Nerve Injury Question

Submitted by Ziff72 on October 29th, 2012 at 8:23 AM

I just had a question from Saturday that puzzled me. I'm not questioning Denard's toughness or the seriousness of the injury just don't really understand the ramifications of a nerve problem.    Maybe someone has some experience with the unjury or was there and knows better, but this is what I saw and then heard from Hoke.

1. Denard gets hurt.... some sort of nerve thing where he has trouble gripping the ball.

2. Denard stands on the sideline with a big coat on.

3. Hoke says he kept checking with trainer and Denard said he can't grip the ball well enough to play.

If the trainers didn't see the injury as serious enough to rule him out shouldn't he have been in the training room getting some treatment?   Not sure what they could do to help a nerve situation but standing in the freezing cold couldn't have been helping it.

Is the injury something that can be numbed?  Denard didn't look in too much pain on the sidelines.  Would playing Denard at qb and having him not pass been a better solution?   Obviously,  in hindsight it could not have been worse.  Just saying at the time I wonder if it was something they discussed.  

 

 

 

 

Comments

JHendo

October 29th, 2012 at 9:40 AM ^

I can't speak to a nerve injury as seemingly severe as Denard's may be, but I've gotten plenty of stingers (a type of brief nerve injury) playing football in my day. After the short duration of pain subsides, you have the same range of motion as you did before...except against resistance. You essentially turn into the world's weakest person with no grip or strength. My trainers wouldn't let us back on the field until we could pass a resistance test. It's not a very painful injury, but it sure is frustrating.

StephenRKass

October 29th, 2012 at 9:45 AM ^

Soi, I'm hearing that rest is what is needed. That makes sense.

There are several things I still don't get. Should Denard get as much rest as possible (and sit vs. MN & NW,) or does he play asap? I'd be for sitting him if the additional rest helps him get that much stronger. If Denard isn't absolutely necessary, and both Devin and Bellomy get game reps, and we're able to win vs. the weaker teams, it is a win - win - win situation:  Denard gets stronger for when it matters, the subs get experience, and we still get the wins.

How injuries heal and how much time is good is something I don't completely understand.

bronxblue

October 29th, 2012 at 9:56 AM ^

I've had stingers that are probably a fraction of the discomfort Denard was under, and the thing is I'm not sure how much you can really do for it.  Like, my arm is basically numb and outside of some electric treatment and anti-inflamatories, there really isn't that much to do.  It isn't like a broken bone that you can set; you just have to wait for the nerve to not be inflamed, for lack of a better word, and then you should get feeling back.  So yeah, standing on the sideline probably wasn't ideal, but it isn't a situation that lends itself to easy treatment.

StraightDave

October 29th, 2012 at 10:00 AM ^

Denard was hurt, I understand.  However, After Denard's Tim Tebow moment following the ND game, I  was expecting a little more leadership from Denard while on the sideline Saturday night.   There is more to  being a leader than making big plays on the field.   DRob showed zero emotion standing on the sideline looking cold.

Ziff72

October 29th, 2012 at 10:27 AM ^

That is pretty funny.

The truth is that is the perception and it is a pretty strong one.   This is the same as when Ladanian Tomlinson stood there as well.

The public relations person on any team should explain to each player they have 3 options if they are hurt.

1. Stay in Locker Room.

2. Lay on table getting attention from staff wincing in pain.

3. If you stay on sidelines you must have helmet off and be engaged with the game or your teammates for every second of the game or you will be obliterated.

I assume Denard was talking to Bellamy on the sidelines but they never showed it so all were left with is "Bundled up Sad Panda".

The sideline was pretty dead.  We had a lot of other Seniors that needed to take control of the situation.  We have no idea if they did or not.

 

 

 

misrara

October 29th, 2012 at 10:21 AM ^

Its irritation of the ulnar nerve.  When I bang my elbow the hand goes numb.  Gotten cortisone shots that helps.  

I wear a brace to keep the pressure off the nerve, it just raises my forearm off the desk.  

There are also full braces that cover the elbow as well but would be impossible to throw with them (restricted movement).  

I am surprised he doesn't put on a forearm brace.  He could still throw with no restriction of movement and when he lands he has less of a chance of hitting his elbow on the ground.  

