Jaylon Smith: A Dark Prediction?

[haleyrules]

This guy:

That's him, right?

 

[tcain2004]

They said his nerve is firing and he can start moving his toes in a way he couldn't before.

That's called "progress", no idea what this guy is talking about.

Was listening to xm radio and they said smith had some test done and the nerve was firing 5x as much as the previous month.

 

[Shuff]

who says they aren't? Is it they are not saying or you don't believe them?

Who are you going to believe? Lost of posts, nothing really concrete.

 

[FuzzyLumpkins]

I've read plenty of stuff about nerve recovery and this Chao guy is the first guy I have ever read saying it has to be quick or it is over. Everything else I have read has been consistently along the opposite line.

For example:

Muscle fibers undergo atrophy as early as 3 weeks after denervation, with collagen deposits forming in the endomysium and the perimysium. However the structural architecture of the muscle and the end-plate integrity can be maintained for up to 1 year69,89. After 2 years, irreversible muscle fibrosis has occurred along with muscle degeneration, leading to a permanent loss of functional muscle tissue. Sensory end-organs such as Paccinian corpuscles, Meissner corpuscles and Merkel cells can last up to 2-3 years, so sensory function can still be recovered even after muscle function is permanently lost33. The time for growth supportive phenotypes of Schwann cells associated with target tissues are also limited90. Nerve transfers have been used to try and prevent denervation atrophy, but full strength and muscle function are seldom fully recovered91.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408553/

It describes not only the time frames as 2 years but the mechanisms that govern the time frame. If it doesn't get back in two years then the fibrosis will prevent innervation.

As the nerve grows down it will continue until scar tissue blocks it. He can wiggle his toes now so his nerve has regenerated to those most distally extreme location. It has nto been two years and he has been seeing steady progress on that front for months now.

I don't find Chao credible at all.

 

[DanTanna]

Recovery from a nerve injury is either early or not at all

What a friggin liar!
I had almost the same type of nerve damage as Jaylon and I felt no regeneration for 4-6 months. After a full year it was 80%ish. Years later 95%ish.

 

[Macnalty]

Every time I hear the FO talk about Jaylon Smith it reminds me of Shakespeare's Hamlet "The lady doth protest too much, methinks" with the aromatic hint of Danny Coale and Matt Johnson. I so hope I am wrong.

 

[Doomsday101]

Who are you going to believe? Lost of posts, nothing really concrete.

I believe those who are working with Jaylon and Jaylon.

 

[Doc50]

Is there any truth in his statement that "Recovery from nerve injury is usually early or not at all." and that the fact that only 12-15 months later we hear bit and pieces about him getting his feeling back is really a bad thing?

No.

And by that statement alone, he identifies himself as ignorant of traumatic neurologic injury syndromes, which have been presented and discussed on this site ad nauseum.

 

[Rogerthat12]

This guy:

That's him, right?

 

[Vinnie2u]

Was listening to xm radio and they said smith had some test done and the nerve was firing 5x as much as the previous month.

He using Nervagra..

 

[yimyammer]

Not sure how credible this is . . . but some of the analytical points are worth noting . . . .

"Recovery from nerve injury is usually early or not at all.
At this point medically, it appears there is no way for the nerve to ever be 100 percent.
Smith has blown through the reported recovery estimate already, as his doctor initially indicated a three-month timeline from April of 2016. No question he had a top surgeon, who happens to be the Cowboys team doctor, but there is not much one can do about a nerve. It either does or doesn’t recover."

http://www.sandiegouniontribune.com...oys-nerve-update-minicamp-20170509-story.html

and they're off!

 

[lkelly]

Actions speak louder than words. Our FO did not sign a free agent LB or draft one. That is all any of us needs to know at this point about the state of Jaylon Smith's recovery.

The Jets didn't draft a QB.

(Haven't read the rest of the thread, so if that's a duplicate please deduct the appropriate number of likes.)

 

[casmith07]

kinda catching up to this whole gloom and doom with jaylon as of late. is the whole fuss being about garrett's comments being that he wont do Rookie Ota's? is there more info?

Basically it. Garrett and the Cowboys said that he would participate in the rookie OTA program, but never said to what extent. Media and fans took it to mean he would be out there in gear running drills. The Cowboys clarified the statement, and now everyone is back on the "he'll never play a snap" train.

Overreaction, typical of the offseason. Go Cowboys.

