- 7 minutes ago
Board-certified orthopedic surgeon Dr. Harrison Solomon joins The Kevin Sheehan Show to break down Jayden Daniels’ elbow dislocation suffered against the Dallas Cowboys. Dr. Solomon analyzes why repeated dislocation events have caused chronic instability in the elbow, explains why season-ending reconstructive surgery represents the safest long-term recovery path, and provides an expert medical outlook for the star Quarterback.
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00:00Dr. Harrison Solomon is a board-certified orthopedic surgeon specializing in hand and
00:07upper extremity surgery in town. He's a native Washingtonian, raised in Bethesda. He attended
00:15my high school, Walt Whitman High School. By the way, I just pulled up his website. You look very
00:20familiar. I think we've probably run into each other at some point. I don't know if we have or
00:25not, but that's beside the point. This is a Big Tony recommendation. Our good friend,
00:32Big Tony, said you got to get Dr. Harris Solomon on the show. This is his area of expertise and
00:39that's why he has joined us. Thank you so much, by the way, for the time. Have we met before?
00:48You know, I think that's quite possible, Kevin. I'm sure we have so many connections and friends
00:54in common. I suspect we have, but I don't know exactly where and when, but I really appreciate
00:59you having me on today to talk about this unfortunate situation. Yeah. All right. So what I'd like to do
01:06is actually go through it chronologically, starting with last year, because there have been, as I'm
01:14sure you know, so many of sort of the social media internet, you know, surgeons and doctors weighing in,
01:21many of whom have said he should have gotten surgery last year. When you saw as a D or your
01:30skins fan, I'm assuming, right? You're a Washington fan. Oh yeah. Born and bred. Yep. Okay. So when you
01:36saw this last year against the Seattle Seahawks in that night game, Sunday night game, when he first
01:44dislocated the elbow, what should have been done or what would you have needed to know more about that
01:50surgery, surgery, that injury before you could have made a recommendation? Right. I mean, well,
01:58I mean, it seems like everything went pretty normally. So elbow dislocations are not terribly
02:04common, but they certainly happen on the football field. And we can get into this later, but I remember
02:09Ray Lewis during some of the Raven paydays, he had a, he had an elbow dislocation treated successfully
02:16without surgery. So they, the first step is first aid, which is putting the elbow back in joint.
02:23And then of course, um, an MRI ensues the next day or later that night to really assess the damage.
02:31And the first sort of decision point, uh, is whether this is a pure soft tissue dislocation
02:38or whether there is any, uh, bony involvement such as a small fracture and even small fractures when
02:45it's, when it's together with an elbow dislocation can really treat, can really change your treatment
02:52paradigm because it makes the situation more complex. But, um, so all the words that came out
02:58were that this was a simple elbow dislocation that was, um, of course, popped back into position.
03:05And, um, so at that point it is fairly normal treatment. And I think for, even for an NFL
03:13player, quarterback, non-dominant arm, of course, to, um, at least initially treat that non-operatively.
03:21And, uh, usually when you put those back in, it's, it's quite stable and, uh, uh, usually, uh,
03:29stays, stays together. And that's the norm as in the Ray Lewis case. Um,
03:33Um, um, unfortunately that's just not how it all played out.
03:39So, I mean, what I'm hearing from you is the way it was handled last year, assuming that it was
03:44just
03:44soft tissue and not, uh, and it didn't involve any sort of fracture that your guess is it was handled
03:51appropriately, right? That most of these don't end up in surgery, it pops back in. And typically,
03:58do you have to let it heal? Uh, like how long he was out, it ended up being four weeks
04:04before they
04:04brought him back three games. There was a bi-week, then they brought him back. What's the process when
04:09you pop it back in before you're able to use it on a football field, let alone in, in normal
04:16day,
04:16every life? Right. I mean, in most situations you pop it back in and you, you keep it immobile for
04:25a short period of time, meaning, uh, roughly about a week. Um, but in the elbow say different,
04:32very different from a shoulder, there is a lot of what I would call bony congruity. And what I mean
04:38by
04:39that is that, um, if you took like a real bone, um, like ball and socket joint, that's very stable.
