treatment ed

Life and Inches

Written By: DrGayedDPT - Oct• 11•12

The casual fan watches with sub-50% attention to the screen as the previously irrelevant Rams and Cardinals square off (not as irrelevant this year but no one expects to see them in New Orleans come February). The casual fan sits and glazes over the screen, the rams offense sets up as they had done already many times that game. A play like no other seemingly. Fantasy owners look on cheering for their respective players to make a mark on the game. All is business as usual in the NFL with a primetime game.

Then in the stadium there’s the die-hard fan. The one who stuck with the Rams through the bad times and….well…more bad times. The navy blue and gold draped all over his body with various Rams apparel. He sees his team break the huddle and set up at the line of scrimmage. Intently watching with great hope yet slight skepticism as he is conditioned to be upset by his beloved St. Louis Rams. Hopes are high as a victory over the undefeated Cardinals is certainly within reach but he’s no stranger to disappointment. All is business as usual.

In the huddle is Danny Amendola; a “made-man” one might say. Trained his whole life and was never much on the radar but certainly is now. Fresh off a 160 receiving yard week and certainly the go-to-guy for this offense. He lines up at the line of scrimmage. Its primetime. Its business as usual. The play is set for him. A fade route up the left sideline that he’s trained his whole life to perfect against defenders who’ve also trained their whole lives to stop such a route. Man coverage and a safety waiting his arrival 20 yards out.


Danny races up the sidelines and the window is there. Bradford makes the routine read, Danny makes the routine catch, the defender makes the routine tackle. All seems business as usual from the fan in the stands cheering to the casual fan at home; but it’s not business as usual. In fact, nothing is usual at all. Danny stays down. The team’s trainers rush to the field to decipher his symptoms and come up with a plan. But this is not a usual injury. They know the area affected but are unsure of how to handle it. He gets carted of with caution.

Reports state that the Rams medical team reached out to other medical teams in the league to figure out how to handle Danny’s rare injury. Landing on your shoulder and staying down from the pain usually screams out a broken clavicle (collar bone); but this wasn’t the case. Danny actually separated his SC joint (circled in the picture below).


Above is the site of the injury for Amendola. The ligaments keeping the clavicle attached to the sternum failed and couldn’t handle the load that was transferred through his shoulder into his sternum (chest bone). If you can picture the shoulder as the 3-dimensional structure that it is (or look below), Amendola landed on the outside of his shoulder pushing his clavicle in. And with the ligaments unable to withstand the force they snapped allowing the clavicle to continue to separate back behind his sternum. The picture below shows the forces (in purple) acting on the shoulder as he lands forcing the clavicle back behind the sternum.

Ok…whats the big fuss? Sucky injury, so what? Its football, stuff happens. Well, if his clavicle went back even just another inch it could have punctured his trachea which would have compromised his breathing.

Feel your sternum with your fingers (the bone in the center of your chest where your chest muscles – pectorals – meet). Now with your fingers, travel up your sternum up to your throat. If you feel a firm bumpy surface then you found your trachea; simply put, it is your “breathing tube”. You inhale the oxygen from your mouth or nose and it travels down the trachea into your lungs. If the clavicle dislocates from its normal position (attached to the sternum that you felt) and it goes back into the trachea and pierces it, then the oxygen can no longer go from outside the body to inside the lungs. From there we have a serious medical emergency and Amendola’s jersey wouldn’t be the only thing thats blue. With a lack of oxygen to the body the affected person would actually turn slightly bluish.

Say the the clavicle goes back far enough missing the trachea; The aorta is also back there. The aorta is the largest artery in the body and is actually the first artery to come off the heart (not necessarily true – there is another artery going from the heart to the lungs but the aorta is certainly the largest). If the aorta gets punctured and disrupted then Amendola would bleed out within minutes; the only thing that can save his life from there is to have him prepped, on a surgical table, ready to be cut open in 3-4 minutes or less – that’s not very likely, in case you’re wondering. But why so fatal? The heart is essentially a pump. The “pump” has to send blood all the way from your chest to all parts of your body – including all the way down to your big toe nail. So when you see the aorta come straight from that “pump”, you can imagine that the force of the blood in the aorta is much higher than the force at your toe (by the time it gets to your toe, it slows down – note: I am severely over-simplifying it). So if Amendola punctures the aorta right where it comes out of the heart, the heart would then essentially be pumping the blood out of the wound at a very very fast rate (hence the limited time to get to a surgical table).

This was a very unusual injury that at first glance seemed all too common. Amendola did not break his clavicle (collarbone) as expected which would’ve required surgery. He is looking at about 6-8 weeks heeling time for the shoulder. This is the most common time to allow a ligament to appropriately heal. Expect him back with 100% function in that time period – back to business as usual.

Time out: 6-8 weeks

55 %

Chance of Reinjury:
20 %

Performance Upon Return:
100 %

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