 

[Bullflop]

Obviously, we have a choice as to whom we wish to believe. To me, Dr. Chao has enough discrepancies with his records of past practice to cast a significant number of doubts as to the likelihood of his overall credibility.

On the other hand, Jaylon's surgeon, Dr. Cooper, is known to be extremely reputable. In addition, he has had first-hand experience with Jaylon's case. It was close up and personal enough to have, by far, more reliable knowledge than Dr. Chao.

Given their polar opposite reputations, I'm inclined to put much more trust in Dr. Cooper than someone who professes to know all about it from afar. I believe the evidence points very convincingly in favor of optimism for Jaylon's highly satisfactory recovery, rather than the opposite.

 

[hra8700]

I'm a doctor (though not an orthopedist) and I've looked into the subject a bit. Things I would note:

1. Dr. Chao is very qualified to discuss this topic, however, complete peroneal nerve palsy after total knee dislocation is a rare event, even for an orthopedic surgeon specializing in sports medicine. A 2014 meta-analysis of all published studies found only 214 documented cases in the literature. Of course, most cases are not published, but even still Dr. Chao has probably not personally seen enough patients with this condition all the way through their rehabilitation process to be able to statistically give an accurate assessment of their outcomes.
2. Looking through the literature, in a pt with complete peroneal palsy clinically there is about a 1/3 rate of adequate (not FULL) recovery. However, this includes patients that have persistently negative findings on EMG/NCS and clinical exam (which does not include Jaylon). Furthermore it includes pt with known severing of the nerve (this does not include Jaylon).
3. If patient demonstrated no neurologic recovery on EMG/NCS, they would not have continued to observe him for as long as they did. Jaylon mentioned early on that they did a test that had good news, likely implying that there was detectable nerve conduction even if there was no clinical improvement. That is why they continued to observe him. The prognosis in these patients is considered "good" in the literature I saw, but I'm not sure there is any study to document an exact rate of recovery. He now has FNC 1-2 reportedly (can move toes); 3 is considered "good" recovery

I think Jaylon has a good chance of reaching FNC 3 (meaning he can lift his foot off the ground against gravity). His chances of reaching full strength I think is pretty low. To what degree he is able to play football and at what level is also completely unknown. Dr. Chao notes that very few players have come back from this injury in the NFL. He fails to note that very few players have HAD this injury in the nfl. So who can and can't come back is not completely known.

I agree that people need to pump the brakes. The odds are still very much AGAINST Jaylon Smith. But I think he is exaggerating the degree of pessimism.

 

[waldoputty]

I'm a doctor (though not an orthopedist) and I've looked into the subject a bit. Things I would note:

1. Dr. Chao is very qualified to discuss this topic, however, complete peroneal nerve palsy after total knee dislocation is a rare event, even for an orthopedic surgeon specializing in sports medicine. A 2014 meta-analysis of all published studies found only 214 documented cases in the literature. Of course, most cases are not published, but even still Dr. Chao has probably not personally seen enough patients with this condition all the way through their rehabilitation process to be able to statistically give an accurate assessment of their outcomes.
2. Looking through the literature, in a pt with complete peroneal palsy clinically there is about a 1/3 rate of adequate (not FULL) recovery. However, this includes patients that have persistently negative findings on EMG/NCS and clinical exam (which does not include Jaylon). Furthermore it includes pt with known severing of the nerve (this does not include Jaylon).
3. If patient demonstrated no neurologic recovery on EMG/NCS, they would not have continued to observe him for as long as they did. Jaylon mentioned early on that they did a test that had good news, likely implying that there was detectable nerve conduction even if there was no clinical improvement. That is why they continued to observe him. The prognosis in these patients is considered "good" in the literature I saw, but I'm not sure there is any study to document an exact rate of recovery. He now has FNC 1-2 reportedly (can move toes); 3 is considered "good" recovery

I think Jaylon has a good chance of reaching FNC 3 (meaning he can lift his foot off the ground against gravity). His chances of reaching full strength I think is pretty low. To what degree he is able to play football and at what level is also completely unknown. Dr. Chao notes that very few players have come back from this injury in the NFL. He fails to note that very few players have HAD this injury in the nfl. So who can and can't come back is not completely known.

I agree that people need to pump the brakes. The odds are still very much AGAINST Jaylon Smith. But I think he is exaggerating the degree of pessimism.

i thought he did not have a dislocated knee.
surprised there is only 214 cases when you included severing of nerve and negative EMG.

