Grand Rounds: Breaking down injuries to Gordon Hayward and more

Significant injuries popped up for a number of NBA teams this week and we’re breaking down each in detail.

You know what they say: Bad things often come in threes. Well if that is the case, Monday was an extremely bad day as we received reports on injuries to, not one, not two, not three, but four of the NBA’s more prominent names. It’s worth discussing each injury in detail, as some are significant and others are sound scarier than they actually are.

Gordon Hayward undergoes surgery for broken hand

ESPN’s Adrian Wojnarowski reported Monday afternoon that Boston Celtics’ forward Gordon Hayward would ultimately undergo surgery to repair the broken left hand he suffered during Saturday’s win against the San Antonio Spurs after meeting with a hand specialist; ESPN’s Tim Bontemps would later relay that the procedure was to repair the fourth metacarpal bone and The Athletic’s Shams Charania reported that Hayward would ultimately miss six weeks.

The fourth metacarpal bone is located in the palm of the hand and connects the ring finger with the wrist. A break of this bone is often called a “Boxer’s fracture” as the injury often occurs with blunt force trauma, such as after a punch. The fourth and fifth metacarpals are the most frequently fractured of the metacarpal bones.

It is natural to want to compare Hayward’s injury with that of Golden State Warriors’ point guard Steph Curry, who fractured his second metacarpal bone — which connects the pointer finger with the wrist — in late October. Curry also underwent surgery and is expected to miss at least three months.

So, what is with the discrepancy between Hayward’s six-week and Curry’s three-month-minimum timelines? The answer has less to do with which bone was broken and more to do with fracture severity.

There are multiple different types of metacarpal fractures and discussing the surgical procedure to remediate each is beyond the scope of this article, but suffice it to say that the more complicated the fracture, the more complicated the surgery, the longer the recovery time.

The good news is that regardless of the severity, most NBA players don’t have a problem returning to play. According to a study published in The Orthopedic Journal of Sports Medicine, NBA players returned to the court 56.7 +/- 26.3 days on average after surgery to repair a fractured metacarpal bone. Hayward projects to return on the low end of this average, whereas Curry projects to return on the high end.

The Celtics are owners of the NBA’s best record and Hayward was having what some considered a career year up until his injury. Boston’s depth will be tested over the next six weeks, so look for the Celtics to rely more on the likes of Jaylen Brown and Jayson Tatum to make up for Hayward’s production.

Anthony Davis has a sore shoulder

Los Angeles Lakers’ star Anthony Davis raised some eyebrows after the team’s loss to the Toronto Raptors Sunday night when he admitted to playing through, seemingly, constant right shoulder pain.

Davis told reporters in the post-game lockerroom scrum, “There’s really never a play I don’t feel it. I try not to let it affect my game. I just play through it and then worry about taking care of it after the game.”

Davis has suffered a plethora of injuries during his professional and collegiate career, including a torn labrum in his left shoulder, an injury he reportedly played through for three years before considering going under the knife in 2016. Davis ultimately did not have surgery to correct the injured left labrum, a decision that isn’t uncommon among athletes.

The labrum is a ring of cartilage located in the shoulder that helps stabilize the joint. It is not uncommon for the cartilage to tear in overhead athletes as the repetitive motions place quite a bit of strain on the structure; many athletes have labral tears and never experience any symptoms. Non-operative treatment (i.e. physical rehabilitation) is nearly always the first line of defense for labral tears and is often quite effective at reducing pain and improving function.

However, there is little indication that Davis’ current injury is another labral tear. NBA players play through pain on a near-daily basis, so as long as Davis’ production isn’t hampered by his shoulder pain, it’s not an injury to be too concerned about.

Khris Middleton‘s thigh contusion

Charania also reported Monday afternoon that Milwaukee Bucks’ forward Khris Middleton is expected to miss 3-4 weeks with a thigh contusion. Luckily for the Bucks, an examination did not reveal any serious pathology.

A contusion is essentially a bruise that involves the underlying musculature and can be extremely painful. Contusions occur because of a direct, forceful impact, such as being kneed in the thigh. This isn’t an injury to be concerned about long-term and pain tolerance is typically the main factor in determining whether or not a player can return to action.

On rare occasions, an interesting phenomenon can occur in which the muscle involved in the contusion can temporarily calcify, essentially becoming bone. This usually happens with extremely deep contusions, particularly those that are repeatedly over-stretched, either during treatment or when playing through pain. There is no indication that this is the case with Middleton, but obviously it is a condition worth avoiding.

De’Aaron Fox rolls his ankle

ESPN’s Zach Lowe contributed to the injury reporting Monday, relaying that Sacramento Kings’ point guard De’Aaron Fox sprained his ankle during practice when a teammate stepped on his foot. Charania reported that Fox will be re-evaluated in three to four weeks and that he suffered a grade 3 injury.

There are three types of ankle sprain: inversion, eversion, and high. Inversion ankle sprains occur when the ankle “rolls” inward, eversion sprains occur when the ankle “rolls” outward, and high ankle sprains occur when the ankle “rolls” outward along with the entire lower leg. Inversion, also known as lateral, sprains are the most common, whereas high ankle sprains are often the more difficult to return from. At this point, it’s unknown which type of injury Fox suffered.

The grade 3 diagnosis means that greater than 50 percent of the fibers of the involved ligament(s) were torn, which often leads to significant instability. Grade 3 injuries can heal on their own with conservative treatment, however, surgery is sometimes indicated. According to Jeff Stotts, the average time missed for players with grade 3 ankle sprains is 33 games.

This injury is a devastating blow for the Kings as Fox is the motor that keeps the Sacramento car moving. Fox missing a significant chunk of time would likely burry the Kings already slim playoff odds.