Injury Updates for 2013 NFL Draft's Biggest Medical Red Flags

Dave Siebert, M.D.Featured ColumnistMarch 28, 2013

Injury Updates for 2013 NFL Draft's Biggest Medical Red Flags

0 of 11

    The way the 2013 NFL draft unfolds may depend on health concerns and recovery from injury more than any other in recent memory. Knee injuries, heart conditions, spine anomalies and autoimmune disorders represent only the tip of the iceberg, and NFL medical staffs continue to scramble for information leading up to April's draft weekend.

    Some of the red flags are more concerning than others. They range from minor nuisances with few downstream effects to bona fide career-threatening injuries and maladies.

    Which conditions can be dismissed, and which can't? How will they affect the draft strategies of the 32 NFL teams?

    To answer those questions and more, let's take a look at each player currently heading into the draft with a medical concern, ranked in order from lowest to highest draft risk.

Author's Note: Ranking Criteria and the Concept of Risk Versus Reward

1 of 11

    Risk-versus-reward decisions are the heartbeat of sports medicine. Some teams may decide that a player is undraftable due to a medical condition, while others may factor it in only minimally when determining his draft stock.

    Among other criteria, the decision of whether or not to drop a player on a team's big board due to a medical concern depends on the following:

    • Severity of the injury or condition in question
    • Present player limitations, if any
    • Player's injury and healing history
    • Projected recovery timeline, if applicable
    • Risk of re-injury or condition progression
    • Player's skill set and potential
    • An individual team's need at the player's position

    Additionally, each NFL team's medical staff must come to its own conclusion about a player's health report and prognosis. Therefore, a player's value can vary widely from team to team, and the following slides should only be used as one possible guide to the medical issues at hand.

    Finally, remember that it only takes one team to give a player a shot at the big time.

10. Dee Milliner, CB, Alabama (Labrum)

2 of 11

    In March, Alabama cornerback Dee Milliner—widely regarded as the top cornerback entering this year's draft—underwent surgery to repair a torn labrum in his right shoulder (h/t Kareem Copeland, NFL.com). Milliner suffered the injury at some point during his final season at Alabama, but it did not force him to miss any time. He also completed all of his workouts at the NFL Scouting Combine, save for the bench press.

    Depending on the type of tear and its severity, a labrum tear can be a minor afterthought, an extremely serious issue or something in between. Since Milliner did not miss any time due to the injury, the assumption that his tear is on the minor end of the spectrum is a safe one.

    Nevertheless, Milliner required surgery because even minor labrum tears are very stubborn to heal. Labrums—like all cartilage—have relatively poor blood supplies compared to other tissues in the body, which limits their self-healing ability. Surgery assists the healing process, and once Alabama's season concluded—and once he showed off his stuff at the Combine—Milliner had ample time to undergo surgery and get started with rehab.

    Milliner is still recovering and, therefore, will be unable to perform any additional physical workouts, but he already turned heads at the combine by putting up a 4.37 second 40-yard dash time.

    He is also still hard at work. On March 27, NFL.com's Ian Rapoport reported that Milliner will meet with the Kansas City Chiefs, the owners of the first overall pick this year.

    Assuming no complications develop regarding his shoulder, Milliner will likely remain at—or very close to—his original position on most teams' big boards. According to Adam Schefter of ESPN, doctors expect a full recovery by the time training camps roll around, and nothing has yet suggested that his injury should be too much of a concern.

    Risk Level: Low

    Potential Upside: Very high

    For more technical information about labrums, check out my March 8 article on Dee Milliner's shoulder injury here.

9. Eddie Lacy, RB, Alabama (Hamstring)

3 of 11

    Keeping with the Crimson Tide, University of Alabama running back Eddie Lacy strained his hamstring in February while preparing for the Combine. An MRI showed a "small tear in some tissue around the hamstring," and the injury held Lacy out of both the Combine and Alabama's pro day.

    It is very easy to dismiss hamstring injuries as insignificant, as they occur frequently enough to become a sort of injury white noise, so to speak.

    Unfortunately, it isn't quite that simple. Hamstring strains put a player at increased risk of future strains, and this particular injury has continued to linger into late March.

