 Welcome to PFF, Injury Update. Of course, we're joined by Dr. Pomeranz of MRI Online. And Dr. Pomeranz, thanks for joining us. Let's get started with LA Rams linebacker, Micah Kaiser. We understand that he has a torn pectoral muscle. What does that all entail? Sure, well, the pectoralis muscle is your chest muscle. And these are particularly well-developed in men because, you know, men go into the gym, boys go to the gym, they do a lot of bench pressing and push-ups their favorite exercise. And they really overdevelop this muscle. Unfortunately, this muscle has a very tiny tendon. It's actually given the name falciform ligament and it attaches to humerus bones. So it goes across your chest. So here you have this big, giant muscle with a little tiny tendon that makes it crawling to injury. Now, when you have a pectoralis injury, you could have something as inconsequential as, say, a muscle strain, which is just a little swelling of the muscle. And in those cases, you're pretty functional. But if you can't pick your arm up as this player was unable to do, the odds are that you have more than a muscle strain. You have what we call a musculotendonous unit injury or you've injured or torn this tiny little tendon. And even though it's tiny, when you do that, that is a season-ending injury for almost all players. Now, usually that tendon will retract into a little groove between your shoulder and your chest. That's more of a medical thing. But what's relevant to those that are playing fantasy and other interested parties is that a pectoralis injury of this type where the player isn't picking up his arm on the field, you saw him grab it, he is unlikely to be playing any time this year unless he's a kicker or a punter or perhaps maybe a quarterback, the non-dopinant arm. But short of that, any contact player, especially on defense, is likely to be out for the season sawing. Dr. Pomerance explained for our viewers how Micah Kaiser, he was able to stay on the field. I think he even stayed in and played another snap. But you could see he tried to play, tried to go at it and he went to lift that arm and didn't get the response he was looking for. What allows a player to maybe have this kind of injury? But for a moment, they seem to think that they're okay where he could stay in the game and play for another play. Well, it does take a few moments for the blood and the hemorrhage and the manifestations of the injury to sort of get in the way to produce pain for the neuro receptors in the body to perceive what has happened. So a lot of times, very acutely in the first minute to 30 seconds after an injury, you do have some residual function, your adrenaline is going until you realize what's happened and then you actually feel discomfort then your function declines within a matter of a minute or two. And that's probably what happened here. When I watched the initial play, it was very subtle but I could see where he wrapped his left arm around the player and squeezed. Just that motion is what caused him to injure and perhaps rupture the pectoralis tendon. And this resulted in the very next play in his inability to pick his arm up at all. You could see him grab right in the spot where you would expect a pectoralis injury to be. So I'm not optimistic that he will take the field again this season. Wow, our fantasy players, they can use that information because Michael Kaiser was penciled in as a starter for that LA Rams defense but according to Dr. Pomerance, we don't expect him to return for the 2019 season. Let's move on to the Los Angeles Chargers because they're second year all pro safety. Derwin James, he sustained a foot injury in practice. We're told it's a fifth metatarsal fracture. Dr. Pomerance, what does that even mean? Well, you know, you've got a foot and you've got five long bones that are attached to your toes and those long bones are called metatarsals. Your big toe is one and then it goes all the way out to the fifth. Now the reason that's relevant to our fantasy players and other interested parties out there is if you actually fracture or have a stress fracture of say the third or the fourth, the other toes support those toes. In other words, they buttress them, they protect them kind of like a fork. So the fifth and the first protect the inside ones. And what that means is you usually or don't always have to have a rod or a screw placed into that long metatarsal, that long toe bone. Whereas the fifth one is very vulnerable because it's on the outside and has no one protecting its flank. And so when you fracture that it usually requires a screw or some type of fixation device. And that means you are gone for 12 weeks. Now I've seen people come back from that as early as eight weeks, but that's uncommon to rare. In a solidus injury, I particularly see in defensive backs because of their backwards running activity and how they rotate on turf. I've seen this a number of times in the fifth metatarsal in this particular type of player at this position. So this is not uncommon. I would say that at week 12, if they're still in the hunt, if all goes according to plan, they'll play again. If they're not in the hunt, my guess is to protect a player of this caliber and ilk, they may not put them on the field for the rest of the season if they're not in the playoff picture. Yeah, right now they're saying they're expecting him back right around week 11, November 18th in a game against the Kansas City Chiefs. And so they're probably are gonna need him. Just kind of talk to us about this type of injury based on maybe the position, the weight of the individual, this type of injury, it seems to be just this broad perspective in terms of when we could expect the player to return based on his height, weight, and maybe even his size. Well, you know, the prognosis, I think they've, they've guesstimated this, you know, right in the middle. They've gone for the sweet spot, which is 11 to 12 weeks, which is what most established, respected positions would say is a timeframe for solid recovery, for solid bony bridging, for stability to be able to twist and turn and run backwards flat out. The, on the short side, advanced healing or accelerated healing is much less common. You know, seeing somebody come back at six, seven or eight weeks, much less common, but delayed healing. In other words, somebody that can't come back in 11 or 12 weeks, but needs 17, 18, 19 weeks or more, that's more common. So while we've given you the middle range of 11 or 12 weeks, it's more likely that that could be longer than shorter. And that's probably important for our audience to know. And he is certainly a player that they don't want to risk having some kind of setback once you get to the tail end of that recovery period. Dr. Pomeranz, we want to thank you for joining us. I always feel much smarter after talking with you. It's a pleasure. And I'll, I'll be with you again next week. All right. That's going to do it for our weekly PFF injury update with Dr. Pomeranz of MRI online. Thanks for watching the PFF YouTube channel. And if you want to subscribe, all you have to do is push the button. Don't forget everything you get. Little fantasy, push the button. A little green line for the gambling aspects of the game. Push the button. College football, push the button. The YouTube channel from PFF.