User -not THAT user

October 29th, 2012 at 10:27 AM ^

Dude had a nerve injury that effectively deadened his left (fretboard) hand to the point where he essentially had to re-learn guitar over the period of a year (anyone familiar with Megadeth's music can attest to the difficulty of that task) due to his hand's refusal to do what his brain told it to do.

I'm not saying Denard's injury is in that same ballpark, but if you use your hand for something that requires more than gross motor coordination (like playing guitar at the speed of light or passing a football in a reasonably accurate manner), then the ability for your hand to react exactly the way your brain tells it to is important.  Hopefully Denard's injury is a stinger that isn't as acute as Mustaine's injury was and he'll be able to resume play this year for his sake and his team's; you know it's killing him not to be able to help his teammates on the field.

And let's face it, without him Michigan may be lucky to go .500 the rest of the year.

Seth

October 29th, 2012 at 10:34 AM ^

[EDIT: read the replies below since they add a lot of clarity and clear up some things I was wrong about]

I'll pass along what a former physicial therapist who worked with athletes (who happened to be watching the game with me) said, with the HUGE caveat that this person was very clear that specific situations and diagnoses could change the math entirely, and that this person would not have the expertise to make such a diagnosis even if they were Denard's doctor and standing right next to him.

So...

Nerve injuries happen in football with some regularity. They are painful in a way that would be debilitatiing to anyone who isn't a football player, because football players can shrug off ridiculous amounts of pain and do so all the time. In most of these cases, it is caused by some sort of swelling that cuts off a nerve (in this case a swelling in his elbow that cut off the nerves in his hand) and that is treated by giving a cortisone shot to the affected area. Cortizone is essentially a steroid, but shot into the affected area to reduce inflammation, not to juice. It doesn't help with the pain, just the swelling.

The downsides of a cortisone shot are well known to football fans. The reason you swell and hurt around an injury is to protect the injured area by making you super-sensitive in that area and providing some extra natural padding. Take away the swelling and you increase the likelihood of adding serious injury to an already beaten thing. The other big thing preventing its use in this case is it can cause permanent damage to joints and is not recommended for use with younger patients. For your dad, or on a 39-year-old NFL quarterback, it's not big deal since the tissues are not going to ever be what they used to be, but a 21-year-old is likely to heal 100% and you don't screw with that for a temporary fix.

The other natural way to treat swelling is to immobilize and ice it, however you don't want to ice it and then use it again until the muscle has warmed up, or risk cramps and  tears. If they put his arm on ice, he would have been done for the day.

Anyway, it is possible for these reasons that the coaches decided that the best course of action for Denard's long-term health and to preserve the possibility of his returning in this game was to keep the arm warm and see if feeling returns to his hand in 30 minutes or so. Or perhaps a cortisone shot is not even allowed by NCAA (wouldn't be surprising) for an in-game situation, so that wasn't even an option. If anyone knows more, please share.

NYC Blue

October 29th, 2012 at 10:50 AM ^

As a physician (though not a physical therapist) I agree with most of what you said, but would add and amend a couple of things.

The swelling or inflammation in an injury like this is caused by blood flow increasing to the area.  This increases delivery of white blood cells to fight infection and red blood cells to deliver more nutrition to the area.  So the inflammation helps heal the area faster.  This is the reason that an injection like cortisone to reduce inflammation is considered counter-productive.  It does take away the pain (the pain is caused by the increased pressure caused by the inflammation) but reducing inflammation slows the healing of the area.

Cortisone is a steroid, but not an anabolic steroid, so it could never be used for "juicing".  In fact, systemic use of cortisone and similar steroids actually promote muscle breakdown (although local injections have little such effect).

I have no idea if the NCAA allows the use of cortisone shots within games, but I am pretty sure that these injections are allowed (but regulated) between games.

There are also non-steroidal anti-inflammatory agents.  The most common are aspirin and ibuprofen, but there are also intravenous and intramuscular agents available which are much stronger and may also be used in place of cortisone.

ericmj

October 29th, 2012 at 10:51 AM ^

Cortisone is not appropiate treatment for this injury.  In addition, it takes hours to days for the affect to be felt.  If you've noticed relief from any injection instantly, it wasn't the steriod, it was the numbing medicine it was mixed with.  