04:47You've got a ball stuck pretty deep in a socket. And for example, a joint like the hip is extremely
04:53stable just from the bone, even if you cut all the ligaments around the hip. But if you contrast that
05:02to a shoulder, and I know I'm not talking about elbows right now, but I'll get back to that.
05:06A shoulder is the opposite. It's like a golf ball sitting on a golf tee and it's all soft tissue.
05:13So that's why shoulder dislocations, certainly in a contact sport means almost always surgery.
05:20Um, so it starts with the bones and it starts with how conforming is that joint? How much surface area
05:27do we have that's going to impart a lot of stability just because of the way that the bone anatomy
05:33is.
05:34Now the elbow is more on the side of the hip. It's got a lot of bony congruity.
05:40And that's why it's usually when it's purely soft tree, purely soft tissue. That's why it's usually
05:47treated non-operatively. And, um, and so that's what they did. And, and so you do this brief period
05:55of immobilization that allows the ligaments that are torn and there are torn ligaments every time you
06:01dislocate an elbow. Okay. I was going to ask that. So it's not just popping it back in and it's
06:06all
06:07fine. There are some torn ligaments that are part of the dislocation. So you've got to let that heal.
06:15You have to let that heal, but again, it can sort of heal while you're still moving the elbow because
06:24of all that bony congruity. So there's a lot of inherent stability to the joint. And so you let
06:29the arms start moving after about a week and usually about three weeks later. And in Jaden's case, four
06:35weeks, it feels pretty good. The swelling is down. You, you feel good about that stability. Although,
06:43you know, usually there would be a brace involved to protect it further since it's such a rough sport. And,
06:49um, in general, um, you can get away with it, but I, I would also just dovetail on that by
06:55saying,
06:56so that was the initial treatment, but I think where, where the decision-making gets more interesting,
07:02Kevin is when he tweaked that elbow again in like mid December, I think it was Minnesota. Right.
07:09And, uh, yeah, against the Viking. So, so that was week 14. And I don't know what tweak means,
07:18you know, and of course I'm not part of the medical staff and I don't know what all the details
07:23here is,
07:24but tweak to me means the elbow had another instability episode. And you'll hear patients
07:32talk about that. Like you, the elbow gets popped back in, everything's fine, but then something happens.
07:38And it, something felt wrong. It sort of popped or it very split second popped up, popped back in
07:46something, uh, something happened there as, you know, quote unquote tweak, but I would,
07:53you know, maybe more officially call it an instability episode. So I think that would be a situation. And
08:01then ultimately, of course, they shut them down at that point, but it's at that point in the off season,
08:07where I think there probably was a big decision making, uh, session going on in terms of, okay,
08:15has this now gone from an acute dislocation to more of a chronic instability situation? Or do we feel like,
08:24uh, we still have good tissues, we're still going to get good healing? And, um, you know, ultimately,
08:33I think if, if you could have, if you could have told Jaden and the medical team at that point,
08:39hey, look, this is unstable and there's a decent chance this thing could pop out again, even just
08:44flipping, coming out from under center and, and getting stepped on. Um, I think the decision
08:51making might've gone different, but of course, Monday morning quarterbacking is really easy and
08:55there's pluses and minuses and you just have the data you had at that time. And so it's easy,
09:01it's easy to second guess now, but now I think we do have chronic instability. It I'd be shocked if
09:08there was not surgery involved. And, uh, it's more of a question of timing. Um, but, uh, you know,
09:16and I, there will be multiple medical opinions, multiple surgical opinions and see where they all
09:23land. All right. So we're talking to Dr. Harrison Solomon, uh, an orthopedic surgeon hand, you know,
09:31who handles these types of injuries. So I want to, I want to jump to Sunday and you, you just
09:36did, uh,
09:37and you gave your opinion on it already, which is fine, but I want to make sure everybody's clear.
09:43The Seattle game, non-operative that's totally normal. You think everything was handled normally.
