The beginning of training camp did not prove kind to San Francisco 49ers running backs LaMichael James and Kendall Hunter, both of whom went down with injuries on back-to-back days earlier this week.
According to Cam Inman of the San Jose Mercury News, Hunter suffered a torn ACL and will miss the entirety of the 2014 season. It comes as no surprise, as reconstructive ACL surgery almost always requires seven to eight or more months of rehabilitation, essentially eliminating the chances of the young back meaningfully contributing this year.
The prognosis for James, though, sounds more promising—despite initial grim reports from NFL.com's Mike Coppinger and others stating the running back required a cart to leave the field after going down. In fact, CSN Bay Area's Matt Maiocco tweeted Wednesday that the 49ers expect the former Oregon Duck to be ready for Week 1:
In other words, it seems James thankfully avoided serious damage in or around his joint. As always, a closer look at the anatomy can help explain the positive turn of events.
What is an Elbow Dislocation?
A dislocation describes an injury where one or more bones slip out of place relative to another, disrupting the skeletal system's normal anatomy. For example, a dislocated shoulder involves the bone of the upper arm, the humerus, falling out of the shoulder socket. The very serious dislocated knee occurs when a hit forces the tibia, or shin bone, to move out of alignment with the thigh's femur—either forward, backward or to either side.
In an elbow dislocation, the end of the humerus furthest from the shoulder shifts partly or completely out of place from where it meets both the radius and ulna—the bones of the forearm.
Elbow Dislocation Prognosis
While all dislocations cause pain, it is important to remember that a dislocation diagnosis describes only the nature and mechanism of injury. The extent of damage resulting from the dislocation determines an athlete's prognosis.
For example, a severe dislocation—one where the humerus completely and fully separates from the radius and ulna—can cause serious injury to the multiple important surrounding structures.
When the bones move out of place, they can compress, stretch or tear neighboring structures, including blood vessels, nerves, ligaments, muscles and other tissues. Bone fractures can also occur, and surgery may become necessary—sometimes emergently so—to satisfactorily restore normal anatomy.
On the other hand, mild or partial dislocations—called subluxations—might yield significantly less damage. In fact, subluxations sometimes correct themselves on their own, leaving no obvious dislocation to be seen on physical exam, X-ray or CT scan. Collateral damage may prove relatively minimal, such as a mild to moderate sprain.
LaMichael James' Case
Precise NFL medical details and radiographic images are never available to the public. That said, the positive follow-up reports after James' injury hint his dislocation fell on the minor end of the severity spectrum. It's possible it successfully reduced—or shifted back into normal position—on its own or shortly thereafter with manipulation by a team physician.
49ers reporter Taylor Price wrote Thursday that while James will likely wear an elbow brace for some time after he recovers—adding extra support to the healing joint—both head coach Jim Harbaugh and James himself are optimistic the running back "could return to action prior to San Francisco's Week 1 road matchup with the Dallas Cowboys."
That said, Price also cites James' prior left elbow dislocation in 2011. Due to this, his 2014 version possibly overstretched previously injured ligaments. As such, the 49ers medical staff might understandably decide to play it safer this time around—hence the need for a brace.
Either way, reports of surgery never surfaced—and neither did the word "fracture"—suggesting James' optimism might just pan out. For now, nothing yet suggests otherwise.
Dr. Dave Siebert is a second-year resident physician at the University of Washington who plans to pursue fellowship training in Primary Care (non-operative) Sports Medicine.
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