Bruschi Could Miss a Week ... or Six

Pats Play Wait-and-See
Possible Scaphoid Injury Could Be Serious

Holy strained Scaphoid, Batman!

Man, I hope it's only a sprain.

I bet Tedy Bruschi does, too.

If it wasn't for bad luck, this guy would have no luck at all.

This isn't your typical Patriots close-mouthed, Bill Belichick misdirection, government conspiracy** type of injury. Scaphoid injuries -- if this is indeed a Scaphoid injury -- are mysterious in their early stages. Fractures are often dismissed as sprains, and the consequences of such ignorance are dire. More on that later. A Scaphoid strain is nothing serious: A week or two of rest, and it's back to business. But it's only after that initial week or two that a fracture may be evident.

The Scaphoid is a peanut shell-like -shaped and -sized bone buried among several others in the wrist. A fracture may cause swelling, but no more than a sprain; and the swelling may decrease, as in a sprain, misleading one to misdiagnose a break. In fact, until the swelling decreases, it's difficult to properly diagnose the fracture, so the initial period of caution is required, while uncertainty and speculation rule.

A look at the Scaphoid bone and its healing from a fracture.
Patriots linebacker Tedy Bruschi has a wrist injury, which may
be a Scaphoid injury, but whether it is sprained or fractured
is the real mystery.

Photos Courtesy: Apex Physical Therapy

A fracture must be treated properly and immediately, so true wisdom is to treat even a sprain as a fracture to prevent further damage. This is the Patriots staff's approach, which is good. Even if it turns out to be something other than a Scaphoid injury, it's better safe than sorry.

Scaphoid injures are often caused by a person bracing an impact (such as a simple fall) stiff-armed and palms to the ground. These injures are most common in football and basketball players, bicyclists and motorcyclists taking "headers" and auto accident victims.

The Scaphoid is a strong bone, and it takes a significant impact to break it. As such, Scaphoid injuries can also be accompanied by wrist ligament strains, which can impair proper healing and may require surgery.

This, certainly, is not the first adversity Bruschi has confronted. The story of his stroke is well chronicled and well-known to us all. From the time he was drafted and moved from defensive lineman to linebacker, it's been an uphill battle. Fortunate only for his coaches belief in his abilities and his own determination and work ethic, Bruschi has been overlooked, discounted and ignored by other teams and the leagues players until the Patriots dramatic run in 2001. Never elected to a Pro Bowl and already shunned as a Hall of Fame candidate, Bruschi has thrived through it all, right up to last year's insult of calling him "co-" Comeback Player of the Year.

Bravado notwithstanding, work ethic and sheer determination are no aid in this setback.

John Tomase of the Boston Herald on Thursday painted a pretty bleak picture of the situation, cataloging other athletes who have endured Scaphoid injuries and occasionally dealt with unpredictable complications of the difficult-to-diagnose injury.

The good news is the Patriots' caution is the right way to treat the problem. What turned Tomase's referenced cases into career-ending, life-altering events are the initial misdiagnoses of sprains. A misdiagnosed fracture can leave small bits of bone in the wrist.

Over the course of years, those bits slowly shred the insides of the wrist (euphemistically called "degeneration" by some), ultimately resulting in "traumatic arthritis," which, unlike other forms of arthritis, remains honed to the affected joint and does not spread to others.

As mentioned earlier, ligament damage can complicate this to even a far greater degree.

I should mention that Tomase seems to be the only mainstream writer who insinuates that this may be a Scaphoid injury. Any other reports are from bloggers or other newspapers attributing Tomase's story. A lot of mainstream outlets haven't even touched it.

So why make a big deal about it? Why do I, a guy who generally rejects mainstream media hype and innuendo, give such credence to apparent conjecture?

Because it's the worst-case scenario, and we fans have an innate need to contemplate the worst case. You can bet the Patriots coaching staff is contemplating and preparing for the worst case, despite their intimation that Bruschi is "day-to-day."

OK, so what is the worst case?

The accepted worst case is that Bruschi misses up to 6 weeks. That brings us to around Week 1 at home against Buffalo or Week 2 on the road at the New York Jets. But what point in the schedule and who the Pats are playing are far from primary concerns. Far more important are "What do the Patriots do until then?" And, "Do they change things up after that?"

There are two short-term options: Stick a backup in Bruschi's place, or move Mike Vrabel back to the inside (where he did a great job last year in Brushci's absence, though he's more comfortable on the outside) and sub for Vrabel outside. There are pros and cons to both options, and the ultimate decision impacts question No. 2.

If you insert a backup for Bruschi, you lose a lot in the middle. You hear a lot of talk about Bruschi being "a coach on the field," which is accurate, but a bit of a slight against Vrabel. Vrabel did an admirable job in all respects in Bruschi's stead last season. Any way you look at it, there were players on the field who wouldn't have been if Bruschi had been there, so Vrabel was behind the 8-ball right off the bat. So if Vrabel's "coaching" was lacking, it was more a lack in personnel than in his direction.

Beyond Bruschi's field general status, moving Vrabel inside last year was a disruption in the overall makeup of the linebacking corps and the defense, in general. What made last year's move necessary was the doubt that Bruschi would come back that early in the season (much less that season at all, or just plain ever).

And that's the problem with moving Vrabel inside now. It's a disruption in the overall plan. And, if our worst case is accurate, when Bruschi returns, do you then move Vrabel back outside and revert to your original design? If that's the case, the whole preseason of preparation is virtually completely wasted.

So our other questions may be answered by contemplating this question: What do the Patriots risk by playing Buffalo and possibly the Jets with a substitute for Bruschi? Remember, while these teams are expected to be far from powerhouses this season, they're division opponents, which make the games more crucial in the long run; as division opponents who see each other often, they almost always play New England really tough; and, while all teams are still gelling early in the season, there's a greater likelihood that a poor team can beat a good team.

Still, barring any unforeseen catastrophes (meaning, assuming Tomase's worst case really is the worst case), to me, this is the best option. It causes less disruption in the long run, and the Bills and Jets may be the best teams to face given the situation. But note that when Bruschi is expected to return, it's Denver, Cincinnati and Miami -- three very tough teams -- before the Week 6 bye.

Of course, this is all rendered moot if the cast or splint or whatever comes off in the next week or so and the diagnosis turns out to be a sprained Scaphoid or something else entirely.

Otherwise, it looks as though the Pats are going with subbing for Bruschi. Barry Gardner, an 8-year veteran the team signed as a free agent, is currently filling Bruschi's spot (but not his role).

So, as usual, we watch, we wait. We expect no tipped hand from the coaching staff. And we hope for the best.

* * * * *

** Did you ever notice that conspiracy theorists seem to imply that only Republican-led governments conspire? The one exceptions of UFOs, which apparently isn't just a Republican conspiracy, not just a U.S. government conspiracy, but a total, world-wide governments-of-all-peoples conspiracy. Evidently, there are wars and protests and disagreements of all kinds among governments, but they all seem to agree on denying this UFO thing.