09:49We don't really know the specifics of the Minnesota game, but if it was tweaked, if it was the elbow
09:55that was tweaked, you think that maybe there should have been some conversation about a surgical approach
10:02because the stability obviously, uh, was a problem there. Now, Dan Quinn did was asked yesterday about
10:10was surgery considered in the off season. And he said, no, um, was a brace considered,
10:16you know, before, uh, you know, this year. No. Um, so I'm guessing that the conversation didn't go
10:23very far with respect to surgery. If it went that far at all, if that was actually the tweak in
10:29the
10:29Minnesota game, but that aside, now we get to Sunday in Dallas and you saw it, you saw the injury.
10:36So now, now what you've kind of already, you know, you didn't, you, you, you already said that you
10:43think it's surgery that's coming or that it would be recommended, but walk us through what you saw
10:49Sunday and what you think's going on right now. Right. Well, so what I saw was another dislocation.
11:00And, uh, there are a couple of ways an elbow dislocates and, uh, and it's hard for me to tell
11:08exactly which way it is. And I'm not sure it's even useful, but it, it, it would speak to which
11:15exact ligaments might be problematic. Um, by the way, over time and after an elbow dislocates a few
11:23times or has these instability issues, the elbow can actually change. And I was talking about the,
11:30the bones before, but it's not even crazy that the bones evolve over time because the elbow is a
11:38little bit unstable. And then you start to get a little bit of a bony deficit, which might be noted
11:47on an MRI, or I suspect there will be a three dimensional CT scan done to really look hard at
11:54the bone because sometimes that's a cause of recurrent instability of the elbow, but it clearly popped
12:02out. Uh, they popped it back in. And, uh, so then, um, you know, I'm, I'm confident he's had MRI
12:12and CT scan
12:13by now. And now it's a matter of really getting the opinions and looking at it and saying, what do
12:19we have to do to get this elbow stable in an NFL quarterback? And so what are the options?
12:28Yeah, well, I mean, it's, uh, I would say a worst case scenario, let's say there is some sort of
12:35bony
12:35defect. Sometimes you actually have to do some bone work and, um, whether you use some artificial bone to
12:43fill in a deficit that has been created, like, like the elbow pops out. So there can be a notch
12:49in the bone, similar to what happens in a shoulder. And until you fill in that notch with either some
12:57artificial bone or something else that that doesn't work, hopefully that's not the case because that just
13:03makes it a bigger operation. Um, but, uh, if the bone, if the bones look good, then we're looking at
13:12ligament reconstruction, which typically involves using a tendon most often from the patient,
13:21um, themselves. And we, we harvest the tendon at the time of surgery and we put some bone tunnels
13:27in the arm, not, not much different from a Tommy John. It's usually on the other side of the elbow,
13:33the outside of the elbow compared to a Tommy John, but it's the same type of surgery as the
13:38ligament reconstruction. Sorry. Where do you take the tendon from?
13:43Usually from the wrist forearm area. So most people have a small tendon called the palmaris
13:49longest, uh, which is, doesn't really do anything. It's a completely redundant tendon
13:55in the palm. And, uh, but about 10% of people aren't born with it. And in which case you
14:00take,
14:00uh, usually half of a, of a different wrist tendon, which also, um, is redundant and has a lot of
14:08other
14:08tendons doing the same function. So, um, and that, that's the safest. That's the strongest. It's the
14:14most biologic. In orthopedics, there's always the option to do a cadaveric tendon. And these are tendons
14:21harvested, uh, from organ donors and then they're, they're modified and, and, uh, treated.
14:30We're talking about the worst case though right now, right?
14:34Yeah. I mean, well, here's what I would consider the worst case to me. The worst case would be to
14:40further delay surgery, see if we can't get them fixed up enough to salvage some of the season.
14:47And then he dislocates it yet again, because at this point, every time this thing gets tweaked or
14:53pops out, the situation is getting a little worse. Um, and that's why I, I feel that ultimately the
15:01conclusion is going to be to shut them down and not try to salvage because it becomes a worse and
15:07worse
15:07situation in the elbow. But then surgically though, whether it's purely a ligament reconstruction,
15:14or even if there has to be some bony work done, um, that that's, that's the season. Um,
15:23I'm afraid I would be very surprised if he would be cleared to play after that. I, um, you know,
15:29typically that's kind of a minimum three months before that would be solid enough for contact and so
15:35forth. So I, I feel that's the likelihood. I, I, maybe there's a more accelerated path. And
15:44with these guys, they heal so fast and they have so much, uh, so many resources at their disposal
15:50in terms of oxygen, peptides, and everything else to enhance the healing process. But, uh,
15:58um, I, I'm afraid he just needs elbow ligament reconstruction, most likely probably not the bone
16:04and that it's, it's going to be the season. It's not going to be worth bringing them back
16:09by the time we get there, probably putting that together with what our record will be at that point.
