
new house, not in California
trophy wife, sorry

Gotcha covered.
New House: Im in Texas!
Trophy Wife: I am far less picky than you could possibly imagine!

 

[waldoputty]

Gotcha covered.
New House: Im in Texas!
Trophy Wife: I am far less picky than you could possibly imagine!

I got a solution for you for both the house and the wife.
How about (be careful, Risen may get jealous...) :

 

[Proof]

I'm not expecting Jaylon to play this year, even if I'm hoping. I don't see why they'd take him off the NFI if there weren't a degree of optimism though which is great news to me in any case.

And yes I understand they have nothing lose, but I don't think it would be worth the hoopla if there wasn't even a slim chance.

 

[waldoputty]

I'm not expecting Jaylon to play this year, even if I'm hoping. I don't see why they'd take him off the NFI if there weren't a degree of optimism though which is great news to me in any case.

And yes I understand they have nothing lose, but I don't think it would be worth the hoopla if there wasn't even a slim chance.

Any fan is being dishonest if they saying they are not hoping somewhere in the back of their mind.

I think there is still a chance and there is nothing to lose at this point.
But there is a price in 3 weeks, and the problem is there is no time for rehab.
Even if they exercise his ankle manually and regularly (probably done), I cannot see it as the same.

The expert's comment to me was EVEN if he is ~100% by the end of the year, do you want to risk it?
That is one difficult question to answer if we make it at least to the NFC championship game...

I was at 25%, went to 33% but now at 5%-10% max.
The problem is that the updates are provided by people who are not even consistent with the terminology.
Makes it really difficult to deduce anything when they use terms like regenerate, grow, fire, etc. interchangably.

 

[Proof]

Any fan is being dishonest if they saying they are not hoping somewhere in the back of their mind.

I think there is still a chance and there is nothing to lose at this point.
The problem is there is no time for rehab.
Even if they exercise his ankle manually and regularly (probably done), I cannot see it as the same.

The expert's comment to me was EVEN if he is ~100% by the end of the year, do you want to risk it?
That is one difficult question to answer.

I was at 25%, went to 33% but now at 5%-10% max.
The problem is that the updates are provided by people who are not even consistent with the terminology.
Makes it really difficult to deduce anything when they use terms like regenerate, grow, fire, etc. interchangably.

Agree verbatim

 

[CalPolyTechnique]

 

[waldoputty]

Agree verbatim

I am going to start tweet (if I had an account):

frustration
maddening
reaching
hope
closure

 

[waldoputty]

Agree verbatim

If you take Jerry and Jaylon at their words and trust Gil Brandt got his terms correct, then the nerve axons may not be done growing:

Gil Brandt ‏@Gil_Brandt Nov 21
Gil Brandt Retweeted Todd Archer

Jerry told me last week the nerves in Jaylon's knee are regenerating, signs pointing in right direction. Jaylon told me same few weeks back.

 

[Doc50]

Here is some more info:
1. Jaylon is being monitored with EMG - or that is what we are told.
2. There are more sensitive techniques such as MRI and MRN. There are no reports of more involved testing.
3. Use of EMG is consistent of someone who is more of a routine case than some super difficult case.

Take this for whatever it is worth.
@FuzzyLumpkins and @Doc50 - would appreciate your input
Thanks

EMG & nerve conduction studies are the definitive monitoring modality for this type of nerve injury.
MRI and CT are of no help in evaluating microneurophysiologic function.

As posted several times previously, his test results and physical assessments are improving within expected parameters.

He'll be ready to play by next season; could possibly see spot duty in the playoffs.
If his availability appears to be too unlikely as the season winds down, his spot may be taken by a player to fill a greater need.
Same thing applies to several others, including Claiborne; his ligamental tear and subsequent avulsion fracture could affect his performance and delay his return more than expected.

It's a game of injuries, and the 'Boys' depth has been a blessing this year.

 

[Zimmy Lives]

I really wish the Jaylon Smith threads would stop. He's not playing this year, and all the other people who have had similar injuries have nothing to do with his rehab and how HE heals.

I really wish people who do not wish to know about Jaylon Smith and his firing/not firing nerve would stop joining these threads. He is playing this year and he will win.

 

[waldoputty]

EMG & nerve conduction studies are the definitive monitoring modality for this type of nerve injury.
MRI and CT are of no help in evaluating microneurophysiologic function.

As posted several times previously, his test results and physical assessments are improving within expected parameters.

He'll be ready to play by next season; could possibly see spot duty in the playoffs.
If his availability appears to be too unlikely as the season winds down, his spot may be taken by a player to fill a greater need.
Same thing applies to several others, including Claiborne; his ligamental tear and subsequent avulsion fracture could affect his performance and delay his return more than expected.

It's a game of injuries, and the 'Boys' depth has been a blessing this year.

Hi Doc

Thanks.

If his recovery is proceeding within expected parameters, why does it appear his nerve has not regenerated the 6"?
Perhaps the 1"/month figure is the best case scenario as others have suggested?
Or the fact that EMG data is improving means that the nerve has regenerated the 6" and it is now innervating?

Based on the update, you still think it is a 2nd degree injury (intact endoneurim/axon sheath)?

Also the update indicated he still has foot drop?
Are we reading his results/updates incorrectly?
Perhaps the updates are contradictory and simply incorrect?

Happy Holidays!

 

[waldoputty]

I'm not expecting Jaylon to play this year, even if I'm hoping. I don't see why they'd take him off the NFI if there weren't a degree of optimism though which is great news to me in any case.

And yes I understand they have nothing lose, but I don't think it would be worth the hoopla if there wasn't even a slim chance.

check out doc50's reply

 

[waldoputty]

At this point, is number 5 the worst case scenario? So signs of improvement are there, just need the nerve to make its way to the muscle?

What are the options if it does approach 18 months without nerve firing?

check out doc50's reply

 

[waldoputty]

We're all going to be Doctors Zoners!

check out doc50's reply

 

[waldoputty]

Where has it been said definitively that EMG results are improving?

check out doc50's reply

 

[waldoputty]

not everyone who is interested in this nerve thing with Jaylon are thinking he is gonna play this year, but there are plenty of us who do wonder if he is gonna play at all for this team. meaning no disrespect, you can just ignore the posts I believe.

check out doc50's reply