    As a result, Lacy remains unable to address questions about his top-end speed. His injury history is also somewhat extensive.

    Lacy's hammy will fully heal—eventually. However, the timetable continues to be vague, and Dusty Compton of the Tuscaloosa News reported on March 13 that Lacy plans to work out for scouts on the "last date possible." The Sideline View's Lance Zierlein also states that "there are some long-term durability concerns" surrounding the running back.

    More questions than answers is the last thing any prospect needs heading into the draft.

    Risk Level: Low to moderate

    Potential Upside: Moderate to high

    Curious why hamstring injuries tend to linger? My March 13 article on Lacy's hammy has your answers.

8. Matt Barkley, QB, USC (Shoulder)

4 of 11

    Though many projected him to be among the first players taken in the 2012 NFL draft, Matt Barkley decided to return to USC for his senior season.

    His plan backfired.

    After struggling down the stretch, Barkley's 2012 season abruptly ended on Nov. 17 when he suffered a separated throwing shoulder on a tackle by UCLA linebacker Anthony Barr (h/t CBS Los Angeles). Pro Football Talk's Mike Florio later clarified the injury to be a grade three separation, implying tears to both the shoulder's acromioclavicular and coracoclavicular ligaments.

    Fortunately, Barkley avoided surgery, but by the time the Combine rolled around in February, his shoulder remained only "90 percent" healed, according to Florio. As such, he elected not to throw.

    The decision to not throw was probably a smart one. Questions about Barkley's arm strength had already started to surface prior to the injury, and loose shoulder ligaments can interfere with throwing mechanics, shoulder range of motion and overall arm strength. In other words, throwing at 90 percent would have probably hurt Barkley's stock more than not throwing at all.

    Fast forward to USC's March 27 pro day. Barkley, now fully healed, showed off what he could still do. Regrettably, it probably didn't do much to improve his stock.

    "Although NFL Network analyst Charles Davis thought Barkley 'did a good job,' it was not enough to 'knock Geno Smith off his pedestal,'" NFL.com's Chris Wesseling wrote on Wednesday. Smith is expected to be the first quarterback taken in April.

    Wesseling also mentions that NFL Network draft analyst Mike Maycock saw what he expected to see from Barkley in terms of arm strength.

    "It's good. It's just not elite," Maycock said. He added that Barkley's spiral underwhelmed at times and that some throws "fluttered against the wind."

    Bleacher Report's NFL featured columnist Jesse Reed noted many similarities. More promising, though, is that Yahoo! Sports' Doug Farrar reported Barkley's throwing velocity to be about equal to its pre-injury level.

    In short, it seems like Barkley performed as many expected he would, and his shoulder is likely back to 100 percent. Nevertheless, tissues such as ligaments are never quite the same following injury, and it is possible that teams will consider the possibility of Barkley being injury prone when determining his value.

    Risk Level: Low to moderate

    Potential Upside: Moderate to high

    For more technical information, take a look at my Feb. 20 article on the anatomical details behind Barkley's shoulder separation.

7. Robert Alford, CB, Southeastern Louisiana University (Crohn's Disease)

5 of 11

    Southeastern Louisana University cornerback Robert Alford drew attention at the NFL Scouting Combine for a few different reasons. For one, he tore up the track with an official 40-yard dash of 4.39 seconds. He also posted a 40-inch vertical leap.

    Unfortunately, according to a tweet from Russell Lande of the National Football Post, doctors also discovered that Alford suffers from Crohn's disease.

    What is Crohn's disease? Essentially, it is an autoimmune condition that primarily affects the digestive system. In other words, the body's immune system attacks itself. Both former New England Patriots tackle Matt Light and New York Jets quarterback David Garrard suffer from the disease as well.

    During disease flares—for still unclear reasons—the lining of the intestines becomes inflamed. The most common resulting symptom is abdominal pain, pain that can range from mild to downright debilitating. Intestinal bleeding is also possible, as are a number of other extra-intestinal complaints. In the worst case scenario, sections of inflamed intestine can become blocked or infected and require surgery.

    Nevertheless, with proper treatment and medication, many cases of Crohn's disease can be controlled. It is also safe to say that Alford's case is relatively new in onset, as most cases present in adolescence or early adulthood. He also made it this far without too much trouble.

