Major Injury Feared For Jack Hillen

Posted on October 04, 2013

By special contributor Dr. Samuel Sanders 

(Orthopedic Surgeon: Greater Washington Orthopedic Group)

It was tough to watch Jack Hillen struggling to bear weight on his right lower extremity after the first period injury last night. Immediate thoughts go through your head, both as a fan and a physician, regarding the medial collateral ligament (MCL) and anterior cruciate ligament  but there are also many other injuries that can lead to the extreme difficulty bearing weight, including concerns for tendon ruptures (patellar/quadriceps), fractures (patella), and dislocations (patella, knee). I hope this article provides some insight into the workup that occurs in the locker room immediately following such an injury.

Now, what happens behind the scenes?

The athlete is brought immediately into the treatment room where his pads will be removed. The setting is a surprisingly quiet one even though there are 20,000 screaming fans hundreds of feet away inside of the Verizon Center. The athlete is also generally quiet and tough to elicit a history from as they realize they have a significant injury.

A quick but detailed history is taken asking specific questions regarding whether a crack or pop was felt/heard, any instability and specific location of pain. An exam is performed focusing on ligamentous stability and tendon continuity. For example, having the athlete raise his leg straight up in the air demonstrates no quadriceps or patellar tendon rupture and generally rules out a fracture. The physician also tests the four major ligaments of the knee and can determine any injury based on if any laxity is present. 

At this point, the physician has a pretty good idea of the injury. A statement is released to the public with a vague diagnosis such as "lower body injury".  He is then taken for x-rays down the hall.  An X-ray machine is generally within close proximity to both locker rooms. Unless the x-rays show a obvious fracture, he is generally set up for an MRI that night or next morning (Hillen was reported to have been at the hospital last night). If the x-rays are positive for a fracture, there is an option is to obtain a CAT scan at a hospital that evening which will provide more detail on the fracture pattern and characteristics.  An MRI, on the other hand, will show better detail for soft tissue injuries (meniscus, ligament, tendon). Generally within 24 hours a definitive diagnosis is obtained and treatment is initiated. 

Stay tuned for information regarding Hillen's specific injury once released to the public. 

next up:

Don't Do It George! Part 2

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