 

[Idgit]

I've always thought the Smith pick was a stupid and unnecessary risk. I do think the team seems to be legitimately high on his prospect of returning, and I do think absent an explicit medical opinion from someone familiar with his case, the fact that we let two LBs walk and drafted zero is pretty telling re: what the team is expecting from him on the field this season.

 

[FuzzyLumpkins]

I'm a doctor (though not an orthopedist) and I've looked into the subject a bit. Things I would note:

1. Dr. Chao is very qualified to discuss this topic, however, complete peroneal nerve palsy after total knee dislocation is a rare event, even for an orthopedic surgeon specializing in sports medicine. A 2014 meta-analysis of all published studies found only 214 documented cases in the literature. Of course, most cases are not published, but even still Dr. Chao has probably not personally seen enough patients with this condition all the way through their rehabilitation process to be able to statistically give an accurate assessment of their outcomes.
2. Looking through the literature, in a pt with complete peroneal palsy clinically there is about a 1/3 rate of adequate (not FULL) recovery. However, this includes patients that have persistently negative findings on EMG/NCS and clinical exam (which does not include Jaylon). Furthermore it includes pt with known severing of the nerve (this does not include Jaylon).
3. If patient demonstrated no neurologic recovery on EMG/NCS, they would not have continued to observe him for as long as they did. Jaylon mentioned early on that they did a test that had good news, likely implying that there was detectable nerve conduction even if there was no clinical improvement. That is why they continued to observe him. The prognosis in these patients is considered "good" in the literature I saw, but I'm not sure there is any study to document an exact rate of recovery. He now has FNC 1-2 reportedly (can move toes); 3 is considered "good" recovery

I think Jaylon has a good chance of reaching FNC 3 (meaning he can lift his foot off the ground against gravity). His chances of reaching full strength I think is pretty low. To what degree he is able to play football and at what level is also completely unknown. Dr. Chao notes that very few players have come back from this injury in the NFL. He fails to note that very few players have HAD this injury in the nfl. So who can and can't come back is not completely known.

I agree that people need to pump the brakes. The odds are still very much AGAINST Jaylon Smith. But I think he is exaggerating the degree of pessimism.

"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?

 

[willia451]

The Cowboys bet the farm at LB on JS. Especially since we drafted no one to hedge the bets.

If it works out, Jerry will look like a genius. If not. Then it just adds to his list of risk taking busts in the second round.

And not harm done. He'll take the heat for it. And won't be losing any sleep either way.

In his 40 year old mind, I'm sure he thinks it was worth the risk.

 

[diefree666]

I'm a doctor (though not an orthopedist) and I've looked into the subject a bit. Things I would note:

1. Dr. Chao is very qualified to discuss this topic, however, complete peroneal nerve palsy after total knee dislocation is a rare event, even for an orthopedic surgeon specializing in sports medicine. A 2014 meta-analysis of all published studies found only 214 documented cases in the literature. Of course, most cases are not published, but even still Dr. Chao has probably not personally seen enough patients with this condition all the way through their rehabilitation process to be able to statistically give an accurate assessment of their outcomes.
2. Looking through the literature, in a pt with complete peroneal palsy clinically there is about a 1/3 rate of adequate (not FULL) recovery. However, this includes patients that have persistently negative findings on EMG/NCS and clinical exam (which does not include Jaylon). Furthermore it includes pt with known severing of the nerve (this does not include Jaylon).
3. If patient demonstrated no neurologic recovery on EMG/NCS, they would not have continued to observe him for as long as they did. Jaylon mentioned early on that they did a test that had good news, likely implying that there was detectable nerve conduction even if there was no clinical improvement. That is why they continued to observe him. The prognosis in these patients is considered "good" in the literature I saw, but I'm not sure there is any study to document an exact rate of recovery. He now has FNC 1-2 reportedly (can move toes); 3 is considered "good" recovery

I think Jaylon has a good chance of reaching FNC 3 (meaning he can lift his foot off the ground against gravity). His chances of reaching full strength I think is pretty low. To what degree he is able to play football and at what level is also completely unknown. Dr. Chao notes that very few players have come back from this injury in the NFL. He fails to note that very few players have HAD this injury in the nfl. So who can and can't come back is not completely known.

I agree that people need to pump the brakes. The odds are still very much AGAINST Jaylon Smith. But I think he is exaggerating the degree of pessimism.

you ignore the recent reports on Smith. So trying to claim NOW the odds are against him playing is frankly weak.