    So, what's the take-home message?

    Unfortunately, Crohn's disease is an incredibly variable diagnosis. It might go into remission for decades, or it might flare-up multiple times per year. For now, there is no method of predicting its course outside of an individual's disease history, and even then, nothing is a guarantee.

    Risk Level: Moderate

    Potential Upside: Moderate

6. Star Lotulelei, DT, Utah (Heart)

6 of 11

    UPDATE: Tuesday, April 2, at 2:37 p.m. ET

    As expected by many, Lotulelei's heart scare seems to be a thing of the past. Pro Football Talk's Darin Gantt reports Lotulelei's heart function is back to normal. Specifically, there is "no evidence of dysfunction."

    Put Lotulelei back to the position he occupied on big boards before the February echocardgiogram. His medical risk is now likely insignificant.

    --End of update--

     

    The stars were aligned for University of Utah defensive tackle Star Lotulelei to be taken with one of the first few picks of the 2013 NFL draft.

    Then, doubts began to swirl.

    In February, ESPN's Chris Mortensen reported that Combine physicians discovered Lotulelei's left ventricular ejection fraction (LVEF) to be 44 percent. In other words, Lotulelei's heart was pumping out only 44 percent of the blood within it with each beat. A normal LVEF is 55 to 70 percent.

    Even though he was experiencing no symptoms, concerns that his heart might not be able to meet his body's demands during intense exercise—something that could lead to anything from mere light-headedness to a life-threatening irregular heartbeat—led to Lotulelei being held from working out at the Combine. Instead, he returned to Utah to undergo further testing.

    Causes of a low LVEF range from the minor and temporary to serious and chronic. As of March 27, no reports detailing the exact cause of Lotulelei's low LVEF yet exist, possibly owing to the fact that no cause is identified up to 50 percent of the time.

    Of course, exact medical details are unavailable to the public, but at this point, it is probably safe to say the cause of Lotulelei's low LVEF is a reversible one. Additionally, the probability that he suffers from a chronic or progressive heart condition is essentially zero.

    How can anyone be so sure of that from the outside looking in?

    Simple. When it comes to the heart, the balance of risk versus reward is too dramatically skewed toward risk to allow for any uncertainty. No doctor would clear Lotulelei to work out at Utah's pro day with a dangerously under-performing left ventricle.

    With that in mind, the fact that Lotulelei did work out at Utah's pro day after being cleared by cardiologist Josef Stehlik is extremely reassuring (h/t Doug Farrar, Yahoo! Sports). It strongly suggests the condition is both temporary and resolving. In fact, there is a decent chance the low LVEF may have gone entirely unnoticed if it didn't happen to be caught by an echocardiogram.

    Nevertheless, teams will be curious. Medical reports should help clear the air, but questions will remain. Is his LVEF back in the 55-to-70 range? Will this happen again? When it comes to possibly investing in a top-10 draft pick, teams can never be too sure.

    Risk Level: Moderate

    Potential Upside: High to very high

    I took a more detailed look at what could be going on with Star Lotulelei's heart back on Feb. 25.

5. Jarvis Jones, LB, Georgia (Spinal Stenosis)

7 of 11

    Among the more polarizing medical risks in this year's draft, Jarvis Jones' story began in 2009 while playing for USC (h/t Jordan Conn, ESPN The Magazine). Following a tackle during a game against Oregon, Jones experienced numbness in his shoulders.

    Doctors later diagnosed Jones with cervical spinal stenosis—a narrow spinal canal—at the C4 and C5 levels. Basically, Jones' fourth and fifth vertebrae in his neck form an abnormally tight circle around his spinal cord. USC physicians would not clear him to return to football after the diagnosis, prompting him to transfer to Georgia in 2010.

    Players with cervical spinal stenosis are at increased risk of "stingers," an injury defined as temporary numbness or weakness in one arm following a hit that sharply bends the neck. Cervical cord neurapraxia (CCN)—temporary paralysis of up to all four limbs—also probably occurs more frequently in athletes with cervical spinal stenosis.

