Denver Nuggets rookie Michael Porter underwent a second lumbar surgery, just a few months after having a microdiscectomy. Details on the second surgery are scarce, but it likely was one of two things. The first, and more likely possibility, is that there was recurrent or residual disc material near the nerve, and Porter was having ongoing symptoms that were not resolving. This surgery would be very similar to the initial microdiscectomy, and will set his timeline back. Return to play would probably be around 3-6 months. The second possibility for the surgery is that he had a spinal fluid leak. Surgery for this is rare, but sometimes necessary (this is the surgery that Steve Kerr required twice). This has a shorter timeline to return to play, likely 6-8 weeks.
Injuries 101: Markelle Fultz diagnosed with neurogenic thoracic outlet syndrome
Breakout candidate Dejounte Murray tears ACL
Just this past Sunday, Spurs starting point guard, Dejounte Murray, suffered a season-ending, ACL tear. Murray was aggressively pushing the ball into the half court, trying to take advantage of a disorganized Rockets defense, until he ran into brick wall, James Harden, just feet from the basket. It was a split second occurrence that stopped the hearts of all the Spurs faithful. Murray’s freakishly long stride, at such close proximity to the rim, caused this because of the lack of stability that is associated with an excessively wide base. At a meager 170 pounds, Murray was no match for the 220 Harden, even more so in a comprised, non-athletic position.
The timeline for Murray’s return isn’t crystal clear, but the general timeframe for an ACL tear is anywhere from 9-11months, according to Dr. Selene Parekh. We’ve seen other long, slim-framed point guards like Shaun Livingston and Lonzo Ball sustain these different types of knee injuries. A greater amount of precaution may very well be taken due his unique body composition. The commonality of Livingston’s and Murray’s ACL tears were that both were attacking the rim while striding out aggresively. Sometimes, the bigger they are, the harder they fall.
Ever since the departures of Kawhi Leonard, Tony Parker, Danny Green, Kyle Anderson and the retirement of the Manu Ginobili, there have been drastically lowered expectations for the Spurs. There may have not been a team in the NBA that experienced less roster turn around each year before those veterans departed. Head coach Gregg Poppovich likes nothing more than cerebral, selfless ball players that can thrive in his efficient system for years.
Unfortunately, even more skepticism has filled the room when talking about the Spurs potential success for this year with the recent injury news to rookie, Lonnie Walker IV. The high flying Spur has shown flashes throughout summer league and pre season. Fortunately, his meniscus tear should only keep him out 4-6 weeks. With a depleted backcourt, the Spurs are going to have to rely heavily on LaMarcus Aldridge and Demar DeRozan to score and find open opportunities for role players. The Spurs are lucky enough to re-hand the reigns back over to veteran point guard, Patty Mills. Mills has shown the ability in the past of setting up and running an offense. Another important variable for the Spurs success is Brynn Forbes. Forbes has shown the ability in the past few seasons to make shots consistently and create off the dribble for his teammates. He will need to bring more to the table than he has ever in his young career.
A closer look at the Robert Williams diagnosis-Dr. Morse
Recently the Boston Celtics drafted Robert Williams with the 27th pick of the 2018 NBA Draft out of Texas A&M. A 6’9” center, Williams has not had the best introduction as part of the Celtics organization. Initially he overslept causing him to miss an introductory conference call. Then he missed his flight, and had to skip his first Summer League practice with the Celtics. Unfortunately, things have not gotten much better for Williams once he started playing in the NBA summer league games.
Williams sustained a left knee injury in the first half of the Celtics win over the 76ers, where he scored four points and grabbed a pair of rebounds before banging knees with a 76ers player. The initial diagnosis was a left knee bruise/contusion, which could’ve definitely explained his discomfort and continued time off the court. Sometimes bone bruises can be very painful, especially in the knee area, just ask NFL quarterback Sam Bradford.
Then last night, MassLive broke a story stating that Williams reportedly has an artery condition in both of his legs, a condition known as Popliteal Artery Entrapment Syndrome (PAES). Apparently NBA teams interested in Williams were aware of this condition at the time of the draft, including the Celtics, as was Texas A&M, where Williams played his college ball. The L.A. Clippers’ doctors, who performed Williams’ pre-draft physical, reportedly disseminated the results to the other organizations (a common practice) after discovering this condition. Obviously this did not deter the Celtics from drafting Williams, which should give you an idea of how significant of a concern of this condition presents.
So what is Popliteal Artery Entrapment Syndrome? As a sports medicine doctor I see all types of unique variants of the normal human anatomy, and PAES is one that I have read about but not personally seen in my practice – yet. This condition is probably misdiagnosed, as the complaints are often very vague, sometimes described as cramping, numbness, tiredness, and calf pain during exercise (this is called intermittent claudication).
In PAES, symptoms typically go away after about 3 to 5 minutes of rest, and if they do not then there are other conditions that need to be taken into consideration. PAES occurs because of an abnormal configuration of the muscles and tendons behind the knee, which when engorged with blood compress a vital blood vessel that delivers blood to the lower legs – the popliteal artery. This is basically the main artery that runs through and behind the back of the knee. Compression of this artery restricts blood flow to the lower leg, resulting in poor cell nutrition and slow development of symptoms.
So how do you get PAES? There are basically two options; either you’re born with it or you develop it. If you were born with it, this is secondary to large calf muscles (gastrocnemius or popliteus muscle). The condition can also develop over time, secondary to exercise and training, which in turn causes hypertrophy of the calf muscles, thereby compressing the popliteal artery.
Who is at risk for PAES? This condition most commonly occurs in male athletes under the age of 30 – Williams is 20. Certain sports increase the likelihood of developing the condition, including soccer, football, rugby, and runners. Reportedly less than 3% of people who are born with the muscle variant/defect that can lead to PAES develop the symptoms, consider it a case of bad luck for Williams.
How is this condition diagnosed? This is not something your typical family medicine doctor or orthopedic surgeon will usually diagnose. While many of them will be aware of the condition, typically the patient is referred to a sports medicine specialist or vascular surgeon for a complete work-up. Evaluation begins with checking the pulses of the foot and popliteal artery, first at rest. Certain diagnostic tests can be used to diagnose the condition including an ankle brachial index (ABI) with and without exercise – this test basically measures the blood pressure in the arms and legs before and after exercise. Another options include Duplex Ultrasound, Computed Tomographic Angiography (CTA), or Magnetic Resonance Angiography (MRA). Each of these options uses a form of imaging to evaluate the arteries and sometimes even the muscle and tendons as well.
Once diagnosed, what are the treatment options? The most common treatment is careful observation, along with modifications to lifestyle and exercise. Surgery can also be done to correct the problem, where the muscles and tendons are surgically released to alleviate the compression of the popliteal artery.
In Williams’ case, I completely expect the Boston Celtics medical staff to carefully observe him with serially monitored ABI’s of his lower extremities. If this issue continues to bother Williams, especially in the event of a situation where he has to play on back-to-back nights, surgery may be the best option. Surgery for this is typically pretty straightforward and often involves a quick hospital stay. A normal follow-up protocol includes serial ultrasounds of the repaired artery as well as lower extremity blood pressure checks at 4 weeks, 8 weeks and 1 year.
In review, new Boston Celtics draft pick Robert Williams was diagnosed with a condition called popliteal artery entrapment syndrome, which causes an aching, numb and tired pain in the calves after exercise and resolves with rest. The expectation is that Williams will be monitored closely, and his exercise schedule will be adjusted accordingly.