John Doherty

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The NFL season is officially underway and even in its very first weekend, for some players and teams, the injury bug bit hard enough to ruin a season — and perhaps to teach a lesson.

Nowhere was that more apparent than in the Jacksonville-Kansas City game.

Hopes were high for the Jaguars with the debut of Nick Foles, whom the Eagles had allowed to depart as a free agent, having decided that Carson Wentz is their quarterback of the future. It isn’t often that a Super Bowl MVP quarterback is so readily available to change teams. Combine that with Foles’ opening day record of 3-0 and the Chiefs did not look so formidable.

Nonetheless, the visitors were leading 10-0 with 5:31 remaining in the first quarter when Foles dropped back and threw a 35-yard touchdown strike to DJ Chark to pull the hosts within three points of the Super Bowl co-favorites. The Jacksonville crowd went into a celebration frenzy.

Their joy would be short-lived.

After releasing the ball, Foles was driven to the turf by defensive tackle Chris Jones, both landing hard on Foles’ left shoulder. How he was able to then get up and jog off, I’ll never know, because his left collar bone (clavicle) was broken.

By the time the game was over, surgery had already been scheduled for Monday. Expect him to go on injured reserve and return in November. Without hardware implanted surgically to stabilize the fracture, the entire season would be in jeopardy.

Three years ago, Tony Romo decided against surgery and returned in seven weeks only to re-fracture his left clavicle.

With Foles sidelined, the Jaguars were unable to match the Chiefs’ offensive fire power and the visitors prevailed 40-26.

However, a member of the winning team suffered a serious shoulder injury of his own.

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Late in the second quarter, Chiefs wide receiver Tyreek Hill was taken down, similarly to Foles, by corner back Jalen Ramsey, both landing on Hill’s right shoulder. Instead of returning to the sidelines in a sling, though, Hill was rushed to the hospital.

Rather than fracturing, Hill’s clavicle had dislocated posteriorly from its attachment to the breast bone (sternum). In so doing, according to a 2014 article in the medical journal Orthopedic Reviews, the dislocation threatened “vital structures that lie posterior to the medial clavicle, namely (major blood vessels, )the trachea, esophagus, and thoracic duct.” Consequently, according to the same article, “This injury is a true emergency.”

Fortunately, it is extremely rare, occurring typically in motor vehicle accidents, martial arts, football and rugby. It occurs so infrequently, that fewer than 150 have ever been documented in the medical literature. And therein lies a dangerous dilemma; its rarity leads to the injury being mistaken for something else or missed altogether. With the mechanism of injury and perhaps the entire shoulder area being initially sore, the thought is a clavicular fracture or a separation of the acromio-clavicular joint – which is at the opposite end of the clavicle.

That is why a thorough physical examination is so important, rather than relying on x-rays alone of a nearby but wrong area. The spot where the clavicle and sternum meet will be tender, there may be some swelling (days later, there will be plenty of swelling), and a palpable bump — where the other clavicle meets the sternum — will be absent on the injured sign.

Fortunately, the Chiefs sideline medical staff recognized the injury for what it was immediately. Better yet, there was no damage to the soft tissue at risk, the dislocation was reduced at the hospital, and the media is under the impression Hill will “miss a few weeks.”

That may be a bit optimistic.

In 2012, Detroit Lions wide receiver Danny Amendola suffered the same injury while playing for the St. Louis Rams. He suffered no complications and, remarkably, returned just five weeks later, according to a case study of the injury published in Sports Health in 2015.

Other case studies recommend a far more cautious approach. In one of a college football player published in the International Journal of Sports Physical Therapy, the athlete was not cleared to return to football until five months later. The Orthopedic Reviews article suggested a minimum of six weeks but typically far longer.

For an uncomplicated and successful recovery regardless of duration, though, the key is recognizing the injury in the first place.

John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at jdoherty@comhs.org. Follow him on Twitter @JDohertyATCPT.