There is a huge difference between cubital tunnel syndrome (a chronic nerve compression syndrome) and a direct impact to the nerve itself.  The direct impact causes a neuropraxia and is treated entirely differently.  

There is absolutely no "quick fix" or injection or therapy that will effectly allow him to return to a game any faster from the sideline.

NYC Blue

October 29th, 2012 at 10:54 AM ^

As a physician (though not a physical therapist) I agree with most of what you said, but would add and amend a couple of things.

The swelling or inflammation in an injury like this is caused by blood flow increasing to the area.  This increases delivery of white blood cells to fight infection and red blood cells to deliver more nutrition to the area.  So the inflammation helps heal the area faster.  This is the reason that an injection like cortisone to reduce inflammation is considered counter-productive.  It does take away the pain (the pain is caused by the increased pressure caused by the inflammation) but reducing inflammation slows the healing of the area.

Cortisone is a steroid, but not an anabolic steroid, so it could never be used for "juicing".  In fact, systemic use of cortisone and similar steroids actually promote muscle breakdown (although local injections have little such effect).

I have no idea if the NCAA allows the use of cortisone shots within games, but I am pretty sure that these injections are allowed (but regulated) between games.

Ice does reduce inflammation, and there are also non-steroidal anti-inflammatory agents.  The most common are aspirin and ibuprofen, but there are also intravenous and intramuscular agents available which are much stronger and may also be used in place of cortisone.

 

JamieH

October 29th, 2012 at 10:34 AM ^

I think this may just be a case of Hoke having wishful thinking or just giving misleading info on injuiries to the media.  Based on Denard's behavior in the 2nd half (i.e. rain jacket on, head down, not doing anything physical at all to stay warmed up) he looked like a guy who knew he was done for the day and had no shot of coming back in.   I think Hoke's proclamation that he was likely to return was probably just wishful thinking that was disspelled at halftime by the doctors. 

Michigan Shirt

October 29th, 2012 at 10:35 AM ^

I may be wrong, but isn't this injury pretty much the exact same thing Colt McCoy had in the MNC game a few years ago. They had video of him in the hallway of the stadium trying to throw passes and they said that due to the numbness he had no way of knowing where the ball was going. I can't say that Denard throwing would have been any better if he had the same injury and it could have potentially caused more fumbles when running if he doesn't know with how much pressure he is holding onto the ball.

Sten Carlson

October 29th, 2012 at 10:44 AM ^

I played lacrosse in high school and for Michigan.  I had a very similar injury in my senior year of high school.  Despite arms pads, I got popped right on the "funny bone" by a long stick d-man while dodging.  We've all hit our funny bone, but this was far worse.  Pain shot up my arm into my shoulder, and my entire right hand went numb.  The pain was as intense as I've ever experienced.  Like we're hearing about Denard, I couldn't close my hand round my stick for at least an hour or so, and for days after, the bottom three fingers on that hand remained completely numb, and making a fist hurt like hell.  To make matters worse, even after the feeling came back, even the slightest bump to that area caused a similar, albeit milder, reaction.  That was in 1991, and to this day, anytime I bump my funny bone on my right arm, it causes a far worse reaction than it did before.

misrara mentioned a brace as a preventative measure.  For my part, I was told that there was nothing that could be done to prevent it from recurring, other than stop taking shots to the elbow -- which was difficult for an attackman.

I hope Denard isn't too hampered by this injury, as it seems that there is little to nothing that can be done to make it heal.

Yeoman

October 29th, 2012 at 11:04 AM ^

But what is it you would expect him to say if he had had any doubts? "I lost confidence in Russ after the second interception but we didn't have a better option so we left him out there anyway."?