16:15But, um, but so I, I think that's probably the path we're headed down.
16:20So the recurrence, uh, probability just increases every time you, this happens, right?
16:29That's right.
16:31And then the risk of waiting, playing, uh, and operating later, you think is meaningful,
16:39like he could do a lot more damage to it.
16:43I, I do. I do think it's meaningful, um, because
16:49it, uh, like I said, it's, uh, things evolve over time and even, you know, even in a, uh,
16:56you know, grown men, obviously not, not a growing, not a growing athlete, but as, as the elbow is
17:02unstable over time, uh, the, the bones wear down a little bit because the ligaments are somewhat
17:09incompetent and, uh, the elbow has this little bit of instability. And so you take what might be a,
17:17uh, easier, uh, easier, easier surgery to recover from like a pure ligament reconstruction.
17:23And then you wind up with perhaps some bone deficit or, uh, a much more significant operation
17:30requiring more recovery. Um, and so I think when the dust clears and, you know, again, obviously
17:38I'm on the outside, I haven't seen MRIs or CT scans or looked at Jaden Daniels elbow, but I suspect
17:45this is now a chronic instability situation and the, uh, the decision-making is going to go down
17:53the path of, of surgical reconstruction of the ligaments. And, uh, that, that probably is it for
18:00the season. What, what is the, the prognosis post one of those surgeries?
18:07Excellent. Um, those surgeries work, they work very well. Um, and, uh, it's, it's a longer recovery,
18:16much longer, obviously than when you can treat these things, not operatively. That's why, um,
18:21we like to do that, but the elbow is demonstrating its instability. And, and again,
18:26I would compare it to Ray Lewis. Ray Lewis obviously plays a much more physical position,
18:31a middle linebacker and, um, he put on a brace and two to three weeks later, he was playing in
18:37the playoffs and he did not have a recurrent elbow problem. And so there's something going on in this
18:44elbow, um, that's just not allowing it to fully stabilize. And I don't think that there's any old
18:53issues. I don't think Jaden has old issues with the elbow, at least nothing that I've ever read about
18:58or seen about. So I think it all happened in this past year, but now at the very least,
19:05he's had three separate sort of instability, um, accidents, two of them, two of them being full
19:13dislocations, one of them tweaking it. And so it's just unstable and it's not gonna, I don't know how
19:19it's gonna hold up without surgery at this point. What would a brace do if you saw them back in
19:26a couple
19:26of weeks with a brace? What do you think that would mean? Yeah, a brace would be helpful and,
19:35um, it's, it's usually a hinge. So it's a little clunky. It's going to get in his way a little
19:40bit.
19:41I think it would help. Um, and so it, it provides sort of an external sort of exoskeleton to the
19:49elbow
19:49to protect it from getting hit one way or the other. But as you noticed in this particular injury,
19:54this is, this is usually a problem when your elbow is fully straight. And so that's exactly why it
20:02happened as he was stumbling and he put out his elbow to regain, put out his arm to regain his
20:07balance. And so when your elbow is fully straight, that's when it's in its most unstable position
20:13because it has less of that bony contact. So one other way the brace can help besides being just the
20:21external shell, they can set the hinge so that the elbow won't fully straighten. Let's say it would
20:28block the elbow from straightening beyond say 30 degrees. Um, that would potentially keep the elbow
20:36in more stable positioning. Having said that that's going to affect his play on the field. If he needs
20:42to use that arm to brace him. Well, he's not going to stiff arm anybody at that point. Yeah. Yeah.
20:48Yeah. I mean, it would be quite limiting.
20:52What haven't I asked you that I should have asked you already? What haven't you said that, that
20:57should be said? Um, uh, nothing in particular. I think, you know, to me, it's, um, it's easy,
21:08you know, just like the, the social media experts are saying to, to, uh, second guess the situation.
