The importance of scans – Johnathan Thurston

“We'll wait for the scans”. Almost every potentially serious injury during a game of NRL is followed by this statement post match from any one of the coaches, medical staff or teammates of the injured player. Often we are provided with an idea of what the player may have injured (“he’s done a shoulder”) without too much detail. The agonising wait then begins as the player, team and fans all brace for the scan results. These results can provide answers to three very important questions:

  1. How long will the recovery be for the player?
  2. When they return, how limited will they be?
  3. Do they have a high risk of re-injury?

There are three main types of scans used in the NRL:

X-Ray: to keep it simple, they look at the bones. Most fractures/joint dislocations can be diagnosed using X-rays.

CT: Essentially thousands of X-rays taken from different angles. Quite common after a blow to the head to look for signs of a bleed within the skull. Allows radiologists to examine bones (particularly of the spine and skull) in much finer detail

MRI: Best used for examination of soft tissues (ligaments/tendons) as well as cartilage. MRI's are quite complex, and diagnosis can often not become clear from the imaging alone. Second opinions, repeat imagine and further physical examination is sometimes required, and this appeared to be the case with Thurston

Medical staff will often be fairly confident post game of the nature of injury the player has suffered, as they will perform any number of orthopaedic/physical tests and be aware of the injury mechanism. But it is not until the scan results come back that a specific diagnosis and timeframe is provided by the club. It would be easy to assume that the bottom of Thurston's MRI report reads "grade 2 rotator cuff strain, 4-6 weeks out", but this is not the case. Reports containing scan results will not include recommendations on a player's recovery time; it will provide information on the location and severity of injury whilst ruling out potential damage in secondary (surrounding) structures. 

Whilst the scan results are a vital part of determining the recovery timeframe, other factors such as function, pain, physical exam testing, past history and associated injuries are always part of the equation. It is problematic to make time-fame recommendations based on scan results alone, which is why it can take anywhere from a couple of days to a few weeks after the scans have been performed for recovery details to become available.

With Thurston's extensive history of shoulder problems, if he had scans of his shoulder in a "healthy" state, say a week ago, he would have had considerable scar tissue from past injuries/shoulder reconstructions which makes a diagnosis of a new injury complex. Thurston had his shoulder scanned on Saturday (with the images available that morning) but needed to wait for a review with his specialist on Monday to determine the full extent of the damage.

That’s why it was premature to treat any reports on JT's recovery timeframe that came through on Saturday as gospel, and also why his time on the sideline may not be set in stone just yet. The first 2 weeks of rehab are extremely important for a complex injury such as this. If he responds well to treatment over this time I would expect Thurston to miss somewhere in the 4-6 week range, which will have him return for the Cowboys in Rd 13-15 and possibly be fit for Origin 2

Josh Dugan

Dugan suffered a depressed fracture (when a portion of the skull “sinks” in) of his cheekbone in the Test on Friday night. When a fracture becomes depressed it will always require surgery, however, this does not always mean considerable time on the sideline. Surgery can often decrease the time on the sideline, and this is no doubt the case with Dugan as he is only predicted to miss 3 weeks.

Aaron Woods

The “wishbone” tackle Woods was on the receiving end of resulted in a suspected grade 2 hamstring injury, ruling him out from what he states as “4-8 weeks”. With that timeframe suggesting a grade 2 strain, it is likely his recovery will fall in the 4-6 week range unless he suffers an early setback with rehab.

Josh Reynolds

Whilst initially being reported as a grade 1 hamstring strain and 2-4 weeks out, it was revealed today Reynolds will be expected to miss 5 weeks of NRL action for the Bulldogs. This would suggest either more significant damage was found in Reynolds’ hamstring, or he responded poorly to rehab in the first few weeks resulting in a revised recovery timeframe.

Nelson Asofa-Solomona

NAS suffered a fractured metacarpal in his hand which required surgery, ruling him out for 4-6 weeks. The metacarpal is a long bone that makes up the palm of the hand. Similar to Dugan, the plates and screws inserted during surgery can often mean a quicker return. There have been cases of players with this fracture returning in 2-4 weeks, so he will be one to watch for a possible early return over the next month.

James Roberts

After copping a direct blow to his knee, Roberts collapsed to the turf of Suncorp Stadium and had to be carried off the field. This ended up being a surprising injury source, as Roberts had, in fact, rolled his ankle when his knee was hit from the inside. This was a surprise to everyone (me included), as even the trainer had performed tests on Roberts’ knee when he rushed to him on the field. This is likely because the blow to the knee caused considerable pain initially (contusion/cork), but as this had not caused any significant damage it wore off and he was left with the considerable lateral ankle pain. Roberts was cleared of fractures, and the soft tissue damage to his ankle will only hold him out for 2-4 weeks. Like all players listed here, the rep round came at the right time for Roberts, and he should be back in the next week or two for the Broncos.

Gareth Widdop

Just an update from 2 weeks ago, Widdop's scans came back revealing “significant” damage to his MCL and a 6-week timeframe for recovery. As he was able to stay on the field (albeit momentarily) when he suffered the injury this could suggest a grade 2 injury (as opposed to a grade 3/complete rupture). Many grade 2 MCL sprains return in the 2-4-week range, but Widdop will only just be coming out of a knee brace this week. I would not be surprised to see him return sooner than the initial 6-week reports.

Shannon Boyd

Shannon Boyd was cleared of a fracture in his leg, however, did suffer some soft tissue damage. Grade 1 strains usually involve a 2-4 week recovery, and Boyd is expected back between Rd 12-13

David Nofoaluma

Unfortunately, there have been no concrete reports on Nofoaluma’s injury, just that the Tigers’ will monitor how he responds to treatment. His status will, of course, become clearer when team lists come out this Tuesday, but it was a good sign he was able to play through the injury for the full 80 minutes 2 weeks ago.

Christian Welch

Unfortunately for Welch from the first viewing of his injury mechanism the news was not going to be good. Non-contact, changing direction and knee injuries do not go well together and he, unfortunately, ruptured his ACL. He will have reconstructive surgery and be out for the rest of the 2017 season.

As always if you have any questions, throw a comment down below or hit me up on Twitter @nrlphysio or Facebook:

The opinions given by the author of this article are given by a qualified physiotherapist, HOWEVER they are based on the information available to the author at the time of publication; are general; and are not based on any formal physical assessment and/or diagnosis by the author. If you believe you may be suffering from an injury similar to one commented on by the author, do not rely on the author’s advice as it may not apply to you – see a qualified physiotherapist for a full assessment, diagnosis and treatment plan.

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