I for one am glad to have coaches who don't toss kids under the bus during post-game pressers.

goblueva

October 29th, 2012 at 10:52 AM ^

I am former athletic trainer who used to work college football for 5 years. There isn't much to do other than keep asking the athlete if they're ready. Treating this type of problem on the sidelines is difficult. There isn't a quick fix. An injection can help but usually these are done with ultrasound guidance so as to take extreme care around the nerve. The nerve innervates the small muscles between the bones in the hand so this injury greatly affects grip. Unfortunately time is the best healer here and hopefully Denard is ready this weekend.

profitgoblue

October 29th, 2012 at 10:57 AM ^

The thing that is most interesting about a thread like this is that we all learn so much from it.  I can remember years ago wondering why someone was not playing because he had "turf toe" and thinking that sounded ridiculous only to learn years later that it is a kind of injury that sidelines almost everyone.  These kind of "silly" injuries are unexpected in a game of huge hits (see Lattimore's injury) but are just as dehabilitating as broken bones, etc.  I'm sure there were thousands of people yelling at Denard to shake it off and man-up but we can all recognize their stupidity now.

profitgoblue

October 29th, 2012 at 11:21 AM ^

He'll just never be good enough for many.  Desmond and Woodson never went through this kind of scrutiny and Denard is on their level.  Maybe its because of the QB position but I feel its more than just that, for some reason.

M-Wolverine

October 29th, 2012 at 11:43 AM ^

Going backwards-

Denard

Tate

2008

Henne

Navarre

Henson

Brady

Griese

etc.

Other than maybe one year of Henson, have we EVER as a fanbase been happy with our QB? Even those the vast majority of them have been very good to great?

Bacon said the two toughest positions in the state to play are goalie for the Red Wings, and QB for Michigan. I'd probably add QB for the Lions to that too, but he has a point. It's like OC for Michigan, Manager of the Tigers, GM of the Lions....they're whipping boys, whether it's deserved or not.

 

Edit: As an addition, in the present we're always tougher.  Everyone has ripped on Lloyd, Rich, and Hoke/Borges, but speaks in whispered tones about Bo.  But when Bo was coach people would constantly complain about too conservative, needs to pass more, run a modern offense, loses too many Rose Bowls, etc. Godfather of the program right now, and on the bus with the alumni at the Rose Bowl after Bo's final game someone said "well maybe we can finally run a modern offense now."

Moral of the story? Fans suck.

M-Wolverine

October 30th, 2012 at 12:08 AM ^

Because it's just sports, everyone thinks they know as much. Listen to Detroit talk radio about how many people could manager the Tigers better, even though we've been to as many World Series under the current one as in almost the previous 40 years.

Michigan fans just seem worse because they've been so spoiled that in a season that everyone thought looked like a 9-3/8-4 record they get mad when we're not winning 11 games a year, even though we've never done that...and really, no one else has other than for short stretches. (Closest was probably FSU at their peak)

dmblue

October 29th, 2012 at 11:24 AM ^

Turf toe blows.  I got it last spring and could barely even walk.   I could not have run if i tried.  It sounds like a joke, but it's actually a sprain on your big toe, which is extremely important for acceleration/jumping.  The worst thing is it takes 1-2+ months to heal.

dmblue

October 29th, 2012 at 11:21 AM ^

I've had this exact injury before, though not playing sports. I banged my ulnar nerve very hard (funny bone) on the corner of a chair.  I had my laptop in my hand and immediately had to yell  at my friend to take it from me.  I was in severe pain for about 5-10 minutes.  I could not use my pinky and ring fingers at all.  There was numbness and severe weakness.

3 days later: I was at 60%.  

5 days later: I was at 100%.  

This is without cortisone or any therapy.  Denard will be fine by the end of the week.

Tater

October 29th, 2012 at 11:46 AM ^

The short version: you tell your hand to grip and it doesn't grip because the nerve impulses aren't getting to the muscles.  It has nothing to do with toughness.  Denard's toughness should never, ever be questioned by anyone here, anyway.

misrara

October 29th, 2012 at 1:00 PM ^

By no means was I advocating cortisone for Denard - just telling people my treatment - which had gotten so bad I couldn't sleep at night.  The cortisone eased the pain so I could sleep.  

I am also not a 21 year old kid playing football LOL

In terms of elbow pad - I think Denard could wear something - if you watched both this hit and the Illinois hit - he actually dove forward on both plays leading with his elbow and hit the ground.  So the impact to the ground is actually causing the pain.    

Yes it was exacerbated by guys landing on him but its the initial impact that did it.  

If he instead landed on a small pad that might avoid hitting the nerve.