21:16But, um, and I, I do think what we don't know about is what was actually, how, how bad was
21:24this
21:24tweak, um, on the elbow when he tweaked it. And then I, I'm always wondering, like, what don't we
21:33know? In other words, I wonder if he ever tweaked it in practice. Also, I wonder like,
21:38usually if an elbow is kind of doing this sort of thing, it's going to do it. It might,
21:42it does it in weird times. You might be pushing yourself out of bed and all of a sudden it
21:46tweaks.
21:47So, you know, I always wonder, were there other signs that this was kind of a chronic instability
21:52thing? And no one wants, no one wants to have surgery and it's easy, it's easy to try and get
21:59together and hope for the best. And, and, um, but unfortunately the, the, the proof is in the
22:09pudding and the, and now we have a chronically unstable elbow. So, you know, if we had more
22:15details on kind of the results of the MRI and CT, we could get into the nuts and bolts of
22:20exactly what
22:21surgery would involve. But I think the, the reality is for everything that we do know,
22:27this, this one-time dislocation has now become chronic instability and that's going to require
22:35surgery to get stable again. And, um, given the situation, I suspect that they just do it now and
22:41not, not try to salvage, but who knows? We'll see what happens. And then the prognosis, if he did end
22:48up
22:48having surgery and being lost for the year, you would think that that, that left elbow would not
22:53be an issue moving forward. Correct. I think by and large, these, these surgeries work very well.
23:01They're, they're very good, but it needs the adequate time to heal, which is why I would also
23:06suggest do it now. If you, if you roll the dice and say, Hey, let's put a brace on, um,
23:12you know,
23:13and it's so it, it hurts because he looks so good back there at quarterback and he's such a good
23:17quarterback, but, uh, it, uh, um, you know, it's almost like resisting the urge because if you,
23:25if you do that, then you have the double whammy, I'm sure he's going to tweak it again,
23:30even in a brace. And then, you know, potentially the surgery becomes more, the elbow becomes a little
23:36more unstable, um, and a little bit more damage gets done. And, uh, so I think, I think the,
23:44the risk is too high, um, to go along those lines, but Hey, this is why the guys get paid
23:50the big
23:50bucks and they're going to be the ones making the decision. Thank you for the time. Really
23:56appreciate it. Uh, real insight, uh, rather than internet insight. And the bottom line is you think
24:01this is going to result in them moving forward with surgery. It's just too much instability with
24:07the elbow after now, you know, two severe, you know, incidents and at least one tweak. And as you
24:13said, for all we know, there have been other tweaks as well. Uh, thank you, Dr. Solomon. Really
24:19appreciate it. My pleasure, Kevin. Love the show. Thanks so much for having me on. Yeah, my pleasure.
24:26Uh, Dr. Harris Solomon, everybody. So there you go. Um, I think everything that he said makes a lot of
24:35sense, you know, what I was hoping to hear was even with a vulnerable, you know, elbow to dislocation
24:46that he can't, you know, that another dislocation isn't going to severely damage it to the point where
24:52it's an even harder surgery down the road. That's what I was kind of hoping to hear that, Hey, he
24:57can
24:57throw a brace on it. It'll protect it. And if, you know, if he tweaks it again, or even if
25:03he doesn't,
25:03they'll probably consider surgery in the off season, but he thinks that it will probably be,
25:10uh, a decision that is made here and now, um, which would cost him the rest of the season.
25:17And on the, on, and on the thing of the brace real quick, cause I did see this while you
25:20were
25:21talking to Dr. Solomon, uh, Kurt Warner also tweeted out in light of my comments on NFL live
25:25about playing after elbow dislocation. Here's a quote from my wife, by the way, it is also true
25:30that because you played with a brace, you now can't straighten your arm, can't do yoga and can't
25:35lift me in the dirty dancing lift. So that's the truth. End quote. So there is that according to
25:40Kurt Warner. Yeah, but he is in the hall of fame. Exactly. Uh, all right. Uh, I was hoping to
25:46hear
25:47something different, but that's, you know, that's an actual orthopedic surgeon who does these
25:54surgeries and looks at elbows all the time. And that's what he thinks.
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