    Importantly, no evidence yet suggests that the condition increases the risk of suffering permanent, catastrophic neurological damage—such as in the heartbreaking story of former Rutgers defensive tackle Eric LeGrand.

    Just as important, the degree of increased risk of stingers and CCN is directly proportional to the amount of spinal canal narrowing.

    According to Rob Rang of The Sports Xchange/CBSSports.com, Jones has experienced no symptoms since the 2009 episode. Additionally, his condition—originally called "mild"—has not progressed, as can sometimes occur. Finally, renowned orthopedist Dr. Craig Brigham decided that Jones—after sitting out the Combine—"is cleared to play without restriction" (h/t Dan Pompei, National Football Post).

    So, he's good to go, right? Unfortunately, the answer isn't clear, and it probably never will be.

    Sure, he hasn't had symptoms in four years, but there is no guarantee that he won't re-experience them in the future. Medical opinions will vary from team to team. Combine that with a less-than-impressive March 21 Georgia pro day, and Jones' draft stock is anything but a guarantee.

    Risk Level: Moderate

    Potential Upside: Moderate to high

    Check out my March 5 report on Jarvis Jones' condition for more details about spinal stenosis.

4. Brandon Jenkins, DE, Florida State (Lisfranc Injury)

8 of 11

    Foot injuries certainly aren't the sexiest injuries to discuss, but Brandon Jenkins' Lisfranc joint injury could still affect the former Seminole's draft stock over six months later. He suffered the season-ending injury on Sept. 4, 2012 (h/t David Hale, ESPN).

    According to Hale's column, Jenkins' injury occurred when a teammate stepped on his left foot.

    Wait. Being stepped on by a teammate ended Jenkins' season? How can that be?

    The Lisfranc joint is a large, complex structure. It is located where the long bones that make up the bases of the toes—called metatarsals—meet the bones of the midfoot.

    When too much downward force is applied to the midfoot, the ligaments that connect the the metatarsals to the midfoot can stretch or tear. Sudden trauma—such as falling from a height—can also cause dislocations or fractures at the Lisfranc joint.

    Lisfranc injuries can involve anywhere from one to all five metatarsals. If any metatarsals break or become displaced from the midfoot, surgery is usually required to stabilize the joint. For instance, surgeons may use metal screws to hold the bones in place.

    In November, Bob Ferrante reported in the Palm Beach Post that Jenkins did, in fact, undergo surgery, suggesting at least some displacement of one or more parts of his Lisfranc joint. He also remained in a stabilizing walking boot for several weeks following the surgery—one of the most important aspects of Lisfranc injury recovery is immobilizing the healing joint.

    Lisfranc injuries can be extremely tricky. The mechanics of walking and running place large amounts of stress on the midfoot, and weak ligaments may be unable to cope until they are fully healed. They are also extremely fragile during the healing process and quite prone to re-aggravation.

    Where does Jenkins stand now?

    Fortunately, he is working out once again. Yet the good news might end there.

    At Florida State's Pro Day, he didn't break five seconds in the 40-yard dash, and questions arose about him not yet being fully recovered.

    Due to the troublesome nature of Lisfranc injuries and the extended time Jenkins remained sidelined following the injury, he is likely not in prime shape just yet. Prolonged foot immobilization and deconditioning may have prevented him from being able to show off his best.

    If he truly wasn't ready, NFL teams will be left with one pressing question—when will he be?

    Risk Level: Moderate to high

    Potential Upside: High

3. D.J. Hayden, CB, Houston (Inferior Vena Cava)

9 of 11

    The fact that D.J. Hayden is alive is astounding enough. In fact, him being in this year's draft discussion is downright miraculous.

    In November, Hayden suffered a torn inferior vena cava (IVC)—the largest vein in the body that is responsible for bringing blood from the lower half of the body back to the heart—after a hit to the chest (h/t Jeff Schudel, The Morning Journal).

    Hayden required emergency surgery to repair the vessel and to stop massive internal bleeding. Surgeons accessed his chest cavity by performing a thoracotomy, meaning they sawed through his sternum, or breastbone.

    The internal bleeding due to IVC tears is so extensive that the injury almost universally proves fatal. Even if a patient survives, poor blood flow to the brain, kidneys and other organs may have already taken its toll.