My 2 cents.  

Hope he is good to go for Saturday and the rest of the year.  I will miss him when he's gone from the program.  

Lampuki22

October 29th, 2012 at 1:29 PM ^

I was running back in JV, HS f-ball and had injuries like this all the time. Though it must not have been as bad as Denard's (never came out of the game) I  remember feeling like my funny bone had been hit but it was constant for a few days then went away as the nerves healed.  With a bad one, no way I could have held a ball and thrown it.--but I dould still take handoffs and block.   

Still extremely sensative to this day.  Every time I hit my my elbow on the desk I am reminded of my playing days. 

You ladies who never played the game just can't relate to things discussed on this board the way some of us, including my 7 year old can,  so you should probably just stick to the softball threads.    

jls1144

October 29th, 2012 at 4:38 PM ^

Dude, I hope your being sarcastic. I am a female and have had broken bones, torn ligaments, multiple surgeries from my playing days. Please, don't pretend that your high school highlights give you a one up one anyone regardless of gender.

justingoblue

October 29th, 2012 at 6:54 PM ^

that a) there are common football injuries that a female is more likely to experience than a male (ACL tears come to mind) and b) for a lot of people, the worst injury they will experience won't come from playing a sport. It's one thing to get hit by a high school or even college linebacker, but I'll take my chances against Jake Ryan before I'll take my chances with that Escalade doing 40mph, even in a car. Same goes with a lot of other freak accidents.

Also, as far as that softball remark, I've seen some photos taken during a softball playing friend's shoulder surgery, and it was not pretty, even compared to my shoulder MRI's (which were also not pretty). I've had a grade three seperation from playing hockey and have taken hundreds of violent hits to that shoulder afterwards: in no way would I trade shoulders with her, and I damn sure wouldn't volunteer to go through the surgery and rehab process she's gone through in an attempt to play this spring.

rob50

October 29th, 2012 at 2:35 PM ^

I've damaged my ulner nerve as well (programmer's elbow). My ring and pinky fingers were very numb and my grip was VERY weak, off and on. I went to the doctor, but nothing (not very invasive) could really be done in the short term. I wore a brace / splint for a while, did some physical therapy, changed some work habits and bought some ergonomic equipment and it got better in time, serviceable in the medium term, fine now. At its peak I definitely wouldn't be able to grip or throw a football with any authority.

I'm sure if Denard could have been out there he would have been.

jsquigg

October 29th, 2012 at 4:59 PM ^

Trust me, if there was any treatment that could have gotten Denard back on the field, then Hoke and Co. would have had it done.  I think a fairer question is why weren't we catering the playcalls and personnel more to Bellomy's strengths and weaknesses.  No Rawls and they still ran a lot of the offense out of the gun without the advantage of the extra blocker.  I would think that the coaches should have been more prepared for that scenario given Denard's history...

GR_TrueBlue

October 29th, 2012 at 5:59 PM ^

So this is an ongoing nerve issue in his elbow. We've seen him out mutiple times this season.

Why doesn't he wear any kind of protection on that elbow? I know it's his throwing arm, but like a sleeve or those hexagonl pads are very flexible and wouldn't impede his throwing motion,

NYC Blue

October 29th, 2012 at 7:43 PM ^

This is only the second game this happened.  So it was not really "ongoing" until now.  It happened against Illinois and was fine during the MSU game.

Not sure it could have been predicted, and we really did not need anything inhibiting his passing mechanics further.

Now that it has happened twice, they may look at a sleeve.

michfan6060

October 29th, 2012 at 6:05 PM ^

There is nothing that can be done in that situation. As a Packer fan I remember in 2007 Brett Favre had the same thing happen to him against Dallas and all he could do was stand on the sideline just like Denard.

wolves13

October 29th, 2012 at 8:38 PM ^

I have had both of my ulnar nerve's moved surgically, the one in my left arm got hit numeous time's and according to the surgeon when the nerve is injured the body response is to make scar tissue at the site of the nerve injury and if this is in the elbow this restrict's the nerve from moving smoothly through the cubital tunnel . This cause's pressure on the nerve as it stretches, causing loss of blood flow and feeling. Hopefully for denard this isn't the case.