Checking in on Aaron Rodgers' Broken Collarbone 3 Weeks Later

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Checking in on Aaron Rodgers' Broken Collarbone 3 Weeks Later
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Three weeks ago, Green Bay Packers quarterback Aaron Rodgers went down with a broken collarbone against the Chicago Bears. Even now, speculation as to when he will return continues to run rampant.

Will he play on Thanksgiving? Is this a pain thing only? Is he not tough enough?

The answer to all three questions: probably not. 

Rather, Rodgers must primarily overcome one huge obstacle before returning to the field, and it's not necessarily pain tolerance.

It's also not willpower.

It's time.

NFL.com's Chris Wesseling explained further last week:

Appearing on WAUK-AM's "The Aaron Rodgers Show," the quarterback explained that any decision on his playing status comes down to a risk evaluation as opposed to a pain tolerance issue.

If Rodgers takes a shot to the collarbone before it heals, he risks a displacement that would necessitate a recovery process of 3 to 5 months with the possibility of concurrent complications that would affect his offseason preparation.

While physical ability goals such as strength and flexibility are certainly crucial, risk also comes into play. As of right now, it seems the risk remains too high.

According to ESPN's Adam Schefter, the chances Rodgers plays this week against the Detroit Lions are "slim to none":

Over the coming days and weeks, the odds will begin to shift more and more in Rodgers' favor—a process that, believe it or not, began immediately after the break occurred.

Very generally speaking—as all fractures are unique in severity and location—when a bone breaks, blood and inflammatory cells immediately start to collect at the injury site.

Over the next week or so, macrophages—or clean-up cells—eat away debris and prepare the area for repair. Next, other specialized cells begin to lay the groundwork for new bone. New blood vessels grow, and structural elements start to take shape.

By about two to three weeks after a break, a soft, cartilage callus forms and partially stabilizes a fracture by connecting the two broken ends of bone.

This animation depicts the process of bone healing.

Soft calluses protect a fractured bone from minor hits and stresses, but significant insults are another story.

Assuming it remains undisturbed, a soft callus will continue to harden into tissue more closely resembling healthy bone during the third week, fourth week and onward. A clinically stable bone usually comes about by the sixth, seventh or eighth week, and further remodeling takes place over the weeks and months that follow.

Until it reaches stability, a previously fractured bone may remain at higher risk of re-injury—something the Packers surely want to avoid.

As always, exact medical details are not available to the public. However, speculation suggests that over the past 21 days, Rodgers progressed through the initial stages of bone healing and now sports a bonafide soft callus.

Regrettably, a soft callus does not imply game-time readiness.

If Rodgers takes a hit similar to the one that caused the injury in the first place, an early soft callus would likely break open once again.

Even worse, a soft callus cannot absorb as much stress as healthy bone. As a result, a displaced fracture—where the ends of the bone separate and require surgical reattachment—becomes more likely. Such a disaster would almost certainly land the Packers signal-caller on injured reserve.

Nevertheless, Rodgers' clavicle will continue to solidify with each passing day, hour and minute, and eventually, the balance of risk and reward will tip in the other direction. It's up to the Packers medical staff, coaches and Aaron Rodgers himself to determine just when that occurs.

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Where the Packers will stand at that point remains unclear.

After Rodgers went down, the Packers started down a 0-3-1 stretch, and they now find themselves on the outside of the playoff picture looking in.

Still, doctors must stay the course and evaluate the superstar from week to week. They may utilize X-rays or CT scans to monitor bone healing to do so.

Physical therapists will also likely continue to work with Rodgers—possibly by using advanced rehabilitation techniques such as bone healing stimulators—as he works toward a return. As mentioned, strength, pain and range-of-motion goals are just as important as the bone healing itself—if not more so.

Yet the Packers medical staff can only do so much. In the end, Rodgers' unique healing ability carries the most influence—an ability that is largely set in stone.

Once his collarbone passes a critical healing point—hopefully and likely within the next few weeks—the 2011 MVP will take the field once again. A return for Week 14 is a slight possibility.

Until then, though, he must remain on the sidelines, watching.

And waiting.

 

Dr. Dave Siebert is a resident physician at the University of Washington. Find more of his written work at the Under the Knife blog.

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