    Don't tell that to Hayden. Just four months later, he posted an official 40-yard dash time of 4.39 seconds at Houston's pro day.

    Wow.

    Unfortunately, a hamstring tweak prevented Hayden from completing most of the agility drills. He also forewent the bench press due to his still-recovering sternum.

    The long list of questions still surrounding Hayden may prevent him from being drafted in April. However, his shear determination, work ethic and undeniable spirit—all made evident by his ability to come back from the brink of death better than anyone thought possible—could prove enough to convince teams to select him in the mid-to-late rounds.

    Risk Level: High

    Potential Upside: Moderate

    D.J. Hayden's story is truly a miracle of miracles. I wrote about it in more detail on Tuesday.

2. Walter Stewart, DE, Cincinnati (Spine)

10 of 11

    University of Cincinnati defensive end Walter Stewart's story is a sports medicine physician's worst nightmare. It may also prove to be an unfortunate and saddening end to a promising career.

    In October, Tim Adams of The Bearcat Journal reported that Stewart planned to retire from football due to a spinal anomaly. Specifically, Stewart lacks a "posterior C1 arch."

    C1 is the highest vertebra in the spine. It is located in the neck just below the base of the brain. Like all vertebrae, it makes a circle around the spinal cord, thereby encasing and protecting it—well, usually.

    In the case of Stewart, the back part of the circle formed by C1 is missing.

    What does that mean?

    In short, his spinal cord is less protected than normal, and hits to the head or neck may be more likely to cause damage. Since neurological signals travel downward from the brain to the body, a complete interruption at the level of C1 would lead to complete, total and life-threatening paralysis.

    Admittedly, the likelihood of such a catastrophic injury is probably still low. However, any degree of increased instability of the spine cannot be taken lightly.

    Even more frustrating is the fact that Stewart probably has no symptoms and feels entirely normal. Yet when the downside of something going wrong is as devastating as paralysis or worse, the balance of risk versus reward leans very heavily in the wrong direction.

    Risk Level: Very high

    Potential Upside: Moderate

1. Marcus Lattimore, RB, South Carolina (Knee)

11 of 11

    Last October, South Carolina running back Marcus Lattimore suffered a knee injury so gruesome and so devastating that its effects continue to reverberate throughout the football community almost five months later.

    A brief review of the video makes the severity of the injury painfully clear. Be advised that the video is extremely graphic.

    According to Geoff Hobson of the Cincinnati Bengal's official website, doctors diagnosed Lattimore with tears of his right anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) and lateral collateral ligament (LCL). Many wondered if he would ever play again.

    That was then. This is now.

    Following its surgical reconstruction, Lattimore successfully rehabbed his knee at a pace faster than most would have thought possible.

    By Jan. 22, Lattimore was walking without a limp, according to a tweet by Andy Staples of Sports Illustrated. On March 27, at South Carolina's Pro Day, Lattimore ran agility drills while being applauded by scouts (h/t Robert Klemko, USA Today).

    At the rate he is progressing, his goal of playing in the 2013 NFL season—originally thought to be impossible by many due to the expected 12-month-or-more projected recovery time—no longer seems quite as far-fetched.

    Part of that is due to Lattimore's healing ability and experience with rehab—he tore his left ACL in 2011—and part is due to modern-day surgical and physical therapy techniques. Rehabilitation science continues to advance at a blazing pace—even since Denver Broncos running back Willis McGahee came back from a similar injury that he suffered in 2003.

    Despite the optimism that surrounds Lattimore, he still tore three of the four main ligaments in his right knee, he isn't yet in football shape and he's suffered two major knee injuries before his professional career could even get underway.

    Will that make teams balk at selecting him in the early rounds? Only time will tell.

    Yet one thing is for sure: there isn't a football fan on this planet that won't be rooting for him.

    Risk Level: High

    Potential Upside: Very high

    In February, I broke down Marcus Lattimore's injury and what he needs to do to shock the football world. He seems to be on his way.

    --

    Dave Siebert is a medical columnist for Bleacher Report who will graduate from medical school June 15. He plans to specialize in Family Medicine and Primary Care (non-operative) Sports Medicine. Medical information discussed above is based on his own knowledge.