Donovan McNabb's Injury May Allow Him To Return to Action By Next Week

Donovan McNabb went down with a rib fracture in the Eagles' 38-10 win over the Carolina Panthers this past Sunday. The injury actually occurred after he had crossed the goal line. The Panthers' Damione Lewis's momentum carried him towards McNabb and he landed on McNabb's ribcage while he was already on the ground.

Rib fractures are caused from direct trauma to the ribs, and usually result from an anterior (forwards) force, as we saw in this case. In addition this anterior force most often causes a lateral rib fracture—which McNabb may have.

Lower rib fractures—the Eagles have not identified which rib(s) were involved—can be more serious and are associated in 10-20 percent of the cases with damage to internal organs (spleen or liver).

Provided the rib injury is not displaced (a fracture that is shifted) and is not associated with a more serious organ injury, the management is fairly straight foward. The goal for the athlete is pain control. During the week, the athlete will be placed on a series of pain medications to help him through the initial few days of inflammation.

Ice is also a good adjunct to medication treatment and can reduce the inflammation.

In preparation for game action an athlete may be given a local anesthetic to the involved rib. This will work to block most of his pain during the game. Additional protection for the rib may be provided depending on where the injury is located. At this point it is up to the athlete to decide if he can return to play.

Provided he can effectively perform with some pain, the athlete will be allowed to play.

Because the local anesthetic won't be able to control all of McNabb's pain, he may still be affected by the injury, making it more difficult to make longer throws, and be as mobile in the pocket.

The problem with rib injuries is that they may be a recurring theme for an athlete who sustains an injury during the season. Additional trauma to the area may re-activate the injury, causing a continual low level of pain.

If the athlete can make it through two weeks without re-injuring the rib, the healing process is more definitive. At this stage the initial bone healing is almost complete, and the bone is much stronger, making it more difficult for a repeat fracture.

There is also a chance that the bone may never heal—called "non-union"—but these cases do not usually cause the clinical condition to worsen.

My assessment is that McNabb will play either this week or next, and will be limited for the next few weeks by what he can tolerate due to the pain. It is the team's hope that they can protect the rib long enough for the majority of healing to take place, and prevent recurrence of the injury.

David Webner, MD

Co-Director Sports Medicine Fellowship

Crozer Keystone Health Sytem

Suburban Philadelphia, PA