I think there's a really good chance that Jaylon Smith will play this year

waldoputty

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what muscles? He's rehabbing the knee already, running, cutting, lifting. The nerve is in his ankle and it is the only issue in the ankle.

The muscles that need to work so there is not foot drop.
I think there may be 3 of them.
I dont remember their names but someone had it in some article in this thread.

Nerve needs to attach (nerve endings?) on the muscles to control them.
There is some risk the nerves go to the wrong places on the muscles or the wrong muscle.
 

speedkilz88

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The muscles that need to work so there is not foot drop.
I think there may be 3 of them.
I dont remember their names but someone had it in some article in this thread.

Nerve needs to attach (nerve endings?) on the muscles to control them.
There is some risk the nerves go to the wrong places on the muscles or the wrong muscle.

The foot drop is due to the nerve not firing.
 

speedkilz88

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I am not a MD, but the nerve has to get to the muscle to fire correctly (make the muscle move).
If those muscle do not move correctly, you get foot drop.

But you were talking about rehabbing the muscles after. That is where you are making stuff up.
 

GimmeTheBall!

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I think there's a really good chance that Jaylon Smith will play, in fact, if the Cowboys are thinking ahead here, Jaylon will sleep in a hyperbaric chamber every night from now until his nerve completely regenerates. That makes his recovery happen ASAP.

That's why I think he will play this year.... thoughts???

That is good because then he will earn his salary.
 

waldoputty

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But you were talking about rehabbing the muscles after. That is where you are making stuff up.

I did not make it up.
I talked to a couple experts.
They said the muscle may need to be retrained to work correctly.
 

waldoputty

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I'm not even going to begin to try and figure out this nerve stuff.


I just know the Cowboys better have some info that makes them believe he'll be back for us to make him the 34th pick.

LOL, the key thing is the doctor who did the surgery and monitoring the post-op works for the cowboys.
Jerry is crazy emotional about the cowboys.
But he is not stupid.
He did not become a billionaire by being stupid.
Besides they restrained him from drafting Johnny Football and they probably can do it again if needed.
 

FuzzyLumpkins

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But you were talking about rehabbing the muscles after. That is where you are making stuff up.

While he is able to squat and raise his heel, the muscles in the front of the shin that lift the foot are not functioning because the nerve that controls them is not functioning. Those are the muscles that will have atrophied and need rehab.
 

Eskimo

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A couple of thoughts on the subject.

1. The nerve he injured is the common peroneal nerve which itself splits into a deep peroneal nerve and a superficial peroneal nerve around the level of the knee.

2. While he has a foot drop there is more to the nerve injury than just that. That is only looking at the ankle as a hinge joint moving up and done. The ankle also inverts (twists foot so sole faces the midline) and everts (twists foot so sole faces outwards). The movement in eversion will be severely affected by the superficial peroneal part of the injury and can't be compensated for well in a brace or with taping.

3. 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.

4. In terms of nerve regrowth, the important part is the gap between where the nerve degenerated to the motor point of the muscle. For the tibialis anterior that is fairly high up in the calf and the re-innervation there will end the foot drop. To get down to the peroneii which help with eversion of the ankle the nerve re-growth has to go down a bit further more like halfway down the calf. So while it is true that the main effects of the injury are on the control of the ankle, the nerve regrowth doesn't have to get all the way to the ankle for Smith to recover.
 

waldoputty

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A couple of thoughts on the subject.

1. The nerve he injured is the common peroneal nerve which itself splits into a deep peroneal nerve and a superficial peroneal nerve around the level of the knee.

2. While he has a foot drop there is more to the nerve injury than just that. That is only looking at the ankle as a hinge joint moving up and done. The ankle also inverts (twists foot so sole faces the midline) and everts (twists foot so sole faces outwards). The movement in eversion will be severely affected by the superficial peroneal part of the injury and can't be compensated for well in a brace or with taping.

3. 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.

4. In terms of nerve regrowth, the important part is the gap between where the nerve degenerated to the motor point of the muscle. For the tibialis anterior that is fairly high up in the calf and the re-innervation there will end the foot drop. To get down to the peroneii which help with eversion of the ankle the nerve re-growth has to go down a bit further more like halfway down the calf. So while it is true that the main effects of the injury are on the control of the ankle, the nerve regrowth doesn't have to get all the way to the ankle for Smith to recover.

Hi Eskimo

Great explanation.

The doctor mentioned stretched but not elongated - does that shed any light on his thoughts about 2nd or 3rd degree?
Why does the tingling (sensory neuron) give hope for the motor neuron?
How much of his function will be affected if it is a partial recovery?
Would Magnetic resonance neurography or some other imaging be able to track how the regeneration is going?

Thanks!
 

plymkr

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Man, if I'm peeing out my knee, I'm not coming back any time soon...

Ha, that's funny. I meant tingling. Funny how one letter can change the whole meaning of a sentence. But I firmly agree, if he's tinkling out of his knee football should be the least of his worries. Lol
 

plymkr

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A couple of thoughts on the subject.

1. The nerve he injured is the common peroneal nerve which itself splits into a deep peroneal nerve and a superficial peroneal nerve around the level of the knee.

2. While he has a foot drop there is more to the nerve injury than just that. That is only looking at the ankle as a hinge joint moving up and done. The ankle also inverts (twists foot so sole faces the midline) and everts (twists foot so sole faces outwards). The movement in eversion will be severely affected by the superficial peroneal part of the injury and can't be compensated for well in a brace or with taping.

3. 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.

4. In terms of nerve regrowth, the important part is the gap between where the nerve degenerated to the motor point of the muscle. For the tibialis anterior that is fairly high up in the calf and the re-innervation there will end the foot drop. To get down to the peroneii which help with eversion of the ankle the nerve re-growth has to go down a bit further more like halfway down the calf. So while it is true that the main effects of the injury are on the control of the ankle, the nerve regrowth doesn't have to get all the way to the ankle for Smith to recover.

Thanks, I appreciate the information.
 

cowboyfan4life2

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I'm not even going to begin to try and figure out this nerve stuff.


I just know the Cowboys better have some info that makes them believe he'll be back for us to make him the 34th pick.

I really don't know anything about nerve damage, this injury is new to me, but Jerry better hope this guy can get back this year.
 

mattjames2010

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Sarge

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Way too early to tell and quite frankly, I'm not a doctor.
 
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